roslynr,
I'm sorry it's taken me so long to get back to you. But you're in good hands with Pugsy.
Some random seeming questions and comments:
1) What kind of abdominal pain? Aerophagia or something else? In other words, did it start after you put the mask on or did it precede going to bed? Abdomonial pain can certainly wreck havoc on the quality of sleep.
2) I want to make sure I have a reasonable synoposis of you situation: You report a history of both sleep onset insomnia and sleep maintenance insomnia that predates CPAP, but has been aggravated by PAPing. You've taken Ambien in the past intermittently with some luck, you're currently taking melatonin and the melatonin doesn't seem particularly effective. You're also on a bunch of meds for RA. The pain from the RA is not too much of a problem for you, but the meds are needed to prevent further deterioration of your joints. You don't currently think the meds may be aggravating the insomnia. Does this seem like a reasonable synopsis?
3) You're starting to have a few hours of sleep here and there---mostly late in the night---that with PAP are looking apnea free and that you believe you are sleeping reasonably soundly. But the beginning of the nights are still rough---both in terms of insonmia (at least sometimes) and in terms of the numbers of OAs and CAs. Is that also correct?
So---if I have an accurate picture of what's going on, here are my comments.
A) Continue to try out Pugsy's ideas in terms of tweaking the settings. If you can get the number of OAs to decrease, its possible that the CAs will also decrease
if they're post arousal CAs.. If you can get the number of OAs to decrease, but the CAs remain unacceptably high, then we'll need to look much more closely at them and the possibility of CompSA or a combination of OSA and CSA. But worry about that
later---right now the focus needs to be on increasing the (subjective) quality of your current sleep and trying to get the obstructive events under control.
B) Start doing some serious work on the insomnia. Since you don't mind taking the Ambien and it works for you, you can start there. If you are comfortable with the idea of taking the Ambien every night for a week or so, then consider doing that. But if you really don't want to take the Ambien every single night, you could take it in a way to try to prevent too many sleepless nights in a row: In other words, instead of taking Ambien every night, you could take the Ambien as follows:
- If you DON'T take the Ambien on Tuesday night and you sleep "ok", then DON'T take the Ambien on Wednesday night.
- If you DON'T take the Ambien on Tuesday night and you have serious problems with the insomnia, then TAKE the Ambien at the beginning of the night on Wednesday. This should prevent two really bad nights in a row.
- If you TAKE the Ambien on Tuesday night (because Monday night was a disaster) and you sleep "ok", then DON'T take the Ambien on Wednesday night.
- If you TAKE the Ambien on Tuesday night (because Monday night was a disaster) and you still have serious problems with insomnia, the TAKE the Ambien at the beginning of the night on Wednesday. But if you find yourself taking it every night for six or seven days in a row because it's NOT helping the insomnia, then it's time to call the prescribing doc and let him/her know what's going on.
C) But in addition to taking the Ambien (either every night if you're comfortable with that or using the kind of schedule I proposed above), you ought to consider what kinds of things you can do in terms of behavior that may help starve the insomnia monster. In particular, if you spend a lot of time
clock watching when you are in bed and you're not sleeping well, you need to turn the clock around or put it on the other side of the room to make it harder to watch the clock. Also make sure you are
sleepy instead of just
tired or exhausted when you go to bed. And as hard as it is to do, you may need to get out of bed if you find yourself lying awake for extended periods of time. If you do get out of bed, go to a different room and do something soothing, relaxing, and (hopefully) sleep inducing. Go back to bed when you start to feel like you're going to fall asleep anyway.
If you've never considered behavioral approaches to helping manage the insomnia, consider buying a copy of
Sound Sleep, Sound Mind by Dr. Barry Krakow. He's got a large number of very practical ideas how to train your body to understand that
being in bed means
it's time to be asleep.
