Fractured sleep, Ambien, dial wingin' and other things

Hi Robysue

{{{{ Hugs }}}}

You have tried everything I would have suggested and anything else others have said. So just hugs and I hope you find a way to ride the beast.

Blackspinner,

The hugs are appreciated. I know that eventually things will start turning around again. But in the meantime, sometimes what I really need is just the reassurance that others do care about my troubles.

Robysue

In your stories about your pains areas only the Aerophagia (actually Meteorism or Abdominal Distention in medical terms, Aerophagia comes from abdominal surgeries) seemed serious to me if it was not caused by both nose and mouth being tightly closed, knowing that there could be other more serious medical reasons causing it. The NEJM article, in spite of being related to Invasive (controlled) Ventilation does cover the same issue as we have as beginners CPAPers. I don't understand the going norm in this forum whereby newbies who complain about "ingested air" problems are told to tape their mouths in order to cut their mouth leak and achieve better AHIs, while this is most likely the cause of the Aeropagia problem .

Sue, All those knee bruises and back aches that you have, seem to me to be minor. About the back pain I have found Aleve (2 daily) working great for me with spine pain.

I regret not replacing my knees at an earlier age ( I did replace one of my hip joint at age of 55). I also got epidural corticosteroid injections in my 2 knees a couple of weeks ago. That dam steroid did not let me fall asleep till 3 a.m., and did not help at all with the pain. I still have pain on the sides of the knees which I am sure are coming from my lower spine. I have degenerative lumbar stenosis in 4 of my lumber vertebrae, and the pain in my knees comes from them.

In three weeks I hope to have Laminectomies in 3 of those vertebrae, without using any implants (such as the X-Stops) or doing any fusions. Just removing parts of the intraspinous vertebrae's bone processes, and leaving it open as is. A surgery lasting only 30 to 45 minutes. Something new at Duke Medical.

avi123 wrote: In three weeks I hope to have Laminectomies in 3 of those vertebrae, without using any implants (such as the X-Stops) or doing any fusions. Just removing parts of the intraspinous vertebrae's processes, and leaving it open as is. A surgery lasting only 30 to 45 minutes. Something new at Duke Medical.

I had this done quite a few years ago; no fusions. At the time I was in much pain across my lower back and down my left leg... now 85% to 95% improved. It was very successful and I hope the same for you.

Re: Pain

avi123 wrote: In three weeks I hope to have Laminectomies in 3 of those vertebrae, without using any implants (such as the X-Stops) or doing any fusions. Just removing parts of the intraspinous vertebrae's processes, and leaving it open as is. A surgery lasting only 30 to 45 minutes. Something new at Duke Medical.

Avi,

Best of luck on those Laminectomies.

Chronic pain issues are indeed something that can significantly affect sleep.

In my case the pain in the acute stage of the injury does seem to have caused some disruption in the sleep quality. Perhaps I am still dealing with fall out from that. But right now I am pain free when it comes to the back and the knee. Headaches are another issue--they are definitely back, but I've got a follow-up with the PA who deals with my headaches next week. Hopefully something can be done that I can also tolerate.

As for the aerophagia: Now that I'm back to running the machine in the tight Auto Range that I've used for much of the last 3 years, the aerophagia is back down to a very manageable level. Most mornings there's little or no discomfort and there's very rarely severe pain when I've got the thing in Auto with a max IPAP = 8.

Last night was the best night's sleep I've had in quite a while in terms of (a) how I feel this morning, (b) the AHI, and (c) number and lengths of the wakes.

The 3-day old double (or triple) whammy of a headache that I've been dealing with since late Monday night finally started to resolve itself a bit before bedtime last night. And that certainly made a big difference.

I did take Ambien at 2:30 because I was not sleepy, but didn't want to push bedtime any later. Hubby got me up around 8:30 this morning. Run time on the machine is 5:52. I got to sleep ok with the Ambien.

There were three wakes where I was awake enough to turn Kaa off and on, and there's a possible fourth awake/arousal judging from wave form data. All the wakes were short--as in 5 minutes or so, and I only remember one of them. Timing of the wakes makes them look like they're all nothing more than brief post-REM wakes, which I don't worry about.

The AHI is 1.19, and that's the lowest it's been in a month and a half except for the three torturous nights during the 8/5 fixed pressures experiment. There were a total of 7 recorded events: 2 short CAs and 5 OAs, the longest of which is an 18-second event that may be a post arousal event or possibly a sleep transition event.

All in all, it looks like I got about 5 1/2 hours of pretty high quality sleep in about a 6-hour time in bed window, for a sleep efficiency of about 92%.

And best of all: I feel rested and almost refreshed this morning rather than feeling like something the cat dragged in ....

In other words, if I were sleeping like this every night, I'd be on top of the world ....

ems wrote:

avi123 wrote: I had this done quite a few years ago; no fusions. At the time I was in much pain across my lower back and down my left leg... now 85% to 95% improved. It was very successful and I hope the same for you.

Comments,

Thanks for the info. My concern is that Duke Spinal Neurosurgeon is talking about Total Anesthesia and not local. I want to be out of the hospital the next day.

RobySue, I am glad to read your post that: "Last night was the best night's sleep I've had in quite a while in terms of (a) how I feel this morning, (b) the AHI, and (c) number and lengths of the wakes."

avi123 wrote:

ems wrote:I had this done quite a few years ago; no fusions. At the time I was in much pain across my lower back and down my left leg... now 85% to 95% improved. It was very successful and I hope the same for you.

Thanks for the info. My concern is that Duke Spinal Neurosurgeon is talking about Total Anesthesia and not local. I want to be out off the hospital the next day.

Avi - I had total anesthesia and was out of the hospital the next day. Of course the doctor prescribed pain meds which I took the first few days. The pain wasn't all that bad and I was pleasantly surprised. From what I understand they won't do this surgery with a local.

robysue wrote:Re DIET:
My current diet is lower in carbs than it used to be, but not (yet) strictly low carb. Some days it really is low carb and others it is not. Sleep problems do not seem to be correlated with diet, but I don't know for sure.

I've tried the raw honey trick in the past (about two years ago). Not sure it did anything, but honey has the advantage that it has no identifiable side affects. And at least it tastes good.

With diet I agree with those who move toward the “Paleo” diet of the way way yesteryear, the one that we got used to over the last million years or so. It is extremely hard to even think in terms of how they actually ate so many years ago considering how we eat today and what we have available to us today. I think they did eat meat but that is was on an occasional basis as it was hard to come by. Most of the diet was likely whole food plant based which is suggested by T. Colin Campbell[1] as the best diet. So in my diet I consider the following.

Meat protein is limited in terms of “how much” and in terms of where it comes from. The amount is varied with activity level and keyed to resistance training. I strive to find meat raised “free range” (not raised in a CAFO) and without growth hormones.

Added sugar limited to less than one hundred grams per day as recommended by Robert H. Lustig M.D.[2]. Considering your modest weight I think that you might consider reducing that a bit.

I pursue anti-inflammatory foods especially when I see that there are obstructive events in my data. I try to make myself aware of how much “room” my tongue has in my mouth as part of my “go to sleep” ritual. My tongue seems to be a pretty good indicator of of the presence of systemic inflammation for me. I believe that moving away from GMOs and “high chemical load” foods is wise.

I try to eat at least half vegetables and fruits with at least a third of that raw. All serves as good prebiotic material and the raw is likely probiotic. I eat many kinds of fermented foods. I do hope to foster a healthy microbiome.

I stay far away from processed foods and pursue whole foods. I believe that a processed “carb” does not come with the things we need to properly process that “carb” in our system. Good whole food in variety is more likely to do the true best for us[1].

robysue wrote:Vitamin B and D levels were checked about a year ago when the insomnia was spiraling out of control. Both were fine. I take 400mg of B2 for migraines and 2000IU of D every day. I've taken B12 in the past, but I'm trying to keep the number of vitamins and pills I take each day down to a number that does not bother me too much psychologically speaking. (Swallowing pills is an issue and always has been.)

For now I am using the tanning booth at the club but really I believe I need to build a sunlight imitation unit in my home to help me through the winters we have at the high latitude where I live. The watching of the vitamin D levels you do is good however the vitamin D produced in your own skin is produced along with many other chemicals and I think we need those too.

I too tend to supplement B vitamins. Considering how this does not occur in nature and that the concentrated presence of one nutrient is likely to very much change the digestive environment (microbiome and other things) I am reconsidering.

robysue wrote:Re SAD:
Seasonal affective disorder (SAD) plays a role, but I use a light box in the morning. With the return of the morning light, I've had to cut back on the light box because it can trigger migraines. The light box does a lot for me, but it does not eliminate too many multiple wakes, frequently caused by discomfort issues.

People are actually now calling this “human hibernation syndrome” these days. Probably that is a good concept.

If you think about it the light they had came from things burning, food tended to become scarce, and sleeping for long hours each night made a lot of sense both in terms of fuel and food (energy) use. I am beginning to wonder if we are wise to fight this so hard or if more sleep in winter would be wise.

I was in Montana lately. I can say that I did find several days in the very bright snow covered lands up high there did notably improve mood and energy level. Full sunlight is special.

I also find that having a treadmill in the home and keeping moving toward active lifestyle levels of activity helps greatly. Long times on the treadmill seem to make for better sleep onset, maintenance, and quality. I got one for the home this winter because a bug tried to get into my lungs and cold air is not what you want when that is trying to happen. Also, the battle will be long term.

robysue wrote:Re: a second dose of Ambien in the middle of the night:
I'm already waking up hung over from taking 2.5 mg of Ambien on the nights that I take it. The Ambien side affect is distinctly different than the tiredness from the insomnia. With the Ambien, it is difficult to wake up enough in the morning to become fully functioning. With the insomnia, I have no troubles waking up and functioning, but I'm tired and cranky all day. Neither is particularly "acceptable" and both interfer with what I need to get done on a daily bases. More Ambien in the middle of the night seems likely to increase the morning groggieness and the Ambien constipation.

Every time I have taken the time to look into the actual research myself concerning a medication I have found the effect size low and the side effects more than unacceptable. I strongly recommend that you look into the actual research about the drugs you take with your own eyes.

I pursue best sleep. Does taking Ambien facilitate your best sleep? If not find another way(s) that do facilitate your best sleep.

robysue wrote:Re: Xanax and other medication:
Medication that is primarily designed to affect moods or other psychological problems seem to trigger really bad side affects in me. And I'm not wild about randomly trying different meds in the hopes that something might work.

Psychoactives never did the job well, had effects on sleep quality which were negative, had other bad side effects especially over time, and had a “time limit” of usefulness where my body apparently adapted to them so the little positive effects noted after starting diminished (replaced by the nasty side effects).

I am very glad I stopped using them and would not recommend them to anyone other than for very short times to get through a crisis.

Research has shown that better results can be achieved by eating well and moving well which does not change brain shape and function negatively as the pharmaceuticals do. Some wonder, therefor, if the use of the pharmaceuticals is ethical.

robysue wrote:No one's mentioned these, but I'll add:
Re: Sleep hygiene:
I need to work on this. I've been back sliding on the sleep hygiene and it's catching up with me. But self-discipline is in limited supply since I've spent so much of it in the last 3 1/2 years complying with doctor's orders and after 3 1/2 years I still don't subjectively feel any better than before starting PAP in terms of the quality of my sleep. The amount of daily pain, however, is something that has improved since starting PAP, and that's really the only reason I keep on PAPing at this point.

FWIW I have found that sleep onset is considerably easier if I manage my daily activity level. This also helps with getting a good amount of deep sleep and with sleep maintenance.

I find that living in a very quiet neighborhood is helpful. When there were sound problems ear plugs did help.

I do like to sleep in a totally dark room. Only some very modest sources of red or orange light are allowed. Never blue.

I now start the night with eucapnic breathing techniques as soon as I go to CPAP. This helps get my feet and lower body warm, helped by my arms and hands, which seems to speed sleep onset.

Recently I have learned some ways to reduce the expiratory pressure “bump” caused by our first expired air meeting the spun up fan which reached its current speed in response to our inspiratory phase. It also quiets the vibration and noise which flows from the fan up the tube and into our airway where our ears become aware of it. My brother is on BiPap and hates the constant change in pitch from the BiPap fan so much that he has taken to using several fans in the room which are constant to mask the noise from the BiPap. I think that noise and vibration from the machine have not been given the kind of attention that they deserve. I do not care so much how much noise the machine makes that you measure a foot from the machine, I care very much how much noise and vibration travel up the tube!!!

robysue wrote:Re: Headaches and TMJ:
The TMJ is under control, the headaches are problematic. The medication needed to take care of the migraine related vertigo triggers a large number of unacceptable side affects, but the vertigo is definitely has an adverse affect on the sleep.

It has been profoundly consistent that any headache I have will find my breathing levels too high and that reducing those breathing levels toward more eucapnic rates relieves the headache. I have taken the time to look into the research concerning cerebral blood flow and CO2 reactivity so no surprise to me.

There are many articles concerning cerebral blood flow and migraine.

robysue wrote:Re: Exercise:
In October I fell on one of my nightly 3.5 mile walks. I messed up one knee and the limping then triggered significant back pain. The back pain has been addressed through physical therapy and it is now feeling better than it did before the fall. The knee continued to give me problems and I got cortisone shots in early Feb. It's feeling better and I start PT for the knee tomorrow. But walking has been problematic since Oct between the back, the knee, and the weather.

90 minute yoga classes twice a week are wonderful (most of the time) and skiing once a week are the main exercise. On days were I teach, I naturally get about 9000+ steps during the day without doing anything special; other days it's much less.

Previous winter my personal trainer and I found that I had arthritus getting into my knees. The recommendation by all is to do a lot of low level repetitive motion which moves the joint but does not load it too much.

But I found that I had pain on the cycle – but – only if my breathing levels were too high (at the exertion level used an SpO2 of 96% was previously found to produce the lowest heart rates - - when pain occurred I would find the SpO2 at 98% (always too high) – reducing the SpO2 back down to 96% made the pain go away and the treatment has kept arthritis very very reduced for over a year now). I think that much of arthritis may be related to loading the joints while circulation is compromised by hypocapnea.

robysue wrote:Re: Weight:
Weight has remained stable at between 105 and 112 for the entire last 12 months. I'm 5'1" so weight is not my problem.

Twenty percent of those with fatty liver disease are of normal or less body weight[2]. True metabolic health requires learning how to eat well and move well and in my case that knowledge did not come from my family of origin or what I happened across in my young and middle age.

I think you would do well to hire a dietitian and personal trainer for at least three years (shop well!). Keep up with the yoga and perhaps add some TCM. It appears that the disease care system[1b] is not doing well for you.

I think you would also do well to study up on OSA and high respiratory control system gain, arousal threshold, and cerebral blood flow vs CO2 reactivity. As you talk with your doctor, if he does not understand the connections begin your search, you need another doctor.

May you find many better solutions soon!

[1] http://www.amazon.com/China-Study-Compr ... 932100660/ http://www.amazon.com/Whole-Rethinking- ... 1937856240

[2] http://www.amazon.com/Fat-Chance-Beatin ... 0142180432

Todzo wrote:

robysue wrote:Re DIET:
My current diet is lower in carbs than it used to be, but not (yet) strictly low carb. Some days it really is low carb and others it is not. Sleep problems do not seem to be correlated with diet, but I don't know for sure.

I've tried the raw honey trick in the past (about two years ago). Not sure it did anything, but honey has the advantage that it has no identifiable side affects. And at least it tastes good.

With diet I agree with those who move toward the “Paleo” diet of the way way yesteryear, the one that we got used to over the last million years or so. It is extremely hard to even think in terms of how they actually ate so many years ago considering how we eat today and what we have available to us today. I think they did eat meat but that is was on an occasional basis as it was hard to come by. Most of the diet was likely whole food plant based which is suggested by T. Colin Campbell[1] as the best diet. So in my diet I consider the following.

Meat protein is limited in terms of “how much” and in terms of where it comes from. The amount is varied with activity level and keyed to resistance training. I strive to find meat raised “free range” (not raised in a CAFO) and without growth hormones.

Added sugar limited to less than one hundred grams per day as recommended by Robert H. Lustig M.D.[2]. Considering your modest weight I think that you might consider reducing that a bit.

I pursue anti-inflammatory foods especially when I see that there are obstructive events in my data. I try to make myself aware of how much “room” my tongue has in my mouth as part of my “go to sleep” ritual. My tongue seems to be a pretty good indicator of of the presence of systemic inflammation for me. I believe that moving away from GMOs and “high chemical load” foods is wise.

I try to eat at least half vegetables and fruits with at least a third of that raw. All serves as good prebiotic material and the raw is likely probiotic. I eat many kinds of fermented foods. I do hope to foster a healthy microbiome.

I stay far away from processed foods and pursue whole foods. I believe that a processed “carb” does not come with the things we need to properly process that “carb” in our system. Good whole food in variety is more likely to do the true best for us[1].

I'm glad your diet works for you.

But I would NOT be able to sustain such a diet. My diet has been discussed ad nauseum elsewhere.

I'm sorry if I sound snarly, but:

I am at normal weight and have been my entire life. Until about a year ago, the triglycerides and cholesterol were normal. The doc's suggestions of trying to cut way back on carbs has been much harder to implement for me than I would ever have thought possible. I am now happy with trying to reduce the carbs without eliminating them since it allows me to eat some foods that actually taste good to me.

I am NOT interested in going to a Paleo diet or an extremely low carb diet---there is just not enough "allowed foods" that I like on such a diet.

Todzo wrote:

robysue wrote:Vitamin B and D levels were checked about a year ago when the insomnia was spiraling out of control. Both were fine. I take 400mg of B2 for migraines and 2000IU of D every day. I've taken B12 in the past, but I'm trying to keep the number of vitamins and pills I take each day down to a number that does not bother me too much psychologically speaking. (Swallowing pills is an issue and always has been.)

For now I am using the tanning booth at the club but really I believe I need to build a sunlight imitation unit in my home to help me through the winters we have at the high latitude where I live. The watching of the vitamin D levels you do is good however the vitamin D produced in your own skin is produced along with many other chemicals and I think we need those too.

I too tend to supplement B vitamins. Considering how this does not occur in nature and that the concentrated presence of one nutrient is likely to very much change the digestive environment (microbiome and other things) I am reconsidering.

My megavitamin doses are to keep the migraines in check without needing to use prophylactic meds that I've previously had severe reactions to.

And I am not willing to use a tanning booth because I do believe that they are inherently unsafe---at least for folks who burn easily (like I do) and who are at higher than normal risk of skin cancer (like I am). However, I also don't believe is slathering sunscreen on all the time.

robysue wrote:Re SAD:
Seasonal affective disorder (SAD) plays a role, but I use a light box in the morning. With the return of the morning light, I've had to cut back on the light box because it can trigger migraines. The light box does a lot for me, but it does not eliminate too many multiple wakes, frequently caused by discomfort issues.

People are actually now calling this “human hibernation syndrome” these days. Probably that is a good concept.

If you think about it the light they had came from things burning, food tended to become scarce, and sleeping for long hours each night made a lot of sense both in terms of fuel and food (energy) use. I am beginning to wonder if we are wise to fight this so hard or if more sleep in winter would be wise.[/quote]
My SAD does NOT come with an increased need or desire to sleep for long periods of time. Rather, when light is rare in the winter time, I have an even tougher time sticking to a reasonable sleep schedule. Without morning light, my sleep schedule starts to go from 1:30AM-8:30AM to more like 3:30-10:30AM or 4:30--11:30AM and I can't reasonably accomodate a sleep schedule of 3:30-10:30 with my job.

My mood is also adversely affected in the winter time, and the light box does a lot to fix the moodiness.

I was in Montana lately. I can say that I did find several days in the very bright snow covered lands up high there did notably improve mood and energy level. Full sunlight is special.

I also find that having a treadmill in the home and keeping moving toward active lifestyle levels of activity helps greatly. Long times on the treadmill seem to make for better sleep onset, maintenance, and quality. I got one for the home this winter because a bug tried to get into my lungs and cold air is not what you want when that is trying to happen. Also, the battle will be long term.

Treadmills do not appeal to me. In previous winters I've had no trouble keeping up with the long evening walks (I rather enjoy walking in the snow and cold), but the knee and back injury this October made walking problematic. I'm working on trying to get back to walking, but finding the time has always been an issue and remains an issue. That would also be a problem with a treadmill quite frankly.

robysue wrote:Re: a second dose of Ambien in the middle of the night:
I'm already waking up hung over from taking 2.5 mg of Ambien on the nights that I take it. The Ambien side affect is distinctly different than the tiredness from the insomnia. With the Ambien, it is difficult to wake up enough in the morning to become fully functioning. With the insomnia, I have no troubles waking up and functioning, but I'm tired and cranky all day. Neither is particularly "acceptable" and both interfer with what I need to get done on a daily bases. More Ambien in the middle of the night seems likely to increase the morning groggieness and the Ambien constipation.

Every time I have taken the time to look into the actual research myself concerning a medication I have found the effect size low and the side effects more than unacceptable. I strongly recommend that you look into the actual research about the drugs you take with your own eyes.[/quote]I do this. And for now, I've been persuaded that for me at this particular time the benefits of the Ambien marginally outweight the risks and side effects.

I pursue best sleep. Does taking Ambien facilitate your best sleep? If not find another way(s) that do facilitate your best sleep.

I have been on a 3 1/2 year quest to "facilitate my best sleep." And for 3 1/2 years, I have felt like Don Quixote---my quest is largely been futile, and yet I keep persevering in hopes that one day I will obtain what seems unattainable: Sleeping well every night rather than sleeping well on random, occasional nights.

The real root cause of my current sleep problems is that I'm caught between the rock of untreated OSA (sleep without the BiPAP) and the hard place of PAP-induced insomnia triggered by sensory overload and aerophagia because I'm sleeping with the BiPAP in an effort to not have untreated OSA.

And so for now it is clear that using the Ambien on a bit more frequent than I'd like basis is contributing to slightly better sleep with the PAP than I would get if I never used Ambien, but sleep with the PAP.

And I'm not (yet) interested in abandoning PAP altogether because I can't really sleep any better without it any more than I can with it. I exchange one set of problems for another that way, and the set of problems associated with "sleeping without the PAP" also includes a lot more health risks than the problems I face that are caused by "sleeping with the PAP".

Todzo wrote:

robysue wrote:Re: Xanax and other medication:
Medication that is primarily designed to affect moods or other psychological problems seem to trigger really bad side affects in me. And I'm not wild about randomly trying different meds in the hopes that something might work.

Psychoactives never did the job well, had effects on sleep quality which were negative, had other bad side effects especially over time, and had a “time limit” of usefulness where my body apparently adapted to them so the little positive effects noted after starting diminished (replaced by the nasty side effects).

I am very glad I stopped using them and would not recommend them to anyone other than for very short times to get through a crisis.

Research has shown that better results can be achieved by eating well and moving well which does not change brain shape and function negatively as the pharmaceuticals do. Some wonder, therefor, if the use of the pharmaceuticals is ethical.

Here is not the time nor place to discuss whether the use of pharmacetuicals to treat psychological conditions is ethical. They help some people function. But for me, the mood medications I have been put on in the past in an effort to control migraines have triggered severe side effects.

I am not on any psychoactive drugs right now, and I don't expect to have prescribed in the near future.

Todzo wrote:

robysue wrote:No one's mentioned these, but I'll add:
Re: Sleep hygiene:
I need to work on this. I've been back sliding on the sleep hygiene and it's catching up with me. But self-discipline is in limited supply since I've spent so much of it in the last 3 1/2 years complying with doctor's orders and after 3 1/2 years I still don't subjectively feel any better than before starting PAP in terms of the quality of my sleep. The amount of daily pain, however, is something that has improved since starting PAP, and that's really the only reason I keep on PAPing at this point.

FWIW I have found that sleep onset is considerably easier if I manage my daily activity level. This also helps with getting a good amount of deep sleep and with sleep maintenance.

I find that living in a very quiet neighborhood is helpful. When there were sound problems ear plugs did help.

I do like to sleep in a totally dark room. Only some very modest sources of red or orange light are allowed. Never blue.

I'm not in a position to change my neighborhood, which is reasonably quiet. Ear plugs make my tinnitus worse, and noise in general is not a huge issue for me, but too much silence is because of the tinnitus.

The bedroom is on the street side of the house because that's the side that gets morning light. I'm not willing to do blackout curtains because I rely on the morning light to help make it easier to get up in the morning.

I now start the night with eucapnic breathing techniques as soon as I go to CPAP. This helps get my feet and lower body warm, helped by my arms and hands, which seems to speed sleep onset.

Focusing on my breathing after putting my mask on unfortunately makes my brain become much more alert, which in turn makes it harder for me to get to sleep. Once I mask up, I focus as much as I can on "blanking my mind" and unfocusing on all the stimuli coming from my body. If I'm sleepy enough when I climb into bed and mask up, I'll be asleep within 5-10 minutes. If I'm not, the sensory stuff will wake me up and then the rest of the night is at high risk for being touch and go for the insomnia. The role of the Ambien is this: It will allow me to go to bed between 1:30-2:30 even if I'm not "sleepy enough" to get to sleep before the PAP machine wakes me up. And that's critical for me to get enough sleep time since I can't just allow myself to sleep from 3:30 or 4:30 to around 11:00 on a daily basis.

Recently I have learned some ways to reduce the expiratory pressure “bump” caused by our first expired air meeting the spun up fan which reached its current speed in response to our inspiratory phase. It also quiets the vibration and noise which flows from the fan up the tube and into our airway where our ears become aware of it. My brother is on BiPap and hates the constant change in pitch from the BiPap fan so much that he has taken to using several fans in the room which are constant to mask the noise from the BiPap. I think that noise and vibration from the machine have not been given the kind of attention that they deserve. I do not care so much how much noise the machine makes that you measure a foot from the machine, I care very much how much noise and vibration travel up the tube!!!

There is some truth to this, but it's there for plain CPAPs as well as BiPAPs. It took me a long time back in 2010 and 2011 to figure out just where to put the hose and machine relative to the bed to minimize the noise conducted through the hose. Unlike your brother, I don't find additional fans in the room any help because I dislike sleeping under a fan---moving air bothers me at night.

My solution was and remains playing Gregorian chants at a soft volume on speakers attached to my iPod all night long. I've got a play list that is about 4 hours long and regardless of whether I just "repeat" the play list or set the iPod on shuffle, the Gregorian chants have an ethereal quality to them: There's enough variation where they do not sound repetitive (repetitive noises tend to bother me). But they also all sound so similar that I can't really distinguish one from another, and hence I don't have the problem of the brain saying, "Hey I know this one and in 10 more minutes there's a really gorgeous one. Let's stay awake long enough to hear it ...."

robysue wrote:Re: Headaches and TMJ:
The TMJ is under control, the headaches are problematic. The medication needed to take care of the migraine related vertigo triggers a large number of unacceptable side affects, but the vertigo is definitely has an adverse affect on the sleep.

It has been profoundly consistent that any headache I have will find my breathing levels too high and that reducing those breathing levels toward more eucapnic rates relieves the headache. I have taken the time to look into the research concerning cerebral blood flow and CO2 reactivity so no surprise to me.

There are many articles concerning cerebral blood flow and migraine.

Site some sources for me??? I'd be interested in learning more ..

At any rate much of the migraineous vertigo is triggered by things that are well known to trigger migraines in me: Sudden loud noises. Bright glaring light. A general visual overload---too much visual noise, such as walking down a grocery store aisle filled with brightly colored packages of all kinds of shapes and sizes. A general auditory overload---too much background noise buzzing around, a tv or radio left on in the other room that's on a different station than the tv or radio in the room I'm in, the volume of a TV or radio simply being too loud. Or, converserly, too much silence---which triggers my tinnitus kicking into overtime which then can trigger the vertigo. A room that's too hot. Forgetting to eat. Or getting too thirsty. Consuming some caffeine by mistake.


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Todzo wrote:

robysue wrote:Re: Exercise:
In October I fell on one of my nightly 3.5 mile walks. I messed up one knee and the limping then triggered significant back pain. The back pain has been addressed through physical therapy and it is now feeling better than it did before the fall. The knee continued to give me problems and I got cortisone shots in early Feb. It's feeling better and I start PT for the knee tomorrow. But walking has been problematic since Oct between the back, the knee, and the weather.

90 minute yoga classes twice a week are wonderful (most of the time) and skiing once a week are the main exercise. On days were I teach, I naturally get about 9000+ steps during the day without doing anything special; other days it's much less.

Previous winter my personal trainer and I found that I had arthritus getting into my knees. The recommendation by all is to do a lot of low level repetitive motion which moves the joint but does not load it too much.

But I found that I had pain on the cycle – but – only if my breathing levels were too high (at the exertion level used an SpO2 of 96% was previously found to produce the lowest heart rates - - when pain occurred I would find the SpO2 at 98% (always too high) – reducing the SpO2 back down to 96% made the pain go away and the treatment has kept arthritis very very reduced for over a year now). I think that much of arthritis may be related to loading the joints while circulation is compromised by hypocapnea.

Except for well identifiable injuries, I have no pain when exercising.

And when I mean well identifable injuries, I really do mean specific identifiable events that I can point to and say: "Here's the event that triggered this pain." The hard fall back in October caused a specific knee injury (that is only now beginning to heal) and favoring the knee caused the back pain. With the PT therapy for the back, the back was able to heal and there is no more back pain; the knee is now on the mend and both I and the physical therapist expect that the knee will have no more pain within a few weeks of targeted therapy.

But pain is a huge issue in general for quality of sleep for many people.

One of the things that keeps me paping is indeed pain related. Pre-CPAP, I was waking up with significant hand and foot pain every morning. I'd tell my husband that it felt as though I'd been sleeping with my feet and hands in fists all night long. The pain would ease as the day went on, but it was very intense during the first two or three hours each morning. This hand and foot pain mysteriously disappeared about 5 months after I started PAPing. There were NO other changes in my life that could account for the disappearance of that pain. The doc's theory, which I agree with, is that the pain was being triggered by both the stress hormones going through my system after each apnea and OSA-induced low levels of inflammation. And it took some time for the body to sleeping with the PAP and not having all those stress hormones and it also took time for my body to heal.

The three days without PAP last summer reminded me of the kind of hand and foot pain I used to endure every morning. I'd rather not go back to it, and that's what keeps me PAPing, in spite of the fragility of my sleep.

robysue wrote:

Todzo wrote:

robysue wrote: At any rate much of the migraineous vertigo is triggered by things that are well known to trigger migraines in me: Sudden loud noises. Bright glaring light. A general visual overload---too much visual noise, such as walking down a grocery store aisle filled with brightly colored packages of all kinds of shapes and sizes. A general auditory overload---too much background noise buzzing around, a tv or radio left on in the other room that's on a different station than the tv or radio in the room I'm in, the volume of a TV or radio simply being too loud. Or, converserly, too much silence---which triggers my tinnitus kicking into overtime which then can trigger the vertigo. A room that's too hot. Forgetting to eat. Or getting too thirsty. Consuming some caffeine by mistake.

Most of the above issues are related to the VESTIBULAR system, and I would be surprised if they could not be treated by specialists found on this website:

http://www.vestibular.org

As to issues such as "a tv or radio left on in the other room that's on a different station than the tv or radio in the room I'm in, the volume of a TV or radio simply being too loud", it is also related to being a teacher. A few of my teaching professors in my Biomedical engineering school were annoyed with those students who were late and did not close the classroom door behind them, while most other professors did not give a damn about things like that. They just focused on teaching. The professor who constantly kept talking about closing that classroom door and could not proceed with lecturing until it was done, happened to be the top Neurologist MD. In this case, IMO, a psychiatrist could fix it.

Talking about SAD, during the first winter after moving to the Boston area in 1958 and coming from the Middle East (Israel) I was really miserable. Beside the SAD hitting me like a rock I started to come down with Psoriasis skin patches. In addition to all those skin injections of Synalar, by nice physicians at Tufts Univ. Medical Center, I also started to use UVB radiation lamps against the Psoriasis and fluorescent light boxes against the SAD. The above posting of nice sunshine at the northern states at latitudes above the Dixie Line is nonsense b/c the atmospheric belt there, in winter time, does not let UVB radiation to come through to Earth. For "thin blooded" persons like me, the thing to do was to move out from there for good, which I did after 14 years, and never went back to live there again.