I expected a miracle!

Good afternoon from this hot and muggy Chicago Monday: I am fairly new to CPAP, actually started at the end of May of this year. After going through several masks, nasal and pillows, either leaked, hurt my nose after a few weeks, I finally settled upon the Airfit P10 nasal pillows, with a band aid underneath my nose an above my lip and a chin strap underneath.

According to my doctor, my numbers look good at my follow-up. Pressure 10-20 and my average that I need is around 13.8, so it is set at 10. AHI is always been 0.8 and 1.8. The doctor look at the card and said sleep apnea wise I am doing good. I can sleep with the machine for 8 hours, but am still up and down all night long. No insommnia.
Going to the bathroom at least 2 times (I was promised this would stop) had urinalysis all normal, coughing from GERD, get up every hour or so and see myself looking at the clock, and remember every single dream, in fact dreams are more vivid now than before. I guess I was promised a miracle! I sleep just as bad (horrible) as I have in the past prior to CPAP, but at least I know that I am being helped with breathing. This is the best I will get, I guess.
Anyone in the same situation after getting adjusted to the CPAP mask, expecting a "miracle" of being able to sleep well, and still not getting it? By the way, I am not overweight and had my throat and stomach just scoped for GERD and it was not shown on exam. Not getting surgery for enlarged tongue.

Way back when we first started therapy you pooh poohed off the idea that your med(s) might be causing sleep architecture issues.
If your fragmented sleep is related to your meds (and it entirely possible and far from impossible) then this may be as good as you get because the machine can't fix problems not related to sleep apnea.
Cymbalta can cause insomnia/fragmented sleep and even though you don't want to call your awakenings a form of insomnia...that's what they are.
Also the reason for taking the Cymbalta (in your case back pain) can also affect sleep architecture and cause awakenings. Even low level discomfort will do it.

When you wake up during the night getting up and down....how long does it take you to go back to sleep? And just how often are we talking about? Is it really just about every hour on the hour or does it just seem like it?

Thanks Pugsy for writing back! Actually my Primary is weaning me off Cymbalta for the back-pain. Down to 30 mg every other day from 60 mg once a day. And then once every 3 days (for 2 weeks) and then off. So this will be a non-issue in a couple more weeks. Thank you for making me aware that Cymbalta can cause fragmented sleep. I never knew this. Fortunately, my back pain is under control somehow right now anyways (?) maybe with the Celebrex.
When I do wake up often, I am only up for a very short time, less than 1 minute and then fall back to sleep, but it is quite often, probably 5 times a night that I am aware of because I see the clock/time and then fall back asleep between 1-2 minutes. I also not even including the need to go to the bathroom breaks (2 times usually, lucky sometimes 1 time). I am disappointed that I thought that would be helped too. I stop drinking liquids at 6 pm. My dreams are very vivid, ok ones, not unpleasant ones. I remember them all the time. But then I had this too before starting CPAP. I asked my sleep doc about all these dreams and he said it is neither abnormal or normal (?). Any ideas?

While nocturia is a common symptom of sleep apnea...sleep apnea isn't the only cause of nocturia.
When you have to get up....is the bladder painfully full or do you just get up because you are awake and figure you might as well go pee?
Have other possible causes of nocturia been investigated?

Since you remember a lot of dreams associated with the awakenings you may just be awakening right during the dream...and we can dream in all stages of sleep...not just REM.

You might want to read this especially the part about awakenings and arousals.
http://www.sleepapnea.org/treat/diagnos ... tails.html

and this paper
http://www.journalsleep.org/articles/240604.pdf

It's normal to have arousals that we don't remember....and a few that we do remember which makes it an awakening even if short term. Annoying when they come in large numbers because it totally messes up the natural progression of the sleep stages that we need.
http://en.wikipedia.org/wiki/Sleep

you might also read this
http://www.ninds.nih.gov/disorders/brai ... _sleep.htm
it mentions that people are more easily aroused during the lighter stages of sleep.

Cymbalta is a SNRI
http://www.pharmatherapist.com/antidepr ... s-on-sleep

I can't help but wonder (and have no way to prove anything) if you aren't getting into REM as much as you need to..so you are more easily awakened from whatever.
I also can't help but wonder how much is "habit" that the brain has sort of got used to.

It's a slippery slope for sure. I don't think there is a quick fix no matter what the cause of the problem.

Thanks Pugsy for your response! I will read each and every article when I get home from work tonight. I can't read them at work, but I am going to read each link you sent me.
Yes, I agree that I think that part of my awakenings is because my "brain got used to it." I will be sleeping (with the mask) and all of a sudden my eyes are wide open and I am looking at the clock after sleeping for 1 or 2 hours, sometimes only 45 minutes of sleep. I can tell because I look at the time and know what time I approximately fell asleep. Some times when I do wake up, I decide I may as well use the bathroom now before I fall back asleep and get awakened again by a real need for the bathroom. But many times, having a full bladder does wake me up. No known nocturia reasons, except maybe getting older? (63). The dreams are annoying in some ways, because they are all the time and I can't control them and I remember every specific detail about them, colors and all. That is exhausting in itself. It's amazing I can put in a full day's work. I am never sleepy, just fatigued all the time. I did not realize that we can dream in other phases of sleep too. I will read the links later tonight. Thank you Pugsy!

Hi Luthie,

Your fast taper of Cymbalta also might be causing your sleep difficulties. And an RN I know said that tapering the drug every other day wreaks havoc on the system because the body needs a consistent dose on a daily basis.

Unfortunately, there doesn't seem to be an easy way to taper it very slowly. Please see this thread to see if anything may be useful.

http://survivingantidepressants.org/ind ... uloxetine/

By the way, I know you're not taking it for depression but obviously, the principles would still be the same for tapering.

49er

Thanks 49'r! Unfortunately I had the "awakenings all night every night" way before the Cymbalta for back pain and the CPAP machine. I thought perhaps the CPAP would help my awakenings because I was losing my breath during sleep apneas. Apparently not helping. Wow, I didn't realize the tapering process is so gentle and tempermental. So far, no side effects. My doc cut the dose in half (30 mg) after 2 weeks, and then next week, every 3 days for 2 weeks until OFF. I can't see doing this tapering process for 4-5 months as the article stated. Yikes. I have been on it for 8 1/2 months now.

Luthie2006 wrote:Thanks 49'r! Unfortunately I had the "awakenings all night every night" way before the Cymbalta for back pain and the CPAP machine. I thought perhaps the CPAP would help my awakenings because I was losing my breath during sleep apneas. Apparently not helping. Wow, I didn't realize the tapering process is so gentle and tempermental. So far, no side effects. My doc cut the dose in half (30 mg) after 2 weeks, and then next week, every 3 days for 2 weeks until OFF. I can't see doing this tapering process for 4-5 months as the article stated. Yikes. I have been on it for 8 1/2 months now.

Well, if you have only been on the Cymbalta for 8 1/2 months, hopefully, your taper will continue to go smoothly. Best of luck.

49er

I have been on cpap for just over 6 months now, and while most nights are good, I still have occasional nights of fragmented sleep. Last night was one of those nights, and I can't figure out why. I initially thought it was an exceptionally leaky night, which would explain it, but sleepyhead did not show excessive leaks, and most of the night my graph was at 20L/mn or less. It is probably normal to have fragmented sleep from time to time.

It takes a long time for the "miracle" to happen; I know I was disappointed to have such a rotten time at first. I had thought I was going to have wonderful sleep from night one, but it wasn't so. Some people report that they had great sleep from night one, but for most people the adjustment takes a few weeks, or even months, and it takes a long to get to the point of sleeping well.

49er wrote:

Luthie2006 wrote:Thanks 49'r! Unfortunately I had the "awakenings all night every night" way before the Cymbalta for back pain and the CPAP machine. I thought perhaps the CPAP would help my awakenings because I was losing my breath during sleep apneas. Apparently not helping. Wow, I didn't realize the tapering process is so gentle and tempermental. So far, no side effects. My doc cut the dose in half (30 mg) after 2 weeks, and then next week, every 3 days for 2 weeks until OFF. I can't see doing this tapering process for 4-5 months as the article stated. Yikes. I have been on it for 8 1/2 months now.

Well, if you have only been on the Cymbalta for 8 1/2 months, hopefully, your taper will continue to go smoothly. Best of luck.

49er

Unfortunately, for some people tapering high doses isn't a big deal... it's when you get lower that the problems seem to begin. Check out the link that 49er mentioned in her previous post. It's the best site of its kind on the internet. I wish you well.

Pugsy wrote:While nocturia is a common symptom of sleep apnea...sleep apnea isn't the only cause of nocturia.
When you have to get up....is the bladder painfully full or do you just get up because you are awake and figure you might as well go pee?
Have other possible causes of nocturia been investigated?

Since you remember a lot of dreams associated with the awakenings you may just be awakening right during the dream...and we can dream in all stages of sleep...not just REM.

You might want to read this especially the part about awakenings and arousals.
http://www.sleepapnea.org/treat/diagnos ... tails.html

and this paper
http://www.journalsleep.org/articles/240604.pdf

It's normal to have arousals that we don't remember....and a few that we do remember which makes it an awakening even if short term. Annoying when they come in large numbers because it totally messes up the natural progression of the sleep stages that we need.
http://en.wikipedia.org/wiki/Sleep

you might also read this
http://www.ninds.nih.gov/disorders/brai ... _sleep.htm
it mentions that people are more easily aroused during the lighter stages of sleep.

Cymbalta is a SNRI
http://www.pharmatherapist.com/antidepr ... s-on-sleep

I can't help but wonder (and have no way to prove anything) if you aren't getting into REM as much as you need to..so you are more easily awakened from whatever.
I also can't help but wonder how much is "habit" that the brain has sort of got used to.

It's a slippery slope for sure. I don't think there is a quick fix no matter what the cause of the problem.

Pugsy, thanks for all these interesting resources. I read them all.

Did you try to set your machine in straight cpap mode? Maybe you are sensitive to the pressure change. Some report better result with it.

this may seem crazzy... My first thought after reading everything that is happening with you is that you "keep looking at the time" It may seem like nothing, but if your waking yourself up "to look at the time" it can be a problem.. Maybe you are worried about not waking up on time so you are always waking yourself up to make sure you have not overslept?? It could also be just something you have always done and now it is a habit and you continue to do it...

Maybe try turning your clock around to where you cant see the time and set another alarm clock for the time you need to get up... try it for a week or 2 and see what happens.. I hope you can figure this out..

Luthie2006 wrote: Yes, I agree that I think that part of my awakenings is because my "brain got used to it." I will be sleeping (with the mask) and all of a sudden my eyes are wide open and I am looking at the clock after sleeping for 1 or 2 hours, sometimes only 45 minutes of sleep. I can tell because I look at the time and know what time I approximately fell asleep.

and

Unfortunately I had the "awakenings all night every night" way before the Cymbalta for back pain and the CPAP machine.

I want to second what Cowboy Casey said: The clock watching is likely making the situation worse. As soon as you wake up and look at the damn clock you consciously (or unconsciously) start calculating the time you've slept and that's part of what's bugging you and making you keenly aware of the wake. Some of those brief wakes are likely normal post REM wakes. Others may very well be being triggered because your brain has gotten so used to waking up just to check on the time.

Why didn't I think of that "clock watching" first before you guys came up with that? That is why I love all of you for your support!
I think you are 100% right that I am worried that I won't wake up in the time for work! I have to get up at 5:30 am every morning M-F for work and am worried that I will oversleep.
However, on Sunday's I don't sleep all that much better when I am not pressured to wake up! I think my brain is used to getting up so much and looking over at the clock to see how many more hours I have left to sleep, etc. Like this morning, I got up at 3:30 am, and I was calculating that "Ok, Luthie, you have 2 more hours to sleep, so you are good to sleep." When I wake up and it is 4:30 am, I say to myself, "Luthie, you only have 1 more hour to go, so don't get too used to this thing called "sleep" because you will have to get up too soon anyways. I do think this way. And I think turning the clock around (with my alarm on) will help. I believe I was told that before by my sleep clinician, but forgot about this, worrying so much about the CPAP masks. I think Robysue and Cowboy Casey hit the nail on the head at least with this clock situation. I will try turning it around and not look at it. I even check it 2 times every night to make sure it's set correctly. So I will try turning the clock around every night and see if this helps! Thanks on that.

Now I am more concerned about weaning off the Cymbalta. I have heard horror stories about this too. I am on 30 mg every other day, (dropping from 60 mg) and starting next week, Aug 13th, then every 3 days only for 2 weeks (so about 1-2 times a week) for 2 weeks and then OFF. If anyone has any more suggestions regarding this, please let me know. My Primary suggested this withdrawal method. I feel ok so far, no withdrawal side effects. So when I go lower, I will become sick?