Do you wake up frequently during the night?

[JJJ]

Well, I do, five to seven times, and it has a negative effect on the quality of my sleep. With CPAP my AHI is averaging under 2.0, but I'm still not getting the best sleep. I usually stay asleep for the first hour and a half, sometimes longer, but then I wake up every hour or less. A full sleep cycle is supposed to be an hour and a half or so, so I'm not getting all the REM sleep I need.

I have tried everything, including melatonin, benadryl, doxylamine succinate, changes to lifestyle, and lots more. Nothing has helped.

Today I had a consultation with my sleep doc to discuss this. After ruling out everything else she suggested that I have psychophysiologic insomnia. I haven't googled on it yet (just got home), but the gist of it is that the sleep apnea (which I have had for at least a couple of decades) caused me to wake up, with the result that eventually my unconscious mind has become trained to wake up, even though I no longer need to.

The good news is that there is a possible solution, called "sleep restriction therapy." Basically, instead of sleeping my usual seven and a half hours I should go to bed later and sleep only six hours. The idea is to delay going to bed until I am dead tired, then force my body to compress the sleep I am capable of into six hours. After a while (hopefully) I will stop waking up so many times. I'm to try this for a week and, assuming I have positive results, add 15 minutes more sleep each week. The goal is to re-train my subconscious mind to stay asleep.

She suggested that if I need further help with the therapy that I see another physician who specializes in just psychophysiologic insomnia. Apparently it is a sub-field within sleep medicine. Supposedly there is also a web-based physician who treats people with this problem.

I know waking up in the middle of the night is a problem for many here, so I wanted to post this right away in case it helps someone else.

[PaulaO2]

The human body is a creature of habit. It loves them. And hates like heck to let go of one.

I can see how your body is in the habit of waking up so often. It's the "normal" it got used to and by gosh, it's gonna keep doing it!

But I don't see how just a week is going to do much. So don't give up if you don't see any improvement in a week. Try for another week or two.

Good luck and let us know how it goes! Deep down, we care!

[Allen]

Before commencing on cpap I woke every 1 to 2 hours to urinate. Now I can sleep up to 5 hours before waking and usually can go straight back to sleep after going to the bathroom. I am averaging between 6.5 and 7 hours of total sleep which is what my sleeping pattern was before I had apnea.
I usually go to bed between midnight and 12.30am because I work permanent afternoon shift (second shift I think it is called in the US) and by that time I am dead tired.

[PaulaO2]

A person who is a light sleeper would probably have more of an issue with this than a person who is a deep sleeper.

I sleep rather deep. It takes a lot to wake me, although it depends on how usual and how important the sound/disturbance is. I can sleep through the dogs dancing on the bed but wake up instantly if the front door opens. (We had a deaf Dalmatian and the front door opening was not a good thing. Ever looked for a deaf Dalmatian in the fog? Not fun nor easy. So I would wake up quickly and get it shut before she noticed.)

I think that is the purpose of the proposed treatment. Make him so tired he sleeps deeper and is less likely to be woken up even by his own brain.

[JJJ]

Well, last night was the fourth night since I tried what my doc suggested.

To clarify, she suggested I had psychophysiologic insomnia, where the body gets awakend by sleep apnea repeatedly over years without treatment. And then, even after successful treatment, the boyd is conditioned to wake up over and over again during the night. Her suggested therapy is to restrict the amount of time I sleep so that by bedtime I will be so sleepy that I will sleep without waking up. Assuming this works I am to increase the amount of sleep by 15 minutes every week.

So after four nights I can report a minute improvment in sleeping without waking up. At this rate it's going to take a looooong time to break the waking up habit. However, as long as I am improving I will stick with it.

I can also report two just about insurmountable problems with the therapy:

1) In my case she suggested limiting myself to six hours. How do you do that? Even if I use an alarm clock, when I get into bed I can't predict how long it will take to fall asleep. Usually it takes me just a few minutes, but sometimes as long as 20 minutes. So I get into bed, set the alarm clock for six hours and ten minutes later, assuming that it will take me ten minutes to fall asleep. But if it takes me 20 minutes, then I am getting ten minutes less than six hours. If I fall asleep in five minutes, then I am getting six hours and five minutes of sleep. It is extremely difficult to control exactly how long you sleep.

2) If I sleep only six hours I am supposed to be dead tired by bedtime the next night. Except what happens is that I fall asleep during the day to make up for the lost sleep. So at bedtime I am no more sleepy than before.

It's been only four nights, so I'm going to keep trying for a while longer. Meantime, I wanted to report that "sleep restriction therapy" may not be as easy to do as it sounds.

[PaulaO2]

I don't think the ten minutes plus or minus is going to hurt nor hinder anything.

I read somewhere (or maybe heard an interview on FreshAir on NPR) that it takes 27 days to break a habit. Now that was for a habit you are consciously aware of versus one your own body and brain have gotten on its own.

[Sleepster]

Well, I do, five to seven times, and it has a negative effect on the quality of my sleep.

I wake up at least once, usually three or four times per night. It's not as bad as it used to be.

Today I had a consultation with my sleep doc to discuss this. After ruling out everything else she suggested that I have psychophysiologic insomnia. I haven't googled on it yet (just got home), but the gist of it is that the sleep apnea (which I have had for at least a couple of decades) caused me to wake up, with the result that eventually my unconscious mind has become trained to wake up, even though I no longer need to.

I was thinking that I may have this very same thing.

[Sleepster]

So after four nights I can report a minute improvment in sleeping without waking up. At this rate it's going to take a looooong time to break the waking up habit. However, as long as I am improving I will stick with it.

I think it will take a long time, but maybe not as long as you think.

My body has spent a long time waking itself up to breathe. I figure at least 20 years, maybe 40 or more. For the last year I've had CPAP therapy, so that's not that long in comparison.

It will take time to adjust to not having to wake up to breathe, but it may be that once your body gets used to doing that it'll get the idea and start cooperating.

The other thing I would suggest doing is breaking your routine in other ways. Go on weekend excursions where you are forced to sleep in different places. When I do this I come back really tired and manage to follow it up with a couple of better night's sleep.

[dcgrafix]

I too have been diagnosed with insomnia.
Mine started in my early 30s but have never been a good sleeper.

I would be up 17 to 23 times in the night & as well many times could only get a little & even in the day it was 2 or 3 times an hour at least.

My Doctor at that time put me on Amitriptyline 50mg (I am now at 175mg plus Zopiclone)
At the time the Amitriptyline was to help control the frequency & the pain to a small amount & it is a mild antidepressant, he never said anything about being depressed I think he must have noted it but never said anything about depression for a few years.
I did have many tests done in my home town but they could not find anything so I spent a week in Vancouver hospital & had many unpleasant tests done.

First day with the urologist in a small cold room in the basement & was told he was going to put a catheter in (you know where) & fill me up with air while X-Raying then pull the catheter out & X-Raying again.
My first question was "where is the anesthesiologist?"
Oh no he said you must be awake for these tests!!
So we proceeded & it felt like I was going to blow up & he pulled it out & I sounded like a balloon losing pressure. A few days later after many more catheters & fluids I got the privilege of more tests & more catheters in & out then came to the endoscope (what I called the camera crew) to look in all the way to my bladder to find the inner bladder lining was whitish & deeply rippled with muscle (should be smooth & pinkish) from having to constrict to empty the contents through a restricted path This is the same effect as building muscle from exercising.
This condition gave me the massive & painful urge to pee that I was complaining about & the frequency due to not being able to empty my bladder!
The next set of X-Raying this time I was in a room large enough to park 12 or more cars with 3 young women talking of their partying & 2 or 3 techs with the door wide open to the hallway & there I stand completely naked on a very large cold stainless steel pivoting X-Ray bed with another catheter in (for anyone that are not familiar with a catheter it consist of 2 tubes of surgical rubber slingshot rubber 1 larger & 1 smaller connected to a plastic rounded end that look way too big to go in) Once the catheter is in they inflate the small & it expands into a balloon in your bladder to keep it in place.
So the next X-Raying sequences are taking place while filling my bladder with fluid started while laying down until I was full & arched backwards into a bridge with pain then tilted upright so they could pull it out & I go to pee into a nice new shiny bucket.
At that time the tech said to my jokingly “wouldn't that be a bitch if the X-Rays didn't work”
Five minute later he came back & told me they were blurry so he needed to fix it & do it again & he wasn't kidding.
After all the tests were done they told me I had a blockage in my urethra that blocked fluid going out but worked well going in basically a 1 way valve so I had laser surgery to remove the tissue but they only wanted to do a little at a time because it was very close to the shut off valve & told me they would get a hold of me in about 6 to 8 weeks but they never did & I didn't want to go through it again so I took the small improvement they gave me & ran with it.
This brings me to your post JJJ Do you wake up frequently during the night?
This sounds like where I started & the sleep doctor said I am probably suffering from depression which causes Insomnia & the viscous circle is formed, can’t get enough sleep cuz I gota pee so bad & often & it seems to me that would be the reason for the depression but they say it is a textbook example that you would be depressed fist then that causes insomnia But not everything is textbook with me & my question is “what came first the chicken or the egg?”
He recommended a book “No More Sleepless Nights by Peter Hauri, PH.D & Shirley Linde PH.D so I am reading it now & it talks about the proses of "sleep restriction therapy" & keeping a sleep log.
I picked up another book called “Sleepmanual by Wilfred R. Ppigeon PH.D & it has a CD with it with some sleep logs like Sleep Diary.pdf if you are interested I can send them to you if you.
Well sorry about the huge story it is going to take up a whole page.
But for me they say, Sleep apnea is just a symptom of Insomnia & may be the case with many other people.

[JJJ]

No More Sleepless Nights by Peter Hauri, PH.D & Shirley Linde PH.D

I have it ordered from Amazon.