Sleep health tips needed

[StillHoping]

Hello, for my obstructive sleep apnea which started in 2015 I've made progress with machine, mask, humidity, pressure, and other settings.

Here's my latest data (screenshot from Oscar Statistics):

   

The problem now has been getting regular sleep of (a) More than 75-90 min's at a time without waking to use the bathroom and (b) Getting a total amount of sleep of about 7.5 hours. I feel best when both of those conditions are met (and no mask issues). My diagnosed anxiety, which started when I had out of control apneas back in 2015, gets in the way of both of those. Sometimes I don't fall back asleep again, after waking at night, or I can't sleep more than 6 hours, I just lie there (which helps as a workaround).

My doctor now wants to put me on Trazodone to help reset my length of sleep, to break the learned cycle of intermittent sleep (vicious circle of anxiety and waking at night). I tried Doxepin and Ambien 6 years ago (previous doctor) for a few days and hated it (so quit that), so I've doubled down on trying to control my anxiety naturally, using what I've learned, and reset things myself.

Here's what I've done in the last week:

• Practiced letting go of worry before sleep, and make an intention in my mind of sleeping until 8am. No matter what. Like setting an imaginary target.
  
• Eliminating liquids after dinner
  
• Eating a banana with some peanut butter a couple hours before bed
  
• Walking at least a mile with uphill (treadmill or outside) until my legs really feel it - at least 30 min's
  
• Eating some peaches (lite sugar) as a snack on first night-time bathroom wake-up and another banana on 2nd wake up
  

Results

• I feel pretty good during the day, not perfect but pretty functional
  
• I get 3 sections of sleep of about 2.5 hours each so at least I'm getting 3 times where I don't wake up during REM / Deep sleep. Not perfect but progress from waking up every 75-90 min's or only getting 6 hours.
  

Analysis

• I was not diagnosed with RLS in 2015 but have always noticed I will REALLY sleep well after a long hike. There's something going on with stress relief / endorphins / whatever makes it work magic.
  
• Bananas and peaches also settle me down. There's magnesium, tryptophan in bananas, or perhaps it's also the primordial imprint of the entire nutritional pattern from these fruits that our body needs. Bottom line it works.
  
• Why am I eating? I've taken to lighter meals, and I'm probably still stress eating, I'm still overweight. I do wake up a little hungry too, especially later.
  
• Am I proposing all this as a solution? No. It's just a data point of where I'm at now.
  

Questions

• What other things can I do in a natural non-drug way to eliminate my night time wake-ups and eating? Is there a website for sleep / anxiety nutrition? Do I need a special doctor for that? Or is the eating OK?  Do I need a massive high protein dinner to get me through the night?
  
• What other things can I do to eliminate the need to use the bathroom every couple hours at night, given that men, as I read, lose the strength of the hormone to control that. My regular doctor checked all that out in 2015 - there were no issues. Just normal older man issue. Why can't medicine create that hormone so we can take it as a pill?? Or is this 2.5 hour awakening still just my anxiety rhythm that needs resetting via Trazodone as the doctor says? But I do have to go - a lot - when I use the restroom. Not diabetic at all. I'm totally healthy otherwise.
  
• Should I try the Trazodone (50mg non-depression dose) as prescribed? Short term? Or just continue my own natural approaches for awhile? I'm not sure. I'm fine with trying it, but if the natural ways can address it, then it's better to avoid potential side effects of non-natural drugs? There are other medicines and each depends on the dosage and timing to know if it works. It's a personal choice of course but looking for dialogue, opinions.
  

Thanks!

[Ratchick]

Thanks for the really detailed post. That answers a lot of my questions.

First - have you ever tried CBT-I? It's a form of CBT specifically to help people with insomnia, and the VA has a phone app that anyone can download for free and use to work through the process. If that sounds like something that you would like to try, then the link is here: https://mobile.va.gov/app/cbt-i-coach

Second - when you wake up, are you waking up because you really need to pee, or are you just kind of needing to go, and figure "might as well while I'm awake"? The problem is that by not sleeping for a longer stretch, your body doesn't "click" that it's nighttime and produce enough ADH - anti-diuretic hormone (aka vasopressin) - which is what slows down urine production at night. You CAN actually get it as a nasal spray, called desmopressin, and it's used primarily to treat a kind of diabetes where you fail to make enough of this hormone and literally pee gallons a day (called diabetes insipidus, not to be confused with diabetes mellitus, which is what most people mean when they say diabetes). It is used, too, to reduce bedwetting in kids by slowing down urine production AND it can be used in older men who have to get up to pee a lot because of excess urine output (as opposed to prostate hypertrophy and incomplete bladder emptying). It's relatively safe with a well-known side-effect profile so if you genuinely are producing excess urine at night, which is interrupting your sleep, maybe ask about that.

Re: the Tradzone. Entirely up to you if you wish to try it. Antidepressants aren't addictive and habit-forming in the same way that meds like benzodiazapines are, but it's definitely an option. I may also help with your anxiety, too.

Another medication that I use to reduce nighttime bladder overactivity is nortryptiline. This is a tricyclic antidepressant, and I take it a very low dose (10-20mg at night) because it can help with an irritable bladder, plus it also tends to help people sleep as drowsiness is a big side effect. With the right dose taken just before bed, you may be able to kill two birds with one stone.

A lot of people don't like using medication because they somehow feel that natural is always better - this isn't always the case, and my opinion is that if medication is going to help, then go for it. You have to draw up the risks vs the benefits (bearing in mind that not all risks are equally likely and that even simple meds like Tylenol or ibuprofen can cause serious problems if used incorrectly, or just through bad luck). And sometimes, natural products can be dangerous too, especially if combined or taken with other medications. But it does look like you're doing your best to make things work for you.

I presume you're already doing the general sleep hygiene things - cutting out screen time for an hour or so before bed, other calming things as a bedtime routine, going to sleep at the same time, getting up if you can't sleep after 20 minutes instead of tossing and turning, avoiding doing anything except sleeping (and intimate moments) in bed, always getting up at the same time even if you're exhausted, avoiding naps etc.

Eating... generally, you shouldn't really need to wake up and eat every two hours or so through the night. A snack before bed is good, to help keep away the munchies, but not to snack unless you wake up hungry enough that it's going to stop you from sleeping. If you wake up, decide if you really need to get up, and try to do as little as possible before coming back to bed and settling down again. Maybe keep something next to your bed, like a glass of water and a snack so you don't have to get up and go find something if you're not already doing that.

Last of all... I'd make sure that you're managing your anxiety as much as you need to do so. If it's still a problem, then yeah, you really need to get a handle on that if needed because anxiety is the enemy of good sleep.

I hope some of this proves useful, anyway!

[Nightynite]

I quit drinking anything around 8:30 p.m. and go to bed at 10:00. That help me with the pee problem.

Try eliminating carbs, you may be battling sugar spikes as far as getting hungry at night.

Keep us posted on what works.

Edit: Also, did you have your A1c checked lately?

[StillHoping]

Thank you both. My sleep definitely needs help I can see now. With some other consultation, I'm going to try the Triazodone as directed and see if that helps and then after trying that see about getting an A1C test result to be sure. The risks vs the benefits argument is good. I'll update here in a few days, and after the 3 weeks advised by the doctor for taking Triazodone.

My fasting results from Sept. 2021 are:
Glucose 107 mg/dL (normal: 65-99 mg/dL)
Triglycerides 100 mg/dL (normal: 30-200 mg/dL)

I went over various symptoms with someone who is a medical (lab) technologist and familiar with diabetes (mellitus) and there is only a little concern. The only solution would be to get an A1C test to know for sure, after trying Triazodone and/or other feedback from the sleep doctor.

I do have my anxiety treated well therapeutically. CBT-I would be another project. Thank you for that info.

More clearly: At night when I have to pee, if I'm waking every 75-90 min's it won't be much. When I wake after 2-3 hours I'll have to go more, a medium amount. Not "a lot" - sorry I had just meant more than "not much". So for the diabetes insipidus I'll research more. The ADH / desmopressin / nortryptiline info is good, thanks.

I do have good sleep hygiene otherwise: same exact sleep time, no screen time before, I fall asleep quickly initially. I haven't tried getting up at the same time. Gotcha, will start that, and avoiding naps.

I'm still amazed at how REALLY effective a long hike is. One time I slept straight through the night. So is there any way to get tested for hormones (e.g. cortisol, endorphins, etc) and brain chemicals (serotonin, etc.) to see what is off-kilter? Otherwise trying med's like hypnotic / tricyclic / benzo whatever drugs - it's just guessing. Everyone's different so is the only solution to try try try, each taking weeks, then weeks to ween off, then new trial. Sigh.

Another question is, if someone takes Triazodone for a few weeks and sleep is helped, can they then ultimately stop taking it (after reducing dosage as needed for a time)? I will consult with the doctor too. He indicated the sleep pattern "reset" / getting the "click" that it's night time concept.

[Nightynite]

I’m the same way with exercise, If I don’t walk my 4 miles, I don’t sleep good.

[StillHoping]

Update: After taking Trazodone 50mg for 9 days, I am no longer (a) Waking up every 90 minutes or (b) Eating any snacks at night. I wake up only about twice now in the middle of the night (sometimes just once). I have felt woozy / wishy washy (after-effect) during the day, but I have lower anxiety, more energy and after a few days felt good. 

I did have a bad night on the 4th night of taking the drug, Jan. 11th, with CSR for 15 minutes (AHI of 4.0), so I separately posted about that just now, the subject title of the post is "Cheyne Stokes Respiration", same date as this new post.  I think the CSR is unrelated to the drug since there was some serious stress during the day on Jan 11th, and there are a few other days in months prior to starting the drug, with CSR. The longer the CSR pattern, the higher the AHI, with OSCAR flagging lots of CA (clear airway) events during the CSR.

Lastly:
- Other than Jan 11th, my AHI has been between 0.7 and 1.7.
- I have noticed that the Trazodone hasn't quite as strong effect on me now after taking it for more than a week. Just a tad less potent. 
- I am concerned about the woozy head during the day, but need a couple more weeks I'm told for Trazodone to settle in.
- I still need to investigate the desmopressin because I still feel like I'm using the restroom like it's day time. I mean I wake up after about 2.5 hours after going to sleep, but sometimes I'll then sleep all the way through after the first wake up which has nicely happened at least a couple times.
- I'm curious if a smaller amount of melatonin might also help my body to know it's nighttime. There's a supplement in the stores that has Chamomile, Valerian, lemon balm, lavender and Melatonin (2mg) but may not be good to take with the Trazodone. And what about Ashwagandha. All things to go through the doctor.
- The Hiking 1 mile uphill comments I made were because maybe my issue is with high Cortisol levels.

Thanks for the support, appreciated!