Still waking up... can someone help?

[mcsheltie]

Two + months have gone by and I am still waking up at least three times per night. Sometimes I can go back to sleep, more than often I cannot. This is the main reason I did the sleep study in the first place, as I had no idea I had apnea.

I fall asleep right away. The machine and mask don't bother me. In fact they actually add an additional feeling of comfort to my bedtime routine. Leak aren't waking me up anymore and the leak rate is good. Sometimes they spike, but never near a time when I wake up.

I have no idea why I am waking up. I look at my SleepyHead info trying to see if I can find a pattern, but the waveforms don't make much sense to me and I can't find any resources online that teach you what the different ebb and follow of breath on the charts indicate. Often when I look at the actual events I don't see that flowrate looks much different than what proceeded or followed the event. Then I see periods of flat line for over 10 seconds that weren't flagged. I see some areas that are totally wild and spiky during times that were the during the best sleep I got that night. Sometimes there are clusters of events and I didn't wake up. Most of the time the waveform right before I wake up looks uneventful (to me).

I am so tired of this. I've been fighting depression and this makes it so much harder to cope. I was hoping CPAP treatment would stop this. But there has been no change. If there had been even a little improvement to date I would be okay with it, but it's not happening. Can anyone help me with this?

[RichardVT]

I know with me, the first three weeks or so the pressure was too low - I knew if I moved my head certain ways on the pillow my airway would close in my throat. I experimented with raising the starting pressure and then discussed it with the technician on Oct 5th. I told him that the pressure seems like it should be higher starting out than five and he increased it to 12. I told him I would no longer touch the pressure. From then on, I seemed to quickly get more comfortable with the whole thing to the point where I stopped taking my card out every morning to see my results in SleepyHead.

I still awaken two to three times a night but try not to think at all about the CPAP which usually lets me fall right back into a deep sleep within less than about 15 minutes. I have to use the PapCap chin strap which causes my chin to itch. I take everything off usually each time I awaken then put it all back on to resume sleeping which stops the itching.

[Beej]

Here's a checklist for sleep hygiene and related stuff. You may already be doing these, but it helps to summarize, since folks may not recall every detail of previous posts. I hope you don't mind. You could make a summary write up in Google Docs, then link it in your signature.

Go to bed at the same time every night, even on weekends?
Get up at the same time every morning, even on weekends?
Avoid eating within 2-3 hours of bedtime and not trying to sleep if ravenously hungry? (that one has to be balanced based on what works for you!)
Make a bathroom stop before bed?
Have light blocking curtains/shades on all windows?
Avoid any caffeine or chocolate within 8 hours of bedtime? It takes 8 hours for half of whatever caffeine you consumed to be metabolized. Also, chocolate contains theobromine and theophylline which can be activating; the latter is used to help asthma patients.
Avoid using computers and TVs within around 2-3 hours of bedtime? The blue in their displays can be activating.
Eliminated other sources of light in the bedroom - clocks, devices, etc.?
Have a white noise generator, like a small fan, to mask any intermittent sounds that could wake you?
Use any relaxation or meditation techniques when you find you've woken up?
When you wake up, get out of bed and do something unpleasant? (That's a form of aversive conditioning - if I wake up, I have to do something noxious. Guess I'd rather sleep. Eventually, one's brain gets a clue).
Have a clear idea of how much sleep you need? Not everyone needs 8 hours; I run on about 7 most of the time.
Have had a good physical and know there are no other health conditions affecting sleep? High thyroid makes it difficult to sleep, as will illness, asthma (can't breathe!), pain, heart issues, etc.
If on medication, have reviewed the side effects to determine if they impact sleep and adjusted the timing of those which do to minimize adverse problems and optimize benefits (if any). Do discuss making any timing changes with your doc(s).

You mention you've been fighting depression. What ways are you doing this?

[mcsheltie]

I experimented with the pressure. My prescription was for 7 fixed. I never felt like I could breath on 7. I changed it to 8-13. My 90% pressure has been right around 10. I tried 8 fixed and 10 fixed for a week each. I feel better on APAP 8-13, but none of the above has kept me from waking up frequently.

[mcsheltie]

Here's a checklist for sleep hygiene and related stuff. You may already be doing these, but it helps to summarize, since folks may not recall every detail of previous posts. I hope you don't mind. You could make a summary write up in Google Docs, then link it in your signature.

Go to bed at the same time every night, even on weekends?Most of the time
Get up at the same time every morning, even on weekends? Most of the time
Avoid eating within 2-3 hours of bedtime and not trying to sleep if ravenously hungry? (that one has to be balanced based on what works for you!) I have to eat something resistant starch-ish to keep my blood sugar from tanking in the middle of the night.
Make a bathroom stop before bed? Always
Have light blocking curtains/shades on all windows? Yes
Avoid any caffeine or chocolate within 8 hours of bedtime? It takes 8 hours for half of whatever caffeine you consumed to be metabolized. Also, chocolate contains theobromine and theophylline which can be activating; the latter is used to help asthma patients. I don't do caffeine and rarely any chocolate since I am not eating sugar.
Avoid using computers and TVs within around 2-3 hours of bedtime? The blue in their displays can be activating. Unfortunately this isn't possible because of work. But I have done the best I can. I have Twilight running on all my electronics and use blue blocking computer reading glasses. At sundown I put on wrap around blue blocking glasses and take Melatonin.
Eliminated other sources of light in the bedroom - clocks, devices, etc.? Yes, except for the spotlight on my CPAP ... LOL
Have a white noise generator, like a small fan, to mask any intermittent sounds that could wake you? There isn't anything making noise in my house to wake me up.
Use any relaxation or meditation techniques when you find you've woken up? I hate that stuff! I put on a boring YouTube video on my phone (the screen is turned off) if I can go back to sleep that does it in five minutes. I pick out a couple that are about 20 minutes long before bed each night.
When you wake up, get out of bed and do something unpleasant? (That's a form of aversive conditioning - if I wake up, I have to do something noxious. Guess I'd rather sleep. Eventually, one's brain gets a clue). I read. If I do anything other than sit still I will be awake until morning.
Have a clear idea of how much sleep you need? Not everyone needs 8 hours; I run on about 7 most of the time. No idea, I have had insomnia my entire adult life.
Have had a good physical and know there are no other health conditions affecting sleep? High thyroid makes it difficult to sleep, as will illness, asthma (can't breathe!), pain, heart issues, etc. According to my PCP all my tests are normal. I am working with a Functional Practitioner to dig deeper. Typical thyroid tests that main stream Docs run often do not turn up many thyroid problems or underlying issues for most health problems!
If on medication, have reviewed the side effects to determine if they impact sleep and adjusted the timing of those which do to minimize adverse problems and optimize benefits (if any). Do discuss making any timing changes with your doc(s).
You mention you've been fighting depression. What ways are you doing this?
I'll answer both of these questions together. I don't take any medication. I was prescribed TWO Benzodiazepines for insomnia. And was on them for 12 years. When I went to the Doc about depression, brain fog and a SCARY loss of memory all he wanted to do was put me on another pill. Typical American standard of care Instead of trying to find the cause they mask the illness by treating symptoms with pharmaceuticals, meanwhile you get sicker and are soon taking a handful of drugs. But I digress... I know my depression isn't caused by a anti-depressant deficiency. And until the past couple of years I was an upbeat, optimistic person. More meds with scary side effects aren't the answer. I was thinking something like adrenal fatigue, thyroid or hormonal imbalance etc... might be the cause. But during my research I found out Benzos cause all of these problems and so does Apnea. Also Benzos are only to be taken for two weeks max... not for 12 years!!!!

[mcsheltie]

I know with me, the first three weeks or so the pressure was too low - I knew if I moved my head certain ways on the pillow my airway would close in my throat. I experimented with raising the starting pressure and then discussed it with the technician on Oct 5th. I told him that the pressure seems like it should be higher starting out than five and he increased it to 12. I told him I would no longer touch the pressure. From then on, I seemed to quickly get more comfortable with the whole thing to the point where I stopped taking my card out every morning to see my results in SleepyHead.

I still awaken two to three times a night but try not to think at all about the CPAP which usually lets me fall right back into a deep sleep within less than about 15 minutes. I have to use the PapCap chin strap which causes my chin to itch. I take everything off usually each time I awaken then put it all back on to resume sleeping which stops the itching.

I experimented with the pressure. My prescription was for 7 fixed. I never felt like I could breath on 7. I changed it to 8-13. My 90% pressure has been right around 10. I tried 8 fixed and 10 fixed for a week each. I feel better on APAP 8-13, but none of the above has kept me from waking up frequently.

[kwhenrykerr]

I have been woken up by pain that I just ignored for years. I am recovering from the repairs and starting to sleep better. I had a total joint replacement on my right shoulder. I sleep on my left side and have used a pillow to take the load off the joint and hold it open. I had no idea that it was causing added problems.

I take Melatonin 1/2 dose (2.5 mg) 3 to 4 hours before bed time. This was suggested by my Dr. to replace the prescribed sleep aid. I have found it just as effective. His reasoning was that the sleep aids were only effective for a short while where as the Melatonin was good for a much longer time when taken as stated above. So far it has worked to improve my sleep.

I keep working on better sleep and would not give up my CPAP. I am looking for a replacement neck brace to keep me from tucking my head into my chest while sleeping, I have worn out the last one.

Good luck with your efforts do not let the depression win and give up. I was ready to crawl into the grave and have made it a long way back. The doctors keep cutting and have sometimes said that it has not helped but I feel much better. Every time I go in the hospital I see just how lucky I am.

[Mr. Van Winkle]

Sounds to me there is some other issue that is waking you,it looks like your CPAP therapy is going fine.
I know just before I started my cpap, I was struggling with sleep anxiety and had a heck of a time going to sleep I would lay down and think I was going to die, I'd be out walking at 3:00 am some nights trying to get tried enough to go to sleep so I could get up at 4:45 for work..... After a few visit to the doctor, a few good drugs, and a sleep apnea diagnosis, I'm much better and enjoy going to sleep now.
Anyway if I were you I'd have a good talk with your doctor and see if he can help you through this issue.
I know it's tough but be strong you'll get though it!
I wish you the very best !

[Beej]

Eliminated other sources of light in the bedroom - clocks, devices, etc.? Yes, except for the spotlight on my CPAP ... LOL

Hmmn. Mine turns off after a few seconds.

Use any relaxation or meditation techniques when you find you've woken up? I hate that stuff! ....

There are numerous different techniques, including guided imagery, breathing exercises (breathing is the 1 autonomic process you can control and several other processes are affected by it), biofeedback, progressive muscle relaxation (most helpful when tight muscles are an issue), self hypnosis, and so on. Specifically, which ones have you used and what about them do you hate?

... I have had insomnia my entire adult life.

Ah. Have you heard of the sleep restriction method? I saw that written up on here; do a search to find it.

...According to my PCP all my tests are normal. I am working with a Functional Practitioner to dig deeper. Typical thyroid tests that main stream Docs run often do not turn up many thyroid problems or underlying issues for most health problems!

Sometimes, they change reference values for the tests, too. For 20 years, I was told my thyroid was fine. Then the level for the TSH test was lowered. Getting on thyroid hormone let me eat without becoming unconscious afterwards. Always remember the doc is treating a patient, not a lab! (and you may need to remind the doc of that)

How do you feel about herbs to help with your sleep? Valerian is a calmative. St John's Wort is listed in the German Pharmacopia (herbal guide) for depression. Iceberg lettuce actually has a small amount of a sedative in it ... but you'd have to eat an awful lot of it (That last bit comes to you from a lecture by Dr Kirksey at Ohio University, in a psychopharmacology course!)

As far as medication goes ... you might find it useful to study some physiology and neurology info, because you may be misinformed. Antidepressants may, for some, help correct chemical imbalances, something which is physical, not "mental", nor failing to fix some undiscovered issue. If all the coping tools in the world don't make something better, you might consider that it is, in fact, physical, at the chemical (ex hormones or neurotransmitter) level, and not some personal failing. Serotonin and norepinephrine are 2 neurotransmitters implicated in depression; antidepressants affect the circulating levels of those neurotransmitter chemicals. You believe it is possible not to have hormones at the correct level; it isn't a stretch to consider that the chemicals that help transmit the signals from nerve to nerve may be off.

[chill]

Sleep restriction might have been me, I have been known to foam on about it. https://en.wikipedia.org/wiki/Sleep_restriction

I had a fairly similar history: frequent nighttime awakenings, too exhausted to think during the day, depression. A sleep test showed hypopneas but no apneas. The doctor suggested that I do sleep restriction / sleep compression therapy. I am here to tell you that it sucked. I hated it. Absolutely hated it. But... it worked. For years after I went to bed, went to sleep, and got up at most once. All was fine until my hypopnea grew up into full flow OSA and... where here I am. But I still usually only wake once a night on CPAP.

I also found that when the therapy started working that it dramatically lessened the life-long depression and anxiety. It is not 100% gone, I still do better with a low dose anti-depressant.