Still waking up... can someone help?

[49er]

""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.""

With all due respect, the chemical imbalance theory is not true and was due to a drug company marketing campaign.

http://diginole.lib.fsu.edu/islandora/ob...m/PDF/view

I am not suggesting that people not take antidepressants. But if you are taking them thinking they will correct a chemical imbalance, you will be totally misinformed.

49er

[Beej]

Neurotransmission steps

To alter the functioning of neurotransmitters:
Increase or reduce the base chemicals to create a neurotransmitter - ex tryptophan is used to create serotonin.
Block the release of the neurotransmitter.
Block the receptor sites - which increases the circulating levels of the neurotransmitter.
Block the release of the neurotransmitter from the receptor sites.
Block the re-uptake of the neurotransmitter.


Drugs affecting neurotransmission may block, hinder, or mimic the action of the neurotransmitter and alter post-synaptic transmission.

If the drug increases the effect of the neurotransmitter it is called an agonist. If it decreases the effect of the neurotransmitter it is called an antagonist.

[robysue]

mcsheltie,

I'm sorry to hear that you're still having a lot of problems adjusting to therapy after 2+ months. I had a long 12 month "adjustment" period before I managed to get everything working. And insomnia played a large role in my problems.

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

What does your typical sleep schedule look like? And how variable is it?

And what does "most of the time" mean? Does "most of the time" mean M-F, but you do things differently every weekend? Or does "most of the time" mean all but 2 or 3 days a month? Or something else?

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.

What time is your resistant starch-ish snack? And specifically what kinds of foods do you eat for your resistant starch-ish snack?

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.

Any hidden sources of caffeine like diet soda? Also, how much alcohol do you consume on a daily basis? And when?

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.

What is the work schedule and what is your desired sleep schedule?

What do you do in the last 30 minutes before you climb into bed for the night?

How much melatonin do you take? Many people inaccurately believe more melatonin is better, but studies have shown that the most effective doses are often in the 0.5-1mg range, even though melatonin is usually sold in doses that are many times this level. Too much melatonin can make things worse.

And when do you take the melatonin relative to bedtime? Many people find that it works best if it is taken 3-6 hours before your desired bedtime.

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.

Anything outside the house that might wake you up? Things like barking dogs, traffic noise, garbage trucks?

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

Why? Which specific techniques have you tried and what made you "hate" them?

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.

Even a boring YouTube video without the screen on can allow the brain to wake up enough to follow the sound track.

When you say "boring YouTube video" can you provide an example?

You might find it more useful to have a very long playlist of very boring music that you can play all night long---something that's already "on" for you to listen to when you wake up. As an example, I use a four hour long playlist of Gregorian chants playing on my iPod every night. When I wake up, the chants are already playing and I don't have to do anything but relax and listen to them.

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.

Do you read in bed? Or do you go to another room to read? Do you read things on your phone? Or do you read a real book? How bright is the light you use for reading?

Sometimes a simple trip to the bathroom (even if you don't think you need to go) and a small drink of water is enough to calm the brain enough to let you get back to sleep in a timely fashion.

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.

How much sleep do you think you actually get on a typical night? How long are you in bed each night? If you can't answer these questions, then it's time to start keeping a sleep log for a few weeks to gather some data on just how bad your insomnia actually is.

One thing that people with chronic lifelong insomnia often do is spend too much time in bed not sleeping and instead of sleeping, they're worrying about not sleeping. All that time spent in bed fighting for sleep tends to make the insomnia worse rather than better. Most people with insomnia start to feel like they're getting restful sleep only when their sleep efficiency is above 85% or even 90%. And sleep efficiency = (Total time you think you were asleep)/(Total time in bed)

So if everything were perfect with your sleep, what would your normal sleep schedule look like? In other words: What is your desired bedtime? And what is your desired wakeup time?

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.

Which two benzodiazepines were prescribed for insomina? What were the doses? Were you supposed to take them every night? Or only on an as needed basis? Did they work at all for you?

How long ago did you quit taking them? And how fast did you taper off of them?

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.

If more meds are not the answer, what kinds of nonpharmaceutical therapy would you consider for treating the depression?

I was thinking something like adrenal fatigue, thyroid or hormonal imbalance etc... might be the cause.

All of which are treated with drugs that have side effects.

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!!!!

Specifically which benzos are you talking about and which problems are you talking about? There's a lot going on here and it's tough to tease out which problems you think the benzos are responsible for.

And again, how long have you been off the benzos?

As for the apnea: What was your diagnostic AHI? How long do you think you had OSA before being diagnosed? And what is your treated AHI? In other words, what does the data from your Dreamstation look like for a typical night?

Because at this point: If your treated AHI < 5.0 every night and IF you are using the APAP all night long, every single night, then chances are your on-going problems are not due to untreated or under treated OSA.

That doesn't mean they're not real and it doesn't mean that you're not getting enough sleep. And it doesn't even mean that the APAP isn't potentially disrupting your sleep. But it does mean that if the APAP therapy is (part of) the problem, we're looking at comfort issues and "learning how to sleep with a hose attached to your nose" issues. And it can take more than 2 or 3 months for your brain to really learn to trust the APAP to do its job. And if there are any comfort issues at all, it can take longer. I say that as someone who had a disastrous first 6 months of therapy due to CPAP-induced insomnia and then had to work (hard) another 6 months to bring the insomnia under control. And I didn't really feel much better until after my insomnia, my migraines, my TMJ, and my tension headaches were all properly controlled.

[49er]

I am also curious as to how long you have been off of Benzos. And how slow or fast did you taper?

The reason i am asking is many people who tapered off of psych meds too quickly find they get a case of rebound insomnia that can take awhile to go away. This may or may not be applicable in your case.

49er

PS - I just realized that the melatonin you are taking may be causing depression particularly at moderate to higher doses. You might want to google melatonin side effects depression to see if anything resonates.

[mcsheltie]

Sorry it has taken so long to get back. I've been on the road for work. While I read the forum and post short responses on my phone, something of this length is impossible. Too old and blind!

mcsheltie,

I'm sorry to hear that you're still having a lot of problems adjusting to therapy after 2+ months. I had a long 12 month "adjustment" period before I managed to get everything working. And insomnia played a large role in my problems.

I really don't think I am having problems adjusting to therapy. It has been much easier than I anticipated. But something is waking me up and I'm REALLY sick of it!

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

What does your typical sleep schedule look like? And how variable is it?

I try to be in bed by 10 and get up at 7. Sometimes I get involved in doing something (like right now...LOL) and time gets away from me.

And what does "most of the time" mean? Does "most of the time" mean M-F, but you do things differently every weekend? Or does "most of the time" mean all but 2 or 3 days a month? Or something else?
All but 2 or 3 days a month

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.

What time is your resistant starch-ish snack? And specifically what kinds of foods do you eat for your resistant starch-ish snack?

Right before bed. Usually cashews. Doc gave me a list of things I could eat and those are my favorite.

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.

Any hidden sources of caffeine like diet soda? Also, how much alcohol do you consume on a daily basis? And when?
I don't drink soda. Have never drank diet. No need and it tastes gross. I have a drink or two when out to dinner. MAYBE twice a month. Caffine makes me feel ill. There is no way to hide it, ever!

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.

What is the work schedule and what is your desired sleep schedule?

I have to check email and work website before I go to bed. But there is no blue light getting through both the app and glasses.

What do you do in the last 30 minutes before you climb into bed for the night? I let the dogs out for last call, shut down the house and do my bathroom things.

How much melatonin do you take? Many people inaccurately believe more melatonin is better, but studies have shown that the most effective doses are often in the 0.5-1mg range, even though melatonin is usually sold in doses that are many times this level. Too much melatonin can make things worse.

And when do you take the melatonin relative to bedtime? Many people find that it works best if it is taken 3-6 hours before your desired bedtime.

I am supposed to take 1.5 mg each night. It is a liquid, .5 mg per dropper. I take the first dropper when the sun goes down. And the other two divided in the remaining time left before bed.

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.

Anything outside the house that might wake you up? Things like barking dogs, traffic noise, garbage trucks?

I am not waking up from anything external. The problem is me. Be it physical or mental. I am not sure my problem can be classified as insomnia. I thought that was what it was. But the sleep doc said there was no evidence of it. And I am starting to agree. Usually I fall asleep within 30 minutes of starting to read and if I wake up I go back to sleep. But I am waking up too much and too often. And I want to know why.

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

Why? Which specific techniques have you tried and what made you "hate" them?

Meditation is not supposed to be done before bed. The practice is meant to refresh and rejuvenate. As far as relaxation techniques half way through I start thinking how stupid this is. My problem is not going to sleep it is staying asleep. Thinking is what keeps me from going back to sleep.

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.

Even a boring YouTube video without the screen on can allow the brain to wake up enough to follow the sound track.

Actually that is what I am trying to do! Thinking is what keeps me from going back to sleep. Listening to something (my brain following the sound track) stops that process. Besides, if I am awake enough to turn on a video my brain is already awake :-)

When you say "boring YouTube video" can you provide an example?

Essential Oils Q&A, Side Affects of Statin Drugs, BHRT Patient Case Studies

You might find it more useful to have a very long playlist of very boring music that you can play all night long---something that's already "on" for you to listen to when you wake up. As an example, I use a four hour long playlist of Gregorian chants playing on my iPod every night. When I wake up, the chants are already playing and I don't have to do anything but relax and listen to them.

Music wakes me faster than anything. As I said I need to distract myself from thinking. There is nothing to do but think when listening to music. I used to listen to the news, that really put me right to sleep. But now the thing to do is have a panel of people yelling at each other. Definitely not conducive to sleep.

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.

Do you read in bed? Or do you go to another room to read? Do you read things on your phone? Or do you read a real book? How bright is the light you use for reading?

I am starting to find that it is better to read in bed. If I go in the living room by the time I get back to bed I am cold and wide awake again. I used to read a real book. But by the time I feel sleepy, sit up to turn off the light I am wide awake. I have to start over from scratch. If I read on my phone and start to fall asleep I just close my eyes and go to sleep. Like I said I am using Twilight set to 2700K and using blue blocking glasses.

Sometimes a simple trip to the bathroom (even if you don't think you need to go) and a small drink of water is enough to calm the brain enough to let you get back to sleep in a timely fashion.

That is what I do every time. Most times I do go back to sleep

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.

How much sleep do you think you actually get on a typical night? How long are you in bed each night? If you can't answer these questions, then it's time to start keeping a sleep log for a few weeks to gather some data on just how bad your insomnia actually is.

I am not getting a lot of sleep when I wake up every hour. In bed from 10 pm to 6-7 am. Out of 8 hours I probably sleep for 4. With CPAP those four hours are better quality. I slept fairly well during my PSG and I was told I never got out of Stage 1 sleep. I was surprised because for me that was a good night!

One thing that people with chronic lifelong insomnia often do is spend too much time in bed not sleeping and instead of sleeping, they're worrying about not sleeping. All that time spent in bed fighting for sleep tends to make the insomnia worse rather than better. Most people with insomnia start to feel like they're getting restful sleep only when their sleep efficiency is above 85% or even 90%. And sleep efficiency = (Total time you think you were asleep)/(Total time in bed)

So if everything were perfect with your sleep, what would your normal sleep schedule look like? In other words: What is your desired bedtime? And what is your desired wakeup time?

10 pm - 6 or 7 am... but actually sleeping during the entire time.

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.

Which two benzodiazepines were prescribed for insomina? What were the doses? Were you supposed to take them every night? Or only on an as needed basis? Did they work at all for you?

Xanax 1 mg & Restoril 30 mg. I thought they were working. But after my research I was probably still waking up, but the memory loss they cause didn't allow me to remember.

How long ago did you quit taking them? And how fast did you taper off of them?

It took me almost a year to taper off. Benzos have some of the worst withdrawal problems of any medication. Much worse than Opioids.

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.

If more meds are not the answer, what kinds of nonpharmaceutical therapy would you consider for treating the depression?

I believe the Benzos and apnea has caused my depression. Time will heal the damage the Benzos did and CPAP is treating my apnea well. It took years to get this messed up and it will take a while for it to resolve.

I was thinking something like adrenal fatigue, thyroid or hormonal imbalance etc... might be the cause.

All of which are treated with drugs that have side effects.

Yes if you pursue the Standard of Care. But I prefer Functional and Orthomolecular medicine. None of these conditions can be successfully treated with drugs. The symptoms may be masked, but the problem will still be there, causing more damage.

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!!!!

Specifically which benzos are you talking about and which problems are you talking about? There's a lot going on here and it's tough to tease out which problems you think the benzos are responsible for. Depression, brain fog and memory loss. Some of the same things that long term apnea can cause.

And again, how long have you been off the benzos? 1 yr

As for the apnea: What was your diagnostic AHI? How long do you think you had OSA before being diagnosed? And what is your treated AHI? In other words, what does the data from your Dreamstation look like for a typical night?

Dx AHI was 30. Pulse Ox dipped into the 70s. I have had it for a long time. I have snored like a freight train forever with frequent awakenings. When I was a kid I had constant nightmares, among other things that are symptoms of OSA. My parents took me to the doctor and a psychiatrist. Both said there was nothing wrong. The nightmares were usually about being crushed by a large rock. Looking back I think I couldn't breath. Last night my AHI was 0.4. It consistently stays under 3.

Because at this point: If your treated AHI < 5.0 every night and IF you are using the APAP all night long, every single night, then chances are your on-going problems are not due to untreated or under treated OSA.

I don't think they are. But something is waking me up. I fooled around with my Sleepyhead settings and flagged 50% flow restrictions under 8 secs and started charting my RDI. My AHI would be <1 and my RDI would be 8. My awakenings always seem to happen after a couple of these. OSA and CA are well controlled now. I bumped up my starting pressure and the flex settings and RDI has improved.

That doesn't mean they're not real and it doesn't mean that you're not getting enough sleep. And it doesn't even mean that the APAP isn't potentially disrupting your sleep. But it does mean that if the APAP therapy is (part of) the problem, we're looking at comfort issues and "learning how to sleep with a hose attached to your nose" issues. And it can take more than 2 or 3 months for your brain to really learn to trust the APAP to do its job. And if there are any comfort issues at all, it can take longer. I say that as someone who had a disastrous first 6 months of therapy due to CPAP-induced insomnia and then had to work (hard) another 6 months to bring the insomnia under control. And I didn't really feel much better until after my insomnia, my migraines, my TMJ, and my tension headaches were all properly controlled.

Which is what I am trying to figure out too. But it seems to be a frustrating game of the chicken or the egg :-( I tried a week at 8 and 10 fixed to see if the pressure changes might be an issue and I was miserable on CPAP. Put it back to 8-13 (95% is 9.5-10) and felt better. Still waking up tho. Mask is good, leaks don't bother me... maybe it is just habit that needs time to be broken??? But I am not a patient woman. So waiting to see if that happens is not a do-able game plan for me. I am waking up for some reason and I want to know why NOW!!!! (LOL)

[mcsheltie]

I am also curious as to how long you have been off of Benzos. 1 yr And how slow or fast did you taper? 1 yr

The reason i am asking is many people who tapered off of psych meds too quickly find they get a case of rebound insomnia that can take awhile to go away. This may or may not be applicable in your case. It was hard to sleep when I got off them, but I wasn't sleeping before so not a lot changed.

49er

PS - I just realized that the melatonin you are taking may be causing depression particularly at moderate to higher doses. You might want to google melatonin side effects depression to see if anything resonates. I wish it were that simple. I've been fighting depression for more than 5 years. Just started taking Melatonin recently.

[mcsheltie]

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.

I've looked into it and have been resisting it...LOL From what I've read it does work. I'm using the excuse that I'll try it after the holidays How long before you saw results?

[chill]

You sound like me and picking a day to stop drinking for a while. I think it took about a week before the exhaustion kept me asleep for the whole night. It was a few years ago, but I think that was pretty much it. From then on, when I go to bed, I quickly go to sleep. On CPAP, I have become a bi-phasic sleeper waking after about four hours for a while. I've only been on CPAP since March (er, I think) so I have no idea if this bi-phasic sleeping is permanent or just a phase. There have been a lot of changes over the past few months.

[mcsheltie]

You sound like me and picking a day to stop drinking for a while. I think it took about a week before the exhaustion kept me asleep for the whole night. It was a few years ago, but I think that was pretty much it. From then on, when I go to bed, I quickly go to sleep. On CPAP, I have become a bi-phasic sleeper waking after about four hours for a while. I've only been on CPAP since March (er, I think) so I have no idea if this bi-phasic sleeping is permanent or just a phase. There have been a lot of changes over the past few months.

From what I've read biphasic sleep cycles are normal. Our ancestors (before electricity) got up in the middle of the night for several hours and went back to sleep. It is believed to be the normal sleep state for mammals too. So you may be stuck with it! I could deal with that. It is the waking up every hour that ticks me off!

During the sleep restriction how many hours did you allow yourself each night? And what time frame did you use? What I've been reading most recently said they went to bed so they would be asleep by 10 and got up at 4.

I don't mind restricting the hours as much as getting up at 4. When I used to be on the road for work constantly I usually had to get up at 4 am and I despised it. So I am very resistant to doing it again! I'd rather go to bed late and get up at 7. But the screws up your sleep cycle and Circadian rhythm. I am a night owl by choice so I know doing that would be a step backwards.

[chill]

I am not a morning person either. If I had to get up at 4AM, I don't think I would have done it. No, I am sure that I would not have. From memory, the sleep doc gave me 5.5 or 6 hours in bed a night, asleep or not. Hating to get up early in the morning, I stayed up as long as I could. Staying up got progressively harder. You want the time in bed to be slightly less than the amount of sleep you need - if you remember what that is for you!