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CPAP and Insomnia
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eviltim Offline

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Post: #1
Angry CPAP and Insomnia
So since long before I started CPAP therapy I have had a case of insomnia. It seems to be a fairly odd one compared to most peoples insomnia; I wake up and then go back to bed in about 5 minutes with no apparent cause. I will go to the bathroom if I have to, but I don't think that is the cause of waking.

I was hoping that the sleep apnea was the cause of it and CPAP would cure the insomnia as well but no dice. I wake up a lot less frequently, but I'd still say that I wake up about 5 times a night. So I figured I would just forge ahead with the CPAP and hope it got better. It took me a few months to clamp down on my various mask and leak issues anyway. But I'm finally to the point where I can't think of anything that would improve my CPAP experience, my AHI and leak numbers are superb, and I am still waking up every night. I'm not sure whether it is CPAP or apnea related but since everyone on here is pretty smart and tracking their own data I thought I would run it by you guys.

Looking through sleepyhead I *have* noticed some interesting patterns. Here's my chart from Friday.

[Image: UWDuhEF.png]

This is a fairly typical night for me. (Well, I couldn't fall asleep and disconnected the hose a couple times early in the morning as you can see, but other than that, it's normal). I will sleep for about 3-4 hours straight, wake up and use the facilities. Then I wake up fairly frequently after that. You can see I woke up at 6:40 on the chart and disconnected the hose. I also woke up about three times after that. These disturbances appear to be associated with a very erratic (compared to normal) respiratory rate. I understand that the erratic respiratory rate is an indicator of REM sleep.

But that's pretty much all I know. I still don't understand why I am waking. Anyone have any bright ideas? Has anyone seen similar patterns in their sleep?
(This post was last modified: 11-16-2013 09:47 PM by eviltim.)
11-16-2013 09:44 PM
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Tez62 Offline

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Post: #2
RE: CPAP and Insomnia
eviltim, my sleep patterns are fairly similar, remember CPAP opens our airways and helps us to breathe rather than help us to sleep, the by product of being able to breathe means we should sleep better but not necessarily the whole night. Other factors could come into play, for me I have become extremely sensitive to sound, light and the temperature and any change to one of those will wake me up. I can hear a cat walking on our fence and it could wake me up. I try just to let go and not worry about it, most days I still feel really good and 100% better than I was prior to being diagnosed. Make sure you follow good sleep hygiene etiquette and hopefully over time you will get back into a better sleep pattern. You could try herbal sleep medication (over the counter) like Valerian or Melatonin for a short period of time to try to get your sleep back into a better pattern, hope this helps a bit.
11-16-2013 10:08 PM
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me50 Offline

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Post: #3
RE: CPAP and Insomnia
I wake up a lot during the night and sometimes I get up and stay up for a few hours and go back to bed. Last night, I started forcing myself to stay in bed after I stayed up a few hours. I would turn the machine off and back on every time I woke up.

My sleep doc is going to try me on BIPAP to see if the high pressures of my APAP is causing this. If it isn't the high pressures, then I don't know what he will do but something has to give and I need to find out what is causing the frequent waking up (arousals as he called it).

All I can say is, like you, my AHI's are under control and until I got the AMARA GEL mask, my leaks were under control.

I can go to sleep easily, never feel like the air is blowing too hard, never remember my ears or gut being affected. Did not like the Quattro FX but maybe that is just because my sleep quality was lousy.

I am tired during the day, need a nap but recently I started making myself not take a nap, I have brain fog. Not sure what the cause is or the answer.

This is my data from last night for you to look at. As you can see, there are a lot of leaks with the Amara Gel and they were better last night than they have been since Monday.

[attachment=553]
(This post was last modified: 11-16-2013 10:15 PM by me50.)
11-16-2013 10:09 PM
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PaulaO2 Offline
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Post: #4
RE: CPAP and Insomnia
There's been some study lately (as in the last ten years) about this type of waking up. They've come out with some better sleep medication that is, basically, time released. Instead of knocking you out in the beginning, you go to sleep like always but it kicks in several hours later, about when you would normally be waking up.

Talk to your doc about these. I can't recall the name of any of them. Maybe someone here can. I've not tried any of them.

PaulaO2
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11-16-2013 10:18 PM
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zonk Offline

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Post: #5
RE: CPAP and Insomnia
From wikipedia, Segmented sleep
http://en.wikipedia.org/wiki/Segmented_sleep

Segmented sleep, also known as divided sleep, bimodal sleep pattern, bifurcated sleep, or interrupted sleep, is a polyphasic or biphasic sleep pattern where two or more periods of sleep are punctuated by periods of wakefulness. Along with a nap (siesta) in the day, it has been argued that this is the natural pattern of human sleep. A case has been made that maintaining such a sleep pattern may be important in regulating stress.

Historian A. Roger Ekirch (2001, 2005) discovered that before the Industrial Revolution, segmented sleep was the dominant form of human slumber in Western civilization. He draws evidence from documents from the ancient, medieval, and modern world. Other historians, such as Craig Koslofsky, have endorsed Ekirch's analysis.

The myth of the eight-hour sleep http://www.bbc.co.uk/news/magazine-16964783
We often worry about lying awake in the middle of the night - but it could be good for you. A growing body of evidence from both science and history suggests that the eight-hour sleep may be unnatural
11-16-2013 10:31 PM
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eviltim Offline

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Post: #6
RE: CPAP and Insomnia
zonk, interesting reading. I certainly don't enjoy waking up since it seems mostly pointless to me but I also associate the waking with the period of time in my life when I was getting absolutely terrible sleep. Perhaps it is not such a big deal.
11-16-2013 10:34 PM
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robysue Online
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Post: #7
RE: CPAP and Insomnia
eviltim,

You say your wakes are very short---as in 5 minutes or so. It could be that you are making mountains out of molehills. And from the data you show and write about, the wakes appear to be at regular intervals; in the data you post, the irregular respiratory rates are at roughly 90 minute intervals. That could point to normal post-REM wakes.

Most normal (non-insomniac) people tend to wake up briefly several times during the night, often just after every REM cycle (when we tend to be in a light sleep). But when a non-insomniac wakes up, they quickly establish that there's nothing "wrong" that needs their attention and they quickly settle back down and fall back asleep. Indeed, they usually don't even remember the wakes in the morning because they are typically awake for less than 5 minutes. And a human being typically needs to be awake for about 5 minutes or so before they will remember the wake the following morning.

When an insomniac wakes up at one of these perfectly normal middle of the night wakes, the insomniac tends to focus on the fact that they are awake in the middle of the night instead of quickly assessing the situation and deciding there's nothing that needs their attention and then very quickly returning to sleep. And the fact that the insomniac focuses on the fact that they are awake tends to make the wake last longer (so that they're more prone to remember the wake) and the longer the wake, the more disruptive the wake becomes to the overall quality of the sleep. In other words, the problem is not so much the post REM wakes themselves, it's the insomniac's reaction to these wakes and how that reaction makes these wakes last long enough for them to become disruptive to the overall sleep quality.

With the really short kind of wakes that you seem to be experiencing, the best thing to do may literally be don't worry too much about them. In particular if the first things you do when you wake up is look at the clock and/or try to figure out why you woke up, you might want to simply quit looking at the clock and quit trying to figure out why you woke up. Instead, just quickly assess your immediate comfort: Do you need to move around in bed to get more comfortable or tug on the mask to make it more comfortable? Make yourself comfortable and settle back down and don't start thinking about why you are awake yet again.
11-16-2013 10:40 PM
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eviltim Offline

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Post: #8
RE: CPAP and Insomnia
robysue, that is a very interesting point. I will flip my clock over this week and see if it helps (I nearly always look at the clock).
11-16-2013 10:42 PM
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robysue Online
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Post: #9
RE: CPAP and Insomnia
eviltm,

You might find some of the suggestions in Sound Sleep, Sound Mind by Dr. Barry Krakow very useful for helping you to quit focusing so much on looking at the clock when you first wake up and trying to figure out why you woke up when you find yourself awake in the middle of the night.
11-16-2013 10:47 PM
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Tez62 Offline

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Post: #10
RE: CPAP and Insomnia
eviltim, there is a name for looking at the clock at regular intervals it is called 'clock watching' and is one of the things you need to look at for proper sleep hygiene.
We think it is time to get up or close to it and we have to look at the time.
Try and get rid of it all together if you can or at worst cover it and put it somewhere that is not reachable.
11-16-2013 11:05 PM
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