Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Julie · Post by **Julie** » Thu May 23, 2019 4:25 am

Have you tried e.g. a mask liner from Padacheek.com to help control minor (but possibly multiple) mask leaks?

Chris8243 · Post by **Chris8243** » Thu May 23, 2019 8:18 am

remstarcpap wrote: ↑
Sat Mar 16, 2019 1:25 pm
Hi there,

I actually wonder if your problem is more with sleep hygiene than with CPAP although I agree with the others about changing your therapy in order to improve your AHI. You have a lot of event flags, but these may represent wakefulness as well as CPAP issues.

You say that you sleep from anywhere from 8 to 14 hours and that your bedtime is all over the place. This is a classic marker of bad sleep hygiene. The goal in good sleep is to have high efficiency, which means that most of the time you are in bed you are actually asleep. Good efficiency numbers are 85% or higher. People with sleep problems can train themselves to be worse sleepers by doing what you are doing.

I'd recommend you consider consulting with a professional who offers CBT-I. This is cognitive behavioral therapy for insomnia. General rules of thumb include:

-Try to go to bed and wake up at the same time each day including weekends
-limit time spent in bed to roughly 8 hours regardless of sleep
-if you wake up in the middle of the night and can't get back to sleep in 20 minutes or so, get up, leave the bedroom, and do something uninteresting until you are sleepy again and then go back to sleep.

Also, consider trying sleep restriction therapy.
https://stanfordhealthcare.org/medical- ... ction.html

This is where you only spend the time in bed that is roughly about how much sleep you're actually really getting. This trains you to be a more efficient sleeper.

Good luck and I hope your sleep improves. Nightmares are no fun. Is there something going on in your life that's particularly stressful, other than sleep issues?

I agree with all of the above. The two Sleepyhead reports you posted indicate 13 hours in bed. Regular bedtime & regular wake up time regardless of how you feel are important. I wonder if too much time in bed, laying there frustrated, is contributing to the nightmares?

Dan_McD · Post by **Dan_McD** » Thu May 23, 2019 10:30 am

How long has it been since you have had a 'full-on' in lab sleep study? I'm wondering about such things as erratic pulse rate, O2 blood saturation, cardiac problems, and or pulmonary problems? If you have been on PAP for 10 years and do not sleep well, where is your determination to look at other possibilities? Also, just asking..... you joined in 2017, where have you been with letting this slide until now? Really, I'm not trying to be snarky, but I would have been asking these questions here 2 years ago.

vintshave · Post by **vintshave** » Thu May 23, 2019 11:18 pm

Dan_McD wrote: ↑
Thu May 23, 2019 10:30 am
How long has it been since you have had a 'full-on' in lab sleep study? I'm wondering about such things as erratic pulse rate, O2 blood saturation, cardiac problems, and or pulmonary problems? If you have been on PAP for 10 years and do not sleep well, where is your determination to look at other possibilities? Also, just asking..... you joined in 2017, where have you been with letting this slide until now? Really, I'm not trying to be snarky, but I would have been asking these questions here 2 years ago.

Good questions. I'm currently on Medicaid so finding a place that will take my insurance is very difficult. My former sleep specialist is not on this plan. Not too long ago I had a full cardiac workup and chest x ray and CAT scan. No abnormalities. It's not a sleep study, but it gives a good snapshot of my general cardiac and pulmonary health. These problems have been going on for several months, not the entire time I've been on PAP. I used a full face mask with a humidifier but switched to nasal pillows because I was waking up frequently using the full face mask with bone dry mouth. The nasal pillows with a chin strap fixed that. Sometimes I get slightly better sleep switching from one mask type to another. I can't explain this, but I've noticed that it happens.

Hope this data is helpful. Thanks for caring.

Cpapian · Post by **Cpapian** » Fri May 24, 2019 1:25 am

I am wondering about what drugs and/or supplements you take, if any. Many have side effects that could disrupt your sleep with nasty dreams.

E.g. Melatonin with vitamin b can cause weird dreams. Heart medicine can disrupt sleep. When i take magnesium citrate before bed, I sleep heavily. A glass of warm milk at night can help sleep.

Since this is a recent occurrence, knowing and following sleep hygiene could help you get over this rough spot.

Is there a recent event in your life that could have contributed to this sleep problem?

vintshave · Post by **vintshave** » Wed May 29, 2019 9:02 pm

Cpapian wrote: ↑
Fri May 24, 2019 1:25 am
I am wondering about what drugs and/or supplements you take, if any. Many have side effects that could disrupt your sleep with nasty dreams.

E.g. Melatonin with vitamin b can cause weird dreams. Heart medicine can disrupt sleep. When i take magnesium citrate before bed, I sleep heavily. A glass of warm milk at night can help sleep.

Since this is a recent occurrence, knowing and following sleep hygiene could help you get over this rough spot.

Is there a recent event in your life that could have contributed to this sleep problem?

Drugs have been stable for many years, with the exception of the clonozepam, which I have been reducing by .25mg every 2 weeks (I was on 3mg originally). I do take magnesium before sleep. I gave up melatonin because it wasn't helping. I take an B vitamins in the morning.

emcee13 · Post by **emcee13** » Thu May 30, 2019 8:41 am

vintshave wrote: ↑
Wed May 29, 2019 9:02 pm

Cpapian wrote: ↑
Fri May 24, 2019 1:25 am
I am wondering about what drugs and/or supplements you take, if any. Many have side effects that could disrupt your sleep with nasty dreams.

E.g. Melatonin with vitamin b can cause weird dreams. Heart medicine can disrupt sleep. When i take magnesium citrate before bed, I sleep heavily. A glass of warm milk at night can help sleep.

Since this is a recent occurrence, knowing and following sleep hygiene could help you get over this rough spot.

Is there a recent event in your life that could have contributed to this sleep problem?
Drugs have been stable for many years, with the exception of the clonozepam, which I have been reducing by .25mg every 2 weeks (I was on 3mg originally). I do take magnesium before sleep. I gave up melatonin because it wasn't helping. I take an B vitamins in the morning.

Klonopin taper sticks out to me for sure! I’ve successfully completed 2 benzodiazepine tapers. But they weren’t without their hiccups and issues.

A taper should take 9-12 months. A .25mg reduction every 2 weeks could be too much too fast. A 5-10% reduction every 1-2 weeks is standard, in divided doses, reducing the amount you are currently taking, not the original dose. See the Ashton Manual for more info. I can help you draw up a taper schedule if you need it. Just PM me.

You might “hold” your current dose, and not cut again until your symptoms have calmed down. Nightmares and sleep issues are a hallmark of withdrawal. You might need to slow your taper way down. I hope this helps you some. Nightmares and restless sleep are truly the worst and I can completely empathize with you!

Also I will agree with the others who have mentioned sleep hygiene. Limit to 8 hours in bed, no matter how much sleep, bedtime/wake time the same every day. Also try “blue blocker” glasses ($6-8 on Amazon) about an hour before bed. They are great!

Good luck to you!!!

Sluggish · Post by **Sluggish** » Thu May 30, 2019 10:37 am

I know you listed your meds but if you forgot to mention any anti-depressants I would look at those for the cause of the nightmares.

vintshave · Post by **vintshave** » Fri May 31, 2019 8:23 pm

Sluggish wrote: ↑
Thu May 30, 2019 10:37 am
I know you listed your meds but if you forgot to mention any anti-depressants I would look at those for the cause of the nightmares.

Effexor. Unlikely since I've been taking it for over 20 years

Pugsy · Post by **Pugsy** » Fri May 31, 2019 8:34 pm

Just because you have been on Effexor for years without obvious problems doesn't mean it can't be a factor now.

Your might want to google SNRIs and sleep....they are well known to cause pretty much every symptoms you are complaining about.
https://www.livestrong.com/article/8898 ... s-effexor/

Sleeping Difficulties

Treatment with Effexor can cause sleeping difficulties. During treatment, some patients can become abnormally fatigued or tired and can begin to yawn frequently. Other patients may have difficulty falling asleep or staying asleep through the night (insomnia), which can contribute to additional side effects of daytime sleepiness, fatigue, headache or weakness. Abnormal dreams or vivid nightmares can also occur due to Effexor, which may cause you to wake up frequently throughout the night. Such side effects can further contribute to side effects of tiredness and fatigue.

https://www.rxlist.com/effexor-drug.htm

Diotima · Post by **Diotima** » Fri May 31, 2019 9:10 pm

Just curious what type of mask are you using? The nightmares don't sound like the symptom of sleep apnea but rather something psychological. Anyways the reason I ask what type of mask you're using is that I get nightmares when I am using a mask that I'm "working against" as in I was u sing a N20 Nasal Mask and at some point in the night my nostrils were closed up and I couldn't breath (I've since gone back to nasal pillows full time)... I remember having a nightmare up to the point where I woke up my heart racing, couldn't breathe, threw off the mask and immediately went back to the P10.

Sluggish · Post by **Sluggish** » Sun Jun 02, 2019 9:47 am

vintshave wrote: ↑
Fri May 31, 2019 8:23 pm

Sluggish wrote: ↑
Thu May 30, 2019 10:37 am
I know you listed your meds but if you forgot to mention any anti-depressants I would look at those for the cause of the nightmares.
Effexor. Unlikely since I've been taking it for over 20 years

My doctor once asked my about 20 questions from his computer screen and determined that I was depressed.
He prescribed Prozac.
As with many meds, I did lots of research before NOT taking it. One of the main things people report is horrific vivid nightmares. Some say they these nightmares involved bloody murder and were so realistic that they woke up thinking it really happened for days on end. I have not researched Effexor. I have no idea if it has any similarities to Prozak or would cause nightmares. Just throwing it out there.

Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog