[bcwalter]

Hello!

I am a 28 yr old male, who is 6' tall and 235 lbs.

I have been diagnosed with moderate sleep apnea, sever in REM (40 times per hour in REM)

I have been struggling with CPAP for 3 months with little success.

I have no problem falling asleep with the mask (full face or nasal) although I wake up every night between 1 am and 3 am.

I have recently been prescribed, by the same Dr., 25mg of Amitriptyline. I have not filled the prescription yet as I read very mixed reviews.

Please reply with your knowledge and thoughts, epecially if you have had something similiar!

[bcwalter]

Oh yes, my Dr's idea is that I can take Amitryptaline in order to get my body/brain used to sleeping through the night with CPAP, then just to stop taking the drug.

I am not educated, but this sounds like BS to me.

[Dr. Smith]

It's not BS. That's a very low dose for amitriptyline compared with what's prescribed for depression. It's helped both my wife & I acclimate to our cpaps, and neither of us need/take it anymore. There are a LOT of people with peripheral neuropathy or other types of chronic pain for whom it helps get a good continuous night's sleep (not that it works for everybody - nothing does).

If it really freaks you out, call your doctor and discuss it with him, and if his answers don't satisfy you, ask him for something else instead, but all medications have side effects and bad reviews.

Is it possible you need to adjust your mask? We know that if ours are too tight (which you don't always notice at first) they can wake us up later on, but that usually involves a sore nose, etc.

Or is there something else (event) that's waking you up? Figuring out the reason for waking may lead to a better solution.

Doc

[bcwalter]

Originally Posted by Dr. Smith

It's not BS. That's a very low dose for amitriptyline compared with what's prescribed for depression. It's helped both my wife & I acclimate to our cpaps, and neither of us need/take it anymore. There are a LOT of people with peripheral neuropathy or other types of chronic pain for whom it helps get a good continuous night's sleep (not that it works for everybody - nothing does).

If it really freaks you out, call your doctor and discuss it with him, and if his answers don't satisfy you, ask him for something else instead, but all medications have side effects and bad reviews.

Is it possible you need to adjust your mask? We know that if ours are too tight (which you don't always notice at first) they can wake us up later on, but that usually involves a sore nose, etc.

Or is there something else (event) that's waking you up? Figuring out the reason for waking may lead to a better solution.

Doc

Thanks for the reply! I am just worried that I will not be able to sleep without the drug. I have first tried a nasal only mask and now have a nose/mouth (full face) The mask fits fine laying on my back. I usually fall asleep on my right side, and it takes a bit of pillow adjustment to get the mask to fit ok.

With either mask, or no mask, I continue to wake up between 1am - 3am.

When I wake up at this hour, I feel like the mask is restrictive/congesting.

I am not sure what is waking me up. I asked for another sleep study, but I was told that it wouldn't help. They would just watch me wake up and it would be pointless.

[Dr. Smith]

Originally Posted by bcwalter

With either mask, or no mask, I continue to wake up between 1am - 3am.

When I wake up at this hour, I feel like the mask is restrictive/congesting.

I am not sure what is waking me up. I asked for another sleep study, but I was told that it wouldn't help. They would just watch me wake up and it would be pointless.

They're probably right about that, and those studies aren't cheap.

Just parenthetically, the mask feeling restrictive/congesting could be psychological (are you claustrophobic?) or it could be, as I mentioned, they're not adusted right. It took us quite a few tries/long time to find the right adjustments for each of us, and we have to recalibrate that every time we get new headgear (but now that we know how it needs to "feel", it's a snap.) Is your machine one of those with a constant pressure setting (that needs to be adjusted manually by a technician) or one of the newer ones that adjust pressure automatically while you're asleep?

However, if you're waking up even without the mask, I'm inclined to think that you can eliminate the mask/cpap as the cause. So what's left? Mattress? Pillow? Apnea (not addressed by cpap)? Psychological (anxiety)?External stimuli (noise, amorous cats with Elvis Presley complex, wife/S.O. kicking you )? Dreams? (is this constant, guaranteed every night or intermittent?)

I'm sure I haven't thought of all the possibilities, but one other is brain chemistry, which may require some temporary chemical help (or habit change) until the pattern can be broken.

Ringing any bells yet?

Doc

[Dr. Smith]

Originally Posted by bcwalter

I am just worried that I will not be able to sleep without the drug.
....
The mask fits fine laying on my back. I usually fall asleep on my right side, and it takes a bit of pillow adjustment to get the mask to fit ok.

The drug isn't intended to be indefinite, and the doc, having to sign refills, should be monitoring that (and you should still be on top of it to "remind" him anytime you're concerned). Docs often don't change anything unless/until a patient says something (complains); they just assume everything is fine (If it ain't broke...) so speak up and communicate.

I used to be a stomach sleeper - sometimes side - but never on my back; I would snore like a bandsaw and the apnea would have me waking up gasping and choking on my own tongue. With the machine, I had to relearn how to sleep (on my back, which I of course, HATED ). But I gotta tell you, once I did acclimate to it (I sleep on a 12" high wedge now) I sleep better now than before. We're all resistant to changes in habits and lifestyles - that's only normal/human - we're creatures of comfort, and we want what we want, the way we want it - freedom of choice, control... all that. Having suffered years of sleep deprivation (and my own stubbornness) I urge you to stick with this, find a way to overcome it, meet/beat the challenge. It's worth it!

Doc

[bcwalter]

Originally Posted by Dr. Smith

They're probably right about that, and those studies aren't cheap.

Just parenthetically, the mask feeling restrictive/congesting could be psychological (are you claustrophobic?) or it could be, as I mentioned, they're not adusted right. It took us quite a few tries/long time to find the right adjustments for each of us, and we have to recalibrate that every time we get new headgear (but now that we know how it needs to "feel", it's a snap.) Is your machine one of those with a constant pressure setting (that needs to be adjusted manually by a technician) or one of the newer ones that adjust pressure automatically while you're asleep?

However, if you're waking up even without the mask, I'm inclined to think that you can eliminate the mask/cpap as the cause. So what's left? Mattress? Pillow? Apnea (not addressed by cpap)? Psychological (anxiety)?External stimuli (noise, amorous cats with Elvis Presley complex, wife/S.O. kicking you )? Dreams? (is this constant, guaranteed every night or intermittent?)

I'm sure I haven't thought of all the possibilities, but one other is brain chemistry, which may require some temporary chemical help (or habit change) until the pattern can be broken.

Ringing any bells yet?

Doc

Hi. I am not claustrophobic that I know of. The machine is a Fischer Paykel ICON model Novo (I think it is Novo). It set to a static pressure of 5.

I didn't like the humidity turned on, so I turned it to very low. I don't have an issue with a dry mouth or nose in the mornings.

Have 1 dog and 2 cats, but they are not allowed in the bedrooms.

Yes, I believe I have two separate issues, sleep apnea and something waking me up.

The mattress is 3 yrs old, and I fall asleep so quickly in bed. Pillows, I have a variety. I am settled in on one as it is the one I usually fall asleep on.

One thing that the sleep study showed is that I wake up when I am in REM sleep only. So when I am dreaming most likely.

Noise, the odd cat scramble in the house somewhere.. not regularly. Dog is quiet @ night.

The girlfriend and I just broke up and she is moving out, so that doesn't help. It is not the cause of the waking up though. I do it with or withour her.

Thanks for the assistance !

Originally Posted by Dr. Smith

The drug isn't intended to be indefinite, and the doc, having to sign refills, should be monitoring that (and you should still be on top of it to "remind" him anytime you're concerned). Docs often don't change anything unless/until a patient says something (complains); they just assume everything is fine (If it ain't broke...) so speak up and communicate.

I used to be a stomach sleeper - sometimes side - but never on my back; I would snore like a bandsaw and the apnea would have me waking up gasping and choking on my own tongue. With the machine, I had to relearn how to sleep (on my back, which I of course, HATED ). But I gotta tell you, once I did acclimate to it (I sleep on a 12" high wedge now) I sleep better now than before. We're all resistant to changes in habits and lifestyles - that's only normal/human - we're creatures of comfort, and we want what we want, the way we want it - freedom of choice, control... all that. Having suffered years of sleep deprivation (and my own stubbornness) I urge you to stick with this, find a way to overcome it, meet/beat the challenge. It's worth it!

Doc

I have read some horror stories about people taking this drug and never being able to sleep again without it! That's what has made me fear it. (if fear is the right word) I will try and train myself to sleep on my back more so.. I almost always fall asleep on my right side.
Thanks for your help. I really want to be able to sleep well throughout the night and have energy throughout the day!

[Dr. Smith]

Originally Posted by bcwalter

I have read some horror stories about people taking this drug and never being able to sleep again without it! That's what has made me fear it.

I can feel your doctor cringing from here.

Ok, let's forget about all that for a sec and come at it from a different angle.

One thing that the sleep study showed is that I wake up when I am in REM sleep only. So when I am dreaming most likely.

This may be a pretty good clue. When that happens to me it's usually a bad dream of some kind (or when I die in a dream). Sometimes I wake out of a good dream, and that can really [euphemism for create negative pressure], cuz I can't get the dream back! I hate when that happens...

Google: Middle-of-the-night insomnia

If, after reading a few articles, that sounds like what you're experiencing, add amitriptyline to the search criteria and read a few more, and you'll see why your doctor prescribed it. Some of the medications mentioned for this (or any) type of insomnia are even scarier than amitriptyline.

All medications have side effects of some kind, and I don't know of any medications prescribed for sleep/insomnia that don't have some potential for dependence. But at least now you can bone up on the subject and some alternative meds (and other treatments) for consideration and to discuss with your doc.

Doc

[mrsD]

Sometimes waking in the night can be due to low blood sugar.

Try and have a balanced snack before bedtime, and see if that helps. A clue might be dream content, or rapid heart rate also with the waking. Low blood sugars are common during the night and indicate insulin resistance. Disturbing dreams or frank nightmares may occur with impaired glucose metabolism.

Have you had your glucose checked...fasting? Was it really low?
or was it borderline high? People on the way to type II diabetes may have YEARS of impaired glucose handling.

A snack with some protein, and moderate carbs may help if this is your problem.

Amitriptyline is not a thing to be fearful of. In low doses, it is used by millions of people daily, for management of chronic pain and neuropathies. It has been recently shown to stimulate nerve growth factors in helping the nervous system repair itself.

[bcwalter]

Thanks for the replies and assistance.

I have filled the prescription for Amitrip. yesterday. I have yet to take one yet, although I think I will do so tonight.

The breakup has been harder than I thought it ever would be. I totally want her back (she left). I am a bit scared to take this drug when in this state of mind.

I had an anxiety attack yesterday while driving and had to pull over.