ah ha! since you snore....have you had a sleep study? perhaps you need CPAP?? is there anyway you can get the head of your bed elevated a couple of inches? NOT pillows....the whole bed at a slight tilt..

get a sleep study ASAP. there is a direct link between P/N and sleep disorder.
Sedatives only make it much worse by collapsing the muscles in the throat. elevating the bed will do little if anything if you in fact have moderate apnea, only a cpap machine will help, I know Im on cpap 5 years and thought it was hell.
UNTILL I got P/N

There's a possible clue. Do you ever wake up gasping for breath, or from dreams of drowning/suffocating? If so, then I'd speak to a doc about getting a sleep study. My wife snores - I have apnea. Now our cpap machines keep each other awake all night....

Doc

yep doc , and to add sweating around the neck, very vivid dreams, waking with a headache, feeling like death. heck just google it ..10mill in usa have it or something like that. You have to wonder how many symptoms P/N masks.
It so easy to blame it on meds when there can be a lot of underlying issues,
my mum had P/N but died of cancer because she was maxed out on everything. she thought it was creeping P/N. on a brighter note she was pain free for 2 months in palliative care and the happiest I saw her in 10 years

Interesting that in all my looking into causes of PN, I never saw that one once, yet when you know to search for them together, up it pops...

I'm thinking I may have to rule it out (though someone's going to get an inquiry). While my apnea is considered moderate, I only had it for a couple years prior to it being discovered, and the PN did not begin to manifest until a couple of years after I started using the cpap.

Doc

I think the primary mechanism is low oxygen saturation in the blood during sleep apnea attacks. Low oxygen impacts the whole body, and would decrease circulation and hence oxygen to the periphery.

It seems more likely that sleep apnea may cause or worsen PN...
But I'd like to see more information that the reverse is the reason.

Thank you all for your input. I did have a sleep study a couple of years ago. Was told that symptoms were minor and did not require any treatment and a suggestion to try to sleep on my side.

Since have been able to sleep on my side and stay off my back, my snoring is very much improved and sometimes I don't even snore.

I cannot elevate the front of my mattress. What I do use is that large triangular hard foam "pillow". I have forgotton what it is called because I always refer to it as my "wedge of cheese". It is usually used to elevate the legs. I also use a cervical pillow on top of my "cheese". I have used this since I started on higher doses of fentanyl to avoid breathing problems.

I have never woken up gasping for air or had any disturbing dreams of dying.

Ok, admitting I'm pretty stumped here, let's try this from a different angle. Is your gut (brain? body?) telling you anything about the reason for insomnia? (Not very scientific, but sometimes enlightening.) I guess I'd start looking into the condition itself for clues about a specific cause, because you know yourself, symptoms, and history best. I often use WIKI as a starting point (not necessarily a legit erudite source) and go from there to Google and/or the references cited at the bottom of the WIKI article....

http://en.wikipedia.org/wiki/Insomnia

FWIW, I sleep on a wedge too (but mine's made of foam instead of cheese ) since my head started congesting whenever I lay flat.

Doc

IMO the scariest part of P/N and p/n meds apart from p/n itself is its ability to mask underlying disease. How do I know if Im fatigued due to the P/N or could it be one of 100 much more serious conditions.

Eg not sleeping. Is it meds, stress, pain? or Apnea. I have moderate apnea yet never once woke up choking. headache and fatigue were the only symptoms.

I have fatigue now and the drugs would probably mask the headache , Im also having trouble sleeping since starting elavil since Im permanently dopey I cant tell what tired enough to sleep is. So if I developed apnea I wouldn't know it now.

I can relate. I sleep very little. I can go a couple nights without a minute. I am also on meds and enough for a horse my doctor says. Even in the hospital they could not believe. This was a pattern for me pre pain and now with it a disaster. I will say I have a lot of anxiety at night that for some reason meds don't seem to work with. Some other things I have tried. Listening to relaxation tapes,music,tv on tv off,not going into the bed till bedtime,deep breathing,diet changes,no caffeine. I was also suggest a sleep test but since I don't fall asleep even at times I don't think it would help.
Some meds for a time worked were trazadone and remeron. Now I am starting ativan which we will see. My friend is on serequel which I am on and does nothing but for her puts her out like a light.