For years, I did not sleep well. I went to bed every night, but I was consciously aware of the passage of time… I had a low-grade awareness of EVERYTHING going on around me all night long, and the slightest noise/movement in the room could get me out of bed. Even if I “slept” all night long, I would feel like absolute dog shit in the morning. Usually, by Friday night, I would be so utterly beat down that I would not get out of bed until noon or so on Saturday. I felt “better”, but still not 100%. I would occasionally use benadryl as a sleep aid, and it sometimes seemed to help, but not always.
Finally, I asked for a sleep study, and turns out I have moderate-to-severe apnea, so I literally was not able to hit full sleep until I was so exhausted that it overrode my brain’s desire for oxygen. I had another sleep study with the CPAP, and while it was uncomfortable at first, the fact that I was able to actually SLEEP, REM-stage and everything, made it worth it.
I feel much better than I have in a long time. I would recommend getting the sleep study done, if possible. The benefits of going from poor sleep to true sleep are huge!
Sleep centers diagnose ALL sleep disorders, not just apnea.
If you truly have insomnia, you would be begging to go.
When I had a sleep study done, I (and every doctor I had seen except for the last one) did not consider sleep apnea to be a possibility. I’m in shape and certainly not overweight.
My chief complaint was exhaustion and I frequently had insomnia. It took me at least 3 hours to fall asleep every night. I got such sage advice as “Don’t work out so much/often”. It turned out that I had obstructive apnea.
Lack of sleep affects your blood pressure and pain levels. You need more meds. The meds help mess up your sleep. You’ll just keep going in a vicious circle if you don’t get this taken care of.
The sleep specialist when I had my study done told me that what they would be monitoring would be capable of diagnosing 65 known sleep disorders, and if I didn’t fit any of them, there were some different studies that could be done to weed out some of the rarer varieties.
So I concur, definitely more than just testing for apnea going on.
First - no,I don’t use any uppers - maybe a glass of Pepsi every 3 months or so.
In college, the quack at the student health center put me on Doriden (a very nasty sleeper, now withdrawn) and Dextroamphetamine for waking up.
I tried that crap about twice.
The more I read about this group, the more it sounds like “CPAP for everyone!” - they claim to have a test for insomnia - but offer no detail. The rest of the tests involve either CPAP or some thing or another being titrated.
Will find out tomorrow night - my appointment is 22:00. Will take 2 sleepers - I have never been able to sleep in a strange bed, let alone clothed and wired.
I would strongly suggest only taking your normal regimen. Do not double up. If the problem isn’t apnea (be it obstructive, central, or mixed), they’ll be able to tell. Taking double the dose of your Temazepam however could, in combination with your pain medication, trigger more apneic events, and while other factors go into a full diagnosis of apnea, the total number of events in a given night weighs heavily in the final diagnosis.
Likewise, doubling up on mirtazapine or diphenhydramine may not have the effects many would like to think, as antihistaminic effects predominate at lower concentrations, at least initially, but other effects, including increased noradrenergic (with mirtazapine) and serotonergic effects (both mirtazapine and diphenhydramine) begin to predominate the higher your doses go, and these effects may start to shift towards being wakefulness promoting, especially once you’ve developed tolerance to the antihistaminic effects (takes about 3 days of regular use at 50mg twice a day to be no better than placebo, with diphenhydramine, according to one small study). Diphenhydramine can also worsen your cognitive function, thanks to anticholinergic effects (which increase with dose), as well as causing/worsening akathisia–a feeling of inner restlessness.
Finally, since morphine’s ultimate excretion relies on renal elimination, increasing the dose would have a good shot at leaving more morphine-3-glucuronide floating around in the systems of those with kidney failure, which has fun side effects associated with it, including worsening of pain (hyperalgesia), muscle twitching, seizures, hallucinations, and agitation. Oh, and chance of slipping into a coma. Can’t forget about that one.
Sorry, I concur with the idea of getting a polysomnogram. Clinicians should have a high index of suspicion for comorbid sleep disordered breathing in patients with chronic, treatment-refractory insomnia. In these patients, the prevalence of sleep apnea may be as high as 90 percent, and screening instruments such as the Berlin questionnaire may lack sensitivity.
I don’t dispute for a moment that there are good sleep doctors, good sleep clinics, and good sleep diagnostic tests that can “be capable of diagnosing 65 known sleep disorders”.
I also don’t doubt for a moment that there are sleep labs that are just in the business of diagnosing apnea (comfortably aware, of course, that they can just give everyone who walks in an instant knee-jerk Dx of Apnea, and be correct 95% of the time). I had a sleep “study” once that I thought was like that.
First, like OP observes, the waiting room if full of information all about – and only about – apnea. Posters on the wall, brochures on the coffee table, ball-point pens on the receptionists desk with advertising for CPAP manufacturers, more posters on the wall behind receptionist. All about apnea.
Then, the exam itself consists of a take-home e-meter and a few minutes of training on how to wire oneself up. You go home, wire up, and try to sleep that way. Bring the unit back next day and they will tell you how bad your apnea is and write up a CPAP Rx.
I got a moderately severe apnea Dx. I don’t mean to dispute that, but I don’t think that can be the whole story. Like the OP, my most noticeable problem (that I am consciously aware of) is that it takes me a loooooong time of tossing and turning before I fall asleep. That doesn’t fit the description of apnea by any brochure or web page I’ve ever read. What happens after I finally fall asleep may be apnoid as hell as well for all I ever knew.
It’s all cheap-ass one-size-fits-all HMO-style medicine. That’s my Dx.
I added the diphen because I was developing sinus blockage and ending up mouth-breathing, and waking with severe dry mouth.
That hasn’t happened since I added the diphen.
I now wake up due to the neighbor’s barking dog or my 15 pound Maine Coon wanting attention.
How does one diagnose insomnia, if not the inability to fall asleep?
I have gone 4 days without noticeable sleep. Then I broke down and took a hypnotic.
I’d think that one experience like that would be sufficient.
My PCP is employed by University of California, but is sending me to a separate group - not the UC Sleep Center.
Call me suspicious.
I’ll find out tomorrow night (this is not a good neighborhood to be at night)
One of the questions is as bizarre as any I’ve seen: "Have you ever experienced a sudden loss of strength in your limbs?"
"Were these events brought on by a frightening event or laughter?"
Anybody care to say what the Hell this is about?
There is one about restless leg and one about sleep paralysis, but this one?
WRT the diphenhydramine, you may want to speak to your regular doctor about their thoughts on the use of a prescription or OTC (but still prescription strength) nasal steroid if your sinus problems persist, which may allow you to reduce the dose of the diphenhydramine or eliminate it altogether. And of course, don’t forget non-pharmacologic ways to reduce exposure if it’s allergy mediated (pillow/mattress covers for dust mites, HEPA filters for your HVAC system, keeping doors and windows shut as much as possible during days of peak allergen levels for things like pollen, etc).
As to diagnosing insomnia, it’s important to understand that insomnia isn’t, strictly speaking, a disease/disorder in and of itself, but rather the symptom of some other disease/disorder/syndrome. Sometimes after all the diagnostics are said and done, an answer can’t be found and you get left with a diagnosis of primary idiopathic insomnia (the patient population in which most of the sleep drugs are tested first or the most). Frequently though, the insomnia (and/or excessive daytime sleepiness) is a symptom of something else, like hypothyroidism, depression, anxiety, acute or chronic pain, circadian rhythm disorders (delayed sleep phase, advanced sleep phase, non-24 hour), GERD triggering middle of the night microarousals to counter an esophageal reflux event, narcolepsy, some seizure disorders, or apnea of obstructive, central, or mixed origin to name a few conditions. The trick is to rule out if those are causing the insomnia or not. As Qadgop has pointed out, frequently, in treatment resistant cases, apnea ends up being a very common diagnosis, which the polysomnographic study should catch. Hypnotics may help in only some of the previously mentioned conditions and may worsen others.
As to the questions, they are attempting to ascertain if you’ve experienced cataplexy, a frequent symptom found in narcoleptic patients. Cataplexy is the sudden loss of muscle strength/tone without loss of consciousness and it can be brought on by intense emotional reactions, be they positive (laughter) or negative (startling/fear response).
Indeed, not only does cataplexy exist, we now have an insomnia drug on the US market which can cause it as a side effect, along with hypnagogic hallucinations (hallucinations as you are falling asleep, often auditory or visual), hypnopompic hallucinations (same as before only while waking up), and sleep paralysis. Narcolepsy in a pill, as I like to call it, though I’m sure the manufacturer would prefer I call it Belsomra (and likely prefer that I didn’t mention any of this or that it on average only gets you to sleep a full 8-10 minutes sooner than placebo and 11-22 minutes more total sleep time per night compared to placebo).
As for dependence on hypnotics, well, that can be conquered, though it is often challenging, I’ll admit. Hopefully, whatever the diagnostic determination, you get a savvy sleep specialist.
My advice: just walk through the hoops, and use the tools they give you. If they do find breathing trouble, it may or may not be your primary problem, but take the effort to use the CPAP. With the amount of meds you are taking I would think they could cause apnea even if you didn’t start out with it.
If the sleep clinic does find the primary cause, you are still in for a wild ride getting off the meds. I strongly recommend requesting a referral to an addiction specialist. You are not at fault, but your body is almost certainly physically dependent at this point, and an addiction specialist can help keep you more comfortable through the process. They can also tell you what to expect, which helps immensely when weird things start happening.
I suffered for almost 20 years with insomnia, and I understand what you are going through. All I can say is walk through the process and be persistent about reporting your symptoms as they change or don’t change.
I just ran into the “new, much better” (isn’t that what they called the “Z drugs”?) Belsomra last night - at $287/30, I’ll just stick with the benzos.
Unless the DEA decides I can’t have any of them, either.
I thought Lunesta would get me off the benzos - just in time for DEA to decide we old farts shouldn’t have it (or Ambien either).
As far as addiction - between cigarettes and alcohol, I know the drill.
And I am getting quite a tour of the benzodiazepines - suppose they’ll give me Ativan for withdrawal from Temazepam?
Got a call from the head office (LA area code) desperate about my insurance.
Nice to know they really care…
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I’m another insomniac cured by CPAP, of course I’m not the one wearing it!
I have had insomnia my whole life and I have dealt well with it. I know my issue is due to me being a natural night owl so I live on night shift as often as possible. Anyway, my fiance has severe obstructive apnea and his issues were causing me to become severely sleep deprived. Now that he has the CPAP we’re both a whole lot happier and healthier. Adding school, clinical, a job, and an internship to that mix means that my insomnia is virtually nonexistent these days despite being forced to survive on day shift!
I developed an interest in disordered sleep many years ago when someone on the SDMB posted that his young coworker had died of sleep apnea related heart issues. My fiance’s own problems solidified my desire to work in sleep medicine. I chose to get my RRT first just for job security but as soon as I graduate in May, I’ll be transferring to a new school to start my PSG training. With any luck, by this time next year, the board will have a Polysomnographer/respiratory therapist in the ranks to help clear up some of the sleep lab myths.
I can leave you with one anecdote though. Last semester we each had to spend two days in the sleep lab for clinical rotation. I saw two patients that day and both had such obvious apnea that even I could recognize it from the waveforms on the monitors (without any training). Some of my classmates had no apnea patients at all. One had severe insomnia. One was a med student who was ordered to the lab by his professor because he kept falling asleep in class. Turns out he had narcolepsy. There were a couple people with no sleep disorders at all.
If you don’t want to walk into a waiting room filled with CPAP equipment and OSA propaganda, ask to be sent to a hospital sleep lab. Not one of the ones I’ve been in was anything like that. They don’t care one wit what equipment you use and they don’t supply it to you. All they care about is a correct diagnosis. The hospital where I did my sleep lab rotation for respiratory school just took the patients right from the entrance to their bedrooms and the only CPAP they saw was the one to be used in their own study, if needed.
I just buzzed by the place so I can find it at night - I am not impressed.
On the plus side, there doesn’t appear to be a bunch of machines on display (they were closed).
There is a sign stating that the “Technician” will arrive 30 mins before an appointment…
This is definitely a on-the-cheap operation - tacky building (and in the rear office even at that) with parking spaces “reserved” for them. I wonder how much a spot leases for.
You touch on my biggest tip-off: the referral - why does this group (got a letter today) use UofC stationary and get referrals from UofC doctors? UofC has a Sleep Disorders lab of its own - on the same campus, I believe…
I’m guessing this is an attempt to screen out obvious cases of apnea.
I noticed several of the complaints against the group centered on billing - which implies there is more than just a test.
On the plus side, I got very little sleep last night, so I probably will be able to sleep while wired.
I do know that it’s normal for the technicians to arrive between 30 minutes and 1 hour before the appointment. There’s no point in them being there any earlier and they generally work 10 to 12 hours shifts as it is.
As far as the referrals coming from the same organization, that’s not any different from me getting a referral from my doctor to see the specialist across the hall. As for them having more than one sleep lab, they may be doing something besides just regular sleep tests at the main campus. There’s a sleep lab near me which is part of a larger lab at the other end of the state. The larger lab does scientific research as well as the basic sleep studies so some of their beds are dedicated to patients in the research groups. The technicians at the smaller lab send their results to the specialist at the big lab for interpretation.
Again, I know nothing about UofC so this may not be the case and this place you’re going could be planning on drugging you and stealing your kidney.
Try to remember that the technicians are trained and certified polysomnograph technicians. They might also be registered respiratory therapists, ECG, or EEG technicians. They enjoy diagnostics and like helping people. They are most definitely not trying to scam you. They don’t care if you end up on a machine, only that they do their jobs correctly so that you get an accurate diagnoses. If someone is trying to scam you, it’s definitely not them.
As far as the skeevy accomodations, for the longest time I wondered why my fiance’s doctor was based out of a crappy little building that needed a remodel and lots of repairs. It turns out that one of the employees had a psycho ex who burned down the normal building and a replacement was being built. So, maybe the building is temporary.
20 wires on me, in a rock-hard bed in a cool room (with, amazingly, a CPAP machine already installed) - it took them all of 2.5 hours to declare I needed a CPAP. At 01:30.
The tech would not tell me what happened, only that I had “tripped their criteria”.
Nonetheless, I did get some sleep - before being awakened at 06:00 “check out time”.
I drove home (luckily, little traffic) and did not bother putting the truck away.
I crawled into bed, and for the first time in memory, fell asleep without a hypnotic. Until 11:00.
As still groggy.
Well, no surprise there. They just pretended to take 2.5 hours to make that Dx. Of course, they already “knew” that before you even walked in.
This may or may not tell you anything at all about what other sleep disorders you may or may not have. That’s the problem with “sleep labs” like that. That’s what I think happened with my take-home DIY “sleep lab”. I think they just go for the easiest, most likely Dx and, finding that, don’t bother looking any further.
So be sure you ask them what else they found, and when they say “nothing” or “nothing much”, be sure to ask them what else they looked for.
They might be legit. At least there was that big questionnaire you mentioned, with all the weird questions. My “sleep lab” didn’t even have that.
Just thought I’d add that I’ve been using a CPAP machine for fifteen years. Back then I had a lot of trouble getting insurance approval etc. because it wasn’t as well known. I also had to be very persistent about getting a mask that fit properly. It also took something like two weeks to become acclimated to breathing against the pressure of the CPAP. Once I got everything sorted out and acclimated to the machine, mentally it felt like I had stepped out of a dense fog. Before this I knew something wasn’t quite right but didn’t realize how bad until afterwards.
Please give the CPAP a chance. It will probably change your life (for the good).
