Intermittent anxiety - Not sleeping through the night

by Meredith
(New Mexico)

For a long time I refused to believe I even needed a sleep study, that is how freaked out I was about the idea of using a cpap machine to breath at night.

Of course, now I understand that this was because I was having more than 36 episodes of not breathing every hour;

I developed such an acute disorder surrounding sleep that I needed Temazopam just to sleep without a machine.

To make a long story short, I got my machine at the end of October 2010.

It took me two months to even begin to try to acclimate to it.

I used all of the suggestions of slowly introducing myself to the machine while distracting myself etc. and it really seemed to work.

To back up for just a minute, this has been going on over the course of the last 5 years. In order not to disturb my husband (who has to get up every am @4:50 and leaves for work at 5:45am) I started sleeping on the couch.

My goal was to get on the cpap and get back to sleeping in our bed. Apparently my anxiety is two-fold: I am still on the Temazopam (but I pull the capsule apart and only take half every night), I wake up every night, sometimes after 2 or 3 hrs. with the machine and feel "panicky" that I will disturb him and ruin his sleep so I take the mask off and go back to the couch.

Sometimes I take the machine with me, sometimes I can't be bothered.

I am amazed by how great I can feel only having had 2 - 3 hrs. of therapy, but I know I need more hours of therapy, as evidenced by my high blood pressure, and more consistency.

I guess my question is Why am I waking up every night? Is it the Temazopam? Does anyone sleep through the night?

Thanks in advance for even tackling this series of seemingly disjointed questions.


Anxiety is starting to be a more common problem in people with sleep apnea. And I personally understand them, because now you learn more about sleep apnea syndrome than even before.

And what do you learn? That having an untreated sleep disorder can damage your heart, brain and even your life. But for me is much more intimidating just to discover that I stop breathing in sleep for more than 30 seconds!

If I'm trying to hold my breath for 30 sec when I'm awake, it will be really difficult. But it my sleep...and for so many times in one night...

No wonder many people with sleep apnea don't want to go to sleep anymore.

Temazepam (Restoril) can be a good short-term solution to treat insomnia, and is prescribed especially for people who have nightly you.

There are also CPAP users who benefit from this medicine, because it helps them to keep the CPAP mask on all night.

I don't think the Temazepam is the cause for waking up after two or three hours of sleep. It should be something else, and I'll explain this in just a second.

What I want to emphasize is that temazepam is a hypnotic agent which can distort the normal sleep patern, and can depress the central nervous system.

That's why this medication is prescribed ony for short-term use, to treat insomnia. It is usually given 30 minutes before bedtime, and is prescribed for 30 days or less. If you're taking sleep medication every night for any length of time, then there's always a risk of rebound insomnia when you quit taking one.

It's very good that you take a smaller dose, because it shows that you know how dangerous a sleep medication can be.

Other tip will be to only take it 2 or 3 nights a week, and it should give you all the rest and sleep you need.

Reasons of waking up from sleep:

Now, in my opinion, there are 4 main causes who can affect your sleep:

  1. your CPAP machine has a mechanical problem and it should be checked - but I doubt it, because your CPAP machine is new, right?

  2. sensory problem - it means anxiety or panic about sleeping with a mask on the face. Having something against the face that stimulates you enough to keep you awake.

  3. However, this is a problem that you are aware of, and you are working on it, right?

  4. the CPAP therapy is not effective - I would take a look at the leak graphs to see if there's some leaking going on.

  5. Having mask leaks can affect negatively the effectiveness of your sleep apnea treatment. If your CPAP machine has data capability, then it should be easy for your doctor to check what happens during sleep.

    Does your machine record full efficacy data? If so, can you get at it?

  6. the forth reason... Menopause starts the awareness for a a lot of things. But this is a hormonal issue which should be discussed with your doctor.

If you don't have mask leaks, your CPAP machine is OK, and no hormonal problems, then it's time to start addressing the many other obvious insomnia triggers.

And if the insomnia persists (the waking up episodes) after all those other things are more or less dealt with, then we are at the big question: has the sleep apnea gotten worse and is it causing or contributing to insomnia?

Cognitive Behavior Therapy for Insomnia

These are important non-medication recommendation for the management of insomnia:

  • keeping track of your sleep history - Keep a sleep journal for at least the next two or three weeks in addition to everything else you're currently doing for the insomnia. Each morning after you get out of bed, write the following things in the journal:

    • time you went to bed and what medicines you took at bedtime, both sleep aids and other meds,

    • estimated time it took you to get to sleep

    • estimated number of times during the night you woke up. The time of each wake up is NOT that important,

    • time you got up for the day,

    • estimated total time you actually slept during the night,

    • notes on how you feel physically and mentally in the morning.

    The time estimates are just that: Mental estimates based on how long you THOUGHT it took you to get to sleep and how long you THOUGHT you actually slept. It's a really bad idea to look at the clock every time you wake up and use the clock to somehow determine how little (or how much) sleep you've actually gotten.

    If you want to also add written notes about what woke you up at the wakes you remember, that can help tease apart what's feeding the insomnia. And roughly how long you think it took you to get back to sleep.

    Likewise, if you want to add a few written notes about how you felt throughout the day before (exhausted at suppertime; couldn't focus after lunch; etc.) that might also be useful data.

  • Spend 2 hours before going to bed to relax. This means no eating, no exercise, no computer time, no 10-o'clock news, nothing to keep you wound up.

  • Plan to spend no more than 8 hours in bed. If you go to bed at 11PM arise at 7AM. Use an alarm clock if you have to. Get up even if tired. The idea is to consolidate your sleep.

  • No napping during the day, use the bedroom for sleeping, no watching TV or reading in bed.

  • Sleep in a dark, quiet cool room. Turn off the grandfather clock if need be.

  • No pets in bed with you

  • MOST importantly... remove the clock from your bedroom. It causes anxiety when you wake in the middle of the night making your insomnia worse.

Well, Meredith... I hope I covered some aspects that can help you with your nightly awakenings. The cognitive behavior therapy should help you a lot. Better the natural way...

I hope it helps. Don't be afraid to comment back.

Remy Thierry
Founder of Sleep Apnea Guide

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