[Warrior]

Hi,

I’ve had periods of anxiety disorder) several times over the last 18 years. They tend to last for several months or more then everything is back to normal with no anxiety disorder. The primary anxiety has always centered around sleep issues (arousals, panic) and turns into a fear of going to sleep.

To cut to the chase, I think this stemmed from having undiagnosed Obstructive Sleep Apnea. Once diagnosed in 2014 and starting CPAP, I have been 100% compliant and have had excellent sleep.

In October 2018, out of the blue, the arousals during sleep initiation began again. This concerned me but didn’t create the anxiety loop of previous years – well, a little but not so bad right away.

I immediately took steps to get this under control so it didn’t progress. I got on the wait list for a local CBT-I program (and a general CBT program for anxiety) and was told it would be a 3 month wait. As I continued to try to work on sleep hygiene and get the issue under control, my anxiety level did increase.

I fond an online CBT-I course from the Cleveland Clinic and began the program. I was actually seeing results, and getting good nights sleep until I started the sleep restriction. Once I started restricting sleep, my anxiety level really increased.

Being concerned that I was doing something I shouldn’t, I reached out to the Clevelend Clinic for answers and was contacted by the Dr. who created the program.

I explained my situation and she told me to stop the sleep restriction. (I later learned, some CBT-I programs treat people suffering from insomnia due to anxiety a little different – i.e. no sleep restriction).

The doctor actually called the director of the program I was on the waiting list for and I received a call the next day from the CBT clinic. I began consultation to treat my anxiety.

The night before I received the call from the doctor, I slipped on ice and broke my ankle. No surgery but had to wear a walking boot 24/7.

Sleep was going to be even more difficult now.

As I waited to begin CBT after my consultation, sleep became extremely difficult with both the anxiety and trying to get comfortable with a broken bone and a walking boot. I’m not comfortable sleeping on my back (mentally) so it was extremely challenging. Usually, I would wake up every 2 hours. A couple of rare nights gave me almost a full nights sleep.

My left hip (the side I typically sleep on the most) was starting to hurt a lot at night and this made matters worse.

During this time, I was using a very low dose of Klonopin for the anxiety – just at bedtime and only a couple of times per week. Knowing this can be habit forming, I consulted with my sleep apnea doctor and he prescribed Trazodone. I began taking this at a very low dose. I did see improvements but I started experiencing side effects from the meds that were not acceptable.

After consulting with my sleep doctor and PCP, I stop taking the meds.This was 9 days ago. Since then I’ve had some very rough nights.

I experience “Central Arousals” which are periods of not breathing during sleep initiation. These last from 10-70 seconds. It’s my body telling my brain I’ve got enough O2 and don’t need to take a breath. This caused many, many arousals as I was dozing off and therefore increased the anxiety.

Normally, I experience “0” of these. It is most likely due to the anxiety causing me to somewhat hyperventilate which gives our body’s sensor a false reading during sleep initiation. Actually quite common but not these extremes.

14 days ago, the walking boot was removed. Much more comfortable for the ankle but the hip pain still existed. In fact, it became worse and the other side began hurting as well.

So now I am waking up every 1-2 hours with hip pain. No pillow configuration of position change helps it – except sleeping on my back. Normally, I will start sleeping on my left side and end up in all different positions through the night – even my back – with no issues.

I’m extremely uncomfortable, mentally, trying to fall asleep on my back. Probably the undiagnosed sleep apnea thing.

Jump ahead a bit – I’ve started CBT and am seeing progress. The CA’s are much less and getting to sleep is not an issue – although not back to normal. I fall asleep usually within the 10 minutes or less unless I’m having a very anxious night.

The hip pain (from physical therapy) is getting better. However, I am still waking up every 1-2 hours and not from hip pain.

It’s like I’ve conditioned my brain/body to wake up (from hip/ankle pain) so now it jolts me awake – sometimes abruptly. Usually, it’s so mentally stimulating, there’s no just laying there. There is a strong urge to get up. So I usually get up, use the bathroom, get a drink of water and go back to bed. The cycle repeats throughout the night. After about 5  hours the hip pain becomes a factor.

I assume this is just going to take time but it is so torturous. I’m not sure if there’s anything I can do to help my mind get out of this waking cycle.

I follow good sleep hygiene (as learned in the online CBT-I  program). I have been allowing myself to read a little in bed and even watch a little TV some nights with my wife (like my wife and I always did before) from the advice of my CBT counselor. This is to help gain some normalcy back in my life and not let the anxiety be the driver.

Keep in mind – if I’m reading, I start nodding off within 5 minutes. Watching TV – many times within 10-15 minutes.

I shut off the lights and (aside from the anxiety symptoms – sweating, etc) I usually am drifting off within minutes. I experience a few arousals (CA’s) and then eventually am asleep. Sometimes I get that feeling off falling off into sleep and it awakens me. I know it’s just the anxiety, heightened awareness, etc and will improve as my anxiety improves.

Any thoughts or suggestions is greatly appreciated.

 

P.S. Tried melatonin – don’t like it and don’t really need it to get to sleep.

 

 

[Martin Reed]

Hello warrior (what an apt choice of username!) and welcome to the forum. Thank you for sharing your story and I am sorry to hear about your struggles with sleep.

I see a lot in your post that is quite positive and this makes me feel confident that you will get your sleep back on track. It definitely seems to me as though you are making progress.

You have noticed that CBT is helping but you mentioned that sleep restriction wasn’t helpful — what kind of sleep window were you following when you experienced difficulty implementing that technique? Are you following any kind of sleep window now?

A broken ankle and the discomfort and the trauma associated with this is always going to disrupt sleep, regardless of your sleep history. So, it’s important to recognize sleep disruption that stemmed from this injury as being nothing out-of-the-ordinary.

You also mentioned that, even with the associated pain, you noticed a couple of nights where you got almost a full night of sleep. This is great news because it shows that you are still capable of getting that full night of sleep, it’s just a matter of making those full nights of sleep more common.

Are you currently using a CPAP machine for your sleep apnea?

It really sounds as though you are on the right track and that your sleep is going to improve as you continue implementing the CBT-I techniques you are learning.

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[Warrior]

Martin,

Sorry for the delayed response.

If I recall correctly, my sleep restriction window was about 11:30 PM to 5:00 AM.

I’m not following a rigid sleep window per say but I do go to bed about the same time and wake up at the same time. Usually about 9:45pm – 5:00am. Sometimes I’ll stay up just a little later and sometimes I’ll sleep in until 6:00am or later if I can. The reason being, sleep has been so fragmented that I need to get some rest somehow.

I use my CPAP 100% of the time except for a few times when I started having the recent insomnia and anxiety issues.

I do use good sleep hygiene practices for the most part except for sometimes reading a little in bed and sometimes a little TV.

My anxiety (and related fears) are centered around sleeping and going to bed.

CPAP makes this more challenging due to the breathing not being so natural as I’m laying there waiting to fall asleep. This was not the case before the anxiety started.

I also have some anxiety about sleeping on my back or laying on my right side. Anxiety is a bugger. Makes you feel and think the dumbest things.

I’m confident when my anxiety is back in check, sleep will improve.

I do try to mentally separate the sleep issue as being related more now to having been injured. Even now, most of the time I wake up because of the hip pain. I’m working on this at physical therapy but man is it frustrating.

I struggle with not being comfortable “mentally” with going to bed and sleeping. I try to not let myself get worked up over it but it’s frustrating. Again, it’s just the anxiety.

Had no issues like this since 2014.

[Warrior]

Last nights sleep was a bit of a mess. I did take .25 Clonazepam because I had been feeling more anxious the last 2 days and it felt like it was going to be one of those times that it would make me not want to stay in bed.

The meds (although very low dose) did relax me and I looked forward to sleep. Decided to watch a little bit of TV in bed with the wife and we were both falling asleep within about 20 minutes. So turned off the TV and lied down to sleep.

I think I fell asleep relatively quick and I did feel more relaxed than I had in a while. Mentally felt like it was going to be a good nights sleep.

Lights out was about 9:50pm and I woke up just 45 minutes later. I can’t even recll why very clearly except I think I was aroused by something. It wasn’t leg/hip pain. I got out of bed, used restroom, drink of water and back to bed.

Slept for 1 hour and awoken again. Same process.

Slept for 2 hours and awoken again. This time I think I woke up sweating. Been doing that lately. Repeat process. This time it took me longer to get back to sleep when I got back in bed. but CPAP reading says I was in bed for 2 hours.

Woke up again – repeat process.

This time in bed for about 20 minutes before wife’s alarm went off and woke me up. I had intended on sleeping another hour but I just got up instead.

Room temp is cool (66F) and only a sheet on my upper half. No pajamas.

Normally, even when taking medication, I usually remember why I wake up and how often. Last night was a bit of a blur but I don’t think hip pain played a part at all.

It seems like I’ve become conditioned to wake up every 1-2 hours from the pain so now I wake up even if I don’t have pain.

 

Now, I will say that the night before I woke up (or at least only got up) 2 times. I had one period where I slept for 4 hours straight. No medication involved. That night was 1 hour – 2 hours -4 hours.

The night before that I took 50mg Diphenhydramine (Benadryl) and slept 4 hours – 1.5 hours- 1 hour.

So I know there’s hope. I just don’t know what it’s going to take to break this cycle and return to my normal pattern of sleeping blissfully through the night.

The ordeal of my injury and healing and now recovering from the residual aeffects(hip pain/imbalance) I’m sure is a big part of it. The anxiety doesn’t help and I’m working on that with a therapist. Usually, that affects my sleep initiation more ], which has improved.

My best friend is also in the hospital and will be having open heart surgery Saturday so the stress from that is surely playing a part.

Open t any and all suggestions on how to break this pattern.

[Martin Reed]

How are you getting on warrior?

It’s so important to follow a regular (and appropriate) sleep window. This means you don’t go to bed before the start of your sleep window but you ALWAYS get out of bed by the end of the sleep window. It’s so important to always be out of bed by the end of your sleep window, even if this means you might miss out on some additional sleep.

There is no evidence to support the use of diphenhydramine to treat chronic insomnia. Furthermore, after three nights of use the body builds up a resistance to this drug, meaning any benefit after three nights is purely from the placebo effect.

From what you’ve described, I don’t think it’s pain that is waking you during the night. When pain disrupts sleep, it usually prevents us from initially falling asleep. However, what can happen is that when you awake, you once again notice the pain (you didn’t feel pain when asleep) so it’s easy to attribute the sleep interruption to the pain when that’s probably not why you woke.

Waking during the night is actually quite normal, but when we have anxiety about it, it becomes harder to fall back to sleep. At times like this, it’s important to implement techniques that will break the learned association between the bed, wakefulness, and anxiety and to recreate (and strengthen) an association between the bed, sleep, and relaxation. This is best achieved through stimulus control (an alternative technique is countercontrol for insomnia.)

I hope this helps.

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[Warrior]

Martin,

My sleep has been getting a little better over the last several nights. last night, I woke and got out of bed only 1 time. I did wake a few times but just rolled over and went back to sleep.

The night before only out of bed 2 times. As opposed to my normal 4-5.

My sleep specialist says I’m hypervigilant from my anxiety. This makes sense to me.

I believe the CBT I am participating in for my anxiety is helping.

 

My insomnia isn’t the “I just can’t sleep” type. Mine is the “I’m afraid to go to sleep or my anxiety is so revved up I can’t even lay still to go to sleep” type. I can be nodding off reading and then still have trouble getting to sleep because I’m having sleep starts or my mind is racing or I’m so hypervigilant that every little thing makes me nervous.

I do still feel apprehension when going to bed and last night the 1 time I did wake up was after I had been asleep for about an hour. I bolted awake in a panic and was out of bed before I knew it. I did use the restroom and go back to bed so it wasn’t as bad as normal.

I am noticing some improvements in my anxiety and I think it’s helping with my sleep.

The issue of pain is off and on now. It does wake me sometimes but it may be that I’m sleeping so lightly that I wake up from it.

[Martin Reed]

It sounds as though you are on the right track, Warrior! Please keep us updated with your progress!

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

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