A couple of thoughts after 4 weeks on APAP

cyclist56 wrote:I also take Paxil

What do you think about trying to taper off with the help of the prescribing doctor?

I've read cases where doctors prescribed SSRIs when all was wrong with the patient was untreated sleep apnea.

I agree with Sheffey on targeting your limb movement issue. Limb movements can make you still feel like crap even when CPAP treatment is successful. Here's my thoughts on some of the meds people try for limb movements. Is the intent of the med to help you sleep through the movements or to stop the movements? If a med helps you sleep through them, or at least not remember them, did the movements still disrupt your sleep architecture even if you didn't full awaken? Just because one doesn't remember waking doesn't mean their sleep was "good" in respect to sleep stage patterns. Even if a med makes one sleep through the movements and the sleep stages were good, there can still be a tired feeling in the legs even if not in the mind. Our body tissues need rest, or down time, to be restored. Constant activity during the night robs them of down time, so a med that makes one sleep through the movements is not always the better solution. In a perfect world we could relieve the movements and the sleep would self-resolve.

There's so many variables. Some people's movements are little more than a flexion of the big toe. Others have a cycling motion of nearly the whole leg. Understanding what you're working with can help guide the treatment path you are willing to take. Someone can correct me if they have better knowledge, but I think dopamine agonists are the main meds used to actually stop the movements. When they work, they are a lifeline to sleep and sanity. Some here have reported a low dose of one of these meds has been successful. I can't mention these meds as if it is a recommendation without the disclaimer to become informed before starting that route. Done with knowledge they are a viable option. I was not informed and blindly followed the prescribing doctors and there was hell to pay, for years enduring augmentation on a dopamine agonist. My movements became so intense that not only were my legs exhausted, my knees were repetitively wrenched and my hips and lower back were traumatized. (I think the link to my sleep video is still in my signature line.)

How can one begin to figure out what their legs are doing now that their CPAP treatment is in place? A sleep study while using their CPAP all night at their prescribed therapeutic pressure would be most informative, though not realistic for many. Some docs like to do only a repeat diagnostic study, which will not answer the question at hand. Otherwise, videoing the sleep movements can show a lot. Can't measure brain waves (sleep stages) but can still be informative. At least if one can have an observer report how the movements look and frequency it's a start.

BTW, two distinguishing factors of periodic limb movements vs RLS are frequency and appearance. A PLMD diagnosis requires the movements to meet criteria in timing (among other factors). These movements will be stereotypical in appearance and rhythmic. RLS movements are random rather than patterned.

Sheffey wrote:

cyclist56 wrote:I also take Paxil

What do you think about trying to taper off with the help of the prescribing doctor?

I've read cases where doctors prescribed SSRIs when all was wrong with the patient was untreated sleep apnea.

I only take 20 mg. of Paxil. I tapered off a year ago, was OK for awhile, and then was hit with a lot of anxiety and insomnia by November. So I'm back on Paxil. My apnea diagnosis after sleep study in April was mild apnea, mostly hypopneas. So I don't think that the anxiety/depression/insomnia was mainly a result of apnea. PLMD was also diagnosed. Sleep study with CPAP did not improve the PLMD. So drug treatment appears to be called for. I'm also going to be tested for ferritin and magnesium levels, which I understand can effect PLMD.

kteague wrote:I agree with Sheffey on targeting your limb movement issue. Limb movements can make you still feel like crap even when CPAP treatment is successful. Here's my thoughts on some of the meds people try for limb movements. Is the intent of the med to help you sleep through the movements or to stop the movements? If a med helps you sleep through them, or at least not remember them, did the movements still disrupt your sleep architecture even if you didn't full awaken? Just because one doesn't remember waking doesn't mean their sleep was "good" in respect to sleep stage patterns. Even if a med makes one sleep through the movements and the sleep stages were good, there can still be a tired feeling in the legs even if not in the mind. Our body tissues need rest, or down time, to be restored. Constant activity during the night robs them of down time, so a med that makes one sleep through the movements is not always the better solution. In a perfect world we could relieve the movements and the sleep would self-resolve.

There's so many variables. Some people's movements are little more than a flexion of the big toe. Others have a cycling motion of nearly the whole leg. Understanding what you're working with can help guide the treatment path you are willing to take. Someone can correct me if they have better knowledge, but I think dopamine agonists are the main meds used to actually stop the movements. When they work, they are a lifeline to sleep and sanity. Some here have reported a low dose of one of these meds has been successful. I can't mention these meds as if it is a recommendation without the disclaimer to become informed before starting that route. Done with knowledge they are a viable option. I was not informed and blindly followed the prescribing doctors and there was hell to pay, for years enduring augmentation on a dopamine agonist. My movements became so intense that not only were my legs exhausted, my knees were repetitively wrenched and my hips and lower back were traumatized. (I think the link to my sleep video is still in my signature line.)

How can one begin to figure out what their legs are doing now that their CPAP treatment is in place? A sleep study while using their CPAP all night at their prescribed therapeutic pressure would be most informative, though not realistic for many. Some docs like to do only a repeat diagnostic study, which will not answer the question at hand. Otherwise, videoing the sleep movements can show a lot. Can't measure brain waves (sleep stages) but can still be informative. At least if one can have an observer report how the movements look and frequency it's a start.

BTW, two distinguishing factors of periodic limb movements vs RLS are frequency and appearance. A PLMD diagnosis requires the movements to meet criteria in timing (among other factors). These movements will be stereotypical in appearance and rhythmic. RLS movements are random rather than patterned.

PLMD was diagnosed after my sleep study, so I'm assuming that it is PLMD and not RLS. I only slept 2.5 hours during the study, but there were "arousals" from the PLMD. The clorazepam was prescribed to reduce the PLMD, as I understand it, but the sleep effect also is important. I now sleep 7 hours or so without waking.

Another question I have is regarding flow limit data. Mine is below .20 95% of the time. It might spike to .30-.55 once or twice per night. Is there anythng to be concerned about with those numbers? My AHI is now in the 1-3 range consistently.