Analysis Welcome

[SleepyFinger]

I'm hoping the community can chime in on my most recent night's sleep data. It was an ugly number and I've been having more and more of these nights lately.

As background, I've been a compliant user for 3+ years. My typical numbers have never been great, in the 5-8 range, and always driven by centrals. I'm a restless sleeper (involuntary leg movement) so that may be driving it. I will say that unlike others, I really do not feel refreshed in the morning. The only times I do are after a Saturday afternoon nap.

Anyway, any thoughts are appreciated.



Thanks!

[LSAT]

If this is a typical night, you need to see a sleep doctor about your CAs. You might need a sleep study and a different machine that treats Central Apnea.

[kteague]

Yeah, that's ugly. Several thoughts come to mind. First, what meds are you on - any that might cause centrals? I ask that partly because you mention limb movements and sometimes the meds given for those can be problematic in this respect. Secondly, if you have PLMD, the movements can lead to lots of short wake times so I would want to know if any of those flagged events could be sleep/wake junk. Also with limb movements, there can be a tendency to hold ones breath during movements. Not sure how this might look in the data. If you do have an untreated or undertreated limb movement issue, your sleep will still not be refreshing or restorative. A CPAP can deal with your breathing, but other things may need addressed too. If I had that many possible central events, I'd pitch a tent on the doctor's doorstep till I got answers. Looking forward to what our resident data gurus have to say.

[robysue]

SleepyFinger,

I'm going to piggy back on what kteague has said. Given that you report a problem with involuntary leg movement, the important questions to be asking are:

1) Have periodic limb movement disorder (PLMD) and restless leg syndrome (RLS) been ruled out as causes for your continued problems with getting a good night's sleep?

If not, I'd suggest starting there. Note that PLMD and RLS are not the same problem, but both can be treated. Here's the thing: Both PLMD and RLS can cause a lot of miniarousals. And those miniarousals may be leading to lots of time where you are drifting in and out of sleep, which then can lead to lots of sleep transition centrals being scored. The fix for PLMD and RLS, however, is not tweaking the xPAP settings. If either PLMD or RLS is the root cause of your ongoing bad sleep, the fix is getting a proper diagnosis and then starting a treatment to minimize or eliminate the involuntary leg movements; once the involuntary leg movements are minimized or eliminated, the miniarousals should be largely eliminated and you should start to feel more rested in the morning. The machine recorded AHI should also decrease as the mini-arousal sleep transitional central apneas decrease because the number of mini-arousals decrease.


2) If you have previously been officially diagnosed with PLMD or RLS, what (if anything) was suggested as a way to treat them? How well did it work?

3) What medications are you taking for other medical problems? Any chance one or more of them could be causing the centrals? Any chance one or more of them could be causing the involuntary leg movements

[SleepyFinger]

Thanks for the responses!

LSAT...I'm not a cheesehead but I love your avatar. I might have to steal it, put it on a cup and send it as a gift to a good buddy of mine!

kteague and robysue...as part of my sleep study, I was diagnosed with PLMD. At the time, I wasn't really focused on it at all and just worked on getting compliant with my cpap machine. It took some time but I've been at nearly 100% usage for 3 years. During that time my AHI numbers are usually around 6 or 7, although there are times (Spring and Fall) that they hover around 4.

Although diagnosed with PLMD, I have never addressed it. I guess I've never taken it seriously because the doctor wanted to put me on neurotin, a parkinson's type drug, or similar drugs. Reading the side effects I wanted no part of that and dismissed it out of hand. Nobody has seen my sleep numbers since the compliance period so my doctor doesn't really know. I guess I need to revisit it.

As an FYI...since last night was particularly bad, here is a normal night.



I do appreciate everyone's input...it's making me face what I've been ignoring for a while now.

-SleepyFinger

[robysue]

kteague and robysue...as part of my sleep study, I was diagnosed with PLMD. At the time, I wasn't really focused on it at all and just worked on getting compliant with my cpap machine. ...

Although diagnosed with PLMD, I have never addressed it. I guess I've never taken it seriously because the doctor wanted to put me on neurotin, a parkinson's type drug, or similar drugs. Reading the side effects I wanted no part of that and dismissed it out of hand. Nobody has seen my sleep numbers since the compliance period so my doctor doesn't really know. I guess I need to revisit it.

kteague is our resident expert (so to speak) on PLMD.

As she will tell you: Until you get both the PLMD and the sleep apnea under control, you're not going to feel rested in the morning. The untreated PLMD stuff plays just as much havoc on the quality of your sleep as untreated OSA does.

It is worth finding out more about PLMD and about the different ways to treat it. Drugs do wonders for many people, and they are worth a try. Gabapentin (also known as Neurontin) is usually well tolerated and the dose that is used for treating PLMD is usually much smaller than what is used to treat things like Parkinson's.

There are also some nonpharmaceutical ways of treating PLMD. Some docs and PLMD patients have had luck with using a cognitive behavior approach to minimizing symptoms, at least for people with mild PLMD problems. Other docs and PLMD patients have transcutaneous electrical nerve stimulation (TENS) useful. (I believe that kteague has some positive things to say about TENS.)

As an FYI...since last night was particularly bad, here is a normal night.

Your "normal" night is still pretty bad in terms of the CAs. With the history of diagnosed, but untreated PLMD, I think you need to seriously think about revisiting what you are willing to do to treat the PLMD. Because unless the PLMD is addressed, I don't think your sleep is going to get any better.

[kteague]

There are some usual first-line steps to take when one is dealing with limb movements that disrupt sleep. First, have your ferritin level drawn. Get an exact number for your result. Being told yours in within the normal range is meaningless to those with limb movements. It is thought that in PLMD there are issues with the brain getting/using iron, which is important in muscle function. Current thinking is that a person with limb movement issues or RLS should keep their ferritin (storage iron) level up around 100, even though much less is considered normal for the person without these issues. While you are at it, have other things tested such as magnesium, Vitamin D, and some of the B vitamins - anything related to muscle or nerve function. Talk to your doctor about what things in addition to ferritin should be checked. Sometimes correcting deficiencies is enough to give relief. Another thing about the ferritin - it is thought that people whose ferritin is not up in the recommended area of near 100 are more prone to developing problems with some of the meds commonly prescribed for PLMD, dopamine agonists. Are you on any meds, even if not for your legs? Some meds, particularly some mood meds, are prone to cause RLS type issues. And some are prone to causing central sleep apnea.

In addition to getting your body at its optimum to support good muscle and nerve health, read up on things others have done to find some relief. Warm foot soaks before bed are pretty widely touted. As Robysue mentioned, I have had success using a TENS Unit before bedtime. If it does turn out you need to consider meds, particularly the dopamine agonists, keep in mind that if it isn't working at a low dose, increasing the dose too high puts you at higher risk of side effects. Probably wouldn't hurt to try a low dose AFTER making sure your ferritin level is where it needs to be.

Good luck with getting your legs under control and getting better sleep. I'd keep en eye on that data in case those are legitimate centrals that need addressed. I'm no help with that aspect, just a gal with jumpy leg experience.

[SleepyFinger]

Thank you all!

kteague...i just checked my blood work from March and see my ferritin level is 74.

You've given me some good things to look at so I'm off to do some homework on myself.

So have you beaten it or is it just an ongoing battle?

Thanks again,
SleepyFInger

[kteague]

kteague...So have you beaten it or is it just an ongoing battle?

Am I cured? No. Some nights I can skip using the TENS with no repercussions, but if I try to extend that a few nights, I am reminded that the battle is not over. My symptoms are much improved, and the TENS Unit manages them except for an occasional restless night. I now get sleep in consolidated chunks of a few hours at a time - I used to wake up every few minutes and never reach deep sleep. My sleep now usually feels deep and restorative. I use my cpap faithfully. Life feels so much better with decent, even if not perfect, sleep.

[ajack]

you need a sleep doctor, the PLMD may be driving all of it and the machine is picking up the breathing side effects. There are a few meds for it and some that aggravate it.