I got a copy of my sleep stuy HELP!!!!

odawa · Post by **odawa** » Thu Dec 06, 2007 9:20 am

I felt great. I was even able to run on my gazelle for 25 mins. It was awesome. Just like the old me again. Gosh I've missed me.
One of the techs said my pressure was up to 14. Thats alot higher than what I was titrated at before. Before was on my back, this time I was allowed to sleep on my side and front. I thought that was interesting.

Today, I'm yawning again, not as much as usual. I guess that will be tomorrow.

odawa · Post by **odawa** » Thu Dec 06, 2007 9:22 am

My appt w/ my primary is on the 12th. We will be talking about the lapband surgery. My sugar level is high and I now have systematic sleep apnea. I should qualify. YIKES!!!

socknitster · Post by **socknitster** » Thu Dec 06, 2007 2:16 pm

Odawa,

That is crap about not needing slow wave or delta sleep. You do need it.

Please see my post here:

viewtopic.php?p=229109

I cannot imagine why doctors are saying this kind of crap to relatively young people. People over 25 aren't dead. We still need all the same stages of sleep--maybe in different proportions, but they still serve important purposes.

Jen

odawa · Post by **odawa** » Thu Dec 06, 2007 9:01 pm

Well this could be very interesting. I've been on the cpap since May. I'll check when the results come in and see what my new stageIII/IV level is. He was pretty shocked that I was concerned about the 0 levels. I'll ask him for some reading material also. I think the specialists hate me sometimes, I really try to learn about the problems so they have to explain more to me and if they don't listen. I cry. lol serious. I told this doc I wa afraid I was gonna lose my job, and tears welled up.
Truthfully though, my grade point has dropped since I got this. I can't remember as well as I did before. It's scary. I'm in a highly technical field. I need to remember everything.

odawa · Post by **odawa** » Thu Dec 13, 2007 8:15 am

I went to my primary yesterday. I am still tired and I'm 100% complaint with the CPAP. Turns out I have anemia. She put me on Iron tabs. She says that would keep me fatiqued and tired. I hope this will help. I really need to get exercising. The good thing is that the Drs have not given up on me, they are trying to find what is going wrong

odawa · Post by **odawa** » Sat Jan 12, 2008 9:23 am

I finally got the result of that MSLT test, remember 21 hrs of sleep study??
Turns out I'm excessively tired throughout the day. I'm not depressed, big surprise. But I can fall asleep in 8.2 minutes at any time during the day. The Dr is now worried about Drowsy driving. Me too. I've been sick like this for over a year or so.
Please take a look. I go to the Drs on Monday morn to talk about this test. They are talking about putting me on some meds. It began with a P but I can't remember the name to look it up.

<a href="http://s213.photobucket.com/albums/cc29 ... t=mslt.jpg" target="_blank"><img src="http://i213.photobucket.com/albums/cc29 ... 1/mslt.jpg" border="0" alt="Mslt test"></a>

<a href="http://s213.photobucket.com/albums/cc29 ... =mslt2.jpg" target="_blank"><img src="http://i213.photobucket.com/albums/cc29 ... /mslt2.jpg" border="0" alt="Mslt pg2 test"></a>

odawa · Post by **odawa** » Sat Jan 12, 2008 9:53 am

Wow that looks bad. Try this link:

http://i213.photobucket.com/albums/cc29 ... 1/mslt.jpg

http://i213.photobucket.com/albums/cc29 ... /mslt2.jpg

kteague · Post by **kteague** » Sun Jan 13, 2008 12:17 am

Odawa,

So you're not on any medication for Restless Legs Syndrome or Periodic Limb Movement Disorder?

I find it curious how your sleep study is worded in that regard. Generally the word periodic is not used if the movements are thought to be in conjuction with RLS. They did not label your movements when awake RLS, and PLMD movements are not supposed to be seen when awake. I say supposed because my movements were of the PLMD pattern yet were happening when awake. Can you describe those movements that they said happened during that period of wakefulness - are you aware of the movements?

Since they gave descriptions not associated with a diagnosis, I think I would ask the doc at your appointment if your movements are anything they can put a name on. Even if your arousals are only 2.5 an hour, add that to your AHI, plus any spontaneous arousals, etc and it all adds up to a lot of sleep disturbances. And if it is PLMD, the more effective your cpap treatment is, there's the possibility that your movements will increase in frequency.

Considering your anemia and leg movements, did they do complete iron studies and a ferritin level? For some, a low Ferritin level is associated with leg movment disorders. Even though a Ferritin level may be within the "normal" range, persons with RLS and PLMD are recommended to keep their Ferritin level above 60. If not already done, that is something else you could talk to your doc about. It would be best to have a baseline or how will they know if the iron is increasing the Ferritin?

Hope things work out well at your doctor's appointment. Please let us know.

Kathy

Do you have any leg pain from the frequent movements?

ozij · Post by **ozij** » Sun Jan 13, 2008 3:14 am

Odawa,
If I remember correctly, that MSLT was before they diagnosed your anemia.

Are you still as sleepy?

The med might be Provigil - often used to combat excessive sleepiness.

O.

odawa · Post by **odawa** » Sun Jan 13, 2008 9:59 pm

I don't have pain in my legs, mostly. I do have some arthritis that bothers me in the cold. but not when I'm sleeping. No one has said anything about having restless leg syndrome.

the mslt was before the anemia got diagnosed. I've been taking iron and feel alot better but still take naps and am drowsy through out the day. To be truthful it takes at least 6 weeks for the iron to come back up.

StillAnotherGuest · Post by **StillAnotherGuest** » Mon Jan 14, 2008 5:50 am

Boy, between that UM report and phpBB formatting, getting stuff to line up so you can figure anything out is an adventure. Let’s try this, and look at the original NPSG:

Although it’s difficult to predict how people will react to a particular RDI, the symptoms that you describe seem out of proportion relative to that RDI even without CPAP.

Frankly, I’d really put those hypopneas under the microscope to analyze the respiratory component to them, like flow limitation or some sort of paradoxical breathing. Hypopneas in a setting of severe sleep fragmentation can be a real chicken-egg thing (are they simply a reduction in breathing following an arousal, and therefore somewhat central in nature, or are they truly obstructive and the cause of the sleep disruption?)

But let’s say they are truly respiratory events. This is certainly suggested by the REM dependency. Next we have to see if your objective sleep quality improves with CPAP. To do that, you really need to get the Sleep Architecture graphics and total number of arousals. Trying to figure out sleep quality from the only value they reported (“Stage Shifts”) is difficult, but 209 is a ton. Stage Shifts should be about 7 an hour, and you’re running at about 31.2 in the most recent CPAP titration. This would suggest that there are about 24 arousals an hour from something else besides respiratory events (the MSLT noted that the CPAP setting was adequate, so I would assume it took care of most to all of the events).

Sleep efficiency needs to be at least 85%, so in the first 3 studies, that was poor, and the last study wasn’t all that hot. There remains a significant underlying sleep fragmentation issue.

You're a great candidate for "side-sleeping therapy". Especially if lateral REM was OK.

I suppose you could take Provigil to correct the daytime sleepiness, but it might actually increase sleep fragmentation.

A Sleep Latency of 8.2 minutes on the MSLT would be classified as “moderate” sleepiness, not “mild”.

odawa wrote:We talked more about the anemia. My blood level was at 9.4. They have you get a blood transfusion at 8.0.

That sounds like a hemoglobin level. Did you get that rechecked? Did you get a ferritin level? Are you taking any medications besides iron supplement?
SAG

odawa · Post by **odawa** » Mon Jan 14, 2008 9:36 pm

Im back from the Drs.
I have a prescription for miraplex. He doesnt think it will work but he wants to try. I'm to call him next week. He is starting me on a little dose to see if I wake more refreshed.
He wants to put me on the provigil. I'm having other health problems so I have to wait, we are still trying to figure out the anemia. That Dr thinks fibroids. so that will get better pretty quick.<fingers crossed>
this Dr is the one that said I didnt need the delta sleep. I told him I didnt appreciate him calling me elderly and aged, that I do need the restorative sleep that I am still a functioning adult. He doesnt believe that its needed in people over 30. I explained that is what I am missing, how can I not need it, when that is why he is treating me. he had some lousy explanation.
also I made him apologize for the depression remark. Sorry I've been medically validated. I have excessive daytime sleepiness. not depression.
so this Dr will be going to San Diego next month!!! YEAH!!!! I dont have to request a different specialist. I'll be assigned a new Dr. What a relief. I really didnt like this guy.

odawa · Post by **odawa** » Tue Jan 15, 2008 7:12 pm

SAG,
I questioned the Dr about sleep shifts, he said they did not matter. neither did the sleep efficiency. "They shouldnt even be on the test" was his quote.

He wants to try miraplex although he says I dont move enough, he doesnt think it will work. He wants to try provigil, but we are still working on finding the cause of anemia and it will make the birth control ineffective.
I take lots of vitamins b complex, cinnamon, aspirin, chrominium(?) picolate, multi-vitamin,

rested gal · Post by **rested gal** » Wed Jan 16, 2008 3:33 am

odawa wrote:]SAG,
I questioned the Dr about sleep shifts, he said they did not matter. neither did the sleep efficiency. "They shouldnt even be on the test" was his quote.

A "sleep" doctor said that??? Geeze.

odawa wrote:so this Dr will be going to San Diego next month!!! YEAH!!!!

Yea for you, yes.

I feel sorry for the new batch of people who will be unlucky enough to draw him as their "sleep" doctor.

StillAnotherGuest · Post by **StillAnotherGuest** » Wed Jan 16, 2008 4:53 am

The concept of stage shifts during sleep is concerned with sleep fragmentation, or disruption of overall sleep architecture. I believe It gradually fell out of common use when the computerized systems came into being (only in the early '90's, really) and sleep architecture could be better represented graphically. It became relatively easy to differentiate "good" sleep:

from "fragmented" sleep:

And you can see the location of specific areas of sleep fragmentation and periods of wake as well.

While stage shifts may be a little obsolete at worst, assessment of sleep quality (through graphics and analysis of arousals) and quantity (looking at Total Sleep Time and Sleep Efficiency) is essential. That's the whole point of NPSG.

The MSLT must be analyzed with the NPSG in hand to document sufficient sleep of good quality. 403.5 minutes of sleep on the night prior to MSLT qualifies as sufficient quantity, but Sleep Fragmentation needs to be more thoroughly examined. As well as the previous week or 2 of sleep log to make sure you're not, among other things, a Delayed Sleep Phase like that CLFDS^.

Any symptoms of cataplexy (A penguin, a nun and a pirate with a parrot on his shoulder walk into a bar. The bartender says, "What is this? Some kind of joke?")?

One should consider throwing out the 5th nap in MSLT if it's a really long outlier (attributable to "OBOY! I'M GOING HOME SOON!!! YEEHAH!"). With that idea in mind, your MSL is now 6.4.

In re: the Periodic (and Wake) Limb Movement thing, it seems odd that you had zero PLM and Wake Limb Movement on 4.13.07 CPAP titration and now tons on 12.4.07. Suddenly low ferritin levels (or anemia) might account for that. But if your H&H is low, the first thing that one thinks of is "bleeding" not "low iron." If you suspect low ferritin levels, you measure ferritin. If you're missing 25% of your blood supply, you look for a couple of other things. Like a GSW, for instance.

Taking piles of B Complex before bedtime could generate sleep issues.

I can't wait for 2 channel portable testing to start. That's gonna be fun.
SAG

I got a copy of my sleep stuy HELP!!!!

Results of the MSLT test

Periodic Limb Movements

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