help assessing sleep cycles trying to adjust meds

[wilsonintexas]

I know that this may be a little off topic. I do have apnea, but it has been under control for a while. The current problem is that last December they found a jelly bean where my pituitary should be (a benign tumor). They could only take half of it out, because the rest was in a place with a lot of nerves and veins. The Dr decided it was better to leave it than give me a brain bleed or stroke. After surgery many of my hormones were wacky…. But then came the radiation treatments to finish off the tumor. So now many of my hormones are wacky, including cortisol, which controls sleep.

The treatments asl0 kicked off meniere’s which is an inner ear problem that is causing daily nausea.

They are trying to treat the meniere’s with a combination of bnadryl, meclizine and valium…. ( no wonder I am a zombie)

Even with the meds for meniere’s , I am waking up 10-12 times a night……. Not good sleep hygine.

Obviously I am pretty much a zombie.

My neuro suggested trazodone (from ½ to 2 pills) to go to sleep and nuvigil to try and stay awake.

After several seeks of trying things I have found the following:

1) No sleeping pills 10-12 awakings
2) 1 sleepingpill more deep sleep (up to an hour of it) but it is very fragmented.never more than 10 minutes at a time
3) 2 sleeping pills, less deep sleep but more continuous REM and light (up to 30 or 45 minutes if rem)
Here is some data from my ZEO

Oct 14th one sleeping pill
http://i.imgur.com/VGnMQLc.png


Oct 15th two sleeping pills
http://i.imgur.com/rw7gdzw.png

A comparison side by side
http://i.imgur.com/oi4vpYC.png

So the question….. am I better off with fragmented deep sleep, or less deep but more connected rem?

I know the general answer is what makes you feel better….. but with all of the meds I am on, it is hard to tell which makes a difference. I am looking for a recommendation to get some starting point.

edited to try ang get images to appear

[Kennerly]

"So the question….. am I better off with fragmented deep sleep, or less deep but more connected rem?

I know the general answer is what makes you feel better….. but with all of the meds I am on, it is hard to tell which makes a difference. I am looking for a recommendation to get some starting point."

I'm not sure how relevant this will be as your situation is so unique but I have had experience with Trazadone and a number of other sleep meds. I was never able to benefit from Trazadone.

At the moment I'm on Lunesta, and I can say that its not uncommon to see 3-4 fairly clear nrem/rem sleep cycles on my Rescan reports. And it has been beneficial. My experience with Trazadone predates my use of CPAP so I can't provide a direct comparison. (Actually my experience with Trazadone probably predates the existence of data capable PAP machines. It's an old drug.)

[Kennerly]

I've also used Modafinil which is the generic version of Nuvigil. It was helpful but over time I found that it had a negative impact on my sleep -- I believe it has a pretty long half life. If at all possible you might want to get your sleep meds calibrated before trying Nuvigil so you have a better chance of determining which drug does what.

I did find that -- as advertised -- Nuvigil doesn't cause withdrawal problems like other stimulants. I developed tolerance to it very quickly, so I would skip a day or two each weekend to reestablish its effectiveness. This was no big deal since there were no withdrawal symptoms during the off days.

[Jay Aitchsee]

Obviously, the answer probably should be the one that makes you feel better. That said, the second, less fragmented one appears to represent a more "normal" or typical architecture.
I might tend to discount the first where you went immediately to deep sleep. One usually goes through a "light" stage first. It is also odd because I think that's the one you only took one pill. But, I don't think one night is enough to make a judgment. I think you should pick one regimen, try it for several nights and then try the other and compare the results.
BTW, I think most of us old Zeo users are used to looking at a little different color scheme, red for wake, green for rem, You can change them in this viewer under file>preferences.
Jay

[wilsonintexas]

Without nuvigil, I tend to be a zombie most of the day, (like sitting in a chair until 3 in the afternoon unable to get up.

Right now I am also on the steroids making it even more difficult to get decent sleep.

I hav treid several things over the past few weeks. One was going 4 days without nuvigil, sleep did not improve.

[Jay Aitchsee]

edited to try ang get images to appear

Highlight the url in the composing section and select "img" above to place the image code around the url like this. Select "quote" to see the code in this post. You can probably copy and past the img code right from imgur, but I don't use the site, so don't know.

A comparison side by side

[palerider]

You can probably copy and past the img code right from imgur, but I don't use the site, so don't know.

imgur gives several 'code' links, the one he wants is 'bbcode'. there's also a 'linked bbcode' that both puts in the image, and a link back to imgur.

I like to use that one, then change the img to a large thumbnail, and the link back to the full size image

like this:

[wilsonintexas]

I did try several nights on one pill and several nights of two pills...... but I did not have the viewer to upload and save data. I have manual notes......

But these nights are pretty typical.


with no pills, I put tick marks on a paper to say when i was awake, zeo did not pick them up to well. But this was before the new viewer, it may be that they were often lost in the 5 minute summary on the screen....


from my notes:
on one pill by reviewing the data on the machine all stages were fragmented, no deep lasted longer than 10 minutes, most only 5.

stage WAKE REM LIGHT DEEP
percent 0 13 68 19
hours 0 0:59 5:02 1:23

0 19 68 13
0 1:49 6:27 1:12

0 13 73 14
0 1:12 6:50 1:22

a lot of the deep was early (probably false as noted before or late ( I have an alarm at 7:45 to take meds, then sleep in until 9-10, and a lot of the deep was between 7:45 and 10:00..... probably some false

But it was all very broken up, much as the one night pill..


the following are from two nights of pills

stage wake rem light deep
percent 0 35 64 1
hours 0 4:11 6:05 0:06

1 37 60 2
0:06 3:07 5:00 0:11

0 41 57 2
0 4:11 5:46 0:12

the pattern is locks of 45 min to an hour of light and REM, with very few blocks of deep.

I have much more that is about the same.

I do have an apt with the neuro soon, which is why I got the viewer, so I could have some cleaner things to give him than my notes.

Hope this informs he discussion

I am not sure that giving up deep sleep fir blocks of rem is good or not. But when I do get deep it is always very very fragmented and it fragments the rest of the patterns as well.

It may be that I need enough info to say that the trazodone is not working and I need to try something else.


I will try to do better posting images in the future.... thanks for the pointers....

[Kennerly]

I've also used Modafinil which is the generic version of Nuvigil.

I was wrong when I wrote this. Modafimil is the generic version of Provigil not Nuvigil. They are supposed to be similar, but they are not identical. Right church wrong pew.

[wilsonintexas]

I think that provigil was the original. The patten ended and the generic came out..... So they made a slight change and came out with nuvigil. I have tried them both without seeing much difference..... right now I have good insurance and have met the out of pocket max, so the scripts cost me 0.

maybe just the other end of the pew......

[Jay Aitchsee]

So the question….. am I better off with fragmented deep sleep, or less deep but more connected rem?

I can't answer that, but I've found increasing deep sleep to be difficult. From my experience and research, there are very few drugs, if any, which improve deep, but there are many which influence REM, often at the expense of deep.

According to Zeo, people in their 50's average about 44 minutes out of 6.5 hours of sleep in deep or about 11%, people in their 60's about 36 minutes out of 6.3 hours for 10%, and people in their 70's about 30 minutes out of 6.0 hours or 8%. Also according to Zeo, REM stays relatively flat across all ages at about 20%, decreasing slightly with age. Wake and the number increase with age from 38 minutes in the 50's to 68 minutes for people in their 70's. Most people typically experience the most deep sleep in the first sleep cycle with less in each subsequent cycle. REM, on the other hand, typically increases with each cycle, with less in the first.

Like you mentioned in another thread, I have found Zeo to be reasonably accurate with repeatable results, so I think it's very good for establishing trends. Zeo did say the device sometimes had difficulty determining wake from REM and I have found that sometimes, if I wear my headband while away from the unit like to the bathroom, it will register that as deep sleep, perhaps because of diminished signal strength at the receiver.

I've found deep to be heavily influenced by disturbances, environmental or physiological, such as noise (leaking mask) or pain, with any disturbance sharply reducing it. Sleep hygiene generally seems to influence deep greatly as well. For me, restricting caffeine and a minimum of 30 minutes of moderate exercise (walking, biking, etc,) daily have helped. I have had some improvement in deep by using NSAIDs for back pain, but felt the long term risk was too great to continue.

The bottom line, of course, is how one feels. I have taken some drugs which appeared to improve sleep architecture but left me with such a hangover I couldn't function. Better to give up a little and be able to function, I think.

I wanted to ask if you saved the encrypted data before you updated your Zeo to 2.6.3O? If so, this new reader is supposed to be able to read it, so if you point it to the saved encrypted data, it might open it for you and add it to your file. I don't have any encrypted data to try it on.

I wish you great success in achieving better sleep.
Jay

Edit: For anyone interested in getting the new Zeo viewer for Bedside units, see here: viewtopic/p947175/viewtopic.php?f=1&t=9 ... 24#p944413

Edit2: here's a snip for your comparison. Notice my deep is fairly fragmented and I get little in the first cycle where I think I should.

[wilsonintexas]

I appreciate the replies.... I did not save my data before the upgrade, so it is not available.

I also appreciate the comments about medication and deep sleep....... as well as impacting REM.

I know I am better with at lease one sleeping pill..... without it I am awake 10 or more times......

With one, I have gotten ans much as an hour of of deep sleep... but fragmented and it fragments the REM
(I know I am repeating myself..... sorry)

With so many other things (meclazine, valium....) taken during hte day it is really hard to say when I feel better...... and right now I am on steroids, it is stopping hte nausea, but is hard on sleep as well..

I have a neuro apt in a few weeks, for now I will try at lease a week on two pills and get down loads then a week on 1 pill and get downloads..... and see what he thinks......

I feel pretty decent when I get up (after 10 hours in bed) with two pills...... but I end up sleeping in until 10:00 AM....... I take the pills at 9:00 and am just ready to go to bed at 11:30......


So thanks for the advice.......

One of my real concerns is that before this while thing started, I use to be able to get up at 6:30 AM and put in 8-10 hours at work and have the evening to play in my shop...... I do not think that that will be possible. That is hard to accept.


now, even before the meds for meniere's (mecl and val) I was so tired that I can not get out of bed before 9:00..... I can only stand for an hour at a time, I would sweat just from standing and doing the dishes.... then I have t sit in a chair for up to an hour before I can do anything else.


But From talking to the neuro and endo people, they know my hormones are messed up, and this is causing the problems with sleep, excess sweating, and others...... they can replace some of them but I am not sure I will ever be back to "normal"

At least with the apnea, I could see light at the end of the tunnel, and I reached it....... it took a year and a half to go from cpap, to bipap, to ASV and then then to adjust to the ASV, but all along I know I needed the machine and in the end it would help

not so sure on the hormone based problems caused by the pitutary tumor and radiation are ever gping to be fully controlled.

BUT THERE IS GOOD NEWS:
1) it is benign
2) the tumor is under control, it has not grown.....
3) The meniers DRs assure me that that they can stop the nausea..... it may come at the expense of some hearing....
4) My minier's sympton oin only nausea and virto once in a while...... there are many people that have it worse. (but it is really lousy getting sea sick by just walking down the steps hald an hour after you get up)
4) There was only slight dammage to the optic nerve from radiation (so I will not go blind and deaf)
5) I have decent long term disability insurance........ if I can not go back to work I will get something until I can retire in 5 years..... (I turn 60 next month).......

SO thanks again for the recommendations........

The neuro did say that this was the first med to try, it had the lease nu mber of side affects, and is the least addictive...... so maybe there will be something else out there.

My best hope for now it to get the menier's fixed (even if I loose some hearing) and get off of some of the drugs that increase the zombie affect........

Off to find a good meniers forum..... have got to be some out there.

sorry for the typos, this post took an hour and a half to get to this state...... I do not think I am ready to go back to wrk where 80% of my time was on emails and writing documents.....

[Jay Aitchsee]

I'm sorry to learn that you've been dealt such a bad hand, but glad that you seem to have a positive attitude that allows you to find a little good news in all this.
I'll be rooting for you.
J

[wilsonintexas]

Thanks.

I was hopinng that there would be some tech out there who could answer what I (dumbly) thought was a simple question:
is it better to have more connected cycles and less deep, or more deep but fragmented cycles.......

But we shall see.

[Jay Aitchsee]

I was hopinng that there would be some tech out there who could answer what I (dumbly) thought was a simple question:is it better to have more connected cycles and less deep, or more deep but fragmented cycles.......

OK, here's what I think, though I am no expert. Maybe we can get someone to agree or disagree. I think the first hypnogram looks better than the second. The first has short periods of REM increasing through the night. I think that is typical. The second has the longest period of REM early, I don't think that is typical. The first has about 30% REM, the second has 38, I think 30 is closer to the norm. The first has about 7% Deep, not bad, the second only 4.5% Both have REM broken by periods of Wake in the morning which is normal. Remember, Zeo has problems distinguishing between the two as well.
So, I vote for the first as the most normal.
Anybody else?