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[princessbelle]

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[JDS74]

I think he is referring to something like Ambien as a sleep aid. My sleep doctor and I are currently experimenting by titrating dosage of a sleep aid med called Trazodone for the arousal issue. I get 9 per hour of spontaneous non breathing / non-PLMD arousals which sounds similar to the numbers you are seeing. Ambien and others like it have issues so I would be careful. Trazodone is shorter acting and has fewer issues as well as being really inexpensive. A two week scrip without insurance only cost me $9.

You also may need a med for the PLMD. A med like Pramipexole might be a choice. My sleep doctor recommended that I use my neurologist for PLMD issues because I also have CSA issues.

Best wishes.

[tortoisegirl]

PLMs can increase or decrease with the addition of CPAP, if your prior study with a lower PLM index was without CPAP. An increase in PLMs after starting CPAP could be attributed to having less arousals from apneas & hypopneas, so the PLMs could more fully appear. Typically doctors primarily look at the number of arousals per hour from PLMs when considering if treatment (typically medication) is recommended.

With 5.25 hr sleep time, 35 PLMs is 6.5/hr. That may be borderline. I'd discuss it with your doctor when you see them. Does your study report show when they occurred? If they were mostly at higher pressures for example, that would mean the index would be even higher if you had been studied for the entire night at that max pressure. That is something your doctor would hopefully take into account when considering medications. Agreed Pramipexole (Mirapex) (or Ropinirole, Requip) is typically the first line med for PLMD.

It would seem prudent to increase the pressure slowly, 0.5 to 1 at a time, and monitor your response. Do you know your AHI at the pressure of 12 from the study report? That would be helpful in determining a target pressure. Why didn't they titrate higher than 12 if that didn't stop all events? Seems dumb to not have done that since it appears they had a decent amount of time. Or was it a low enough AHI for the tech but the doctor either wants to see it even lower or thought he'd cover his bases by maxing out the max pressure in his APAP pressure range recommendation? It appears he may not have been aware that you were already using a (brick) CPAP, and instead seemed to be making recommendations for a first timer.

Any chance you can swap out your machine for an APAP, or purchase one used? Unless you have no deductible and 100% coverage, the sleep study will likely cost you more than picking up a used APAP would, and that doesn't consider any potential future studies. The data alone would be worth it, since you seem to have doubts on both AHI and leaks. Not everyone can tolerate APAP pressure changes though.

Agreed a hypnotic would likely refer to that class of sleep meds. But if you are already using a machine and still have a month to go until your next follow up, that may be a moot point by then. That could also just be a standard add-on note for all their studies, or like I said above, the doctor didn't notice you were already on CPAP. Best wishes.

[kteague]

If this is how many limb movements you had during titration, keep in mind there's a chance they could be more once your OSA is therapeutically treated. Personally, I'd be hesitant to start a medication that could obscure a problem needing addressed. I found that my PLMD made using CPAP more difficult, as it made me highly sensitive and made anything touching me aggravating. Some people can take the usually prescribed dopamine agonists without a problem with side effects or augmentation. Unless you are in desperate need for immediate resolution, it may be in your best long range interest to check out some things first. It is thought that those with lower ferritin levels are most prone to developing problems on the meds. Getting your ferritin up to approaching 100 is often recommended before starting a dopamine agonist. Also, evaluate any meds you might be taking that might be causing or worsening your limb movements. Another common theme you'll read about is the need to make sure you are nutritionally sound, particularly with magnesium and Vitamin D. You can get a blood test for all those things. Maybe you'll find some of these things will help your symptoms enough to avoid meds, maybe not. I happen to use a TENS Unit to control mine. That's not mainstream - yet. Some find a warm foot soak before sleep helpful. A pillow between your legs won't help the movements, but may buffer them enough to cause fewer arousals. Do some reading and journaling to pinpoint those things that worsen your leg activity. For me there was an ingredient in cough medicine that I had to avoid, as well as caffeine. Playing music while I slept helps me. You'll figure out after a while what helps you. Once you've done everything you can do to calm your legs, then you can decide if you need sedation to be able to get the sleep you need.

[princessbelle]

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[kteague]

Sounds like you're doing a lot of the right things to work toward better sleep. Hopefully you see results. Your doctor didn't already do a ferritin level did they? It's pretty specific and not in a routine panel of tests. Glad to have this reminder - got some blood tests scheduled and forgot to ask doctor to include the ferritin. it's been a few years. Let us know how things progress.

[Guest]

I will ask the Sleep Doc when I see him about doing the test. I sent an email asking if they can per-order the machine I want because I have seen online where they usually not in stock. I am going with the latest Airsense for her. I wish I could have it already and start monitoring my own issues.