Need opinion on PSG results

[Sammy_J]

I am thinking of changing my sleep doc. I have had a PSG done recently but my doctor and sleep doc are not concerned despite the fact that I feel like crap when I wake up in the morning and my xPAP pressure is set to where it should be.

My sleep results are posted here: http://www.freefilehosting.co.uk/files/ ... 1222_2.pdf

[Snoredog]

I am thinking of changing my sleep doc. I have had a PSG done recently but my doctor and sleep doc are not concerned despite the fact that I feel like crap when I wake up in the morning and my xPAP pressure is set to where it should be.

My sleep results are posted here: http://www.freefilehosting.co.uk/files/ ... 1222_2.pdf

Are those results while ON the machine? Because they don't look all that bad to me, you only had 11 Hypopnea, sleep architecture is not all that bad, you are making it to REM.

Your oxygen levels are staying up not dropping any lower than 93%, that would coincide with the obstructive events seen. You only had 1 Central Apnea lasting 24 seconds, that can wake you but you were aroused many more times than that one time per night.

Then down at the bottom I see limb movements associated with some arousals, added to the other spontaneous microarousals you end up at 17.7hr.

So my guess is those micro arousals are what cause you to wake from sleep so much. There is not much they can do about those, if you find a cure come back and tell everyone will ya. Maybe Requip may help you with the limb movements. But the cause of those spontaneous arousals are unknown.

My suggestion: Melatonin promotes a deeper sleep, that may or may not help you, with reducing the leg movements. I would personally increase my magnesium and mineral intake with a supplement. I would also look at any medications you might be taking (for adverse daytime fatigue issues) and address any pain you may have like from arthritis.

But that is only my opinion and it has been known to be all wrong.

[Sammy_J]

Thank you Snoredog.

Yes, the results are while using CPAP. Should I be at all concerned about the centrals and mixed apnea? I dont want to sound like a pest to my doctor but I read some info on complex sleep apneas and how new this area is.

Please feel free to set me straight, but it is my understanding that that scoring rules vary widely from lab to lab and many labs use rules that tend to exclude (i.e. not count) the types of apnea events that can be caused by excessive CPAP pressure. They are obvious to the technician, but the scorer is not permitted to count them and therefore even the physician may be unaware of how disturbed the breathing and sleep were as a result of CPAP pressure unless he investigates the actual tracings first-hand. I know most of the time doctors look at just the final "box score". In fact, my sleep doc was not concerned because of the overall AHI. The summary sheet that my sleep doc wrote also had some contradictions to the actual PSG report when it came to my PLM.

Going back to the centrals and mixed apneas, I see that I have short duration of events, the dominance of mixed and central events, a lack of a clear REM dominance and overall very mild desaturations. All this makes me question whether or not I should seek another sleep specialist with recent experience and knowledge in CompSA?

I have been taking melatonin and magnesium but for the study, I didnt take anything just to see how I would do without them. I am taking 820 mg of magnesium (504 mg of elemental calcium) and 9 mg of melatonin before I go to bed.

[javaide]

Sammy,

You have mentioned that you are using 9mg melatonin. i want to know how long you have been using it and whether such high quanity can be harmful in the long run, according to your doctors. I read in this forum that 0.3 mcg should be used with breaks.

I started using Melatonin when other sleep medicines like mirtazapine, trazadone etc. did not help me and I was pursuaded to use melatonin on the lengthy notes of Snore Dog from time to time. I am now using 1 mg (lingual) and am extremely satisfied with it as it is giving me more restful sleep. I am using 1 mg melatonin for last 15 days and wonder whether I could use it on a long term basis. Snoredog is of course using it for several years. I wish Snoredog could also comment on my condition and question, as I truly believe him to be a great man.

[Sammy_J]

Sammy,

You have mentioned that you are using 9mg melatonin. i want to know how long you have been using it and whether such high quanity can be harmful in the long run, according to your doctors. I read in this forum that 0.3 mcg should be used with breaks.

I started using Melatonin when other sleep medicines like mirtazapine, trazadone etc. did not help me and I was pursuaded to use melatonin on the lengthy notes of Snore Dog from time to time. I am now using 1 mg (lingual) and am extremely satisfied with it as it is giving me more restful sleep. I am using 1 mg melatonin for last 15 days and wonder whether I could use it on a long term basis. Snoredog is of course using it for several years. I wish Snoredog could also comment on my condition and question, as I truly believe him to be a great man.

javaide, very good question. I just went into my cabinet and I realized that I no longer have the bottle. I will have to go to the health food store tomorrow and see. But, I have been using three sublinguals for about 5 weeks straight. On the bottle, if I remember correctly, it states that one shouldnt use melatonin for longer than 9 weeks. I do remember watching a health food show on tv and the lady said you should take at least 3 mg, or was it mcg a day. But, the dose of 3 is not likely to do much.

I will have to get back to you on this.

[Snoredog]

Sammy,

You have mentioned that you are using 9mg melatonin. i want to know how long you have been using it and whether such high quanity can be harmful in the long run, according to your doctors. I read in this forum that 0.3 mcg should be used with breaks.

I started using Melatonin when other sleep medicines like mirtazapine, trazadone etc. did not help me and I was pursuaded to use melatonin on the lengthy notes of Snore Dog from time to time. I am now using 1 mg (lingual) and am extremely satisfied with it as it is giving me more restful sleep. I am using 1 mg melatonin for last 15 days and wonder whether I could use it on a long term basis. Snoredog is of course using it for several years. I wish Snoredog could also comment on my condition and question, as I truly believe him to be a great man.

javaide, very good question. I just went into my cabinet and I realized that I no longer have the bottle. I will have to go to the health food store tomorrow and see. But, I have been using three sublinguals for about 5 weeks straight. On the bottle, if I remember correctly, it states that one shouldnt use melatonin for longer than 9 weeks. I do remember watching a health food show on tv and the lady said you should take at least 3 mg, or was it mcg a day. But, the dose of 3 is not likely to do much.

I will have to get back to you on this.

What the Mayo Clinic says about Melatonin:
http://www.mayoclinic.com/health/melato ... -melatonin

I've taken 1.5-3mg for the past 15yrs, don't have any 3rd arm growing out of my forehead yet. But I also wouldn't take any more than 3mg. I have read many times you should not take more than 6mg, otherwise really bad bad things could happen (like the 3rd arm growing out of your forehead), but do you notice they NEVER tell you what that bad stuff is? Not even the Mayo, they say see your doctor and give them $65 bucks.

Then there are people that just can't get their micrograms and milligrams figured out.

It takes 1000mcg = 1mg. 500mcg = .500mg, 300mcg is about 1/3 (little less) of a 1mg tablet (does absolutely nothing for me at that dose, but what ever floats your boat I guess). It sorta follows the milliamp/AMP model. So there is no confusion, I take 3AMP pills

Sublingal melatonin comes in smaller doses (mcg) because it is dissolved faster under the tongue where it is directly absorbed into the blood stream.

See the link above to the Mayo clinic and what they have recommend for melatonin, they even grade it for a particular use. Dose depends on the brand you take and what you are trying to fix with it.

I'm actually surprised the Mayo had anything good to say about it (where is that misread Mayo study?), they are conventional medicine, if it was left up to conventional medicine we would be going down for a prescription just to have lunch. But then again, that may not be all bad either.

I would cut back to 3mg on the melatonin, I doubt you will see any benefit from taking that much. Mayo says 5mg to 10mg is typical (depending on the brand).

As for your Central and Mixed apnea: Sleep docs have no idea what to do with these, they are still experimenting. Only suggestion I can give you here is: treat the obstructive events and avoid the centrals.

No easy task I know, I have been trying for years, but having pretty good luck with the new 420E I've had for the past week. It set it up to avoid responding to apnea where I know they are likely to occur and then turned off FL response. So far it seems to be working out of 5 days I've only had 2 centrals under pressure, then they happened when it was at the Pmin of 6.5cm. The 420e seems to do a better job at CA avoidance. If they still happen at minimal pressure what are you going to do. The Soyala and its lower exhaust rate seems to also have helped. Still tired during the day, I've come to the conclusion I need longer sleep, but that is hard to get when the Central wakes you at 5:30AM. Those at 5:30AM I don't mind its the ones at 2AM that are a bummer. The 420E is also very good at telling you exactly what time the event took place none of this 5th hour of therapy crap.

What seems to have helped:

1. I lowered the default Command on Apnea from 10cm to 9cm (I know at 9.5cm I can start having centrals).
2. Disabled FL =0 (default FL=1).

I set Pmin=6.5cm, then Pmax pressure to 14cm (I have never been able to use a machine set that high). In 5 days it has gone up to 10.5cm to address some vibratory snore and then it was back down. It seems to go up and splint the obstructive events (mainly Hypopnea) and then go back down within only 5 minutes. Despite what I have read, the rapid up/down of pressure from the 420 appears to have no impact on me.

Have RG post her 420e report before and after with the FL setting. That is pretty much what my activity did, when I turned FL off, just like hers my SDB settled way down once I flipped the switch.

For Sale:
1. Remstar Class Auto w/cflex (probably only has 400hrs on it).
2. Remstar M series Auto (think it has more hours on it).

I haven't tried the SomnoSmart2 yet from Germany, been reading up on it, that rare condition we have may not be so rare afterall, I know cpapman carries it.
http://www.weinmann.de/70/?L=1

[Sammy_J]

Thanks again Snore Dog.

Since you and I have/had the same machine, is there any way of disabling the FL response in the Respironics machine? Would disabling or lowering the CFLEX help?

In my case, the CA's happen usually at the higher range but not always. I am not convinced spending $3000+ for an ST machine is the answer either especially since the machine is so new right now. In the past, I havent had much success with the 420e, predominantly due to it's noise.

[Snoredog]

Thanks again Snore Dog.

Since you and I have/had the same machine, is there any way of disabling the FL response in the Respironics machine? Would disabling or lowering the CFLEX help?

In my case, the CA's happen usually at the higher range but not always. I am not convinced spending $3000+ for an ST machine is the answer either especially since the machine is so new right now. In the past, I havent had much success with the 420e, predominantly due to it's noise.

No there is no way to disable the FL circuit on the Remstar or change the Command on Apnea setting, they are hard-coded in the algorithm, it is the reason I purchased another 420e to try. The Remstar uses a couple different settings, it uses 8cm depending on the event (Hypopnea or Apnea) and 12cm as a reset limit.

My first 420e (several years ago) died on the 2nd night of therapy so I really didn't get to play with those settings any to see the result. Finally, I decided to give it another try after learning how it responds.

Actually I find the 420e to be the quietest of the bunch, but I may have just gotten lucky and gotten a quiet one, I understand some are noisy, some are not:


Do you know if there is a pressure you reach where your central or mixed apnea start increasing in frequency? Mine was shown on my titration table and you could see why they stopped where they did. If you are like me it is below the 10cm threshold set by default and hard coded in these other machines. The 420e allows you to lower that setting to match your threshold.

[Sammy_J]

Do you know if there is a pressure you reach where your central or mixed apnea start increasing in frequency? Mine was shown on my titration table and you could see why they stopped where they did. If you are like me it is below the 10cm threshold set by default and hard coded in these other machines. The 420e allows you to lower that setting to match your threshold.

I have my pressure settings at 9.0 and 10. I will get the centrals at any time, usually above 9cm. I have the delay setting for 2 hours and I usually dont have many events during this time, then I peak around 9.5 to 10. It's at these times that the centrals will appear. Previously, I had the high limit at 11 or 12 and the centrals seems to be worse. From what I read, the respironics machine will go up .5 cm past the maximum setting. I havent seen it do so in a while.

[sleepyjane]

Sammy,

You have mentioned that you are using 9mg melatonin. i want to know how long you have been using it and whether such high quanity can be harmful in the long run, according to your doctors. I read in this forum that 0.3 mcg should be used with breaks.

I started using Melatonin when other sleep medicines like mirtazapine, trazadone etc. did not help me and I was pursuaded to use melatonin on the lengthy notes of Snore Dog from time to time. I am now using 1 mg (lingual) and am extremely satisfied with it as it is giving me more restful sleep. I am using 1 mg melatonin for last 15 days and wonder whether I could use it on a long term basis. Snoredog is of course using it for several years. I wish Snoredog could also comment on my condition and question, as I truly believe him to be a great man.

I read a book o melatonin and I remember it saying, it has been tested at very high amounts (hundreds of times the usual dose for quite some time with no ill effects) so I think 9 mg would probably be fine.

They suggest starting at 1 or 3 mg and then if that doesn't help, going up to 5 mg and so forth.

I did have a nephew that said he had insomnia and wokee up about 17 times a night and he slept straight through with melatonin but he said it caused headache and he topped taking it, so maybe that is a sign to watch for.

Another person I know also mentioned headaches...but maybe nephew had apnea and didn't know it as three people in my family had/have it??

[Snoredog]

I am now using 1 mg (lingual) and am extremely satisfied with it as it is giving me more restful sleep. I am using 1 mg melatonin for last 15 days and wonder whether I could use it on a long term basis. Snoredog is of course using it for several years. I wish Snoredog could also comment on my condition and question, as I truly believe him to be a great man.

thanks for the compliment but what is your condition and question I didn't answer?

I thought I had answered your question in the post below with the Mayo link on Melatonin?

But as I mentioned before, I have used melatonin long term for more than 15yrs straight, there have been a few weeks during that time I didn't use it. Speaking only for myself, I can honestly say I cannot pinpoint a single side effect from using it during that time other than making me fall asleep faster and stay asleep longer. I used it before ever being diagnosed with OSA.

If you compare apples to apples, melatonin has zero side effects compared to any prescription sleep medicine out there.

For me it wasn't too difficult to decide, look at the prescription medications you were once taking and go to their website and read the Prescribing Information and adverse side effects they carry as a byproduct. Many times the side effects are worse than the disorder they are meant to assist with.

Some sites make claims about melatonin I don't particularly agree with, all I know for me anyway it helps me fall asleep faster (I fight falling asleep) and once I am asleep it seems to help me from waking during the night.

As for why I need melatonin? I'm 6' 1", 205lbs, 50yrs old, on my original PSG in addition to classic OSA AHI=72hr, I had desats down to 65%, I had centrals, mixed apnea, snoring and spontaneous arousals of 27 per hour. Good thing I didn't have any RLS or PLMD or I'd be really screwed.

As for should you be taking melatonin long term? I cannot answer that for you or anyone.

That is your personal choice and not for me to decide. I can only tell you how it has worked for me and my experience with it, if you decide to use it, that is your decision and entirely up to you.

[Sammy_J]

Sammy,

You have mentioned that you are using 9mg melatonin. i want to know how long you have been using it and whether such high quanity can be harmful in the long run, according to your doctors. I read in this forum that 0.3 mcg should be used with breaks.

I started using Melatonin when other sleep medicines like mirtazapine, trazadone etc. did not help me and I was pursuaded to use melatonin on the lengthy notes of Snore Dog from time to time. I am now using 1 mg (lingual) and am extremely satisfied with it as it is giving me more restful sleep. I am using 1 mg melatonin for last 15 days and wonder whether I could use it on a long term basis. Snoredog is of course using it for several years. I wish Snoredog could also comment on my condition and question, as I truly believe him to be a great man.

I wasnt able to go to the health food store yesterday as I had a real nasty headache all day. I dunno if it was attributed to my centrals or my PLM.

The sublingual melatonin is 3 mg (milligrams) sublingual. The owner of vitamin place said the info regarding the maximum dosage is all over the place. However, he goes on to add that one expert suggested going no more than 9 mg while alot of people are saying it is ok to take 3-6 mg a day indefinitely. So, it looks like the maximum dosage is debatable. I will try 3mg and see how I do.

For RLS, I am switching from Magnesium Oxide 420mg (equivalent to 252 mg of elemental magnesium) to magnesium citrate (much more readily absorbed) of 150 mg. It is suggested to try taking 1 capsule 2x/day at breakfast and lunch and calcium at bedtime. I thought I read to take magnesium at bedtime. I don't know how I will fare with this low dosage especially since I had a rough night last night and my sheets were all over the place. Any comments or suggestions welcome.

[Sammy_J]

Today I visited my regular doctor. After some intervention from some key people in Boston, he now admits that he "does not disagree that I have Comp SA (Complex Sleep Apnea)". My sleep results previously posted here do indicate Comp SA.

The new information he has received is causing him to rethink the pathophysiology of OSA. Unfortunately, my sleep doc is still stuck in the dinasour age.

Until we get a treatment, my regular doc's suggestion is to add dead space to my tubing or adjusting the flow rate of the mask. Also SSRI's for breathing.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): tubing

[cohodependent]

I am a bit confused. Are you saying you have complex SA based on the study that you posted? It looks pretty good to me. You had only one Central event and 4 Mixed events with an AHI of 2.9 for the night. Your sats look good as well.

I may have missed it, but are you getting more data from you home device that leads you to belive you have more central and mixed events than what was shown on your study?

Based on the results of your study I would suspect that your 1 central event was probably a "Post-Arrousal" central and your 4 mixed events were probably along the same line. When I do a titration I would be very happy for an AHI of less than 3.0. Folks with true Complex Sleep Apnea are a nightmare to titrate and often require more than one PSG to get it done. Some times several.

One thing I wonder about is your leg activity. In my lab we titrate for PLM's. I find that a lot of PLM activity is related to Upper Airway Resistance Synd.(UARS) and an increase in pressure can get rid of them, but not always. I would not advocate attempting to treat them at home, it is some thing that is best done while doing a full PSG as you can make things worse if you get too much pressure going...

[Sammy_J]

cohodependent, I am not saying it, but I have suspected. Now my doctor and some researchers and specialists have analysed in greater detail my PSG. They don't disagree that I have Comp SA. The short short duration of events, the dominance of mixed and central events, a lack of a clear REM dominance and overall very mild desaturations. In addition, present sleep studies do nothing to measure CO2 levels which is also a factor I was told. To reinforce this, I have sent in my in-home results as well for review.

My sleep doc was NOT concerned with my PLM , even though, as you can see it is quite high. People who suffer from anxiety (cause and effect relationship) from untreated or poorly treated (Comp SA) OSA can also develop PLM.

It's interesting, you mention that you would be happy with an AHI of < 3 (that is never the case with me at home, except one time) but it seems that most posters here report an AHI of < 1 while on xPAP.

The problem with Centrals and Comp Apnea is that even though my titrated pressure was 11 (sleep doc says it can go to 12) the tech wouldnt/couldnt go that far because of the centrals occuring with the increase in pressure. So, the consequence of the higher [prescribed] pressure is centrals.