The Ambien effect-in graphs

[OutaSync]

oh no unless you have a chronic falling asleep problem you can use a natrual method

try melatonin its natural and imo more effective than ambien

preferebly a liquid or chewable tablet of it

works wonders

Thanks, Lewis, but I have been using melatonin, 3mg, for over a year and it doesn't do any good, as far as I can tell. I have also tried the kind that you spray under the tongue - no effect whatsoever.

[-SWS]

I guess SOREMPs are not uncommon for obstructive sleep apnea patients after all: SOREMPs in Obstructive Sleep Apnea.

Next I'll Google for the possibility of dogaplexy in obstructive sleep apnea. I know cataplexy is an exclusive feature of narcolepsy...

[riverdreamer]

In regards to the cortisol, the best is a 24 salivary panel. You collect at 5 different times during the day. However, there is another test that is also important, that shows the precursers and down-stream metabolites to cortisol, as well as the sex hormones. You would especially want to look at DHEA (converts to cortisol as well as other hormones) testosterone, and the various estrogens. This test is a 24 urine test, and comes with good info on how to interpret and correct imbalances, as many of the doctors do not understand them.

Both tests come as kits, as long as the doctor would be willing to sign off on them, you can collect samples at home. If you are interested I can get you the name of the labs. I can't remember them off the top of my head. Chronic fatigue patients very commonly show a phase shift in their cortisol levels, with high levels at night and late evening, when it should be lower, and very low levels in the morning, when it should be rising to help waking. It is rarely one hormone that is off, usually one is too high, and another too low. Seeing the whole picture gives the best idea on where to intervene. Most endocrinologists are not into this kind of detail. You need to ask around to find someone who understands it.

I can tell you, from experience, that correcting the levels can significantly help with sleep.

[StillAnotherGuest]

. . . and admitted to cataplexy. . . .

If you are referring to the older thread, which I may be misreading, that admission may have been clarified/retracted later:

viewtopic.php?f=1&t=35298&st=0&sk=t&sd= ... 00#p306114

viewtopic.php?f=1&t=35298&st=0&sk=t&sd= ... 15#p306241

Can you be a little more specific? I do not see where this comment

I do have what I assume is anxiety attacks where I get a rush of adrenaline and feel weak all over... sometimes I'm so tired I can't move

has been properly addressed, so, given all of the other symptomology, I believe cataplexy is still very much on the table.

In regards to the cortisol, the best is a 24 salivary panel. You collect at 5 different times during the day. However, there is another test that is also important, that shows the precursers and down-stream metabolites to cortisol, as well as the sex hormones. You would especially want to look at DHEA (converts to cortisol as well as other hormones) testosterone, and the various estrogens. This test is a 24 urine test, and comes with good info on how to interpret and correct imbalances, as many of the doctors do not understand them.

Both tests come as kits, as long as the doctor would be willing to sign off on them, you can collect samples at home. If you are interested I can get you the name of the labs. I can't remember them off the top of my head. Chronic fatigue patients very commonly show a phase shift in their cortisol levels, with high levels at night and late evening, when it should be lower, and very low levels in the morning, when it should be rising to help waking. It is rarely one hormone that is off, usually one is too high, and another too low. Seeing the whole picture gives the best idea on where to intervene. Most endocrinologists are not into this kind of detail. You need to ask around to find someone who understands it.

I can tell you, from experience, that correcting the levels can significantly help with sleep.

Virginia Hopkins has that stuff, but I can't vouch for any of those mail order outfits. I don't know if an accurate cortisol profile can be done with 5 tests (I think looking closely at the nighttime area there would be important. And can you simultaneously accurately measure sleep?)

Cortisol kit(s), an All-In-One, and all the rest of this stuff is going to be a ton of $$$, so

What are you looking for here? What are you going to do with the information?

BTW, since a lot has changed, what's the current assessment of those "weakness" events, your Epworth Sleepiness Scale, and overall feeling of tiredness?

SAG

[StillAnotherGuest]

I guess SOREMPs are not uncommon for obstructive sleep apnea patients after all: SOREMPs in Obstructive Sleep Apnea.

OK, but keep in mind that the MSLT must be analyzed in conjunction with the previous night's NPSG. Any time there is train-wreck architecture on NPSG, SOREMs on MSLT are not indicative of anything.

SAG

BTW, I'm tired of being SAG. I think at 999 posts I'm going to become somebody else.

Maybe Muffy.

[-SWS]

What are you looking for here? What are you going to do with the information?

I would be looking for out-of-tolerance cortisol readings since some of Bev's outstanding symptomology correlates with.... out-of-tolerance cortisol levels.

And if out-of-tolerance cortisol levels are discovered, you might even suspect that correcting them just may yield health and/or sleep improvements of all things:

I can tell you, from experience, that correcting the levels can significantly help with sleep.

Curious why a patient who almost never falls asleep during the day should exclusively focus on a narcolepsy test and avoid a cortisol test---or any other test that also happens to correlate with symptoms. There are plenty of dysregulated-cortisol presentations short of Cushings.

[StillAnotherGuest]

What are you looking for here? What are you going to do with the information?

I would be looking for out-of-tolerance cortisol readings since some of Bev's outstanding symptomology correlates with.... out-of-tolerance cortisol levels of all things.

OK, let's say they're "out-of-tolerance level".

Now what?

MAG (we're going to slowly transition over)

[-SWS]

Focused differential diagnosis continues.

Curious why a patient who almost never falls asleep during the day should exclusively focus on a narcolepsy test and avoid a cortisol test---or any other test that also happens to correlate with symptoms. There are plenty of dysregulated-cortisol presentations short of Cushings.

[StillAnotherGuest]

[Jeopardy theme playing in background]

[-SWS]

LOL...

My answer about differential diagnosis and its methodical process of exclusions/inclusions is in the post above the jeopardy music---which is now waiting for you.

[StillAnotherGuest]

LOL! Right! Should've seen the "Somebody just posted" message!

Gotta run tho, see you tonite.

Suffy

[-SWS]

In regards to the cortisol, the best is a 24 salivary panel. You collect at 5 different times during the day. However, there is another test that is also important, that shows the precursers and down-stream metabolites to cortisol, as well as the sex hormones. You would especially want to look at DHEA (converts to cortisol as well as other hormones) testosterone, and the various estrogens. This test is a 24 urine test, and comes with good info on how to interpret and correct imbalances, as many of the doctors do not understand them.

Both tests come as kits, as long as the doctor would be willing to sign off on them, you can collect samples at home. If you are interested I can get you the name of the labs. I can't remember them off the top of my head. Chronic fatigue patients very commonly show a phase shift in their cortisol levels, with high levels at night and late evening, when it should be lower, and very low levels in the morning, when it should be rising to help waking. It is rarely one hormone that is off, usually one is too high, and another too low. Seeing the whole picture gives the best idea on where to intervene. Most endocrinologists are not into this kind of detail. You need to ask around to find someone who understands it.

I can tell you, from experience, that correcting the levels can significantly help with sleep.

Riverdreamer, thanks for that beautifully detailed post. Do you per chance know if that cortisol phase shift was observed in patients who happened to generally manifest chronic fatigue? Or was that phase shift referring to patients who were formally diagnosed with the disorder known as Chronic Fatigue Syndrome?

Again thanks for that post!

[-SWS]

BTW, since a lot has changed, what's the current assessment of those "weakness" events, your Epworth Sleepiness Scale, and overall feeling of tiredness?

I didn't want this question for Bev to get lost in the conversational shuffle.

[OutaSync]

[quote="StillAnotherGuest BTW, since a lot has changed, what's the current assessment of those "weakness" events, your Epworth Sleepiness Scale, and overall feeling of tiredness?

SAG[/quote]

Thinking back to December, I haven't had any times where I was too tired to move. And I mean when I was sitting up, totally aware of everything going on but unable to move. I think I'm much better than I was a year ago, or even last fall, but I'm not sure that I'm any better than pre-APAP. That first year on APAP just about did me in. It was hard enough sleeping without all this stuff on my face. On nights I wake up 4 or 5 times I feel better than on nights I wake up 10 to 15 times.

Riverdreamer,
I've PM'd you. I've read about adrenal fatigue. I think low DHEA and high cortisol are clues to something and I'm interested in any information you might have.

-SWS,
As always, I appreciate your investigational abilities.

SAG, Muffy, Suffy ??
Are you having an identity crisis? I like "SAG". It has history.

Bev

[riverdreamer]

In regards to the cortisol, the best is a 24 salivary panel. You collect at 5 different times during the day.

Virginia Hopkins has that stuff, but I can't vouch for any of those mail order outfits. I don't know if an accurate cortisol profile can be done with 5 tests (I think looking closely at the nighttime area there would be important. And can you simultaneously accurately measure sleep?)

Cortisol kit(s), an All-In-One, and all the rest of this stuff is going to be a ton of $$$, so

What are you looking for here? What are you going to do with the information?

SAG

I understand the reservations. The 24 hour salivary cortisol kit measures at midnight and again at 7 AM. There is a known expected curve, so if the cortisol is rising at 12 midnight, you could expect it to be off the rest of the night. But you won't be testing all night. Plus, I doubt they have expected ranges for the entire night. But you can see a pattern, and also what the total cortisol burden is.

One possible cause of the phase shift in cortisol is blood sugar issues. If blood sugar is bouncing between very high levels and very low levels, or just staying very low, you have jolts of cortisol. When the blood sugar levels go so low that the body feels threatened, the adrenals will release cortisol, which stimulates the pancreas to release glucagon.

Glucagon is an important hormone involved in carbohydrate metabolism. Produced by the pancreas, it is released when the glucose level in the blood is low (hypoglycemia), causing the liver to convert stored glycogen into glucose and release it into the bloodstream.

Wikipedia

So, first the blood sugar goes low, you get a jolt of cortisol (possibly causing panic symptoms, elevated heart rate, sweating, and arousal), and then you may be wide awake, wondering what happened, and why you are in a panic. This is most common in the early hours, between 2 and 5 in the morning. There may be repeating cycles, as the blood sugar rises, maybe too high, insulin comes on the job, but overshoots and brings it too low, and you are back to releasing cortisol. Diabetics call it the dawn effect. They will show very high morning blood sugar, when they otherwise believe their blood sugar is in control, because they can't maintain control during the night. Regulating blood sugar through diet, exercise, and medication, when necessary, will change that. This was one of my issues, though I am hypoglycemic, not diabetic. For months I had to eat protein before sleeping, and kept nuts and cheese by my bed to eat when I woke at night. Eventually my body was more in balance, and I could eat normally, but still have to be sure I don't go too long without food.

There are lots of other reasons for phase shifted cortisol. Inflammation, caused by infection or immune dysfunction, is another possibility. Cortisol can lower inflammation, so it starts as the body's attempt to help. However, if the inflammation goes on long term, everything becomes more unbalanced. They are finding more illnesses have inflammation as a component. Heart disease, high blood pressure, diabetes, and auto-immune disorders are just some of the illnesses shown to correlate with inflammation. Cortisol keeps rising in an attempt to bring the inflammation down. If pushed too hard, for too long, the adrenals may crash, and cortisol becomes chronically low..

Other possible issues could be total hormone imbalance, which might require supplementation and/or help with ridding the body of excessive hormone levels or partial metabolites. Sometimes a high cortisol level is due to another hormone being too low. DHEA and testosterone are likely candidates. Even women require small quantities of testosterone. Or maybe estrogen levels are too high. This is seen more and more with the large quantities of estrogen mimics in our water, air, and food. These chemicals are close enough to estrogen in chemistry, that they may block estrogen from binding to the receptors, leaving excess estrogen floating in the bloodstream, but not really doing the job estrogen is supposed to. Also, due to poor diets, some cannot rid the body of the estrogen once it has been used, and broken down into more toxic metabolites. Excess estrogen is a strong cause of body inflammation. Inflammation raise cortisol. As with all hormones, you have to have just enough. Too much is as bad as not enough.

There are lots of ways these imbalances can show up in people. It really requires an experienced doctor to help out with it. Unfortunately, endocrinologists, which is who you would expect to know, often do not have a clue. Many only focus on one aspect of hormone balance, like working with diabetics to balance insulin (another source of inflammation.) They do not always realize the impact it has on cortisol. So, just as with sleep apnea, you have to hunt down someone who knows what they are doing, and how to put it all together.

Didn't mean to preach! This is just an area dear to my heart. I am not a physician, but have a lot of general exposure to this info in my work. I have the broad picture, but not necessarily all the details. Enough, though, to bring it up as a possible cause for Bev's issues, or at least a contributor.