Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

[carbonman]

neighborhood-sourced sensory intrusions while trying to sleep

Although, personally, I can't sanction XM-214 therapy.

Still haven't figured out billing codes...

In my experience w/neighborhood-sourced sensory intrusions,
I have come very close to administering XM-214 therapy.

....and I didn't care if was in or out of network....

....and didn't need no stink'n billing codes....

...I would glady go out of pocket.


PS SWS, are you spinning for the current administration?
If not, you should be.

[-SWS]

Carbonman, I tend to resonate with rooster's characterization of our current two-party system:

In barnyard terms, two wings of the same chicken.

Politics... now there's another source of cognitive hyper-arousability. Superb leadership from either of those two parties trumps typical party-line mediocrity any day IMHO. But this thread is supposed to be about Jan. Thus back on topic...

Jan mentioned she is well-known in her community newspaper for impassioned political letters, reflecting views ranging anywhere between those of politically liberal and conservative---very often expressing human-rights oriented views. So here we have the two-winged barnyard chicken theory very neatly converging with the hyper-cognitive impassioned-trait theory.


I would also point out that for any given disorder, symptomology is seldom comprehensive or universal across that affected patient population----with patients typically manifesting somewhat unique subsets of symptoms. And for any given trait or symptomatic expression, there are typically correlations to multiple root-sources or disordered conditions in pathology, making the backward-correlation to any one of those candidate conditions ambiguous.

But my understanding is that a hyper-cognitive arousability trait can be largely or otherwise entirely asymptomatic in the general population. That's not to say that same hyper-cognitive arousability trait lacks a significantly heightened correlation with pathology in general. Personality Type A, as just one similar correlative example, is thought to be associated with heightened risk of heart attack. And yet, the majority of Personality A types do not have heart attacks. Yet, the correlation is considered worth noting and symptomatically factoring.

[kteague]

About the tendency toward extending a task beyond reasonable efforts... that almost compulsiveness was my first sign of Mirapex causing a problem. I was out of town visiting the grandchildren and wanted to do a craft project with them one afternoon. Little did I know I would be building memories of the wrong kind. They were done with their projects within an hour or so, but mine, I continued working on it despite their pleas of being hungry - till their bedtime, then fixed them a pitiful excuse for a meal and went back to work. Stopped at 5am then slept all morning when I should have been spending precious time with the kids. Had no idea the med was to blame. Also had started biting my nails till there was nothing left so then bit down the skin around the nails. Seemed to have an inability to stop many behaviors once the wheels were in motion, including eating and thrift shopping (my version of gambling - can I spend little and get much?).

One day I had a snag on my fingernail and when looking for a file, realized I hadn't seen one in a few years - any snags had been removed with my teeth. The light bulb came on for me - I had 1/4 inch fingernails and it hadn't crossed my mind to bite them. I had little interest in thrift shopping, and every meal wasn't a marathon. It had been the Mirapex!!!! I am seeing just hints of old tendencies on Requip, along with occasional awareness of limb movements, which is why I'm willing to deal with the PLMD not being totally resolved rather than increase the dose. I think I'm at my ceiling for tolerance.

When meds can cause such effects, how in the world can a meaningful evaluation of a person's issues be possible? Seems carefully weaning off meds and methodically starting over is about the only way to be sure of anything.

[SaltLakeJan]

Mornin' Muffy, Riverdreamer, and Kteague
The input is in the stratosphere, i'm spending some time at an on-line dictionary. then I understand your comments about ritalin & why Idid not feel at well while taking it. After I started told Dr not feel normal. Dr. said I wd get used to it. I didn't, I also did not consult him re: stopping it. while using it my BP fluctuate up & down. Down as low as 90's & low 100's, & up to 160. BP current range 135-122.

In addition, all of the confounders would have to be accounted for in SLJ, including the effect of SDB (which can create tons of HRV) and medications, like irbesartan (BP down) and methylphenidate (BP up).

.

Re HRV, took Heart Rate Summary to Cardiologist (I see him for yearly stress test) He sd heart rates on 12-2008 sleep tests not accurate based on his stress test figures for about 5 years.)

It seems like methylphenidate would create nothing but problems. High blood pressure and insomnia are darn near absolute contraindications for methylphenidate, so I think that was a bad idea from square one. Yes, I see where you stopped that.

I checked Ritalin on Internet before I stopped. FDA is considering Black Box Warning. I am currently using 1.5 mg Lunesta. Sleep greatly improved after stopping Ritalin.

Dr who prescribed Mirapex was trying to improve my sleep. Asked if movement of legs hindered sleep onset. (Yes, it did) He advise take Lyrica & Mirapex at 6 pm. Never have taken it in the a.m

Appreciate the reminder for Magnesium. Have taken it for years (Fibromyalgia) Bottle ran out, forgot to pick up another.

My sleep titration scheduled 6-7-09. Got message fm Dr. bring F&Paykel unit and my mask. He wants me to use familiar equipment in test.(I have to verify he wants unit there. I can understand mask, but have a question re using my unit. I don't recall ever seeing a unit in sleeping room)

I want to eliminate or reduce any of my prescriptions that I can. I have prescriptions for those I list here. Could possibly get something else from doctor.

I have reduced opeprazole to 1 20 mg. Results seem about the same, am more careful what I eat.
I have to keep Metiformin, Avalide, Vitorin the same.

these are the two I can reduce.
I have a bottle of 75 Mg of Lyrica. Dr had increased dose just after I refilled it.
I will cut a Mirapex in half tonight, and see if leg movement increased.
I have reduced Lunesta to 1.5 mg. When I cut it to 1 mg. I can't sleep. New Sleep Doc. has no problems with 1.5

I DON'T KNOW WHAT TO TAKE TO HELP ME SLEEP AT SLEEP STUDY.
I AM CONSIDERING A 3MG LUNESTA, OR STAY WITH 1.5 MG. I want to be able to sleep under strange circumstances, not to alter the results. Any suggestions how I accomplish both results. I have sample bottle of Ultram. Used it once, felt drugged next day. Never used again.

I have back complications when I sleep on a strange mattress. Back hurt on saggy mattress on 12-2008 sleep study. Could any of limb movements in 12-2008 sleep study be related to me moving in my sleep to relieve back pain.


My most recent labs are dated 12-10-2008. WBC 4.5, RBC 4.47, HGB 12.5, Hct 38.1, MCV 82.5, MCH 28.0, McHc 32.8. There isn't a TICA or Ferritin test included in the rest of the CBX With DIFF. I called Sleep Dr, he made a note to schedule Ferritin test.

Is it possible, my internist schedule sleep study 9-2001, after 3-2000 tests, at different lab, because he either distrusted results, or wanted to verify results?

SWS, Interesting article re: gifted children. I was considered a gifted child, received special consideration through elementary. Can't say if having sustained focus is hyperfocus. After sleeping in a dark room in 12-2008 sleep study, I realized I could change two factors in our bedroom. We had new drapes made with black-out linings. That has worked well. We had extra insulation added in the walls & ceilings, & I don't notice as much noise.

Muffy, thanks for your brain power.
Jan

[-SWS]

SWS, Interesting article re: gifted children. I was considered a gifted child, received special consideration through elementary.

That's interesting, Jan. That was my guess.

Can't say if having sustained focus is hyperfocus.

In light of what you said above, your description of being completely absorbed in certain tasks sounds like "flow experiences" typical of a gifted personality---even well into adulthood. However, that same personality type very often presents what Dabrowski and his followers refer to as "overexcitability":
http://scholar.google.com/scholar?hl=en ... a=N&tab=ws

And once again, that speaks of a certain cognitive arousability that can supposedly be counterproductive to the wake-to-sleep transition itself. I'll also point out that researcher Barry Krakow MD has an interesting and related theory going regarding intelligence and insomnia:
http://sleepdynamictherapy.com/2008/01/ ... -patients/

Remember the Alamo dressing.

Dr. Krakow's Albuquerque-based sleep centers are located very close to the Los Alamos and Sandia national research laboratories. So he should theoretically have a large pool of really bright insomniacs to research.

Here's that HSP screening survey I mentioned earlier when discussing OutaSync's fatigue that is disproportionate with her residual AHI:
http://www.hsperson.com/pages/test.htm

[SaltLakeJan]

KTeague,
Hi Kathy, great story about the grandkids. They will be telling that for years. A lot more than you might want to hear. & Re; your first post about PLM. You really reacted to that drug. I'm glad I reduced my mg, but I have begun to think something like that, might occur at any mg. I regret you had to go through something so traumatic, & still have the lingering effects. However, when you post the details of your ordeal you help everone who uses Mirapex to understand the insidious nature of the drug.

Last Christmas, I wondered if I was being compulsive re: my Christmas Shopping. Because of the economy, I had thoughts that the economy might continue to sink, & who knew what was in our future? Would we having difficulty buying food in another year? Scary thoughts, but I had a suspicion that gift buying might have slipped into compulsivity. Since titrating Mirapex down, that feeling has left. I have been prescribed some crazy drugs, & I am suspicious of the side effects of any drug

Jan

[GrumpyGurl]

[quote="-SWS"]: So here we have the two-winged barnyard chicken theory very neatly converging with the hyper-cognitive impassioned-trait theory. [quote]

I am way too sleep deprived to try to figure this post out. Ya'll just wait until I am myself again!

[-SWS]

I am way too sleep deprived to try to figure this post out. Ya'll just wait until I am myself again!

Sorry about that!

That was just a feeble attempt by me to humorously tie two disparate conversations together: disappointment with our two main political parties (two wings of the same chicken) with Jan's apparent cognitive arousability, that some researchers believe is typical of her gifted personality.

At the time I wrote that, it seemed funny. But I now have serious and verrrrrry repentant doubts...

The important thing is that it might have been funny had I only used completely different words paired with an entirely different topic.

[robertmarilyn]

I am way too sleep deprived to try to figure this post out. Ya'll just wait until I am myself again!

Sorry about that!
That was just a feeble attempt by me to humorously tie two disparate conversations together: disappointment with our two main political parties (two wings of the same chicken) with Jan's apparent cognitive arousability, that some researchers believe is typical of her gifted personality.
At the time I wrote that, it seemed funny. But I now have serious and verrrrrry repentant doubts...
The important thing is that it might have been funny had I only used completely different words paired with an entirely different topic.

Oh no! I thought that it was funny and still do

BTW, -SWS mentioned

And once again, that speaks of a certain cognitive arousability that can supposedly be counterproductive to the wake-to-sleep transition itself. I'll also point out that researcher Barry Krakow MD has an interesting and related theory going regarding intelligence and insomnia:
http://sleepdynamictherapy.com/2008/01/ ... -patients/

and I went to that link and then continued to look at the rest of what Dr Krakow had to say and I want to know "Why does he keep talking about me"

Unlike Jan, I seem to have lived an almost spartan life when it has come to taking drugs. I'm on 3 allergy meds (and none of them are known to cause any kind of unwanted behavior...I guess I'm the only thing to blame for my unwanted behavior) , 1 thyroid med, and now 1 antiacid med. But I was in gifted programs all the way through high school and have always known I "think too much".

I think Dr Krakow has hit on a lot of interesting theories concerning our minds and various aspects of sleep apnea. It is NOT a black and white problem (including the subject of apneas, hypopneas, and UARS and how important each of them can be in accessing our sleep apnea situation) . So much interesting information in the book and on that web site

mar

[SaltLakeJan]

SWS,
I considered it amusing. at least the chicken had two wings.

That was just a feeble attempt by me to humorously tie two disparate conversations together: disappointment with our two main political parties (two wings of the same chicken) with Jan's apparent cognitive arousability, that some researchers believe is typical of her gifted personality.

How could I not agree with your

disappointment with our two main political parties

And, oh yes DH says I have all the good qualities of a Type A personality. He might feel he has to add the "good qualities part."

The next time I am at the mall, I'll pick up Dr. Krakow's book. I read topics that sounded like suspiciously like they related to my behaviors.

The excitable one.

[Muffy]

Chapter 3

He advise take Lyrica & Mirapex at 6 pm. Never have taken it in the a.m

OK, great, this line from May 10th (apparently a tech note) had led me to believe that that wasn't the case:

#5, There is no evidence of periodic leg movement syndrone. Of note is the patient does take Mirapex but often uses it during the day...

Re HRV, took Heart Rate Summary to Cardiologist (I see him for yearly stress test) He sd heart rates on 12-2008 sleep tests not accurate based on his stress test figures for about 5 years.)

I believe he was referring to the minimum HR of 16 and maximum HR of 150 as being artifact. The HR graph could overall have been accurate (post it if you have it).

Heart rate variation (HRV) is something a little different. It refers to the accelerating and decelerating of the HR during such things as a single breath, or a respiratory event such as an apnea. If you graph this value, it looks like the waveform in channel 2:



In this example, the HR slows during apnea, then speeds up during resumption of breathing. This is the concept of "autonomic arousal".

I DON'T KNOW WHAT TO TAKE TO HELP ME SLEEP AT SLEEP STUDY.
I AM CONSIDERING A 3MG LUNESTA, OR STAY WITH 1.5 MG. I want to be able to sleep under strange circumstances, not to alter the results. Any suggestions how I accomplish both results.

I think you should get the physician to rule on that.

Muffy

[Muffy]

Chapter 16

. . . I thought I would take one consideration off the table. Some place, somewhere, depression was mentioned in connectiion with one of the many conditions that have been hypothized. I am not the goody, goody sickly sweet type, but I have a pleasant dispositon. My on-going health problems have not depressed me. They have been a part of the ups and downs that occur in life. . . .

I can understand taking that off the table, but I would like to react to it, not so much for you, SLJ, but for the lurkers.

It is my understanding that some benefit greatly from treatments generally considered "treatments for depression" even though they do not feel "sad" in the traditional sense. The following article is paticularly about the elderly, and I don't 100% agree with some of the details in it, but it makes the point, for any who might be reading this thread:

http://www.aafp.org/afp/990901ap/820.html

Pertinent comment there, jnk.

Muffy would also ask why Effexor was "on the table" back in 2000.

Insomnia, sleep apnea, and the myriad of medications; fibromyalgia (do you have the diagnostic report that says you truly have FBM? Muffy doubts everything. Probably because she's psychotic) as well as at least somebody thinking that at least at some point that depression was on the table would encourage getting at least one "clean" (sans sleep-altering medications) NPSG to try to really see what your sleep looks like. However, suddenly pulling out the eszopiclone would probably create it's share of issues.

Which is why you should call up NOW and ask, "What medications should I be on and how much should I take for the NPSG?", lest you wipe out your REM again and then people think, "Oh yeah, maybe we should have..."

On Sleep And Depression

Muffy

[SaltLakeJan]

Hi Muffy,

It has been quiet in the desert as far as computer work, but it's busy in my garden. Recent visits to nurseries and Home Depot has been europhic. There is a booming business in plant sales, I had a long wait in each line. No evidence of a recession in garden sales.
I have a love of plants in my genes. I bought lots of annuals for quick color, until the perennials bloom, they are the star performers.I like photographing them almost as much as growing them. Don recently came home and saw me lying on the ground in the back yard. He thought something had happened to me. Actually it had, I was getting the best angle for photos of late blooming tulips.

That was a nice interlude, but back the post, it gives me immense relief to have you and SWS probing for answers to my situation.
It is a condrum for you, trying to recreate something when parts are missing. I know from reading Bleeping Beauty and OuttaSinc's extensive posts, that people with similar problems will be following this post for years.

You asked if I had a definitive diagnosis of Fibromyalgia. I was diagnosed the way most are still diagnosed with Fibromyalgia. I went to rheumatologist, two internists who said I had Fibro. I finally found an internist with a sub-speciality of Fibro. He did extensive tests, to rule out other conditions, observed my physical symptoms, muscle spasms, fatigue, on & on. He gave me a firm diagnosis of Fibromyalgia. In my interaction with over 500 women in our Fibromyalgia Educational group, we had similar symptoms, varying in degree. I had a good relationship with the doctor. He had me speak at several conferences on Living with Fibro. His body/mind work with chronic pain illnesses brought Herbert Benson to Salt Lake for a major convention, I spoke at that meeting and participated on one of Jon Kabot-Zinn's workshops.

I would be interested in your reaction to one of my techniques in dealing with the effects of Fibro - it was distraction. Going out with friends,
I could still do some gardening & similar ways of body/mind practices that relieved me. My work was interesting. I could have spent a night interrupted with muscle spasms, pain, etc, but go to work, get envolved in problem solving with other government entities, & largely forget how miserable I felt. I wasn't as successful with bouts of more severe fatigue.

The doctor prescribed Effexor, Clonazepan, Neurontin, and later Lyrica on an "off label" effort to combat the symptoms of Fibro. It was a vain effort.

I have again LMTC to my new sleep doctor re: what medications I should be taking pre titration. He hasn't been in the office. I also have developed sores in my nares again. I haven't used CPAP for 3 nights. I missed the calming/semi-hypnotic effect of Positive Pressure breathing. I think it the PPB occupies my mind. I also want to stop taking 1 1/2 mg of Escpicone. Every time I reduce it to 1 mg, I don't sleep well. Could it be psychological that 1/2 mg. makes a difference between good sleep and off/on sleep. I am not going to do anything further until the Sleep Study. I don't want to stir up a bout of insomnia. As an experiment, after Titration, I plan to run a 10 days string of alternate days of moderate exercise, hopefully to feel tired enough to sleep without Escpicone.

I read the depression material. It would probably take a professional to analyze and decide if I had depression lurking somewhere. I enjoy my DH, our 3 "blasted" kids married & their jobs are not here. But we have a good relationship with them. Most of my friends are interesting, witty people. In person and in phone calls we have a lot of fun. I look forward to my on-going projects. In thinking about it, I do find joy and happiness in every day.
However, I was beyond frustration when I began Cpap in January. When I brought my Cpap equipment home and tried it the first night, I felt despair and kinda panic. I needed/wanted it to succeed. By accident, (if there are such things) I found Cpaptalk.com that day or the next. The relief was enormous, I knew I could find information here that would help. That could be classified as a depressive period. I wasn't in despair when I began this post about the difficulties of CPAP & UPPP. I was worried/troubled until you & SWS intervened. Someone else would have to tell me if I experienced depression. I have a good example. My Mother was 79 when she died. She had an unhappy marriage, but she moved on & found a happier life. Until seven day before she departed, that spunky woman's enterprises kept her busy - at times she tell me, "Janie, I can give you five minutes for a phone call, then I've got to get back."

It seems Muffy, I owe you an apology.

SaltLakeJan wrote:
He advise take Lyrica & Mirapex at 6 pm. Never have taken it in the a.m
OK, great, this line from May 10th (apparently a tech note) had led me to believe that that wasn't the case:

SaltLakeJan wrote:
#5, There is no evidence of periodic leg movement syndrone. Of note is the patient does take Mirapex but often uses it during the day...

My new computer was dumping posts. & after I had written #5, the screen began quivering - the sign it was going to dump. I hurriedly submitted planning to write that #5 was a inaccurate statement. Unfortunately, I forgot.

SWS, I will post re" article Insomnia and Depression. I'm giving it a lot of thought as I plant my annuals.

[Muffy]

Chapter 23

Recent visits to nurseries and Home Depot has been europhic.

What's a europh?

It is a condrum for you...

Thanks, but Muffy don't need no condrums. She's spayed.

The doctor prescribed Effexor...

Insomnia is a very common side effect of Effexor, with the incidence at over 20%. Indeed, in

An Open Clinical Trial of Venlafaxine Treatment of Fibromyalgia

Eleven subjects (73%) completed the venlafaxine trial... The most common side effects reported by completers were insomnia (n=9)

While

Most patients completing the study reported an improved quality of sleep, an increased feeling of restfulness upon awakening, a decrease in daytime fatigue, decrease in pain and morning stiffness, and an improved global assessment of the fibromyalgia, as well as a significant improvement in their quality of life

it is also noted that

Hudson et al. have suggested that fibromyalgia is one of the "Affective Spectrum Disorders," a group of medical, neurological, and psychiatric disorders that share a high comorbidity with depression and other affective spectrum disorders, and responds to antidepressant treatment. In support of this hypothesis, 7 subjects (47%) reported other comorbid affective spectrum disorders (migraine, irritable bowel syndrome, and chronic fatigue syndrome). Furthermore, lifetime history of Axis I psychiatric disorders, in particular depressive and anxiety disorders, were common and predicted response of fibromyalgia symptoms to venlafaxine. Although the lack of correlation of current Axis I disorders with treatment response may be attributable to sample size, Hudson et al. have noted that fibromyalgia patients more often present with a lifetime history of affective disorders than with current disorders. The findings from this study underscore the importance of assessing for lifetime psychiatric disorders when evaluating patients with fibromyalgia.

which would make one wonder if only those FBM patients with concommitant psychiatric disorder will be responders. But then these guys noted

Given the high comorbidity of depression with fibromyalgia, one might speculate that venlafaxine has exerted its effect by alleviating psychological distress. This proved to be untrue in our study group where changes in the pain and FIQ scores were not correlated with the changes in the anxiety or depression scores.

in

Venlafaxine Treatment of Fibromyalgia

I also want to stop taking 1 1/2 mg of Escpicone. Every time I reduce it to 1 mg, I don't sleep well. Could it be psychological that 1/2 mg. makes a difference between good sleep and off/on sleep.

While long-term use of pharmacological sleep aids is generally not recommended, there is some data on that:

Sustained efficacy of eszopiclone over 6 months of nightly treatment

It seems Muffy, I owe you an apology.

No you don't.

Muffy

[robertmarilyn]

Chapter 23

Recent visits to nurseries and Home Depot has been europhic.

What's a europh?

I think she meant euphoric.

It is a condrum for you...

Thanks, but Muffy don't need no condrums. She's spayed.

But Muffy, you are only 19...you are too young to be spayed.

mar