CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[SleepingUgly]

I'm not sure if Muffy also put a placeholder on my questions...

Sort of.

Muffy just gets a little nervous when she thinks she sees another setup coming.

What kind of setup??? And what first setup that this is "another" setup?? I'm just trying to understand this.

Sleep instability begets respiratory instability.

Could you please explain sleep instability and what causes it, if not PLMS?

Thanks, Girlfriend.

[echo]

They should use this instead of the MWT!

A complement never felt so good... NOT!

just responding to kathy and SU's comment that our explanations are confusing (actually mine are great, yours are confusing).

A complement never felt so good... NOT!

I did that in honor of Echo's return to our message board.

Oh these discussions are ALWAYS confusing even if you all (magically) manage to agree on one thing.

Nevertheless, getting back to the topic on hand, I love how complex the human body is, but it's so annoying (as a patient, or sufferer of some maladies) that 'modern medicine' is still only about recognizing some fixed set of patterns and allocating patients into categories for treatment,.... rather than taking a deeper look into what might possibly be going on once they have been categorized, tick-the-box we're done with you. And the more complex interactions there are (other diseases, other 'sleep issues', hypersensitivity, PLMD, GERD, complex apnea, periodic breathing or whatever), the harder it is to find a (set of) solution(s) that solve the problem. I think it's great that a CPAP or APAP can successfully treat, let's say 95%, of patients with OSA, but what about that remaining % (maybe 5%, possibly less, possibly more, i just pulled that number out of my nose), that are 100% compliant, the OSA is well-treated, yet we're still 'feeling tired'. Actually sorry that was NOT the topic on hand. /END RANT.

blizzardboy, good luck! you have definitely come to the right place. While the topic may be complicated, the human body IS complicated too... with time I hope you find what works for you!

And thanks for starting this discussion, I know you did it for _you_, but we ALL learn a lot from these threads.

[-SWS]

A few thoughts...

1. The S8 II auto gives me chronic aerophagia, much like the S8 auto did during my first trial. I presume this is because the machine is pumping me up to an inappropriate pressure during my central events as it treats all apneas the same i.e. with increased pressure. This is well backed up by the fact that the S9 gave me little aerophagia, probably no surprise given that it senses centrals and then doesn't ramp up pressure on detection.

That's one good explanation. However, aerophagia is also localized through the LES (lower esophageal sphincter). An LES gastric breech might be passive or active as a matter of vagus nerve response. And speaking of a vagal nerve response, there's a possible three-way tie-in with your bradycardia and central apneas as well:
http://linkinghub.elsevier.com/retrieve ... 7699701289

Objective: To determine the cause of isolated bradycardia during home cardiorespiratory monitoring. Setting: A tertiary care hospital. Study design: A retrospective review of the charts of 8 patients with severe isolated bradycardia on their home monitoring reports. All subjects underwent polysomnography including a pH probe. Results: Monitor reports showed a characteristic pattern of long (30 to 60 seconds) periods of bradycardia, sometimes with asystole, associated with irregular respiratory efforts. All patients had severe gastroesophageal reflux, with a pH <4 for 63% ± 22% (mean ± SD) of recording time. No patient had other abnormalities to explain the bradycardia. Bradycardia resolved after successful treatment of reflux. Conclusion: A pattern of isolated bradycardia associated with irregular respiratory efforts on home monitoring is highly suggestive of gastroesophageal reflux and should prompt further evaluation and treatment.

...Bradycardia may be associated with central apnea (a presumed vagal response), (J Pediatr 1999;135:321-6)

4. During a camping trip with my family my central index went way down. My sleep was fairly broken due to kids having gastro, being kicked by kids, relatively uncomfortable rest, etc. So my centrals probably only occur when I reach the deeper stages of sleep.

Another possibility is that psychological stressors are not the same while camping versus back at work. Anecdotally, even slight psychological stress can make AI increase according to some patients.

6. The sleep shop said that I was the most compliant person they had seen. I slept for 13 hours on my first night on the Adapt SV and have been averaging 9.5 hrs/night usage ever since.

It's usually the opposite experience for the hypocapnic CompSA/CSDB phenotype first reported by Gilmartin et al. That easy compliance and possible hypoventilation gets us back to wondering whether you're the hypercapnic variety instead.

7. I have developed acute joint pain recently. Quite odd really as each joint in my body seems to be taking its turn. The pain in any joint lasts for no more than two days, during which time it is excruciating to move, and then passes. I have had no joint repeat its pain. Neck. Sholders. Wrists. Knees. Groin. Ankles. Knuckles. Ankles. Fingers. Toes. Feet knuckles. Nearly all gone now. Possibly related to changes in my blood pH?


9. I want to get a full cardio check. I want to get a neurologist. Quite an interesting problem to solve.

10. I also suffer from hearing and touch sensitivity.

Well, let's put your hearing and touch sensitivity together with your also being a bright physicist. As it turns out sensory hypersensitivity is not at all uncommon the gifted, ADHD, Aspergers, HSP, and a few other populations. Since you have children, and there may be a genetic component, I would encourage you to research Dabrowski's Five Overexcitabilities (more here as well). Your anxiety trait seems to fit with Dabrowski's described phenotype as well.

Simply put, prolonged exposure to psychological stressors---whether largely personal makeup or environmental exposure---tends to result in more somatic disorders exactly as SleepingUgly mentioned earlier in the thread. Additionally, some scientists suspect there may by a prolonged-stress induced epigenetic factor regarding the expression of certain disease related genes. And anecdotally, boy have I noticed a lot of bright people like you on the message boards with central dysregulation and PLMD.

I can't wait till the my Adapt SV arrives!

If it works, it works! However, you have a big caveat to be on the lookout for IMO. That ASV will recent-average your flow targets using a 4-minute sliding window. The machine is designed for fast-cycling hypocapnic CompSA---not hypoventilation. So if you manage to hypoventilate for more than 3 or 4 minutes, guess what that narrow sliding window will recent-average and try to target?

Under those somewhat unusual circumstances the algorithm will recent-average and attempt to recreate/target your former subpar volumes. So if you keep turning in hypoventilatory results via the overnight data set, you'll know that it has to do with narrow 4-minute volume-targeting windows being overly narrow for the more persistent hypoventilatory type disorders. If volumes, SpO2, and sleep manage to remain good then excellent!

[SleepingUgly]

Well, let's put your hearing and touch sensitivity together with your also being a bright physicist. As it turns out sensory hypersensitivity is not at all uncommon the gifted, ADHD, Aspergers, HSP, and a few other populations.

Oh, wait, if it's associated with GIFTEDNESS, then I scored very high on that hypersensitivity scale. I thought it was a measure of neuroticism, so I didn't endorse any items.

Sensory Integration Disorder is also reportedly not uncommon among ADHD and Aspergers (I don't know what HSP is).

[blizzardboy]

A few thoughts...

An LES gastric breech might be...active as a matter of vagus nerve response...a possible three-way tie-in with your bradycardia and central apneas as well... Conclusion: A pattern of isolated bradycardia associated with irregular respiratory efforts...is highly suggestive of gastroesophageal reflux and should prompt further evaluation and treatment.

OK. I will have myself checked for GERD.

...easy compliance and possible hypoventilation gets us back to wondering whether you're the hypercapnic variety instead.

I think I have come to assume that I am hypercapnic during sleep given bradycardia+hypoventilation+CompSA. I had CO2 monitored during my titration study but not during my diagnostic.

Well, let's put your hearing and touch sensitivity together with your also being a bright physicist. As it turns out sensory hypersensitivity is not at all uncommon the gifted...Since you have children, and there may be a genetic component, I would encourage you to research Dabrowski's Five Overexcitabilities (more here as well). Your anxiety trait seems to fit with Dabrowski's described phenotype as well.

I'll check it out. My IQ puts me in the 'gifted' range. I'll read up on Dabrowski's paradigm.

Simply put, prolonged exposure to psychological stressors---whether largely personal makeup or environmental exposure---tends to result in more somatic disorders exactly as SleepingUgly mentioned earlier in the thread. Additionally, some scientists suspect there may by a prolonged-stress induced epigenetic factor regarding the expression of certain disease related genes. And anecdotally, boy have I noticed a lot of bright people like you on the message boards with central dysregulation and PLMD.

Apart from self-imposed stress (aah, what a cruel master I can be to me!), I have had quite a stressful life. My father died at 2. I changed schools 13 times. I have lived in 17 different houses. I stopped living with my mother when I was 12 and of those 12 years I lived with her for only 9 years. During the first 15 years of my life I lived with at least 9 different families. My mother committed suicide in 2005, 4 weeks before the birth of my 3rd child. Somehow through all of that I have managed to marry a beautiful woman, have 4 kids, get a PhD, work overseas, buy a house, have a successful sporting life, and hold down a steady job! But, its only been in my mid-to-late thirties that I have been able to get more sensitised to my own body and mind. By working down the list of issues I somehow arrived at the point of discovering that I had sleep apnea. So its now interesting to explore the current dynamic equilibrium of my body as the dust settles on a somewhat eventful period of my life.

However, you have a big caveat to be on the lookout for IMO. That ASV will recent-average your flow targets using a 4-minute sliding window. The machine is designed for fast-cycling hypocapnic CompSA---not hypoventilation. So if you manage to hypoventilate for more than 3 or 4 minutes, guess what that narrow sliding window will recent-average and try to target?

Under those somewhat unusual circumstances the algorithm will recent-average and attempt to recreate/target your former subpar volumes. So if you keep turning in hypoventilatory results via the overnight data set, you'll know that it has to do with narrow 4-minute volume-targeting windows being overly narrow for the more persistent hypoventilatory type disorders. If volumes, SpO2, and sleep manage to remain good then excellent!

My concern, precisely. In fact only last week I put this issue to the sleep clinic by asking if there might be a ventilation machine better suited to manage minute volume in an absolute, rather than in a relative, sense. I didn't get a particularly informative response and haven't yet looked at the range of ventilation machines available. I plan to give my body a good run on the Adapt SV to see if my equilibrium shifts to a more physiologically 'happy' position.

[Muffy]

Do you have and can you scan and post reports, like the AdaptSV report and the titration graphs from the sleep study, especially the graph with the CO2?

...(I) have a successful sporting life...

Great! Muffy is an "athlete" of sorts, too! What is it that you do? Are you a "footballer"?

Muffy

[Muffy]

Also, just what time is it over there anyways? Do you like arbitrarily subtract a half hour from the "normal time"?



And then in the summer, wing the clock ahead an hour just to confuse the "Northies"?

Does anybody really know what time it is?

Does anybody really care?

What time is it now?

About 25 or 6 to 4?

Does anybody get anywhere "on time"?

Is giving somebody a watch as a gift there considered a joke?

Muffy

[blizzardboy]

Also, just what time is it over there anyways? Do you like arbitrarily subtract a half hour from the "normal time"?



And then in the summer, wing the clock ahead an hour just to confuse the "Northies"?

Does anybody really know what time it is?

Does anybody really care?

What time is it now?

About 25 or 6 to 4?

Does anybody get anywhere "on time"?

Is giving somebody a watch as a gift there considered a joke?

Muffy

Hi Muffy, You made me laugh.
As Australia is a Commonwealth of 6 states and 2 territories that each like to do what suits it best, at times we can have a cacophony of time zones and daylight savings (or not). So if you fly all over the place regularly you can get in quite a tizzy if not in possession of good timing.

I know what the time is in SA but couldn't give two hoots what the time is in Tas, Vic, Qld or NT. Last year I flew up to Qld and it took me nearly a day to work out that I had changed my clock the wrong way.

The time here in SA is currently XIV but we don't know the time after the sun sets. Very difficult for shift workers if they forget to bring their hourglass. Watches have started to appear down here in Australia but people are slow to adopt this new technology. Time is not such a big deal as most of us tend to practice subsistence farming so daily routines and the coming and going of the sun tend to mostly satisfy our temporal needs.

Oh, got to go, the rooster just crowed.

[blizzardboy]

...............probably ain't helping the PLMs a lot:

http://www.rls.org/Document.Doc?id=346



Or are helping them a lot, depending on how you look at it.

Muffy

I forgot to mention that I took myself off fluoxetine for over two weeks before the diagnostic PSG and then another week up to the titration. My PLM numbers were roughly the same for both studies.

That was a pretty crappy time having come off CPAP after being on it for nearly 12 weeks and then coming off fluoxetine as well. I turned into a vegetable.

[Muffy]

Oh, got to go, the rooster just crowed.

What do crows do?

Muffy

[Muffy]

...............probably ain't helping the PLMs a lot:

http://www.rls.org/Document.Doc?id=346



Or are helping them a lot, depending on how you look at it.

Muffy

I forgot to mention that I took myself off fluoxetine for over two weeks before the diagnostic PSG and then another week up to the titration. My PLM numbers were roughly the same for both studies.

So now you could have 600 PLMs and/or they're more severe, and your architecture now may be entirely different from the NPSGs.

I don't know why some people find this confusing.

Muffy

[JohnBFisher]

... Does anybody really know what time it is? ...

Oh, great! Here I was minding my own business, taking a few moments to enjoy a quick scan of the forum and suddenly find myself thinking of Chicago, feeling a bit blue, and with a song cycling through in my mind!

Muffy, for that, I hope you have a great day, as I know many of us are now humming a new tune.

[SleepingUgly]

... Does anybody really know what time it is? ...

Don't ask me what time it is. I took my watch off instead of my glasses, laid it down on my daughter's nightstand, got on the bed with her, looked at my wrist and said, "Where is my watch?" Soon I'll be storing my cell phone in the freezer.

[SleepingUgly]

I'm pretty sure I should shut up, because I'm so clearly out of my league in this discussion (not to mention that Muffy has relegated me to time out for I'm not entirely sure what...) Prozac suppresses REM. I'm not sure if that has a role in this discussion of when your events occur, or anything else. I thought I'd throw that out there and let you guys figure out whether it's relevant. I'm going back to my corner.

Blizzardboy, you have had a stressful life. You're a testament to the resilience that some people display in the face of adversity.

[JohnBFisher]

... Soon I'll be storing my cell phone in the freezer. ...

Well, the good news is that you will not the first to do that. In perfect marketing speek, you might even say "There's an 'app' for that!":