CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[blizzardboy]

psssssst... better cpap treatment = worse PLMD/S

I wake up most mornings now with pain in both hands (fingers mainly) and feet (toes mainly). I hobble around when I first get out of bed. I also note that when I awaken during the night that I am clenching my fingers into in a fist and it hurts as I open up my fingers. I also seem to develop pain near tendons, not in muscles. For a few hours after exercise I get pain near the tendons of the limbs that I have been using. Cheers,

[SleepingUgly]

Perhaps the FM diagnosis would be nowhere near as helpful as some of the management strategies for the symptoms...

Yes, let's put him on a medication that enhances slow wave sleep, what do you think? Do you favor gabapentin or gabitril or should we hit him with Lyrica?

SU, are you being sardonic again??

Surely you don't think the term "management strategies" refers exclusively to the notion of "hitting" people with pharmaceuticals. I think a pair of key FM management strategies entails avoiding de-conditioning in the first place, if possible---but also physically re-conditioning within the symptomatic constraints of FM.

Two of my most effective pain management strategies for trigeminal neuralgia entail neither pharmaceuticals nor the likes of licorice root:
http://www.amazon.com/Electrode-Platinu ... 843&sr=8-4
-and-
http://www.amazon.com/s/ref=nb_sb_noss? ... in&x=0&y=0

OK, I have to be honest... I haven't followed this thread so closely as to know how much of an issue his joint pain is and how close he really is to a FM diagnosis. The link you sent to what he said originally was not compelling. My guess is he would pass a rheumatologic evaluation with flying colors (this based on my not paying attention to his rheumatologic symptoms in the first place...). "We" could order an ANA and some other blood work, but in my experience, one should not run blood work for symptoms one doesn't have, lest one have a positive test and then be left wondering what to do about it.

BB, what are your FM symptoms? Being sore after running around when one is out of shape doesn't count (who wouldn't be?).

psssssst... better cpap treatment = worse PLMD/S

Always?

Often enough...

In everyone or just people who have PLMD in the first place?

[-SWS]

Blizzardboy, what is your current treatment regiment for PLMD? How is it currently being evaluated by your sleep doctor?

[SleepingUgly]

psssssst... better cpap treatment = worse PLMD/S

I wake up most mornings now with pain in both hands (fingers mainly) and feet (toes mainly). I hobble around when I first get out of bed. I also note that when I awaken during the night that I am clenching my fingers into in a fist and it hurts as I open up my fingers. I also seem to develop pain near tendons, not in muscles. For a few hours after exercise I get pain near the tendons of the limbs that I have been using. Cheers,

I just saw this... This is only since CPAP?

With the clenching the fingers into a fist... Do you think that could be a metaphorical symptom? (e.g., Is there someone you want to hit?) Please don't hold it against Muffy that he never answered my PM about my oxygen saturation.

OK, 'nuff joking aside. If this developed with CPAP, I don't see how it could be FM. Why would that develop with CPAP?

[-SWS]

The link you sent to what he said originally was not compelling.

Well, then we can agree to disagree, my friend: I think 12-for-12 fibro pressure points is sufficiently compelling to warrant further consideration.

However, I also think BB's strategy of first endeavoring to address outstanding SDB and PLMD is fine. I believe he is correct in thinking that either of those problems can unmask fibro symptoms. Thus satisfactorily addressing those two sleep-related problems might suffice to abate fibro symptoms---if they are even fibro symptoms.

In everyone or just people who have PLMD in the first place?

PLMD tends to be stage dependent. When successful CPAP enables PLMD specific sleep stages, then formerly obscured PLMD becomes unmasked by that successful CPAP treatment.

[SleepingUgly]

However, I also think BB's strategy of first endeavoring to address outstanding SDB and PLMD is fine. I believe he is correct in thinking that either of those problems can unmask fibro symptoms. Thus satisfactorily addressing those two sleep-related problems might suffice to abate fibro symptoms---if they are even fibro symptoms.

Why would treating the SDB unmask fibro symptoms? There is research relating SDB (UARS) with functional somatic syndromes such as fibromyalgia. Why wouldn't treating the SDB either have a positive or no impact on the fibro?

Someone make a list of BB's complaints. There's the ones in the title of this thread (some of which I won't even try to understand like the hypoventilation). Then there's depression, anxiety, now pain, orthostatic hypotension (?), ...

Read some of Avram Gold's work on SDB and functional somatic complaints.

[-SWS]

However, I also think BB's strategy of first endeavoring to address outstanding SDB and PLMD is fine. I believe he is correct in thinking that either of those problems can unmask fibro symptoms. Thus satisfactorily addressing those two sleep-related problems might suffice to abate fibro symptoms---if they are even fibro symptoms.

Why would treating the SDB unmask fibro symptoms?

Apparently I wasn't clear enough in my original wording: I think it is untreated sleep disorders that can unmask fibromyalgia in those who are so inclined. I think fibro consensus currently views that pathogenic scenario as either "secondary fibro" or not even genuine fibro. By contrast I happen to suspect untreated sleep disorder(s) simply exacerbate or unmask the underlying somatic disorder in cases of fibro predisposition.

Therefore I also happen to view that...

treating the SDB either have a positive or no impact on the fibro?

...Treating under-addressed or outstanding sleep disorders tends to have a beneficial impact on fibro symptoms.

Read some of Avram Gold's work on SDB and functional somatic complaints.

Thanks for that reference.

[kteague]

Gee, I doubt anyone could ever say always, but since SWS says often enough, I must not be too far off base. And yes, one would have to have PLMD for it to worsen. I'm speaking true PLMD (or PLMS), not just limb movements. And I would think that would still apply whether the PLMD was primary or secondary. In my understanding, CPAP doesn't cause PLMD, but rather, allows it to manifest. I don't think BB has a formal diagnosis of PLMD, do you BB? Although with the hellish numbers of 362 and 452 on those two sleep studies, I'm a bit surprised your docs haven't been all over this.

Just a little muddying of the waters, a tech told me once that they count PLM's as meaning multiple ocurrences of limb movements that happen from time to time. I felt that LM's should not even be called PLM's unless their pattern met the criteria for periodic in Periodic Limb Movement Disorder. They said that is not the case, and that LM's can be totally random and of any appearance and still be called periodic. I meant to bring this up way back in this thread when the criteria for counting LM's was discussed. What's the official rules?

By the way, PLMD (Periodic Limb Movement Disorder) and PLMS (Periodic Limb Movements of Sleep) are different terms for the same disorder. Not the same as PLM's, small s, which is just plural for periodic limb movement. I remember someone reading their PSG and and thinking they had the disorder when it was only mentioning some movements.

[Rebecca R]

Just a little muddying of the waters, a tech told me once that they count PLM's as meaning multiple ocurrences of limb movements that happen from time to time. I felt that LM's should not even be called PLM's unless their pattern met the criteria for periodic in Periodic Limb Movement Disorder. They said that is not the case, and that LM's can be totally random and of any appearance and still be called periodic. I meant to bring this up way back in this thread when the criteria for counting LM's was discussed. What's the official rules?

AASM FAQs

M.4. Are limb movements counted even if they are isolated and do not occur in a series?
Limb movements are only counted if they meet all criteria in VII.1.A.1‐5 and are incorporated within a PLM series as defined by VII.1.B.

http://www.aasmnet.org/FAQs.aspx?cid=29

[blizzardboy]

Blizzardboy, what is your current treatment regiment for PLMD? How is it currently being evaluated by your sleep doctor?

No treatment at present. My (new) sleep doctor is going to review my PSGs for himself to see the nature of my limb movements for himself. I am just waiting for the sleep lab to get the PSGs out. Cheers,

[blizzardboy]

psssssst... better cpap treatment = worse PLMD/S

I wake up most mornings now with pain in both hands (fingers mainly) and feet (toes mainly). I hobble around when I first get out of bed. I also note that when I awaken during the night that I am clenching my fingers into in a fist and it hurts as I open up my fingers. I also seem to develop pain near tendons, not in muscles. For a few hours after exercise I get pain near the tendons of the limbs that I have been using. Cheers,

I just saw this... This is only since CPAP? If this developed with CPAP, I don't see how it could be FM. Why would that develop with CPAP?

Yes, only since started on CPAP, during my S9 trial at Easter time this year. Never had these symptoms before. Cheers,

[blizzardboy]

I don't think BB has a formal diagnosis of PLMD, do you BB? Although with the hellish numbers of 362 and 452 on those two sleep studies, I'm a bit surprised your docs haven't been all over this.

No-one has ever told me yet that I have PLMD. My diagnostic notes included: "Leg index: Abnormal leg movements were noted in clusters during the first half of the study. A total of 420 PLMs were noted with 25 (7%) associated with EEG arousal." My titration notes included: "Leg index: Abnormal leg movements were noted in clusters during the first half of the study. A total of 448 PLMs were noted with 25 (5%) associated with EEG arousal." When I saw the sleep doctor last time he said that leg movements could be a normal part of sleep and that he wanted to review my PSGs for himself to see the nature of my PLMs. Cheers,

[Muffy]

I'm still stuck on trying to figure out which Indian Nation the Hirsutes belong to.

Muffy

[-SWS]

I'm still stuck on trying to figure out which Indian Nation the Hirsutes belong to.

Muffy

Aren't they distant cousins of the Jesuits, who don't even own a casino? Dunno for sure...

Hairy problem to work on if you ask me.

[blizzardboy]

I'm still stuck on trying to figure out which Indian Nation the Hirsutes belong to.

Come on Muffy, that's an easy one (and I'm from "down there"): Algonquian.