CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

[Muffy]

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.

Guess they weren't really big on fixing typos. Probably caused their downfall.

Algonquin brave: "Here come the palefaces! Quick, Running Tomatoes, give me my gum!"

Running Tomatoes: "Hold on! I'm about to invent the Internet!"

Muffy

[-SWS]

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,

Well, my fear is that your new sleep doctor might consider your initial PLM rate and percentage of PLM-associated sleep arousals without PLMD variability itself in mind---especially in light of the PLMD possibility kteague points out.

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

IF successful CPAP treatment really is unmasking PLMD in BB's case, then those intensified fibro symptoms would probably be considered secondary to that unmasked PLMD:
http://www.fibromyalgia-symptoms.org/fi ... rders.html

So fix that pathogenic causal or exacerbating PLMD in this hypothetical case. Right? Yes IMHO... However, fibro symptoms are known to cause poor sleep which, in turn, intensifies fibro symptoms---and perhaps even BB's erratic central dysregulation which doesn't neatly fit loop-gain modeling IMO. That's a pathophysiologic vicious cycle that can be very tough to break----especially if PLMD or fibro's pathogenic cause cannot be completely fixed. In my way of thinking effectively managing the very FM symptoms that are counterproductive to sleep helps to break or at least manage the vicious cycle in compounded cases of fibromyalgia and sleep-disordered pathophysiology.

The treatment premise is simple: if fibro symptoms turn out to be a text-book match for the disorder, then fix the pathogenic root-cause if at all possible----but effectively manage the viciously-cyclic symptomology along the way, to make recovery as efficient as possible.

[SleepingUgly]

Are his "FM" symptoms interfering with sleep? The medications I listed before (e.g., Gabitril, Neurontin, Lyrica) can be treatments for pain, PLMS, and they enhance slow wave sleep and decrease fragmented sleep/alpha intrusions. But I think he's a long way from this and can come with its own set of problems. Wasn't BB just saying he feels like a million bucks? I think I'm getting lost in this thread. I can't keep track of what complaints are salient at this time and which have been solved. Fortunately BB seems to have a good sleep doc who seems to know that PLMS could be secondary to respiratory events and therefore not true PLMS gives me hope that he can be helpful.

[-SWS]

Wasn't BB just saying he feels like a million bucks?

At this point in treatment BB has reflected both good days and...

Are his "FM" symptoms interfering with sleep?

...An unusually bad night of sleep after exercise. That might be an ordinary physical pain response as you pointed out. However, I was the one who injected the current highly-unpopular fibro suspicions related to exercise in light of BB having matched 12-for-12 fibro pressure points. Wacky me... thinking 12-for-12 fibo pressure points was somehow compelling toward further fibro investigation.

Fortunately BB seems to have a good sleep doc who seems to know that PLMS could be secondary to respiratory events and therefore not true PLMS gives me hope that he can be helpful.

Well, if you can read that highly-specific decision-making behavior into BB's new sleep doctor, then I'd like to borrow that crystal ball, ma'am. But so far I like him a lot too. I think he's going to be helpful.

[kteague]

I was told once I probably had fibromyalgia, but when my PLMD was discovered, it was not pursued. I am very curious about those 12 pressure points, but as in the past, I have purposely not read up on them because I don't want to be influenced by that knowledge if I'm ever evaluated for it. I wish a doc would check 25 points on me so I wouldn't know which would have to be positive for a diagnosis. While I don't think I'd be that influenced by suggestion, my suspicion of frequent misdiagnosis would be tempered by a "clean" approach. In my mind, I categorize fibromyalgia with narcolepsy in that in the absence of overt irrefutable evidence, a definitive diagnosis cannot be made until all other known contributors to the symptoms in question have been effectively treated.

[SleepingUgly]

Wasn't BB just saying he feels like a million bucks?

At this point in treatment BB has reflected both good days and...

Are his "FM" symptoms interfering with sleep?

...An unusually bad night of sleep after exercise. That might be an ordinary physical pain response as you pointed out. However, I was the one who injected the current highly-unpopular fibro suspicions related to exercise in light of BB having matched 12-for-12 fibro pressure points. Wacky me... thinking 12-for-12 fibo pressure points was somehow compelling toward further fibro investigation.

I read the original 12 out of 12 post at night, under the influence of my own SWS-enhancer, so it's very possible I missed something. But I also think that people with SDB can have a lot of functional somatic complaints, which may lead to diagnoses that are irrelevant once the SDB is properly treated.

What kind of investigation do you mean? The only one I know of is a rheumatology consult. He can do that, but if he tells the rheumatologist that this started just recently when he started CPAP, and that he still hasn't optimized that, what is the rheumatologist going to do? He could add medications that will confound the SDB/PLMS/night time picture, that will either help or not. If they help, clearly we will have no idea WHY they help, and now he's stuck on those medications. If they cause other problems, like daytime sedation, how would we know whether it's due to the medication or to not having optimized his SDB treatment? Then how would we know whether to attack the fluoxetine issue, or whether it's the new drug?

Personally (and I do mean personally), I don't make too much of symptoms that occur once, or that occur in response to some known entity that I'm actively treating appropriately and that I need to continue to treat, unless they become extremely bothersome or don't go away or compromise the treatment of the known disorder. I think you have to eliminate things one at a time and see what's left to deal with. It's not always so neat and tidy, but to the extent one can change only one variable at a time, one can better see cause and effect. If BB has reached the point where the pain is interfering too much, or compromising his treatment, by all means, he should have a rheumatology consult (what's a little more bloodwork?!). If it's not that bad, personally (and I mean personally), I would play on and optimize the known issues.

[-SWS]

I was told once I probably had fibromyalgia, but when my PLMD was discovered, it was not pursued. I am very curious about those 12 pressure points, but as in the past, I have purposely not read up on them because I don't want to be influenced by that knowledge if I'm ever evaluated for it. I wish a doc would check 25 points on me so I wouldn't know which would have to be positive for a diagnosis. While I don't think I'd be that influenced by suggestion, my suspicion of frequent misdiagnosis would be tempered by a "clean" approach. In my mind, I categorize fibromyalgia with narcolepsy in that in the absence of overt irrefutable evidence, a definitive diagnosis cannot be made until all other known contributors to the symptoms in question have been effectively treated.

I read the original 12 out of 12 post at night, under the influence of my own SWS-enhancer, so it's very possible I missed something. But I also think that people with SDB can have a lot of functional somatic complaints, which may lead to diagnoses that are irrelevant once the SDB is properly treated.

What kind of investigation do you mean? The only one I know of is a rheumatology consult. He can do that, but if he tells the rheumatologist that this started just recently when he started CPAP, and that he still hasn't optimized that, what is the rheumatologist going to do? He could add medications that will confound the SDB/PLMS/night time picture, that will either help or not. If they help, clearly we will have no idea WHY they help, and now he's stuck on those medications. If they cause other problems, like daytime sedation, how would we know whether it's due to the medication or to not having optimized his SDB treatment? Then how would we know whether to attack the fluoxetine issue, or whether it's the new drug?

Personally (and I do mean personally), I don't make too much of symptoms that occur once, or that occur in response to some known entity that I'm actively treating appropriately and that I need to continue to treat, unless they become extremely bothersome or don't go away or compromise the treatment of the known disorder. I think you have to eliminate things one at a time and see what's left to deal with. It's not always so neat and tidy, but to the extent one can change only one variable at a time, one can better see cause and effect. If BB has reached the point where the pain is interfering too much, or compromising his treatment, by all means, he should have a rheumatology consult (what's a little more bloodwork?!). If it's not that bad, personally (and I mean personally), I would play on and optimize the known issues.

You both make excellent points IMO...

I don't think I'm completely at odds with either of your views in saying that not only should pathogenic root-causes (primary exacerbating factors in my personal fibro view) be addressed when possible, but additionally managing or treating viciously-cyclic symptomology along the way can make for a more efficient recovery. Pharmaceuticals are usually my last choice---and that's probably because my hollow leg already rattles with a variety of prescription pills as I walk, metaphorically speaking.

[blizzardboy]

You both make excellent points IMO...

Hear, hear. BTW, last night I slept with my quattro to give my nose a rest and my AHI=9.1 was nearly double that using the same fixed CPAP (P=9.6) that I have been using for nearly a week with the Liberty (around AHI=5). Sore hands, feet, shoulder and knee this morning. Sure makes it a bit more challenging to leap out of bed and hop on the exercise bike! Cheers,

[-SWS]

Blizzardboy, at this point in the evolving discussion, why do YOU suspect that you might have more pain than most people with SDB---and quite possibly more pain than most people with PLMD? Does it currently interfere with restful sleep on a regular basis?

Kathy and others: is this overall pain presentation that blizzardboy describes a somewhat common PLMD presentation:

Sore hands, feet, shoulder and knee this morning. Sure makes it a bit more challenging to leap out of bed and hop on the exercise bike!

I only developed sore joints only recently. BTW, the pain I feel is sharp and acute, not dull. Reminds me of some of my football joint injuries e.g. groin pull.

Rough night last night. The migrating joint pain seems to have progressed to multi-joint pain. Feet, hands, wrist, groin/hip and neck painful last night. Kept me awake quite a bit.

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,

I don't think that's a common SDB presentation.

[SleepingUgly]

Kathy and others: is this overall pain presentation that blizzardboy describes a somewhat common PLMD presentation:

Sore hands, feet, shoulder and knee this morning. Sure makes it a bit more challenging to leap out of bed and hop on the exercise bike!

Maybe it's just his increased activity level due to his increased energy and attempts to lose weight. That would be the simplest explanation. (My knee was great until I started working out more!) When did the pain start relative to the increased activity? Are the parts that hurt, parts that he is exercising?

Alternatively, in one article, Dr. Guilleminault describes increased PLMS with CPAP use as due to more supine sleep with CPAP use, not due to some "unmasking" of PLMD (this is not to say that phenomena couldn't occur). Just wondering if perhaps there is something about sleeping with CPAP that increases soreness, such as being in one position more. Not sure how we'd test this unless we hooked him up to sham CPAP...

[-SWS]

... unless we hooked him up to sham CPAP...

I think I've seen those on late-night infomercials... I want the one that comes with steak knives!

[dsm]

Maybe I am way to naive and ignorant but CO2 imbalance just keeps staring me in the face.

DSM

[SleepingUgly]

... unless we hooked him up to sham CPAP...

I think I've seen those on late-night infomercials... I want the one that comes with steak knives!

How about the one that doubles as vacuum cleaner? Call in the next 24 hours and we'll throw in a gallon of distilled water FREE.

[blizzardboy]

Blizzardboy, at this point in the evolving discussion, why do YOU suspect that you might have more pain than most people with SDB---and quite possibly more pain than most people with PLMD? Does it currently interfere with restful sleep on a regular basis?

Hi -SWS, I don't know how it for other people, nor do I suspect that I have more pain than others. I don't necessarily think that pain is responsible for the majority of my arousals. Its just that I had never experienced this sort of migrating joint pain before I started on CPAP. The pain is definitely worse in the morning and abates during the day. BTW, when I played sport I was particularly immune to muscle/join pain resulting from strenuous exercise but I must concede that I am older now.

Also, as a purely subjective assessment (but also supported by my wife), I was in far better spirits on waking this morning compared to yesterday (post-exercise), in spite of having my AHI increase by a factor of nearly 2 compared to the previous night. Cheers,

[blizzardboy]

I don't think that's a common SDB presentation.

Seems to be my lot?