Alpha Intrusions? Rapid EMS too much EMG? What?

[jbn3boys]

I finally got the printout of my sleep study from February. I think I'm more confused now than I ever was before.

Can anybody help me understand what these things mean?

Alpha intrusion was seen.

and

Possible REM periods at (3 times). Rapid EMS, but too much EMG. There were not scored as REM, but may be. Otherwise she had no REM periods.

Other notable findings were that "many arousals for no apparent reason" were noted, fragmented sleep, minimal amounts of REM, and "several periods of insomnia during the study with 98.3 minutes of interspersed wakefulness. Oh yeah, and only one central and one hypopnea all night long...AHI of 0.3. (at home AHI is still averaging 5-6)

I'm not even sure what to expect or ask at my appointment with the sleep doc next week.

[-SWS]

Possible REM periods at (3 times). Rapid EMS, but too much EMG. There were not scored as REM, but may be. Otherwise she had no REM periods.

You had rapid "Eye Movements" (EMs) that hint at 3 possible REM periods. However, you also had too much EMG, and that presentation suggests you were not in REM. So they didn't score those as REM based on your excessive EMG. During REM we are supposed to enter a paralysis-like state of muscle atonia. However, all that EMG activity suggests that your muscles were active instead, during those 3 candidate REM periods. Apparently the muscle activity is why they decided not to score REM----despite REM-characteristic rapid Eye Movements (EMs).

Alpha intrusion was seen... Other notable findings were that "many arousals for no apparent reason

Alpha intrusions are sleep-disruptive brain-wave activity. Alpha intrusions are supposedly associated with fibromyalgia, pain, discomfort... Pain/discomfort during sleep might explain your spontaneous arousals as well.

[jbn3boys]

So what is EMG? is that just movement in general?

The pain/fibo/discomfort thing is strange...since I don't think I really have pain.

All I know is I'd like to sleep better....

[Rustyolddude]

EMG: electromyogram

Not sure on the EMS EM's are eye movements. Alpha intrusions are basically waking events They can be caused by pain & discomforts, anxiety & "busy brain" i.e. stuff you can't stop thinking about. Normally your sleep graph printout should look like stair steps going down as you fall asleep, and up as you wake. Yours no doubt looks like a bar code, as did mine. Went through two studies only to discover what I already knew, that I didn't sleep. You'll need to make sure your sleep hygiene is good; comfortable bed, dark room, comfortable temp, no noises, no body aches & pains, little or no caffeine or other stimulants, don't go to bed angry, try to take care of and put to rest the days worries. Once all that is taken care of then you address the medical aspects.

As for your AHI & events, they will be low & few because you never truly fall asleep and thus your body doesn't relax enough for the events to occur. I could always tell when I had a terrible nights sleep because I hardly had any events.

If you haven't already, get a complete physical with blood work. There can be medical issues related to sleep disorders.

You might find you have to take something to turn off your brain at night. I'd recommend staying away from the benzo's like Ambien, Lunesta if offered. Those are for short term sleep issues and have terrible rebound insomnia effects when discontinued. Research any Rx your doc suggests, especially the long term side effects, first before committing to taking it. What works for some, may not work for you. You might find the all natural approach of melatonin and/or valerian works for you etc. Also, don't expect an overnight solution, it took me at least a year or more working with my PCP & doing research & asking folks here to find a solution that worked. Make sure you've got a good doctor that cares about your health and accepts your proactive participation in your own care. If you get a "just who is the doctor and who is the patient here?" Fire that doc and find a new one.

What ultimately worked for me was 15mg of Remeron (mirtazipine) at night and a MP3 player tucked in my pillow with some yoga/meditation music & good quality ear buds aka in ear monitors which seal against outside noise which was suggested by a member here. The Rx took care of the sleep anxiety with no discontinuing side effects and the meditation music occupied my brain and helped with the racing thoughts. CPAP took care of the apnea & UARS.

Be patient in finding your solution, be proactive, ask lots of questions and don't give up.

[-SWS]

So what is EMG? is that just movement in general?

http://www.google.com/search?q=electrom ... =firefox-a

The pain/fibo/discomfort thing is strange...since I don't think I really have pain.

Well, since you have both alpha intrusions and plenty of spontaneous arousals, something's preventing restorative sleep. Perhaps there are subliminal or near-subliminal pain signals that you have learned to ignore while awake? Alternately, I wonder if you are an ultra-sensitive sleeper---one who is inclined to wake or just shift sleep stages based on external stimuli? Minimizing potential disturbances in your sleep environment might turn out to be important. Minimizing subtle aches or pains might turn out to be important.

All I know is I'd like to sleep better....

I can relate. I hope you and your doctor(s) can brainstorm a few things for you to try toward better sleep. Good luck.

[jbn3boys]

Alpha intrusions are basically waking events They can be caused by pain & discomforts, anxiety & "busy brain" i.e. stuff you can't stop thinking about.

Usually not a problem for me. I don't know of any pain/anxiety/discomfort, and I have no problem with shutting my brain down at night. Sleep meds work wonders for that!

Went through two studies only to discover what I already knew, that I didn't sleep.

Yep, that's where I am...second study, and really don't know anything yet.

You'll need to make sure your sleep hygiene is good; comfortable bed, dark room, comfortable temp, no noises, no body aches & pains, little or no caffeine or other stimulants, don't go to bed angry, try to take care of and put to rest the days worries. Once all that is taken care of then you address the medical aspects.

Yep, pretty much all addressed. I do have my occasional "bad hygiene" night, but overall, I'm pretty good.

As for your AHI & events, they will be low & few because you never truly fall asleep and thus your body doesn't relax enough for the events to occur. I could always tell when I had a terrible nights sleep because I hardly had any events.

I have never had an AHI as low as I do during my sleep studies. My lowest ever at home is 2.1, and that was a one time thing. I know I feel better when I'm under 3.5, but my average is still 5-7.

If you haven't already, get a complete physical with blood work. There can be medical issues related to sleep disorders.

Done, but should probably redo some blood tests, as it has been a while.

...What ultimately worked for me was 15mg of Remeron (mirtazipine) at night and a MP3 player tucked in my pillow with some yoga/meditation music & good quality ear buds aka in ear monitors which seal against outside noise which was suggested by a member here. The Rx took care of the sleep anxiety with no discontinuing side effects and the meditation music occupied my brain and helped with the racing thoughts. CPAP took care of the apnea & UARS.

I'm currently on both Trazadone and Mirapex, so I should be good that way. The trazadone has worked well for me since before I was on cpap. The mirapex was added after this last sleep study due to "possible periodic limb movement".

Be patient in finding your solution, be proactive, ask lots of questions and don't give up.

My patience is wearing thin. It's been over 7 months now, and I'm not seeing much improvement. My RT commented today that my printout looks "about the same" as all the others.

Well, since you have both alpha intrusions and plenty of spontaneous arousals, something's preventing restorative sleep. Perhaps there are subliminal or near-subliminal pain signals that you have learned to ignore while awake? Alternately, I wonder if you are an ultra-sensitive sleeper---one who is inclined to wake or just shift sleep stages based on external stimuli? Minimizing potential disturbances in your sleep environment might turn out to be important. Minimizing subtle aches or pains might turn out to be important.

I was a sensitive sleeper, but that was long ago. Once I had kids I started to sleep a lot sounder. Now that I'm on sleep meds, my kids can come in and talk to Dad, and I don't even hear them. I'm out cold....to the point I am leery to take them if my hubby is not home.

I suppose it could be subliminal pain that I have learned to ignore. Great...what else am I ignoring! lol
It just seems like once we think we have something under control, something else pops up. I feel like I'm on a never-ending roller coaster, and I'm NOT enjoying the ride!

Sorry, I'm just tired and crabby today.

[Madalot]

Alpha intrusion was seen... Other notable findings were that "many arousals for no apparent reason

Alpha intrusions are sleep-disruptive brain-wave activity. Alpha intrusions are supposedly associated with fibromyalgia, pain, discomfort... Pain/discomfort during sleep might explain your spontaneous arousals as well.

I don't want to hijack this thread, but the above information has got my wheels spinning. I sleep better on my left side, but have significant pain in my left thigh (still sore from a muscle biopsy 10 years ago -- weird) and I frequently wake up with it hurting and turn over. I really am wondering if I'm waking up a lot more than I realize because of the pain.

I'm guessing, from reading this thread, that IF that is the case, it would show up on the sleep study, so it would still be smart to do it.

[jbn3boys]

I don't want to hijack this thread, but the above information has got my wheels spinning. I sleep better on my left side, but have significant pain in my left thigh (still sore from a muscle biopsy 10 years ago -- weird) and I frequently wake up with it hurting and turn over. I really am wondering if I'm waking up a lot more than I realize because of the pain.

I'm guessing, from reading this thread, that IF that is the case, it would show up on the sleep study, so it would still be smart to do it.

Hijack away, Maddie! Feel free.

I hope that if this is part of the problem, they can see it and know definitely what it is! I pray you have a restful weekend, and Monday comes quickly (so you can get that sleep study scheduled!)

[Madalot]

I don't want to hijack this thread, but the above information has got my wheels spinning. I sleep better on my left side, but have significant pain in my left thigh (still sore from a muscle biopsy 10 years ago -- weird) and I frequently wake up with it hurting and turn over. I really am wondering if I'm waking up a lot more than I realize because of the pain.

I'm guessing, from reading this thread, that IF that is the case, it would show up on the sleep study, so it would still be smart to do it.

Hijack away, Maddie! Feel free.

I hope that if this is part of the problem, they can see it and know definitely what it is! I pray you have a restful weekend, and Monday comes quickly (so you can get that sleep study scheduled!)

Thanks for this. I am very much against hijacking other threads, but when I saw this, I really had a DING DING DING moment.

If I weren't so close to having the third sleep study, I would go ahead and order everything from the first two so I could look at it and try to get a better handle on exactly what they saw during my first two studies. I was hoping to include the data from the third study so I didn't have to order the stuff twice.

Being a complicated case sure makes things difficult, doesn't it?

[jbn3boys]

If I weren't so close to having the third sleep study, I would go ahead and order everything from the first two so I could look at it and try to get a better handle on exactly what they saw during my first two studies. I was hoping to include the data from the third study so I didn't have to order the stuff twice.

Being a complicated case sure makes things difficult, doesn't it?

I just went and got the results of my second study yesterday. What I found out is it was half the price and MUCH faster if I actually went, in person, to the clinic, and requested the information. Cost me 35 cents a page, and I walked out with the information in hand. When I ordered it through the mail, it took about two weeks, and I think it cost nearly twice as much. I know, for me, it will always be quicker and cheaper to get it in person. That might not work as well for you, since your sleep lab is so far away.

But I would not hesitate to get the first two ordered now. My guess is it won't cost any more to get two studies now and one later than it would to get all three later. They may not come in before your sleep study, but at least they'd be in the process of getting to you. Might be worth a try anyway.

[Madalot]

But I would not hesitate to get the first two ordered now. My guess is it won't cost any more to get two studies now and one later than it would to get all three later. They may not come in before your sleep study, but at least they'd be in the process of getting to you. Might be worth a try anyway.

Can't argue with you there, so I just finished faxing the form and request for the first two, specifying Full NPSG & Reports, including histograms...

Let's see what happens and what I get...

[DreamDiver]

Thanks for this. I am very much against hijacking other threads, but when I saw this, I really had a DING DING DING moment.

If I weren't so close to having the third sleep study, I would go ahead and order everything from the first two so I could look at it and try to get a better handle on exactly what they saw during my first two studies. I was hoping to include the data from the third study so I didn't have to order the stuff twice.

Being a complicated case sure makes things difficult, doesn't it?

@Madalot, this was a little of what I was referring to in a previous post asking about whether anything other than the ventilator might be causing arousals. I don't know if it will make a difference to your upcoming sleep lab study team, but you might want to relate that you suspect pain or other forms of arousal may be keeping you from getting restorative sleep, and that you'd like them to keep that in mind while interpreting what they see in your study. It may change their perspective during lab scoring. It might not. Anyway, I'm glad this is an 'Ah-ha' moment for you.

[Madalot]

Thanks for this. I am very much against hijacking other threads, but when I saw this, I really had a DING DING DING moment.

If I weren't so close to having the third sleep study, I would go ahead and order everything from the first two so I could look at it and try to get a better handle on exactly what they saw during my first two studies. I was hoping to include the data from the third study so I didn't have to order the stuff twice.

Being a complicated case sure makes things difficult, doesn't it?

@Madalot, this was a little of what I was referring to in a previous post asking about whether anything other than the ventilator might be causing arousals. I don't know if it will make a difference to your upcoming sleep lab study team, but you might want to relate that you suspect pain or other forms of arousal may be keeping you from getting restorative sleep, and that you'd like them to keep that in mind while interpreting what they see in your study. It may change their perspective during lab scoring. It might not. Anyway, I'm glad this is an 'Ah-ha' moment for you.

Way ahead of you -- I'm composing an email to my doctor and RT as we speak mentioning this as something to be on the lookout for, especially considering my doctor is still working on making sure everything is set up right for the study. I think this is important information for her to have and keep in mind. Plus...

I think lowering the minimum IPAP has had a positive effect, even though I still have the occasional suffocation episode. I did an overnight after being in the lower setting for a few days and it was one of the best I've had. Nothing below 90% at all. Looked about as calm as any I've ever done.

jbn3boys -- It seems I AM hijacking...I'm sorry.

[DreamDiver]

I think lowering the minimum IPAP has had a positive effect, even though I still have the occasional suffocation episode. I did an overnight after being in the lower setting for a few days and it was one of the best I've had. Nothing below 90% at all. Looked about as calm as any I've ever done.

jbn3boys -- It seems I AM hijacking...I'm sorry.

We're learning a lot from both experiences though. Good questions and answers all around.

@jbn3boys -- as many of us have begun to learn, AHI is not the end-all and be-all as a score for sleep. It's only part of the story. In the story of sleep, REM sleep is the most important. Without it, you die in days or weeks. It's like water. Our neural system seems to need this dream-time just to subsist. Deprived, people begin to hallucinate.

Alpha stage is the waking stage and under the best of circumstances might only be seen briefly during a sleep lab, perhaps as you turn in, when you get up to go to the bathroom and when you wake up at the end of the night. However sometimes, alpha waves intrude into deep sleep. They can see it on the electroencephalogram (EEG). That's called alpha intrusion, and it means you're waking up in the middle of your deepest sleep. Depending on how often this happens, also means you're not getting true restorative sleep. This is the kind of sleep needed to repair tissues and fight infection.

Deep restorative sleep (Stage 3 non-REM or NR3) can be put off for a long time, but sooner or later, it catches up with you. It's called sleep deficit. In one study I saw, it was shown that by keeping study participants from being able to achieve NR3 (similar to inducing alpha intrusions) the participants ended up with Fibromyalgia-like symptoms. It also suggests that there may be a connection between sleep and what many have considered to be a rheumatological 'disease' (Fibromyalgia). It may in fact be somewhat more of a neurological impairment that manifests as phantom pain in the extremities due to the inability to get deep sleep.

That you don't have pain from your alpha-intrusions is a blessing. It may well be that you will be able to get more restorative sleep now that you have a cpap.

[jbn3boys]

jbn3boys -- It seems I AM hijacking...I'm sorry.

STOP IT, Maddie! No need to apologize! I've already given you my blessing to hijack!

@jbn3boys -- as many of us have begun to learn, AHI is not the end-all and be-all as a score for sleep. It's only part of the story. In the story of sleep, REM sleep is the most important. Without it, you die in days or weeks. It's like water. Our neural system seems to need this dream-time just to subsist. Deprived, people begin to hallucinate.

I totally agree with the AHI part! I'm shocked that REM is THAT important! I mean, I knew it was important in terms of restorative sleep, but death without it? That part's new to me...and not reassuring!

Alpha stage is the waking stage and under the best of circumstances might only be seen briefly during a sleep lab, perhaps as you turn in, when you get up to go to the bathroom and when you wake up at the end of the night. However sometimes, alpha waves intrude into deep sleep. They can see it on the electroencephalogram (EEG). That's called alpha intrusion, and it means you're waking up in the middle of your deepest sleep. Depending on how often this happens, also means you're not getting true restorative sleep. This is the kind of sleep needed to repair tissues and fight infection.

This is a great explanation. It makes sense, and it also makes sense that I am not feeling like I'm sleeping well. After looking at my sleep study, it appears this is happening often. It also makes me wonder if this has contributed to how often I need multiple courses of antibiotics to clear a sinus infection.

Deep restorative sleep (Stage 3 non-REM or NR3) can be put off for a long time, but sooner or later, it catches up with you. It's called sleep deficit. In one study I saw, it was shown that by keeping study participants from being able to achieve NR3 (similar to inducing alpha intrusions) the participants ended up with Fibromyalgia-like symptoms. It also suggests that there may be a connection between sleep and what many have considered to be a rheumatological 'disease' (Fibromyalgia). It may in fact be somewhat more of a neurological impairment that manifests as phantom pain in the extremities due to the inability to get deep sleep.

During this last sleep study, I had a total of 15% N3 and 4% REM sleep. Could be that this is why I'm feeling so lousy lately. I think I will have to go start looking at fibromyalgia and all it's symptoms. Maybe I'm actually showing some of the signs, but just not the pain? I'm also glad that my sleep doctor is a neurologist.