Please help! Sleep study results

[pablmd]

Hi everyone,

I always feel very tired, anxious and depressed.

My girlfriend says that I choke all the time during my sleep so I had a sleep study conducted.

Today I got my results, and wanted to share them with you guys as im a bit confused.

The results are as follows:


Total sleep time: 263 minutes
Sleep efficiency: 56.4%
Only 1 REM sleep episode (4 minutes) after 194 minutes of sleep
313 arousals (71.4/hour)
AHI: 5.1/hour
Periodic leg movement index: 68.9/hour
Periodic leg movement arousal index: 12.7/hour
Average oxygen saturation: 93.5% (min 86.1% - max 98.2%)


Why do I have such a low AHI? I had 71.4 arousals per hour, although only 12.7 were caused by PLMD and 5 were caused by AHS... Where do the rest come from?

[Pugsy]

Maybe the rest of the arousals came from spontaneous arousals or arousals from flow reductions that didn't quite meet criteria for some sort of apnea flag that would make it into the AHI. A certain about of air flow reduction that lasts at least 10 seconds...meaning if you had 50 of them and they only lasted 9 seconds they don't count.

Something is causing very frequent arousals/awakenings that you may or may not remember that is totally trashing your sleep...
It might be partially related to PLMD or a lot related to the PLMD.

Might also have a UARS component....Upper Airway Resistance Syndrome...google it and read up on it.

Not all crappy sleep can be blamed on the AHI numbers.

[pablmd]

Thanks Pugsy!

I forgot to mention they did not measure my esophagus pressure, so they did not test for UARS, which I also suspect could be causing all those arousals.

Are my results very bad?

[Pugsy]

Obviously the AHI isn't bad.

Hours of sleep and sleep efficiency and lack of REM means your overall sleep itself is in the toilet.
The arousals are significant.
I am not sure about the actual relate to limb movement arousals and will wait to see if kteague chimes in about those because she really understand those numbers and I don't.

Your overall average Oxygen isn't bad at all but the overall average might not tell the whole story since you didn't get much REM sleep where the chances of having a higher real AHI and deeper desats are higher.
Do you see a mention anywhere in the desats as to how low the oxygen might have gone to?

Also...and kteague may correct me if I am wrong but PLMD arousals could mask OSA meaning if you had a limb arousal prior to a period of time where you could have maybe slept deeper then the PLMD arousal brings you "out" before the airway can collapse.
At least I think that sometimes can happen.

The arousals are significant though and likely need to be addressed in some fashion to see if you can get more quality sleep.
You probably feel like crap from lack of any quality sleep architecture.
I don't know if your AHI and your symptoms and the arousals will be enough to warrant cpap trial or not and expect insurance to pay for it. Insurance typically goes by AHI and yours won't buy you enough of an OSA diagnosis to likely get insurance to want to foot the bill for a cpap machine...and I can't guarantee a cpap machine would help.
Lots of "maybes" here that don't point to any clear cut easy fix...unfortunately.

Let me send kteague a note and have her drop by for her input on the arousals...she's the queen of PLMD information around here with a lot of personal experience to draw upon.

[pablmd]

Thanks a lot Pugsy,

I guess CPAP treatment would only make sense if the PLMD are masking OSA or in case I have UARS.

Lets see what kteague or anyone with PLMD/UARS says about all those arousals.

By the way, im 26 years old, 6'1, 180 pounds... Just in case thats of any help.

[kteague]

Somebody say my name?

Here's my non-professional voice-of-experience input... I agree with Pugsy about possibility of a masking effect. Those who have active OSA and PLMD during a study really cannot know how serious either disorder might be if the other were not at play. I'd bet money on both being more severe than the sleep study could capture due to the tug-o-war of each vying for prominence - a "win some, lose some" all night long. Since the OSA has been confirmed, no matter the numbers, I think the first course of action is to treat it with CPAP and monitor the data to confirm effectiveness. There are times when CPAP use actually reduces limb movements, but in the case of actual PLMD, the movements may even worsen once given free rein without the interference from apnea events. While getting the CPAP treatment optimized, start the search for things you might be able to do to help your legs. Have your ferritin level checked. If it is not up close to 100, get it there. I highly recommend not taking dopamine meds before doing this as it is reported those with lower ferritin levels are more prone to developing problems on the meds, particularly augmentation. Also, some with limb movements report vitamin D, B vitamins, and/or magnesium help their symptoms.

You are likely going to have a period of trial and error getting this worked out. My doctor retested me while using my CPAP at the prescribed pressure to see how my legs were then acting. Aside from this, you'll have to go on how you feel, how well you sleep, observation at home, video, etc. Oh, just a word of warning. Most with PLMD have restless sleep. (It's easy to blame the CPAP when it could be doing it's job just fine.) If your movements repeatedly wake you, please don't make the same mistake I did by hitting the ramp every time to go back to sleep. That gives you too much ramp time during the night and not enough therapeutic pressure. Those who wake up often would be better off to not use the ramp feature.

It's really hard to know what all else is going on until there's a clearer picture. In my mind, there could be things going on during the tug-o-war times that may not fit neatly into a diagnostic category. Treat the OSA. Address the limb movements as appropriate. Then see what's left. That's another good reason to retest while on CPAP, after you've done all the things you can do to see how much disruption to your sleep remains. This can help you make a decision on a treatment plan. Good luck and let us know how things progress.

[pablmd]

Thanks a lot kteague!

I have an appointment with the doctor tonight, im pretty sure shell try to put me on dopamine meds, and it won't be easy to get a CPAP or BiPAP due to my low AHI, but ill try.

Also, I take 20 mg of citalopram to treat my depression, and I've read that it can worsen PLMD.

So ill try to get a machine, get off citalopram, raise my ferritine levels and see how it goes from there.

[kteague]

Wouldn't it be great if your medication was the sole cause of your PLMD and the movements resolved once off the med?! Do consider that the sleep deprivation of sleep apnea can symptomatically look like depression. Maybe treating the sleep apnea over time will resolve enough symptoms that the med is not needed and you can be weaned off. I wouldn't want to get in the middle of depression treatment as I don't have the expertise or experience for that. Do work with your doctors. It sounds like you are quite in tune with yourself and can play an active role with your doctor for these decisions. If it is decided that weaning off the med is a viable option for you, I would certainly try that before taking a dopamine med for the movements. I am concerned about taking a med to stop what one med causes. It's a slippery slope, and a scary one to me. Only if the initiating med is necessary to life, health and well being would I recommend adding a med to treat symptoms of a med. Just from what I've read about others' experiences, seems movements secondary to use of a med can be more resistant to conventional treatments. BTW, not all PLMD requires treatment. If the movements aren't significantly interfering with sleep stages, maybe they can be mitigated by home treatments and tolerated. Warm foot soaks before bed are touted by a lot of people with RLS and PLMD. My sleep doc recommended putting a pillow between my feet and legs. Doesn't stop the movements, but provides a buffer so there are fewer wakings. Each case is different. I took various meds for my legs for over 10 years, until their side effects became intolerable. For the last 4 years I have successfully used a TENS Unit on my lower back before bedtime and it has provided enough relief for me to sleep. Hope you are able to figure out what works for you fairly quickly. Let us know what comes out of that doctor's visit.

[chunkyfrog]

Only four minutes of REM? If your apneas occurred in REM only, (did they?)
then your sleep study might be considered invalid, IMHO.
Suppose you have more REM at home, in your own bed?
Would this be a reason for a home study?

[kteague]

Thanks to those who honed in on that lack of REM. I was so focused on the limb movements I glossed over it. I had two studies where they were unable to capture me in REM while supine, and in the reports the sleep doc termed the studies "technically suboptimal". In other words, your study does not contain all the information needed for a reliable conclusion. Making a decision based on this limited information to not treat or further investigate would be a disservice, to say the least.

[pablmd]

So I went to see the doctor.

She did mention that due to the low amount of REM that I got, the study is not very accurate, but she didn't suggest another study yet. My apneas didn't occur in REM, chunkyfrog.

She said that my arousals could be due to UARS, so im getting an Auto CPAP for a week to see how it works for me. If that doesn't make me feel better, she said that my arousals could be due to gastroesophageal reflux disease.

Also, she told me to change my antidepressant because it might be worsening my limb movement at night.

[Morbius]

Also, I take 20 mg of citalopram to treat my depression, and I've read that it can worsen PLMD.

You should see what it does to REM.

[Minky]

I have both UARS and PLMD. My doctor also suggested a trial with APAP. I didn't want to deal with a trial period, so I just got the prescription and got an Airsense 10, masks, etc. from CPAP.com.

The thing that concerns me with your situation is that I don't think that a week is nearly long enough to know if APAP is helping. Since UARS treatment success can't be measured very well by data (my untreated AHI is 1.1), UARS sufferers have to go by how we feel and, based on my own experience, I don't think you'll see a huge difference in a week. I'm two months in and am feeling a lot better, but still need a lot more time to fully recover.

Is there any way that you could get a longer trial period? If you could get a loaner for a month or even two weeks I think you'd have a much better idea if it's helping you.

For me APAP has been great and I plan to use it for the rest of my life. My situation sounds very similar to yours. I had tons of arousals, many periodic leg movements and only 11 minutes of REM during my sleep study.

Also, I took Citalopram for years and felt the worst during those years. Escitalopram (Lexapro) has worked better for me. However, I have no idea if it's having an effect on my PLMD.

I wish you the best.

[Morbius]

ALL them things:

While data have been reported most extensively for fluoxetine and paroxetine, class effects of SSRI therapy appear to include increased sleep onset latency and/or an increased number of awakenings and arousals, leading to an overall decrease in sleep efficiency. Virtually all of the SSRIs examined have been noted to suppress REM sleep.

[Morbius]

... an increased number of awakenings and arousals...

313 arousals (71.4/hour)