OT? REM, delta sleep, migraines, depression

[TahoeGal]

I'm being treated for life-long depression (strong SI component), PTSD, and dissociative disorder.

1.5 years ago, I asked my pdoc for sleep meds. I was always exhausted and couldn't get asleep, stay asleep, wake early, etc.

she wanted a sleep study first. Turns out I have ideooathic central sleep apnea. I got a machine, and it has helped the exhaustion.

I have had 3 sleep studies done. 2 state that there was a delayed onset of REM, with only 1 REM per study and minimal delta (deep) sleep. In one study I had no REM nor delta sleep.

I also have migranes that usually start at night, and have been lasting longer and longer. My current migraine has been since 1/15 and counting.... I am taking ibuprofen, which keeps me (mostly) from crying.

I was treated for continual migrane (1 year long) about 15 years ago, with depikote, amitriptoleine, nortriptoline, zomig and maxalt. Nothing helped, except having jaw surgery to correct a bite problem. Migraines were much better after that.

I had a brain MRI 1/16 and all was clear. With using my ventilator, my 02 levels are ok. I use my ventilator religiously. I am 50 years old, and (otherwise ) healthy. My jaw is ok, and I haven't had any recent dental work. I wear a night guard, which has been checked for fit and was ok.

I recently started seeing a neurologist/sleep specialist. (December) He thinks things look ok. I pointed out the sleep disorders, and I got a huh! I don't have many choices in doctors, the next nearest sleep dr is 5-6 hours away, so I'd like to work it out with this one. We tried fiorcette, which did nothing. He suggested topomax and klonapin at night.

I see my pdoc Monday. I will discuss the med suggestions with her. I took topomax previously as a mood stabilizer- but it made me dumb. My husband said it was bad.

Because of my strong SI, I have learned to be very careful with what and how many meds I have in the house. I was not thrilled with the fiorcette, since it has barbiturate in it. Since it didn't work, I gave the pills to the sleep doc for disposal.

Does anyone have any experience/insight/suggestions? Anything could help. I've searched the net on the REM and delta sleep, with no answers.

[Pugsy]

What meds now (if any) are you taking for the

I'm being treated for life-long depression (strong SI component), PTSD, and dissociative disorder.

and have you researched them deeply for potential impact on sleep architecture/sleep stages?

Sorry, can't help with the migraine problem. No real experience there to draw upon except to ask if your cervical spine has been ruled out as a potential factor.
I have had some killer headaches in the past...the ones related to OSA went away with therapy.
The ones related to my broken down cervical spine...I still get them occasionally if I sleep weird on the pillow but for the most part much improved since I had the cervical spine surgery.

[TahoeGal]

Thanks Pugsy. I did my homework.

My meds are: abilify, cymbalta, wellbutrin, lamictal, amantadine, prazosin, and klonopin prn.

Only cymbalta has an effect of "sleep disorder." The pi sheet lists a Post marketing spontaneous reporting of sleep disorder. I could only find 1 study identifying an effect. It was an experiment consisting of 10 humans with depression, and they found REM latency increased from 58 minutes to 193 minutes (one of my studies showed stats, with a latency of 247 minutes) and a REM length decreasing from 95 minutes to 51 minutes. (I had one 1 REM event lasting 23 minutes. ) there was an increase of delta sleep from 21 minutes to 37 minutes. ( my study showed 1 event lasting 9.5 minutes.). Given the small sampling, and lack of repeated experiments, I don't give this study much weight. But I will keep it in mind.

I tried to reduce my cymbalta dose last fall, with the intention to eliminate cymbalta from my med cocktail. Unfortunately, it was an utter failure and I had to bring my dose back up.

Thanks.

[Pugsy]

Wellbutrin is also known to mess with sleep architecture. Fairly common actually. The primary reason I didn't take it very long quite a while back to help with stopping smoking.

lamictal...drowsiness, insomnia, anxiety, vivid dreams or nightmares,
all which point to possibly messing with sleep architecture

Amantadine.. nervousness, anxiety, agitation, insomnia,

prazosin... possible side effect is dreaming while awake or hallucinations of wakefulness while falling asleep on the medication

abilify...lists headaches as a potential side effect...I didn't even look for headaches in the above meds...along with...sleeplessness, trouble sleeping, unable to sleep

and we already know about cymbalta.

anytime we see insomnia as a possible side effect it means potential for messing with sleep architecture
also when we see mention of stuff related to dreaming or not...that can point to affecting sleep architecture.

Morbius knows a lot more about how these meds might actually affect sleep....hopefully he will stop by and offer some input.
About all I know is they can mess with sleep but I don't know exactly how they mess with sleep.
With all these meds I am not surprised your REM sleep is not what is considered to be normal in most people in terms of latency and how long and how often.

Calling Morbius for assistance in meds messing with sleep explanation.... I would send a PM but he doesn't do PMs.

[TahoeGal]

Thanks Pugsy. I was specifically looking for disturbances in rem and delta stages. I wasn't thinking about the usual insomnia. Meds are very complicated. The brain's function is so unknown.

[Pugsy]

Meds are indeed very complicated and to make a difficult situation even worse, the side effects can vary so widely among individuals.
I take a pain med that comes with a "may cause drowsiness" sticker...as that's a common side effect but there's a very small percentage of people who experience insomnia with it...and guess who drew that short straw?
If I take it after 6 PM then either I can't get to sleep or if I get to sleep I will wake up in 3 to 4 hours wide awake and be cleaning the house at 3 AM.
If I don't take it then the pain I get with every little movement in bed wakes me up a gazillion times and I feel like crap because of the wake ups. Damned if I do and damned if I don't. It took some time for me and my doctor to come up with a workable solution in terms of different meds for nighttime pain control....along with me doing some other stuff to also minimize the pain like a better bed suited for my needs.

How much of an impact your meds are having on your overall sleep architecture and quality is unknown and obviously going without them creates a whole new problem and is not a viable option at this time....but I would bet some serious money that the meds aren't doing you any favors in terms of sleep quality.
Damned if you do and damned if you don't.

[Nick Danger]

Klonopin (as well as other benzodiazepines) can increase the severity of sleep apnea (in fact, sleep apnea is a contraindication for use of clonazepam). Is there a chance that your p-doc is up to speed on sleep disorders?

As a practical matter, it is probably going to take a lot of work on your part (working with your neurologist and/or your p-doc) to figure out what combination of medications best improves your quality of life (I'm sure you've already put decades of effort into that very thing). Now you just have one more thing to add to the mix - what combination of medications will best handle all your symptoms. In some cases, you may have to compromise - deciding which symptoms are most important to your quality of life and which you can live with: for example, it is probably more important to treat your mood and anxiety symptoms than it is to optimally treat your sleep apnea (in other words, clonazepam may be an important medication for you to use to deal with anxiety symptoms - even if there is a chance it may make your sleep apnea symptoms worse). But this gets complicated - as you know disordered sleeping increases the severity of both your mood and anxiety symptoms. I'm sorry you don't seem to have access to health care providers who are expert on your combination of symptoms. Let's hope that either your p-doc or your neurologist is interested enough in learning about this combination that one of them will research this and seek consultation with physicians who do have the necessary expertise.

Have you tried DBT to help deal with the mood and anxiety symptoms? Assuming you live in the Tahoe area, I found a list of several psychologists, psychiatrists, and other therapists who advertise that they provide DBT. It doesn't work for everyone and it is a long slog, but during my internship I was impressed at the improved quality of life I saw in many trauma survivors.

[TahoeGal]

The meds are such a balance of benefits and side effects.

I never thought about the klonopin being a problem. I have central apnea, and what I learned was not to take cns depressants. I had thought opioids would be my biggest problem.

I normally take .5 mg of klonopin a week. Ironically, it's to help me get through my therapy without a panic attack. I'll ask my therapist about dbt.

Thank you for your thoughts. If my pdoc and sleep doc can't work it out, I may be in the market for new docs.

[Morbius]

I'll throw this out there because I feel like I should throw something out there:

[TahoeGal]

Morbius, that chart looks very useful. It shows up for me, but cut off on the right side. Do you have a website address it came from?

[grayghost4]

eather click on it ... or .... press ctrl "-" several times

[Morbius]

Now I always thought trip was pretty good, but it seems to get mixed reviews.

Anyway, back in day:

[Morbius]

Don't forget Gaba:

http://www.ncbi.nlm.nih.gov/pubmed/12460250

[Sir NoddinOff]

eather click on it ... or .... press ctrl "-" several times

Or for MS systems you can just right click the mouse or touch pad and then scroll down and click 'view image'... perhaps a little easier because all you have to do is use the browser's reverse arrow to go back to where you originally were, plus your preferred window formatting and size are just like you left them.

[Morbius]