sleep study (PLMD) and health issues - will CPAP help?

[Rynn01]

Hey everyone. Just found this site yesterday after I got my results from my sleep/nap study. So glad I did!

Anyway, they want me to come back for a CPAP sleep trial. The nurse at the clinic said that I have very mild sleep apnea, only stopped breathing 6/hr. But my limb movement was 35/hr and o2 sat was down to 67%. My main concern is the O2 sat. For that reason alone, I'll try a CPAP.

I have been diagnosed with major depression, anxiety, chronic fatigue, and I have no motivation to do anything. From some of the posts I've read on here, CPCP can help w/ many of these things. With my apnea being mild, how much improvement can I expect to see? I understand YMMV. Will it do anything for my limb movement?

Thank you for taking time to help.
Rynn01

Thought I would add that I'm 39, 5'2 and 103lbs so the apnea came as a surprise.

[49er]

Hey everyone. Just found this site yesterday after I got my results from my sleep/nap study. So glad I did!

Anyway, they want me to come back for a CPAP sleep trial. The nurse at the clinic said that I have very mild sleep apnea, only stopped breathing 6/hr. But my limb movement was 35/hr and o2 sat was down to 67%. My main concern is the O2 sat. For that reason alone, I'll try a CPAP.

I have been diagnosed with major depression, anxiety, chronic fatigue, and I have no motivation to do anything. From some of the posts I've read on here, CPCP can help w/ many of these things. With my apnea being mild, how much improvement can I expect to see? I understand YMMV. Will it do anything for my limb movement?

Thank you for taking time to help.
Rynn01

Hi Rynn01,

Welcome!

Can't comment on the limb movement issue but many people mild sleep apnea can be just as handicapped as folks with severe apnea due to how long the apnea events last and the severe O2 desaturation that you have. So yup, it will definitely help.

During the rare time pap therapy worked for me (another post), it made a huge difference in my mood and motivation to do things. I always tell people it felt like I was experiencing the world in bright living color vs. a dull gray.

Feel free to post here as often as necessary to work all your issues. This is a fantastic board to rely on for assistance.

49er

[kaiasgram]

Rynn01, welcome -- you might want to add something about PLMD to the title of your post so it'll catch the attention of forum member kteague. She's very knowledgeable and experienced with PLMD and she's very helpful.

[kteague]

Hello and welcome. Few things to mention just to get the ball rolling...

Did they diagnose you with PLMD, and do you have a copy of the report to see how many of those limb movements caused arousal? There is a chance your OSA is more than mild, and that your limb movements are actually worse than recorded. Both OSA and PLMD are sleep disorders that can disrupt your sleep. Right now they are likely sharing responsibility for your sleep disruptions, each at times interfering with the other's ability to freely and fully express itself. If either of the disorders is treated, the other is then given more/better sleep in which to more fully manifest.

Especially with the low O2 sat you report, I think treatment of your OSA should be swift and decisive. Don't allow the the word mild to give you doubts. There's nothing mild about what's happening to you. Mild is based on your count, which like I said, may not be a full reflection of your condition. In my first few sleep studies the OSA didn't even show up because the limb movements were so active. You may be one of the lucky people who find treating their OSA helps their limb movements. Let's hope that's the path this takes. Because of the things mentioned it is of utmost importance that you insist on getting a machine that tracks your treatment data so if you continue to have sleep issues you can verify if your OSA treatment is indeed therapeutic and know to then focus on your limb movements. It can be a cat and mouse game that you don't want to play in the dark.

Regarding any limb movements, my first question is if you are on any meds that could cause this side effect? In the event you end up needing to treat the limb movements, there is some due diligence that may help you avoid some pitfalls and potential side effects of some of the meds commonly prescribed. If your movements aren't too severe they may even respond to non pharmaceutical treatment. Ask your doctor to order iron studies. The one I'm most familiar with is the ferritin level. Seems to be a common thread among RLS/PLMD sufferers to have lower ferritin levels and keeping it around 50-60 is generally recommended and my doc wanted mine closer to 100. The dopamine agonists often prescribed for jumpy legs are thought to be more likely to be problematic in those who start taking them before getting their level up. Low magnesium is thought by some to be a culprit, also low Vitamin D. I can't give you science for all this at the moment, but I'm guessing Google can substantiate at least some of it. Warm foot soaks before bedtime and a pillow between the feet and legs while sleeping were recommended by my doctor. Some people use prescription meds without the side effects. I wasn't so lucky. I use a TENS Unit to treat mine.

If I were a betting woman I would bet every one of your symptoms will be improved by treating your OSA, and even further improved by resolving any limb movement issues. The degree of improvement is anyone's guess, but I can't imagine you won't feel better once you are getting better sleep. Best wishes.

[Sludge]

Anyway, they want me to come back for a CPAP sleep trial. The nurse at the clinic said that I have very mild sleep apnea, only stopped breathing 6/hr. But my limb movement was 35/hr and o2 sat was down to 67%. My main concern is the O2 sat. For that reason alone, I'll try a CPAP.

Thought I would add that I'm 39, 5'2 and 103lbs so the apnea came as a surprise.

IIWY, I would get the complete report and ask to see the "raw data" where the 67% desaturation was to insure it was not "artifact" (false value generated by movement, loose sensor, etc.) and exactly what "stopped breathing" means (i.e., were they truly long "apneas", or much less severe events (hypopneas, RERAs)).

This sounds a little

[Rynn01]

Thanks everyone for the responses so far. I'm going to try to get the full report today. All I have is what the nurse told me over the phone. Didn't know what all to ask, but since we're military, I try to get all reports just to make it easier.

I was not dx'ed with PLMD to my knowlwdge, only dozed during one of the naps. I've tried to check my meds for the linb movement/RLS, but none seem to cause it. I am going to my psychiatrist today and will talk to him about the meds.

One thing I did wonder re meds. I do take Soma (carisoprodol) which is a muscle relaxer at night and once during the day. I'm wondering if this could cause the apnea. Unfortunately, that's the one med he doesn't give me. Opinions? Is there a chance that I won't have to take as much meds to sleep? I wake up between 2-4 every am. Sometimes I can go back to sleep and others, I'm up until my daily nap.

Rynn01

[Rustsmith]

If you have PLMD, then there is an 85% probability that you also have WED/RLS as these two conditions seem to go hand-in-hand even though there are thought to be separate.

You can find out more about RLS at the WED Foundation's website at http://www.rls.org or their bulletin board at bb.rls.org.

As for medications, there are a number of medications that are known to be triggers for WED/RLS. The most common of these are the sedating type antihistamines, typically Bendryl, and the tri-cyclic antidepressants. A much more complete list can be found at the Foundation website.

[Sludge]

...only dozed during one of the naps.

"One of", as in one of five naps?

I do take Soma (carisoprodol) which is a muscle relaxer at night and once during the day. I'm wondering if this could cause the apnea.

Time to dig up Bev's study and review the effects of Ambien.

However, in answer to your question, looking at the histograms from the study may provide clues.

[Rynn01]

yes I only fell asleep for one of the 5 naps. I am hoping that the actual study will tell me more. I take Ambien CR and have been on Ambien. They don't really work for me. I have to be in bed with eyes closed and then either one only has a 50% chance of working. What I do take for sleep is Soma, klonopin, abilify, trazadone and a crap load of melatonin. Right now I'm up to 50mg of it! I want off these meds as much as possible. I fight my tiredness during the day w/ caffeine tablets, which the Dr. make me quit for a week before my study, yes I take that much.

Sorry that this is a little off topic, just want to get all the facts out there so the wonderful people here can share their experiences and give me an idea of what to expect.

[Lukie]

Your sleep study seems to be an exact copy of mine. Don't let the "mild" fool you. If you are dropping your oxygen levels during even a few apneas, you feel like hell in the morning. I have been on CPAP for three months and feel much better because like you I was waking up at 2 or 3 and staying up. I now get 8 or 9 hours of sleep every night getting up once for a potty break.
I have restless legs diagnosed but with no arousals so they are not even bothering to treat that. I do take 10 mg of doxepin for sleep and supposedly for the restless legs. It is mild and does help me sleep without affecting breathing.
Keep on top of any oxygen desaturation because it is this factor that leads to dementia, stroke and heart failure.

[jnk]

I'll take a stab at directly commenting on some of your questions from my perspective. Keep in mind I am not a medical anything. Just some opinionated guy at a forum on the Internet.

Hey everyone. Just found this site yesterday after I got my results from my sleep/nap study. So glad I did!

You are already miles ahead of many. You got the study (many do not), you went looking for info on the Internet (many do not), and you found the best place right away (again, many do not).

Anyway, they want me to come back for a CPAP sleep trial. The nurse at the clinic said that I have very mild sleep apnea, only stopped breathing 6/hr. But my limb movement was 35/hr and o2 sat was down to 67%. My main concern is the O2 sat. For that reason alone, I'll try a CPAP.

I commend your clarity of thought. The willingness you are showing to give it a shot will serve you well.

I have been diagnosed with major depression, anxiety, chronic fatigue, and I have no motivation to do anything. From some of the posts I've read on here, CPCP can help w/ many of these things. With my apnea being mild, how much improvement can I expect to see? I understand YMMV. Will it do anything for my limb movement?

Good sleep and good breathing can improve just about anything and everything compared to bad sleep and bad breathing. Sleep and breathing are related to, and interact with, just about everything. Sometimes fixing one small part of the overall condition can cause everything else to fall into alignment. Sometimes not. The trick is to keep trying things and to stay systematic and motivated through the process. Your docs are there to help. But we as patients often need to keep on top of our unique circumstances and the details of our conditions. Sometimes limb movements show up as bad breathing, sometimes bad breathing shows up as limb movements. It is all interrelated in odd surprising ways. Fortunately, modern mainstream medical techniques can help many of us. Others of us find more help in the alternative approaches when we find the mainstream ain't doin' it for us.

Reactions to medications are highly individual. Patterns and averages are recorded in medical literature to show what is commonly experienced. You are not a pattern or an average. You are an individual. So trust your instincts about which medications may be affecting you in which ways. Sometimes the trade-off is worth it to give the body time to adapt to a medication. Sometimes not. If you can keep a calm, detailed approach to sorting your way through it long term as well as you have done and as clear as your expressed thinking has been in your posts here, you will do fine, I'm sure.

Meantime, learn as much as you can about sleep hygiene. Most of us who have had sleep problems develop some bad habits with our sleep along the way. The bad habits may not be the root cause of our problems, but having a sleep disorder does not dismiss us from the requirement to put in the efforts every human being needs to put into the quality of his or her sleep day to day and night to night.

Just one man's opinion.

I wish you well in finding things to help.

I think you will.

My guess is that Sludge will be of great help to you.

-Jeff

[Rynn01]

Well, I went by to get my report, but it wasn't done electronically yet, just hand-written, so they couldn't give it to me yet. They did tell me that my O2 was below 90% for 26 minutes total, and we ahead and scheduled the titration study for a week from Sun. That's before I see the Dr, but I might as well get it done since he'll recommend doing one anyway.

JNK, thank you for your super positive post.
Lukie, the O2 level is what is making me determined to do this. I about freaked out when I heard it.
Sludge, could you point me in the direction of Bev's study and if there is a certain site about Ambien, that also? Thanks
Rustsmith, thanks for the link.

[Denial Dave]

FWIW.... during my sleep study, I had 101 PLM's..my PLM index was 18

My AHI for the sleep study was 38 with oxygen saturation going below 70%

post CPAP treatment, I have ZERO PLM's.

[kteague]

yes I only fell asleep for one of the 5 naps. I am hoping that the actual study will tell me more. I take Ambien CR and have been on Ambien. They don't really work for me. I have to be in bed with eyes closed and then either one only has a 50% chance of working. What I do take for sleep is Soma, klonopin, abilify, trazadone and a crap load of melatonin. Right now I'm up to 50mg of it! I want off these meds as much as possible. I fight my tiredness during the day w/ caffeine tablets, which the Dr. make me quit for a week before my study, yes I take that much.

This list of meds makes me cringe - and want to scream. I'm just guessing but it could be that you actually need very little/few of these medications and it's all been thrown at you in a blind attempt to treat symptoms but they don't help because they don't treat the root cause. Did a doctor tell you to take that much Melatonin? Even if low Melatonin is a cause of your insomnia, there is a point where more is not better. Again just guessing, but it wouldn't surprise me if your limb movements resolve with reducing your meds and your caffeine. Since getting off the meds as much as possible is your desire, I'd just like to caution you to make any medication changes in a very calculated manner. I stopped a med abruptly against instructions that there should be a weaning process, and the consequences remain many years later. Your brain is used to these chemicals, no matter how toxic, so work closely with someone knowledgeable as you pursue getting off some of your meds. I found my pharmacist more knowledgeable about this (and some people here) than the prescribing physicians. Another thing to look at when you get your report is if any/many of your apnea events are centrals rather than obstructives. Some meds increase that liklihood.

I think you are well positioned for good outcomes. It may take a bit of maneuvering, but you're in a good place to get guidance.

[Sludge]

Well, I went by to get my report, but it wasn't done electronically yet, just hand-written, so they couldn't give it to me yet.

Make sure you get the long report, with lots of graphs. Graphs, graphs, graphs!

They did tell me that my O2 was below 90% for 26 minutes total...

If you "stopped breathing" 6 times per hour (and we really need to look at that, and make sure it isn't an exaggeration. One truly only "stops breathing" during central apneas, and if some/all of the events were hypopneas and/or RERAs, then that moves from "stretching the truth" to "outright lie"), and if you slept for 7 hours, that means you had 42 events all night. On average then, each event lasted at least 37.1 seconds, and undoubtedly longer to much longer (since desaturation starts from your baseline, which is about 95%, not 90%). So these are LONG events.

If true, then one needs to ask why. Usually, long events are associated with REM. However, your drug cocktail (aripiprazole, carisoprodol, clonazepam, and trazodone) are all REM suppressants, so how did any REM occur? Perhaps it all came at the end of the night, when drug effect wore off somewhat).

However, if all the events came at the beginning of the night, then they could be drug-related (all them drugs wiping out the protective mechanism of the arousal threshold). If so, this is not "sleep apnea" this is "drug overdose", and we need to push the "Panic Button".

However2, if that time below 90% came in a single block, and had no reasonable explanation, then it could be artifact (equipment issues, sensor displacement, sleeping on arm, etc.).

All of which is why the graphs are necessary to try to put these strange numbers in context. You got something that's either nothing or incredibly bad.

You had an MSLT, so I imagine they were looking for narcolepsy (specifically, the presence of sleep-onset REMs, or SOREMs)(and couple other things, like bad sleep, more on that later)(and if that was there (bad sleep), then sleep time was reduced, so the aforementioned desaturations were even longer). And although stopping the caffeine was a good idea, that REM-suppressing cocktail you're on would surely wipe out the ability to generate SOREMs (at least on the NPSG). So negative results on MSLT are not necessarily conclusive.

But with only one sleep onset on MSLT, then you are technically, and objectively, not "sleepy". Nowhere even close (the worst SOLmean you could have is 16.0). So is this sleepiness, fatigue (entirely different thing) or drug fog?

CPAP will not fix drug fog, may make sleep quality worse, and if the events are drug-induced, may not even address underlying issues (which could be largely central in origin).

Hopefully, this should clear things up.