PSG/MSLT

Ok SAG, seeing as you're still on the insomnia thing... if it's truely that: 1.) How do I get the sleep doc to say that's what it is and 2.) How do I fix it, or get his help in fixing it??? What does he need to see and what do I need to ask for??

See after all this time all I really want to do is to be able to sleep all night. My moods go nutty when I don't sleep all night, no matter what kind of anti-depressant thing that my idiot know-nothing GP has put me on.

cflame1 wrote:Ok SAG, seeing as you're still on the insomnia thing... if it's truely that: 1.) How do I get the sleep doc to say that's what it is and 2.) How do I fix it, or get his help in fixing it??? What does he need to see and what do I need to ask for??

See after all this time all I really want to do is to be able to sleep all night. My moods go nutty when I don't sleep all night, no matter what kind of anti-depressant thing that my idiot know-nothing GP has put me on.

Everything seems to be pointing to that as a major issue, but I think you'll still have to wait for the data from the last PSG because there's a number of variables that still have to be considered. Don't forget, there's 11 types of insomnia in the ICSD, so while all the earmarks of insomnia are there, if it's secondary insomnia, identifying the cause will go a long way. Some of the variables that need to be accounted for include:

Asthma. You noted that you were having asthma attacks during 2 of your studies. Insuring that the asthma was stable by monitoring PEFR will help to account for that.

Effect of Antidepressants. Hopefully, we'll get a glimpse of sleep architecture without the effects of fluoxetine, although it's got one heckuva half-life.

Pressure Therapy. If your testing shows that low level CPAP controls respiratory events effectively, then why mess with pressures of 21/14 BiPAP. CPAP incompatibility could be a problem.

Alpha Intrusion. That you mention pain brings this to mind. Easy enough to check.

Depression. If the insomnia is a result of depression, there are "sleep-friendly' ADMs out there.

To directly respond to your question, within the discipline of sleep medicine is a subspecialty called C.B.S.M. (Certified in Behavioral Sleep Medicine). This certification confirms an individual’s expertise in the application of behavioral and cognitive methods of prevention and treatment. As I mentioned previously, utilizing Cognitive Behavioral Therapy (CBT) will be extremely important to the treatment approach to insomnia. You can ask your sleep guy how well versed he is in CBT (I already checked the list of CBSMs, and he's not on it) or if he is, in fact, comfortable with it at all.

Here's a good summary of the type of approach one takes with CBT:

The ABC's of CBT

Then let's see what the new test results show.
SAG

pain? TMJ=pain... I'm pretty good at ignoring it usually, but there are morning's that I notice it a lot. The TMJ was dx'd about 14 years ago +/-. It was found on an xray, after I complained about nasty headaches and the docs all thought that I was nuts! They tried putting me on valium for the pain, my employer at the time told me to go home 'cause I was stoned. They did say that there was a touch of arthritis in it. The only thing that I've found that deals with the headaches and the pain is a specific type of massage... and I've finally found some folks here that do it.

Still some mornings I wake up and my jaw is very painful, but I rub at it a little and it calms down.

well... I just got back from seeing the doc

he says that the xpap therapy is working. We're trying some medication to see if it's pain that's waking me up. I'm also back on the fluoxetine.

sleep efficacy... 49%
micro-arousal index... 32%

I'm supposed to try the pain meds nightly for a week, i'm supposed to call him then... see if it helps me sleep, otherwise the next step is provigil.

Yes and he has Saturday hours... for which I am very grateful.

StillAnotherGuest wrote:Pressure Therapy. If your testing shows that low level CPAP controls respiratory events effectively, then why mess with pressures of 21/14 BiPAP. CPAP incompatibility could be a problem.

SAG, could you expand on what do you mean by "CPAP incompatibility"?

Also curious about how the gap between High-Low pressure levels you mention could exist -- if low pressure controls events, why would 21/14 Bipap even be considered?

Thanks!

I have been feeling crummy again and miss the energy I was gaining from treatment. I am tired all the time and am wanting to take naps again. I do have a data capable machine and from everything I can tell by my numbers my apnea is pretty much under control. I teach school and it is taking everything I have to make it through the day and by the time I get home I am totally exhausted (usually around 3:30 or 4:00). I am lucky in that I am home earlier than if I had a true 8 to 5 job.

I talked with my family doctor and she said she thought it was just my weight and I should lose weight to help with the tiredness. I KNOW I need to lose weight -- probably 75 to 100 pounds. But it is hard to do when you are so tired you can't think straight. I was starting to walk and was more active after starting apap, but I have slid backwards now and some times can hardly put one foot in front of the other.

I took the Pittsburgh Sleep Quality Index and here are my answers:

1. Go to bed between 9:00 p.m and 9:30 p.m. (most nights at 9:00)
2. How long to fall asleep -- 15 to 20 minutes usually
3. Getting up in the a.m. -- 6:30 a.m work days with alarm -- otherwise I do not wake up naturally until approximately 9:30 to 10:00 a.m.
4. How many hours a night do you sleep -- unsure

5. a. Not during the last month (0)
b. Three or more times a week (3)
c. Three or more times a week (3)
d. Once or twice a week (2)
e. Less than once a week (1)
f. Not during the past month (0)
g. Less than once a week (1)
h. Less than once a week (1)
i. Three or more times a week (3)
j. -- Uncomfortable - not in pain -- Once or twice a week (2)

6. Not during the past month (0)
7. Three or more times a week (3)
8. Three or more times a week (3)
9. Fairly bad (2)

I fight sleep and do NOT actually fall asleep during daytime activities unless I take a nap. Since I do not fall asleep during activities although I have a really hard time with it I don't score like there is a problem on the Epworth scale.

Should I keep persuing this issue with my doctor or am I just needing more time to adjust to treatment?

Due to the daytime fatigue and exhaustion I feel I wish I had the option of taking off work for a period of time and see if I can get straighten out but that is not an option I can do at this time. I am looking forward to May when maybe I can have some time to get more fully rested.

I have a colleague that doesn't have apnea of any kind and has extreme fatigue. He ended up going on Provigil and he said it is the best thing that has ever happened to him. There is no clear diagnosis (narcolepsy is the closest - though he doesn't drop off to sleep without control) but he can sleep easily.

There is still a lot that is unknown about the sleep part of the brain and there could be something not going right in that portion of the brain. But he is able to function fully on the Provigil

There is still so much to understand about how the brain works and then the brain in conjunction with sleep.