Alpha intrusions

where the heck did they come from?

I don't know. I don't think that I have the conditions that they are associated with (fibro, severe pain, chronic fatigue), unless I am possibly in the early stages of development.

Spontaneous arousal index: ~ 30.
Awakenings 60; index ~ 10
Sleep efficiency: 57.9%

My doc prescribed Clonazepam for the SAs, and I took 1mg of Clonazepam on the night of the study.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal

The things you've mentioned are the usual suspects, but alpha intrusion could be normal phenomenon, too, However, since those entities can also destroy sleep architecture, better keep that in back of your mind.

As an aside, benzodiazepines can generate some extra stuff in the EEG (it's usually a little quicker than alpha, like beta, spindling, or sigma waves, different people call it different things). I wonder if that's what they saw instead of real alpha.

The sleep architecture, of course, continues to be abyssmal, that's a terrific number of awakenings (sleep disturbances of greater than 15 seconds).
SAG

Hi,

I have an appt with the doc next week, so I don't know what will be recommended.

StillAnotherGuest wrote: As an aside, benzodiazepines can generate some extra stuff in the EEG (it's usually a little quicker than alpha, like beta, spindling, or sigma waves, different people call it different things). I wonder if that's what they saw instead of real alpha.

Thanks, I'll ask just in case. Why do you wonder if it's not alpha? Is there a scale for alphas (mild, medium, severe).

The sleep lab is in a hospital, and the tech who scored the EEG has been working there for 13 years. She specifically asked me how much benzo was taken that night, and later mentioned that the doc came over to see the results with her. She said that they were going to try to help me, so I am somewhat hopeful.

Maybe the alphas have been there all along? During my first sleep study, I did not achieve any Stage 3/4, so any alpha/delta couldn't be seen. The second study was the titration, and they might not have been looking for them. (???)

The benzo was prescribed in order to help with the spontaneous arousals and to consolidate my sleep. It seems to me from both my experience and the study results that it is not helping much. I noticed on the hypnograms for the MSLT, that there was even significant sleep fragmention during times that I fell asleep during the nap periods.

I remember waking up only twice, so maybe those 60 Awakenings are a typo, maybe it was 6?

I now think that the OSAHS is being treated, therefore no trach.

After all the above, I guess the only thing that really matters now is what the next treament recommendations would be.

Alpha intrusion is usually described as either present or not, although some folks used to quantify the amount as a percentage of the screen or "epoch" they were looking at (25%, 50%, etc., scale of 1 to 4, whatever).

Right, there are a number of possibilites re: it's origin -- it has appearred suddenly, it was missed on prior studies (and it need not be exclusive to delta sleep, either), or it's really a beta pattern. Given that terrible architecture, tho, I wouldn't crucify anybody that "missed" it, it's just easier to see in continuous delta sleep. All this may be academic if it's a normal variant, tho.

If it's not, Xyrem might be a way to kill 3 birds (alpha intrusion, daytime EDS and terrible architecture).

Or just start with the more popular stuff (Ambien, Lunesta, etc.)

Assuming also that all sleep hygiene measures are being faithfully employed and no other drugs are at fault, including caffeine and diet sodas (whether they have caffeine or not), cause as you noted before:

The suggestion was for me to continue to take the Clonazepam, practice strict sleep hygiene, etc. I was somewhat frustrated as I am and have already been doing those things. I am on my third day of the strict sleep hygiene routine and feel awful. I was not successful today as I was "passed out" from 8am to noon.

says that strong sleep pressure does occur, but at the wrong time.

What was the Mean Sleep Latency in the MSLT? What did the heart rate graph in the PSGs look like?
SAG

What was the Mean Sleep Latency in the MSLT? What did the heart rate graph in the PSGs look like?

The mean was 11 min. There is not a heart rate graph in the report, and only mention of cardio in the report is EKG: Sinus rhythm. My BP is normal.

Or just start with the more popular stuff (Ambien, Lunesta, etc.)

I had tried samples of Ambien without improvement, and then the doc prescribed the Clonazepam.

I think that it's probable that the EDS is entirely due to the poor quality of my sleep. 45-55% sleep efficiency, plus the spontaneous arousals and awakenings is more than enough to guarantee a bad day. Even if perfect sleep hygeine gave me a 20% improvement, I would still be getting pretty poor quality sleep.

The letter from the docs office is recommending bi-PAP at 5/11. So I have set my autoPAP at CPAP 11cm with exhale of 8. I am thinking that since the titration determined a new higher pressure, 11cm, that I would "start over" with the new pressure, continue the Clonazepam, and then have a couple of weeks of data to show the doc at the next appt. If I am not better, then it probably wasn't the pressure, it's something else, and I'll have to look at new meds. Am I making any sense?

I'm willing to give it a try, but it looks like a last resort to me.

JulySky wrote:The mean (sleep latency) was 11 min.

Hmmm. That only rates as "mild" EDS, and could very well have been even milder had you had the more common 5-nap series.

There is not a heart rate graph in the report...

One could easily debate the position that there is no such thing as Primary Insomnia (insomnia without a "known" cause). Not having a cause and not finding a cause are 2 entirely different things. Continuing to search for it wouldn't be a bad treatment plan either. Are you/were you on any medications other than the clonazepam?

I had tried samples of Ambien without improvement, and then the doc prescribed the Clonazepam.

Was that the "CR" version or regular? We can get a little bit into "half-lives" of drugs to make sure the sleep medications you select match up with the sleep problems.

Speaking of which, old broad-spectrum benzodiazepines like clonazepam aren't a great idea for insomnia because their very long half-lives can give you a good case of the grog the next day.

Which in turn makes that 11 minute MSL on an abbreviated study (I would have guessed something in the neighborhood of 5 minutes, especially if you were a delayed sleep phase) somewhat curious.

I think that it's probable that the EDS is entirely due to the poor quality of my sleep. 45-55% sleep efficiency, plus the spontaneous arousals and awakenings is more than enough to guarantee a bad day. Even if perfect sleep hygeine gave me a 20% improvement, I would still be getting pretty poor quality sleep.

Emerald City would 95% sleep efficiency, total sleep time 7.5 hours, arousal index <5 and maybe 2-5 awakenings.

If I am not better, then it probably wasn't the pressure, it's something else, and I'll have to look at new meds. Am I making any sense?

Not a bad plan.

JulySky wrote:I'm willing to give (Xyrem) a try, but it looks like a last resort to me.

Also correct, cause without a diagnosis of narcolepsy, it would be easier for Michael Vick to buy a bag a Purina Puppy Chow than you to get Xyrem.
SAG

I "slept" about 10 hours the night of the study, and was not taking anything else. So it was "more" sleep than the usual 8 hrs that my doc limited me to. I also walked outside in the bright sunshine for about an hour before the last two naps.

Only taking Clonazepam during the week of the study.

I have tried Provigil (200mg before 8am) occassionally, but cannot really tell any difference. Perhaps if I could improve the sleep efficiency then the Prozac might give me enough boost to make a difference.

I had tried the regular Ambien. Understood about the half-life, I will look into that.

Okay, you've helped me see that there are several more options to consider. Thanks.