Should sleep be this arousing?

While trying to figure out my CPAP difficulties I have taken a good look at my PSG report and realized that I have three arousal issues. PLMs, a fairly high number of spontaneous arousals, and some breathing arousals (mainly RERAs).

Here are the #s. (I’m not sure what’s best to include from all the #s on my report, but these look good):

1st PSG (no titration) :
155 PLMs w index of 23.7 but only an arousal index of 2.6
Spontaneous arousals 61 with index of 9.3
Resp arousal index 12.4
Total arousal index 24.3

2nd PSG with titration:
226 PLMS w index of 33.3 and arousal index of 4.6
Spontaneous arousals 102 with index of 15
Resp arousal index 7.4
Total arousal index 27

This brings up three questions:

1) Is this a lot of arousals (the spontaneous, particularly), or does it just seem that way to a newbie?

2) Could the spontaneous arousals be from a sort of “lab effect”? Note that they got significantly worse during titration while wearing the mask. Or is this some oddball thing that just goes along with or even defines being a light sleeper, which I am.

3) Why would the PLMs go up like that with titration? I know it’s a lot of PLMs, but is the PLM arousal index also a lot? Am taking iron for low ferritin, and I hope that helps b/c I’d like to avoid the meds.

No, sleep should not be this arousing. Couple things in considering the higher PLMs in the titration. When comparing one test to another, time slept and time spent at the different different stages of sleep can make a difference. Also, when OSA and Periodic Limb Movement Disorder coexist, there are two arousal-causing conditions, and one may be more prominent than the other with either stronger or more frequent arousals. Treating one of them can allow the other to more fully manifest.

An index of 4.6 arousals from limb movements, when multiplied by the number of hours slept and added to the same for respiratory and spontaneous arousals, is pretty disrupted sleep. Hopefully the respiratory and spontaneous arousals will settle down when sleeping at home with a therapeutic pressure and getting used to the new sensations of the mask etc. If after a reasonable amount of time you are not feeling better, you may want to consider if your PLMs have increased.

Just curious... do you have chronic problems with your legs, as in muscle or joint pain? I did (and do) but didn't know if that's a common experience in those with limb movement issues.

Hope things settle down for you soon.

Kathy

So if I treat the PLMs with iron and that works, the apnea could increase? And if I treat the apnea with success, the PLMs could increase? That is most unfortunate! I was kinda hoping that treating one could make the other better.

Kathy, no, I don't have any leg or foot issues. Just an occasional neck issue.

Interestingly (at least to me!), my husband has had PLMs for years. But he won't do anything about it. So I get the added awakenings of his kicks, too! (Mostly as I'm trying to go to sleep.)

Just from me thinking this thru (no science), while resolving the LMs without cpap could result in an increase in number of apnea events, I don't know that it would increase their severity. If you are on cpap, it probably wouldn't make a difference. Because you could have some troubleshooting to do down the line, I think a data capable machine would be of real benefit in helping you know if your OSA is therapeutic and not to blame for any/all residual daytime symptoms.

I was treated for PLMD for years before the OSA, although I knew symptomatically and my doctor was sure the OSA was present. My movements were so frequent for a while(every 4 seconds) the OSA rarely got a chance to show. My LM's stopped during REM, but they rarely allowed me to reach REM, where my OSA was most likely to show, so diagnostically it was difficult. In my mind treating the OSA is priority because of the potential health consequences. If you can get both under control simultaneously, that would be the best scenario. Don't dwell on it too much till if or when you know you need to. Everyone is different, and it may not become a big issue for you. Focus on your OSA treatment so you can know you are protecting your body and mind while you sleep. The rest can wait a bit, and will have to anyway since you are going to try to not use meds for the movements. Let us know how things progress.
Kathy

Thanks Kathy. That makes sense, scientific or not.

I still wonder what a "normal" amt of spontaneous arousals is, and if the lab environment can have an effect.