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Thanks again for your thoughts on my situation. And my apologies for what are probably unorthodox gaps in my getting back to you all. This is the first time I have posted on a forum and the last week or two have been unexpectedly busy.

Thanks for the thought on serotonin syndrome. I just called my GP and he said this syndrome usually arises in an acute sort of way, but we agreed that it would be worth going off the 5-HTP gradually and see what difference it makes. It might not be doing anything or something I don't want, so trying sleep without it would be good to do. I have been increasing the Trazadone (up to 225 mg at bedtime) over the past few months to try to help with staying asleep. I fall asleep easily and feel like I really sleep, but with some regularity I wake up for good after 4-5 hours. The sleep doc didn't comment on my sleep architecture, just staying with the "on this night you didn't have sleep apnea so you can get rid of the machine" response (likening it to a teddy bear I should get rid of!), so at present I don't feel like I know much more about my usual night's sleep architecture than I did before. Maybe I usually sleep fine and maybe not.

I find myself feeling a bit out of my depth in understanding some of the things that have been remarked on such as sleep efficiency and REM supression. One thing I do now is how completely weird that night of sleep in the lab was and it makes me seriously question the usefulness of the data it yielded, and the thought that maybe I never got relaxed enough to have apneas makes sense to me. Between muscle pain, heart pounding, not being able to breath through my nose (I had been using Afrin regularly for years) and no CPAP it all felt pretty extremely unlike what my sleep usually is like. Last winter we had 2 power outages on two nights that left me with my CPAP machine for the first time in twelve years, and both nights I woke up over and over gasping for air like someone was choking me almost. More evidence for apneas it seems to me.

A question I have is about the information I might get if I do get the data tracking software for my DeVilbiss machine. Are Ozij's suggestions on what to do pretty much the standard? Is there somewhere where this is already covered that I could get a link for? What kind of information will I get from doing this-whether I have apnea or something else?

Thanks so much for taking the time to help me out with this.

Berthold wrote:I just called my GP and he said this syndrome usually arises in an acute sort of way, but we agreed that it would be worth going off the 5-HTP gradually and see what difference it makes. It might not be doing anything or something I don't want, so trying sleep without it would be good to do.

Right, serotonin level would progress from "therapeutic" to "serotonin toxicity" to "serotonin syndrome". How much 5-HTP are you/were you taking? Any issues with blood pressure (like feeling faint when suddenly jumping up)?

In response to your original question:

Berthold wrote:Were those old take home tests that wildly unreliable?

Berthold wrote:I was diagnosed with OSA in 1996 with a take home sleep test (Vitalog 5000 machine)

I believe that machine had the ability to stage sleep, so I would not summarily dismiss the results and/or accuracy of that study. Discrepancies could be from a number of sources. FIrst, the initial study could have taken a more aggressive approach in scoring respiratory events, thus giving a higher AHI. Specifically, this might have entailed counting snoring arousals as hypopneas instead of the more appropriately-termed RERAs. In other words, that first AHI was actually an RDI. This would then reconcile the differences between the 2 tests because the RDI in this last test is 20. You're now a little older, a little heavier, the old "RDI" was 16, the new RDI is 20, and that would then appear to make sense.

Second, serotonin is funny stuff. Right now, it's the leading candidate in the search for "The Magic Bullet" (the pharmacological treatment of sleep apnea). I would also theorize that you may, in fact, appear to be a little better because the increased serotonin level has also contributed to some airway stability and the AHI is indeed lower.

This should not be construed to mean, "Hey, let's shovel in a couple of pounds of 5-HTP and see what happens". Before anyone does that, they should reread the Serotonin Syndrome thing.

Further, a lot of these drugs that increase serotonin levels also worsen sleep quality, so there's a real fine line between things they improve vs things they worsen.

Berthold wrote:Are Ozij's suggestions on what to do pretty much the standard?

Yes, and RG's as well, except for maybe for o.'s comment about apneas appearing in Stage 3 or 4 sleep (which is now collectively called Stage N3 sleep). N3 sleep tends to be quite airway-stabilizing and usually has fewer events rather than more. Note how in your sleep study histogram how stable SaO2 is during N3 sleep.

Boy, I'll bet you've got some pretty good Variable Breathing there as well, lemme know if you ever get a Respironics APAP.

SAG

In the histogram, it looks like the SaO2 disappears during the final REM period. That also looks like the supine area as well (although I can't make out that position label there on the left no matter how much I blow it up). What's up with that? I don't think it drops precipitously low (because nadir is listed at 90%) but is that an area that simply didn't scan properly or what?

SAG

I have been taking 400mg of 5-HTP at bedtime, down to 300 starting last night. I do get lightheaded if I stand up quickly, though my BP always measures at 120/80 or so.
I am pretty sure I could borrow a Respironics APAP from my DME company and get a report from it. That sounds like something you would recommend, yes? It would save me buying the software for my DeVilbiss right away too.
Looking at the histogram, that last REM sleep was on my back, and there is a gap in the printout the sleep doc gave me.
Thanks for your input.

Berthold wrote:II have been increasing the Trazadone (up to 225 mg at bedtime) over the past few months...

Berthold wrote:I have been taking 400mg of 5-HTP at bedtime

How did you arrive at that 5-HTP dosage? What criteria or who is titrating trazodone?

Berthold wrote:I am pretty sure I could borrow a Respironics APAP from my DME company and get a report from it.

Only if you can get the actual download or have the DME search through the actual download for a value called "Variable Breathing". This is a parameter that reflects breathing instability that that would not otherwise be classified as respiratory events per se. Consequently, I believe that it could be used as a monitor of sleep/wake and breathing instability.

Berthold wrote:That sounds like something you would recommend, yes?

While I believe that while you have some degree of SDB that may be addressed with pressure therapy and offer some benefit, I also think you'll get a much greater bang for the buck by addressing sleep quality itself, starting with optimizing medications.

Berthold wrote:Looking at the histogram, that last REM sleep was on my back, and there is a gap in the printout the sleep doc gave me.

That's weird. Maybe ask him about that next time you see him. If that's the "critical moment" of the sleep study, it would be nice to have the actual data at that point.

SAG

"How did you arrive at that 5-HTP dosage? What criteria or who is titrating trazodone?"

I started taking 5-HTP several years ago, and other than GP making sure a year ago or so that I was within what he felt was an OK range, I have come up with the dose on my own,just paying attention to whether it seemed to help my sleep or not. I have been at 400mg for probably the past 3-4 years. At this point, I'm not sure what the 5-HTP is doing. My GP is monitoring the Trazadone. It is probably the 5th or 6th sleep aid anti-depressant I have tried over the past 10 years or so, and is the most helpful one I have taken.

"Only if you can get the actual download or have the DME search through the actual download for a value called "Variable Breathing". This is a parameter that reflects breathing instability that that would not otherwise be classified as respiratory events per se. Consequently, I believe that it could be used as a monitor of sleep/wake and breathing instability."

Lincare has cheerfully given me the printout of previous uses of an APAP of theirs, so I'll bet they would again. I will pursue that.

"That's weird. Maybe ask him about that next time you see him. If that's the "critical moment" of the sleep study, it would be nice to have the actual data at that point."

I'll ask the sleep doc's office to email me the digital copy of the results so we can see all of the histogram.

What does optimizing medications in this instance mean? Thanks once again.

Berthold wrote:What does optimizing medications in this instance mean?

Pretty much the same as in any other instance, namely, determining the minimum effective dose needed to achieve the desired therapeutic results with the minimum untoward side effects. In this case, however, with the utmost respect and "IMHO", SAG thinks you're out of your f***ing mind to take an unproven "alternative" medication that could just as easily be a capsule full of Nutrasweet (at which point I guess it wouldn't make a difference), quadruple the maximum "recommended" dose, shove it in all at once with another medication that (theoretically) makes the effect additive and hope for the best. Then the result gets totally bizarre when the sleep efficiency comes back 53.3% (forget "lab effect", that cocktail should have given you at least a front end sleep efficiency of 95% even if you were sleeping on the subway platform at 33rd and Lex).

This disparity, on the other hand, may be explained by the dose-related dual effect of trazodone, where it could be either a 5-HT agonist or an antagonist.

Regardless, this discussion certainly affords interesting insights into the behavior of the entire 5-HT cascade.

SAG

Did you miss your ride on the tail of the comet ?

Hale-Bopp wrote:Did you miss your ride on the tail of the comet ?

Drive-by posters.

The alarm just sound. Attend to your fryer.

Hello there. I thought I would post an update on my being having been told I don't have sleep apnea after my first sleep test in 12 years and that I didn't need my machine.
I had a chance to sleep without my APAP for three nights a couple of months ago. The first night I had an oximetry meter on my finger and recorded myself. The audio recording lasted for three hours and when I listened to it the next day I never heard myself stop breathing. Lots of snoring and tossing and turning, but breathing all the time. My O2 saturation never got below 90% so that was normal too. I felt completely awful and out of it the next day, just like someone who was awake all night. I felt the same way the other two nights without my APAP machine. I woke up briefly over and over, and felt a weird choking sensation a lot when I did wake up. I decided that was enough of sleeping without my machine and have used it every night since. That was great advice one of you gave me to simply see how I felt after not using the APAP. Those results were very conclusive.
On SAG's advice I did cut down the 5-HTP I took, and then stopped it all together. I didn't notice a bit of difference in my sleep without it. That could be because it is worthless, or it could be because I am on 300mg of Trazadone and that has way more of an effect that the 5-HTP.
Either way, I am satisfied with my sleep at present,(and I can tell using a chin strap with my Mirage Swift II pillows makes a huge difference), think I must have something that the APAP machine helps with and am just going to continue using it despite this sleep doc telling me to chuck it. Thanks for the ideas that were offered, and would welcome anymore that anyone has.

Berthold,

Thanks for coming back and posting. I had been wondering how you were doing.

Bev

Berthold, thanks for the update!

Berthold wrote:think I must have something that the APAP machine helps with and am just going to continue using it despite this sleep doc telling me to chuck it.

I think you're absolutely right to keep using your machine.

Hi Berthold,

At one time Trazadone 100 mg was prescribed for me. I didn't go to sleep right away, but I slept for 10 consecutive hours. I felt drugged the next day. Never took it again. Do you feel normal in the mornings after using 300 mg? You probably are used to it. I don't know what mg is usually prescribed.

I have experience with Fibromyalgia, getting a good nights sleep is hard. The body aches and pains hurt every time you move. I used to awaken several times a night.

I wish you well Fibro, can make life difficult.

Jan

Hi Jan,
All these anti-pain and depressants seem to take a while to find out what side effects are going to persist. I did feel drugged in the beginning- for 4-5 weeks as I increased the dose- but that pretty much diminished to a level I don't notice any more. I have some brain fog from the fibro too, so it is hard to tell which is which. This is probably the 7th or 8th one I have used and by far it has the fewest side effects and is the most helpful to my sleep. I have found I just have to be willing to go through a few weeks of non-idealness to find out whether it is worth it or not. The fibro pain really disrupts my sleep, so using this has been important. Thanks for asking.
Berthold