The Ambien effect-in graphs

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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riverdreamer
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Re: The Ambien effect-in graphs

Post by riverdreamer » Fri Apr 10, 2009 11:50 am

-SWS wrote: Riverdreamer, thanks for that beautifully detailed post. Do you per chance know if that cortisol phase shift was observed in patients who happened to generally manifest chronic fatigue? Or was that phase shift referring to patients who were formally diagnosed with the disorder known as Chronic Fatigue Syndrome?

Again thanks for that post!
Happy to share! I may never catch up to all of you on sleep apnea issues, but this I know a bit about. Yes, the phase shift is seen in patients with just fatigue, as opposed to the formal diagnosis of Chronic Fatigue Syndrome/CFS/CFIDS. As mentioned in my post just above, phase shifts of cortisol can be caused by multiple issues.

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Re: The Ambien effect-in graphs

Post by -SWS » Fri Apr 10, 2009 12:20 pm

Thanks for that answer, riverdreamer! I found your posts in this thread to be most educational and very likely relevant to many of us with sleep apnea and its associated comorbidities. I do not have any specialized knowledge in this area whatsoever... That's the usual case for me in any given thread. But this quote of Bev's from an old post sure seemed to me to warrant a closer look at endocrinology:
OutaSync wrote: when I got a copy of the report, I noticed that my cortisol level was very high....Could be caused by sleep problems, or could be causing sleep problems? When I try to sleep, I doze off, wake up, doze off, wake up, over and over until I am am so frustrated that I cannot sleep for hours.


That, in turn, reminded me exactly of the stress related sleep/wake cycles that I quoted on page two of this thread:
A new study suggests that stress may disrupt the nervous system’s natural rhythms during various sleep stages. Stressed sleepers experience more arousal during sleep...Sleepers who were less relaxed during sleep also woke up more often and had fewer episodes of deep sleep, according to the researchers.
Taking a purely syllogistic analytic approach: I think we can easily suspect that glandular stress-hormone dysregulation can alter sleep architecture in a virtually identical manner as that psychologically-based hormonal overproduction quoted in the article above.

How severe and how consistent are those sleep-disturbing and energy-robbing cortisol spikes? No matter how you slice it, I think endocrinology warrants a much closer look in light of Bev's outstanding symptoms. In fact, I think solid differential diagnosis demands it!

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OutaSync
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Re: The Ambien effect-in graphs

Post by OutaSync » Fri Apr 10, 2009 12:48 pm

Riverdreamer,
If I call around to endocrinologists that are approved by my insurance, what questions should I ask to find out if they are knowledgeable about this?

-SWS,
Maybe that would also account for those spikes in my sleeping pulse rate as shown on my pulse-oximeter reports. My stress-echo test came back normal.

Bev
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

-SWS
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Re: The Ambien effect-in graphs

Post by -SWS » Fri Apr 10, 2009 12:52 pm

OutaSync wrote:Maybe that would also account for those spikes in my sleeping pulse rate as shown on my pulse-oximeter reports. My stress-echo test came back normal.
Might even account for the erratic data results in your extended daytime pulse oximetry test as well.

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riverdreamer
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Re: The Ambien effect-in graphs

Post by riverdreamer » Fri Apr 10, 2009 1:55 pm

I suggest you call the lab I gave you, and see if they have any names of doctors that use their lab that are near you. If so, then I would check with the doctor's office, to see if they take your insurance. I would also ask what level of experience they have with treating issues that show up on the labs. Just because they use the lab, doesn't mean they know what to do about it.

You could also check if there is a good local doctor who specializes in Chronic Fatigue Syndrome. You want GOOD references! If the doctor is good at what they do, they will be able to work with other issues than CFS, and should be able to help you with these issues. Ask hard questions, though! You want to hear that people improve in very specific ways. See if they use bio-identical hormones. Those are hormones that are identical in chemistry to human hormones. They can be from synthetic or natural sources, but you want the right chemistry, not a hormone mimic. A doctor who is aware of the necessity of that, will be more likely to know what you need.
The large majority of diabetics are now using bio-identical human insulin. The most often prescribed form of thyroid hormone is “levothyroxine”, a molecule identical to one of the two major thyroid hormones. (It's entirely true that this therapy omits the other major thyroid hormone as well as minor ones, but still, it's progress.) A major prescription form of male hormone therapy uses bio-identical testosterone. Another bio-identical hormone therapy uses erythropoietin (EPO), a kidney hormone which promotes red blood cell production. Some physicians prescribe growth hormone (GH), yet another bio-identical hormone.
However, much progress still needs to be made in therapeutic replacement of adrenal steroid hormones. The most commonly prescribe “replacements” are Prednisone, prednisolone and triamcinolone, (instead of bio-identical cortisol) and Florinef (instead of bio-identical aldosterone). The third major grouping of adrenal steroids, the “adrenal androgens” (whose major metabolite is DHEA) have no patentable, synthetic replacements yet, so they're simply ignored in most endocrinologic practice.
http://www.bioidenticalhormonesociety.com/

It is possible the doctor you want is an endocrinologist, but they could also be a general practitioner, an internist, or other specialty. It is more important what they know, than what the title is. Take your time to ask around, it will be worth it in the long run. Some "natural" doctors will use these therapies, but not have the degree of knowledge you need. You want someone with excellent medical background who is at the forefront in learning what hormone balancing can do. I wish it was going to be easy to find the right doctor, but I doubt it. This is another area where it is important to be aggressive in finding the right treatment.

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Re: The Ambien effect-in graphs

Post by -SWS » Fri Apr 10, 2009 3:05 pm

riverdreamer wrote:You could also check if there is a good local doctor who specializes in Chronic Fatigue Syndrome. You want GOOD references! If the doctor is good at what they do, they will be able to work with other issues than CFS, and should be able to help you with these issues.
That makes very good sense IMHO. Chronic Fatigue Syndrome is one incredibly challenging disorder to differentially diagnose and properly manage.

Any doctor with a genuinely excellent reputation in CFS will necessarily be proficient at differentiating various fatigue disorders. Bev is fatigued almost every day. But she has rarely fallen asleep during the day.

Even if this avenue of investigation doesn't pan out for Bev, the information presented in this thread will probably help many who are searching for answers regarding energy-impacting hormonal disorders. As it turns out, there are many patients on this message board who are also treated by Dr. Brickwall... not just Bev.

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StillAnotherGuest
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Or, "The Poster"

Post by StillAnotherGuest » Sat Apr 11, 2009 5:00 am

OutaSync wrote:SAG, Muffy, Suffy ??
Are you having an identity crisis? I like "SAG". It has history.
Can I be "Muffy" on the weekends? That would also go a long way to explain a few other things.
OutaSync wrote:
StillAnotherGuest wrote: BTW, since a lot has changed, what's the current assessment of those "weakness" events, your Epworth Sleepiness Scale, and overall feeling of tiredness?
Thinking back to December, I haven't had any times where I was too tired to move. And I mean when I was sitting up, totally aware of everything going on but unable to move. I think I'm much better than I was a year ago, or even last fall, but I'm not sure that I'm any better than pre-APAP. That first year on APAP just about did me in. It was hard enough sleeping without all this stuff on my face. On nights I wake up 4 or 5 times I feel better than on nights I wake up 10 to 15 times.
How about your current Epworth score?
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

SITUATION - CHANCE OF DOZING

Sitting and reading
Watching TV
Sitting inactive in a public place (e.g a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic
Your comments last fall all seemed to relate to "sleepiness", but if that has shifted to "fatigue", then certainly a "'mone" hunt would be appropriate.

Do have the printout of that cortisol level?

Boy, I'll tell ya what would be helpful-- some sort of objective data during one of those diaphoretic events. I don't suppose you remember if you had any during your sleep studies, and roughly when, do you?

I know! l think I'll go back to being TPFKAS:

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Aromatherapy may help CPAP compliance. Lavender, Mandarin, Chamomile, and Sweet Marjoram aid in relaxation and sleep. Nature's Gift has these and a blend of all four called SleepEase.

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OutaSync
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Re: Or, "The Poster"

Post by OutaSync » Sat Apr 11, 2009 11:56 am

[quote="StillAnotherGuestHow about your current Epworth score? I always have a hard time with thoseEpworth tests because they don't address my usual life.
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

SITUATION - CHANCE OF DOZING

Sitting and reading I would have to say 0 because if I try to read a book, I soon realize that I have no idea when I stopped reading and am just looking at the page. I have no idea what I just read,so I go back and try again. After a couple of tries, I get up and do something else.
Watching TVAgain, I would have to say 0, because I only watch in the evening and when I get sleepy, I get up and go to bed, where I can ly awake for an hour before I get to sleep.
Sitting inactive in a public place (e.g a theater or a meeting)I haven't been to a meetin in awhile, but the last couple of times I have been, I have dozed off even though fighting it.
As a passenger in a car for an hour without a break Getting packed to go away for the weekend, so I'll let you know. I try hard to stay wake as a passenger because I think it's rude to fall asleep and consider it my duty to entertain and keep the driver awake
Lying down to rest in the afternoon when circumstances permit Huh??? Who gets to do that?
Sitting and talking to someoneAgain, I think it's rude to fall asleep when talking to someone, but I have to say that I zone out and have no idea what they have been saying, especially my boss
Sitting quietly after a lunch without alcoholHuh? Who gets to do that?
In a car, while stopped for a few minutes in traffic
Zero, recently. This is an area that has improved in the last few months
Your comments last fall all seemed to relate to "sleepiness", but if that has shifted to "fatigue", then certainly a "'mone" hunt would be appropriate.

Do have the printout of that cortisol level?I found one from 5/5/08 It says Cortisol, F, ug/L,U 30 ug/L (limit undefined)and then Cortisol, F, ug/24hr,U 45ug/24hr(limits 0-45)
On 4/21/08 DHEA sulfate 24L ug/dL (limits 26-200)
Hemoglobin A1c 5.8 (limits 4.8-5.9)


Boy, I'll tell ya what would be helpful-- some sort of objective data during one of those diaphoretic events. I don't suppose you remember if you had any during your sleep studies, and roughly when, do you?

I know! l think I'll go back to being TPFKAS:The person formerly known as SAG?

[/quote]
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

jnk
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Re: Or, "The Poster"

Post by jnk » Sat Apr 11, 2009 1:00 pm

*

May I help score my soon-to-be stepmom's Epworth?
OutaSync wrote:

Sitting and reading

I would have to say 0 because if I try to read a book, I soon realize that I have no idea when I stopped reading and am just looking at the page. I have no idea what I just read,so I go back and try again. After a couple of tries, I get up and do something else.

-3-

Watching TV

Again, I would have to say 0, because I only watch in the evening and when I get sleepy, I get up and go to bed, where I can ly awake for an hour before I get to sleep.

-2-

Sitting inactive in a public place (e.g a theater or a meeting)

I haven't been to a meetin in awhile, but the last couple of times I have been, I have dozed off even though fighting it.

-3-

As a passenger in a car for an hour without a break

Getting packed to go away for the weekend, so I'll let you know. I try hard to stay wake as a passenger because I think it's rude to fall asleep and consider it my duty to entertain and keep the driver awake

-3-

Lying down to rest in the afternoon when circumstances permit

Huh??? Who gets to do that?

-3-

Sitting and talking to someone

Again, I think it's rude to fall asleep when talking to someone, but I have to say that I zone out and have no idea what they have been saying, especially my boss

-3-

Sitting quietly after a lunch without alcohol

Huh? Who gets to do that?

-3-

In a car, while stopped for a few minutes in traffic

Zero, recently. This is an area that has improved in the last few months

-2-
-22-

-SWS
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"F Triple-S A" Methodology!

Post by -SWS » Sat Apr 11, 2009 3:12 pm

I think Jeff's post above beautifully demonstrates exactly why cpaptalk.com has become one of the world's premier institutes responsible for pushing scientific paradigms:
jnk wrote:May I help score my soon-to-be stepmom's Epworth?
-22-
Until this seminal thread sleep doctors were stuck working with objective data and subjective patient assessments, such as the Epworth. But a third tool---Cross-Country F.S.S.S.A. (Cross-Country Future-Step-Son Subjective Assessments)----has just been added to the scientific arsenal...

Go science! Kick butt, resident "methodology expanders"! Woot!




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StillAnotherGuest
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Happy Easter!

Post by StillAnotherGuest » Sun Apr 12, 2009 5:05 am

OutaSync wrote:
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

SITUATION - CHANCE OF DOZING

Sitting and reading
I would have to say 0 because if I try to read a book, I soon realize that I have no idea when I stopped reading and am just looking at the page. I have no idea what I just read,so I go back and try again. After a couple of tries, I get up and do something else.

Watching TV
Again, I would have to say 0, because I only watch in the evening and when I get sleepy, I get up and go to bed, where I can ly awake for an hour before I get to sleep.

Sitting inactive in a public place (e.g a theater or a meeting)
I haven't been to a meetin in awhile, but the last couple of times I have been, I have dozed off even though fighting it.

As a passenger in a car for an hour without a break
Getting packed to go away for the weekend, so I'll let you know. I try hard to stay wake as a passenger because I think it's rude to fall asleep and consider it my duty to entertain and keep the driver awake

Lying down to rest in the afternoon when circumstances permit
Huh??? Who gets to do that?

Sitting and talking to someoneAgain, I think it's rude to fall asleep when talking to someone, but I have to say that I zone out and have no idea what they have been saying, especially my boss

Sitting quietly after a lunch without alcohol
Huh? Who gets to do that?

In a car, while stopped for a few minutes in traffic
Zero, recently. This is an area that has improved in the last few months
Comments like
I zone out and have no idea what they have been saying
sound like N1 sleep to me, but hey, with a name like

Image

what would you expect.

Anyway, the way I figure it, your Epworth is somewhere between 2 and 17.
OutaSync wrote:As a passenger in a car for an hour without a break
Getting packed to go away for the weekend, so I'll let you know. I try hard to stay wake as a passenger because I think it's rude to fall asleep and consider it my duty to entertain and keep the driver awake
Not for nothin', but would you mind giving this Epworth Questionnaire to the driver?
OutaSync wrote:I found one from 5/5/08 It says Cortisol, F, ug/L,U 30 ug/L (limit undefined)and then Cortisol, F, ug/24hr,U 45ug/24hr(limits 0-45)
Did you actually collect 24 hours worth of urine?
OutaSync wrote:Boy, I'll tell ya what would be helpful-- some sort of objective data during one of those diaphoretic events.
Me too.
OutaSync wrote:The person formerly known as SAG?
Close enough.
jnk wrote:May I help score my soon-to-be stepmom's Epworth?

-22-
I think you should try to recruit Bev as your soon-to-be stepmom.

Image
Image

Aromatherapy may help CPAP compliance. Lavender, Mandarin, Chamomile, and Sweet Marjoram aid in relaxation and sleep. Nature's Gift has these and a blend of all four called SleepEase.

jnk
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Joined: Mon Jun 30, 2008 3:03 pm

Re: The Ambien effect-in graphs

Post by jnk » Sun Apr 12, 2009 7:57 am

StillAnotherGuest wrote: . . . I think you should try to recruit Bev as your soon-to-be stepmom. . . .
Thanks for the clarification, Uncle SAG!