so very tired and it isn't getting better

-SWS wrote:Wondering how 12.2 has been faring, Mar...

robertmarilyn wrote: One thing I have noticed over the last 4 or so days is that I have had slight symptoms of aerophagia and maybe a little heartburn feeling. I think this started shortly before I bumped up the pressure by .2

robertmarilyn wrote:When I have my new sleep test on June 2, there are a lot to things that my doctor wants to watch closely...she is very interested in the type of arousals I am having, wants to see how I handle a variety of machine variations, and she wants to see what happens when I sleep in various positions.

robertmarilyn wrote: She thinks I have Narcolepsy along with other things and if I understand it correctly some things that my body may do when I sleep are indicators of Narcolepsy.

robertmarilyn wrote: Oh -SWS, when folks talk about how smart and intellectual you are...I crack up because your icon fits the description.....that is, if intellectual and primate can be used in the same sentence

-SWS wrote: Mar, I have noticed that aerophagia, acid reflux, and even LES closure in general can be highly variable from night-to-night---but especially week-to-week, month-to-month, etc.. I think the idea is to keep just as many exacerbating factors in check as possible.

That's kind of what I thought...I'm at the best place I've been so far with the machine and the problems have been so much milder than they were when I first started therapy.

She wants to present a variety of challenges to your physiology. That, in turn, helps her get a handle on underlying etiology as well as how to best treat those problem(s). She sure sounds like a "good 'un" as Rested Gal says.

I know...we'll be getting useful information out of the test and that means the world to me.

We recently discussed diagnostic criteria for narcolepsy HERE.

Thanks, I'll go look at that thread. I'd done some research online.

I would point out that smart monkeys don't smoke. Involuntary birth traits such as intelligence or physical stature never impress me. They are never true measures of any person IMHO..

I do always have the urge to bring up the smoking bit to you but since I'm sure it's photoshopped , I've let it go so far. And you are right about people: heart, compassion, generosity...are what make a difference and have nothing to do with IQ and looks...in fact, sometimes IQ and looks can be a hindrance if a person lets those things go to their head

mar

-SWS wrote: We recently discussed diagnostic criteria for narcolepsy HERE.

2007 discussion of two combinatorial ways to achieve a standard narcolepsy diagnosis wrote: Narcolepsy diagnostic criteria is listed below (note the dark red text delineating two alternative criteria categories):

In Defining Diagnostic Criteria for Narcolepsy the ICSD wrote: Minimal Criteria: B plus C, or A plus D plus E plus G.

A. The patient has a complaint of excessive sleepiness or sudden muscle weakness.

B. Recurrent daytime naps or lapses into sleep occur almost daily for at least 3 months.

C. Sudden bilateral loss of postural muscle tone occurs in association with intense emotion (cataplexy).

D. Associated features include:

1. Sleep paralysis

2. Hypnagogic hallucinations

3. Automatic behaviors

4. Disrupted major sleep episode

E. Polysomnography demonstrates one or more of the following:

1. Sleep latency less than 10 minutes

2. REM sleep latency less than 20 minutes

3. An MSLT that demonstrates a mean sleep latency of less than 5 minutes

4. Two or more sleep-onset REM periods

F. HLA typing demonstrates DQB1*0602 or DR2 positivity.

G. No medical or mental disorder accounts for the symptoms.

H. Other sleep disorders (e.g., periodic limb movement disorder or central sleep apnea syndrome) may be present but are not the primary cause of the symptoms.

So in recap, to receive a narcolepsy diagnosis, patients would need to meet one of these two diagnostic criteria categories: 1) B plus C, or 2) A plus D plus E plus G. Since either category is considered a diagnostic minimum, some narcolepsy patients will manifest presentations from both of these diagnostic categories. Note that F (a genetic marker) and H are presently listed as consideration factors only.

robertmarilyn wrote:Or maybe I only need to be barely asleep to have apneas and hypopneas?

-SWS wrote:Well, undiagnosed narcolepsy sure would fit your thread's title, Mar. Do any of these narcoleptic criteria seem like either "maybe" or "definitely" traits---at least as far as you can tell:

Now that I have been reading up on Narcolepsy, I do see how well the title of this thread fits!

2007 discussion of two combinatorial ways to achieve a standard narcolepsy diagnosis wrote: Narcolepsy diagnostic criteria is listed below (note the dark red text delineating two alternative criteria categories):

In Defining Diagnostic Criteria for Narcolepsy the ICSD wrote: Minimal Criteria: B plus C, or A plus D plus E plus G.

A. The patient has a complaint of excessive sleepiness or sudden muscle weakness.

The patient has a complaint of excessive sleepiness - yes definitely

B. Recurrent daytime naps or lapses into sleep occur almost daily for at least 3 months.

I've felt the need for naps every day, all my life. And will fall asleep any time I am in a car and not driving

C. Sudden bilateral loss of postural muscle tone occurs in association with intense emotion (cataplexy).

Not that I know of

D. Associated features include:

1. Sleep paralysis

During my childhood until about 30, about once a month I would be sleeping and having a dream or think I heard the doorbell and I would wake up and not be able to move at all, which would be pretty scary

2. Hypnagogic hallucinations

Yes

3. Automatic behaviors

Not that I know of

4. Disrupted major sleep episode

Yes

E. Polysomnography demonstrates one or more of the following:

1. Sleep latency less than 10 minutes

10.5 minutes on my test without the machine; 21 minutes on my titration test (major mask discomfort made it hard to go to sleep)

2. REM sleep latency less than 20 minutes

212.5 minutes on test without the machine; no REM on my titration test

3. An MSLT that demonstrates a mean sleep latency of less than 5 minutes

First ever MSLT will be June 3

4. Two or more sleep-onset REM periods

My two sleep studies in Feb don't make this clear (except that there was no REM on the titration study...I may have been too busy with acid reflux to have been able to fall asleep deeply (bile entering throat and mouth I didn't know I had an acid reflux problem before that first night on a machine)

F. HLA typing demonstrates DQB1*0602 or DR2 positivity.

Even after some reading about this, I don't really understand what this is...does it have to do with whether my parents have sleep problems? Because, I think I inherited problems from both my mom (disrupted sleep and signs of sleep apnea) and dad (he certainly has the signs of narcolepsy now that I know what they are)

G. No medical or mental disorder accounts for the symptoms.

I saw a psychiatrist for once a week for three months before my UPPP. He tried me on a slew of antidepressants, some which absolutely knocked me out and I would wake up feeling very bad...I think the knock out ones shut down my breathing while asleep even more than I was already doing. I wouldn't take those after one night. After three months of nothing happening with the psych visits, I ONCE AGAIN told him I thought I might have sleep apnea and that I was going to see another doctor.

This is when the psych called a neurologist and got me in that day because the psych said that after no meds helping me, he wanted me to be accessed for a possible brain tumor. Just by looking at my eye movements and my how my body responded to being knocked on the knee with a little hammer the neurologist started a bunch of tests...it was obvious to him that I had something major going on and it was not due to a mental disorder.

According to the cardiologist I had to see, my heart showed some damage (he said that I showed signs of having had a "silent" heart attack). An MRI was done on my head, neck, and torso, a workup was done by a pulmonary doc, and I had a sleep test done in a hospital.

Obstructive sleep apnea would have accounted for some of my symptoms. I did have a UPPP after all the tests.

H. Other sleep disorders (e.g., periodic limb movement disorder or central sleep apnea syndrome) may be present but are not the primary cause of the symptoms.

I may have both of those but my Feb sleep tests don't make mention of them. After my UPPP, I was told that my body was so used to not keeping me breathing all the time like it was supposed to do (because of the obstructive sleep apnea) that my brain still might not always keep me breathing...once I learned what central sleep apnea was, I thought that might be what they were describing.

So in recap, to receive a narcolepsy diagnosis, patients would need to meet one of these two diagnostic criteria categories: 1) B plus C, or 2) A plus D plus E plus G. Since either category is considered a diagnostic minimum, some narcolepsy patients will manifest presentations from both of these diagnostic categories. Note that F (a genetic marker) and H are presently listed as consideration factors only.

-SWS wrote:Mar, my understanding is this is a correct statement:

robertmarilyn wrote:Or maybe I only need to be barely asleep to have apneas and hypopneas?

Many of us do experience apneas and/or hypopneas during that wake/stage-1 transition. And we can also oscillate back and forth between wake and stage 1, without realizing that we are repeatedly entering stage 1.

robertmarilyn wrote: Am I correct to assume that hypopneas and apneas are not good even in this transition? Or are those hypopneas and apneas being caused by breath holding when changing positions and in that regards don't matter very much?

-SWS wrote:

robertmarilyn wrote: Am I correct to assume that hypopneas and apneas are not good even in this transition? Or are those hypopneas and apneas being caused by breath holding when changing positions and in that regards don't matter very much?

They tend to be related to somewhat common ventilatory instability during sleep onset. That can be a tricky transitional time for central breathing, where CO2 based homeostatic adaptation to sleep occurs:
http://jap.physiology.org/cgi/content/a ... /99/5/2036
Other than making for a rough transition or even barrier to sleep, they can be of little consequence---if they are of such short durations that hypoxemia or oxygen desaturation does not result in hypoxia (cellular damage).

robertmarilyn wrote:Thanks and happy Mother's Day
mar

-SWS wrote:

robertmarilyn wrote:Thanks and happy Mother's Day
mar

Thanks... but I haven't adopted a female persona just yet. That's Muffy.