CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

blizzardboy · Post by **blizzardboy** » Wed May 12, 2010 3:19 pm

Muffy wrote:BTW, did you realize that in terms of replies, this is (presently) the #6 thread of all time?

No, I didn't. And what quality postings by all!

Muffy wrote:Truly one that will live on in the anals of cpaptalk!

Hmmm...

blizzardboy · Post by **blizzardboy** » Wed May 12, 2010 3:23 pm

SleepingUgly wrote:BB, is he going to review the raw data on your sleep study to see if they are true PLMS as opposed to muscle contractions in respiratory efforts?

Hi SU, Yes, I believe that is his intention. He mentioned that leg movements can be a normal part of sleep.

SleepingUgly wrote:Yes, you're so lucky to have so much of the experts' attention, when some of us can't get so much as a reply to a PM...

And for that I am truly grateful. I hope that others can benefit from the discussions also. Cheers,

SleepingUgly · Post by **SleepingUgly** » Wed May 12, 2010 3:56 pm

blizzardboy wrote:
SleepingUgly wrote:Yes, you're so lucky to have so much of the experts' attention, when some of us can't get so much as a reply to a PM...
And for that I am truly grateful.

Well, you have the charming accent and all.

dsm · Post by **dsm** » Wed May 12, 2010 4:11 pm

blizzardboy wrote:
<snip>

As suggested by -SWS, I slept last night with fixed CPAP @ P=9.6, that is my ASV EEP pressure (that I have used for the longest.) I would think the most stable breathing that I have exhibited to date, even if my ventilation is still probably lower than the norm: http://users.adam.com.au/sixsome/ASV/0510/051210/.

Hmmm, what I see is a bit of a slide downhill ? - increased instability, increased hyper-v, increased AI & increased HI.

Anyone else have any comments !

DSM

Muffy · Post by **Muffy** » Wed May 12, 2010 7:23 pm

blizzardboy wrote:I remembered another comment that the sleep doctor made yesterday: That it is normal for a man of my age (c.40 y.o.) to have a couple of awakenings during sleep, and that this will only increase as I age (5ish when 50, 8ish when 60, etc).

Awakenings lasting from 30 seconds to perhaps several minutes or so are normal. Long blocks of Wake, such as

blizzardboy wrote:I tossed and turned from 0230-0430 last night

are not normal at any age.

Muffy

Muse-Inc · Post by **Muse-Inc** » Wed May 12, 2010 7:44 pm

Muffy wrote:Awakenings lasting from 30 seconds to perhaps several minutes or so are normal...

Wait a minute Muffy...am I supposed to accept frequent wakeups as normal???? If that's true, then, oh boy, am I in trouble...I'm getting increasingly tired.

blizzardboy wrote:...Showed me a table of latest research showing that on average depression is the number one contributor to arousals (about 10/hour) with BMI at number two (about 5/hr) and OSA at number 7 (about 2/hr)

If this accurate, my depression over no perm job since March '09, losing med insurance for a while, working a temp job likely to end soon, mom's getting laidoff in a month or so, near constant ansting over $ and losing the house. All that added to my regain of 20 of the 57#s I lost with tons more to lose. Then, toss in that my PSG's AHI puts me in the severe category. All that might be the cause of my multiple nightly wakeups?...just lovely, I'm doomed.

SleepingUgly · Post by **SleepingUgly** » Wed May 12, 2010 7:57 pm

Muse-Inc wrote:
blizzardboy wrote:...Showed me a table of latest research showing that on average depression is the number one contributor to arousals (about 10/hour) with BMI at number two (about 5/hr) and OSA at number 7 (about 2/hr)
If this accurate, my depression over no perm job since March '09, losing med insurance for a while, working a temp job likely to end soon, mom's getting laidoff in a month or so, near constant ansting over $ and losing the house. All that added to my regain of 20 of the 57#s I lost with tons more to lose. Then, toss in that my PSG's AHI puts me in the severe category. All that might be the cause of my multiple nightly wakeups?...just lovely, I'm doomed.

Major Depressive Disorder can affect sleep (e.g., insomnia, hypersomnia), and I'm not saying it CAN'T cause arousals because I don't KNOW, but let's read the study first. Second, I don't see how BMI would directly cause arousals except via some mediating variable such as obstructions. And actually, I don't know if there is a strong positive correlation between BMI and arousals, as I think actually there are less arousals in people who are having full-fledged apnea events, which is why they are obstructing to that degree before waking up... This might be why OSA is number 7...

Muse, I feel badly for you. It seems like you have so many stressors right now. Do you have health insurance with mental health coverage so you can see a psychologist who might be able to help you with coping strategies and maybe specific techniques? Also, forgive my bad memory, but have you tried taking something for sleep? (I think I recall that you were leery of taking something) It seems like your worries about staying asleep and getting enough sleep are in and of themselves big stressors (and I hear ya', Sister!), but they don't have to be.

Muffy · Post by **Muffy** » Wed May 12, 2010 8:14 pm

Muse-Inc wrote:
Muffy wrote:Awakenings lasting from 30 seconds to perhaps several minutes or so are normal...
Wait a minute Muffy...am I supposed to accept frequent wakeups as normal????

Negative on "frequent". Depending on age, and as noted above from the BBMD, I think we're talking in the neighborhood of about 2 to 5.

And short! Like REALLY short!

Muffy

jnk · Post by **jnk** » Wed May 12, 2010 8:47 pm

Sleep Med. 2010 Mar;11(3):229-30.

Nocturnal awakenings are one of the most prevalent sleep disturbances in the general population. Little is known, however, about the frequency of these episodes and how difficulty resuming sleep once awakened affects subjective sleep quality and quantity. . . . A total of 35.5% of the sample reported awakening at least three nights per week. Of this 35.5%, 43% (15.2% of the total sample) reported difficulty resuming sleep once awakened. More than 80% of subjects with insomnia symptoms (difficulty initiating or maintaining sleep or non-restorative sleep) also had nocturnal awakenings. Difficulty resuming sleep was associated with subjective shorter sleep duration, poorer sleep quality, greater daytime impairment, greater consultations for sleep disturbances and greater likelihood of receiving a sleep medication. CONCLUSIONS: Nocturnal awakenings disrupt the sleep of about one-third of the general population. Using difficulty resuming sleep identifies individuals with significant daytime impairment who are most likely to seek medical help for their sleep disturbances. In the absence of other insomnia symptoms, nocturnal awakenings alone are unlikely to be associated with daytime impairments. Copyright 2009 Elsevier B.V. All rights reserved.

PMID: 20075004 [PubMed - in process]PMCID: PMC2830306 [Available on 2011/3/1]

http://www.ncbi.nlm.nih.gov/pubmed/20075004

Let's see if we can get this thread to number one!!!!!

SleepingUgly · Post by **SleepingUgly** » Wed May 12, 2010 8:54 pm

jnk wrote:
Sleep Med. 2010 Mar;11(3):229-30.

Nocturnal awakenings are one of the most prevalent sleep disturbances in the general population. Little is known, however, about the frequency of these episodes and how difficulty resuming sleep once awakened affects subjective sleep quality and quantity. . . . A total of 35.5% of the sample reported awakening at least three nights per week. Of this 35.5%, 43% (15.2% of the total sample) reported difficulty resuming sleep once awakened. More than 80% of subjects with insomnia symptoms (difficulty initiating or maintaining sleep or non-restorative sleep) also had nocturnal awakenings. Difficulty resuming sleep was associated with subjective shorter sleep duration, poorer sleep quality, greater daytime impairment, greater consultations for sleep disturbances and greater likelihood of receiving a sleep medication. CONCLUSIONS: Nocturnal awakenings disrupt the sleep of about one-third of the general population. Using difficulty resuming sleep identifies individuals with significant daytime impairment who are most likely to seek medical help for their sleep disturbances. In the absence of other insomnia symptoms, nocturnal awakenings alone are unlikely to be associated with daytime impairments.

Which is why we are very fortunate to have sleep aids that are safe to use in the presence of apnea.

blizzardboy · Post by **blizzardboy** » Thu May 13, 2010 1:03 am

dsm wrote:Hmmm, what I see is a bit of a slide downhill ? - increased instability, increased hyper-v, increased AI & increased HI.

Hi DSM, I was focused on tidal volume when I commented that my breathing was more stable. Here is a comparison of last night with fixed CPAP@9.6 compared to 2 nights previous with ASV EEP=9.6, PS=3->8:

.
See what I mean? Which outcome is more restful for me? My latest sleep doctor said he would not consider any need for improvement once I had an AHI<10! He also commented that bursts of higher resp rates (e.g. 35 bpm) is normal when asleep.

Muffy · Post by **Muffy** » Thu May 13, 2010 3:23 am

Well, "IMHO", that difference simply represents the effect of Controller Gain that is taken out of context, but you guys go ahead with the dial wingin', I'll wait here, you'll be right back where you started from soon enough. I'm going to stay on the "sleep instability" bus until a few more rocks are overturned.

Muffy wrote:Did you ask specifically if the fluoxetine was contributing to the sleep instability?

On the other hand, perhaps potentially opening the SSRI Discontinuation Syndrome can of worms was something he really wasn't interested in.

jnk wrote:Let's see if we can get this thread to number one!!!!!

I'm trying.

That subtopic should have elicited another 200 replies.

Muffy

NotMuffy · Post by **NotMuffy** » Thu May 13, 2010 3:31 am

Muffy wrote:
Muffy wrote:Did you ask specifically if the fluoxetine was contributing to the sleep instability?

On the other hand, perhaps potentially opening the SSRI Discontinuation Syndrome can of worms was something he really wasn't interested in.

jnk wrote:Let's see if we can get this thread to number one!!!!!
I'm trying.

That subtopic should have elicited another 200 replies.

Doesn't the search for the OSA "Magic Bullet" (the pharmacological treatment of obstructive sleep apnea) often include the use of SSRIs?

Might the discontinuation of fluoxetine create a whole new set of respiratory parameters?

NotMuffy

blizzardboy · Post by **blizzardboy** » Thu May 13, 2010 4:42 am

Muffy wrote:Well, "IMHO", that difference simply represents the effect of Controller Gain that is taken out of context, but you guys go ahead with the dial wingin', I'll wait here, you'll be right back where you started from soon enough. I'm going to stay on the "sleep instability" bus until a few more rocks are overturned.

Hi Muffy, My motivation for doing the fixed CPAP trial is that I think that I have OSA that needs to be treated and sleep instability that doesn't mesh well with ASV. I was even thinking about sleeping with fixed CPAP at the lowest settable pressure just to remind myself that I do actually have an OSA problem ie. not just a person with possible mental-health induced sleep instability or some altered state of sleep due to fluoxetine resident in my members!

Muffy, just to check that we are on the same page in regard my Controller Gain being the source of my sleep instability, would you agree that during sleep my average PCO2 probably sits quite close the apneic threshold, and that this is likely due to an unusual Controller setting?

blizzardboy · Post by **blizzardboy** » Thu May 13, 2010 4:53 am

NotMuffy wrote:
Muffy wrote:
Muffy wrote:Did you ask specifically if the fluoxetine was contributing to the sleep instability?

On the other hand, perhaps potentially opening the SSRI Discontinuation Syndrome can of worms was something he really wasn't interested in.

jnk wrote:Let's see if we can get this thread to number one!!!!!
I'm trying.

That subtopic should have elicited another 200 replies.
Doesn't the search for the OSA "Magic Bullet" (the pharmacological treatment of obstructive sleep apnea) often include the use of SSRIs?

Might the discontinuation of fluoxetine create a whole new set of respiratory parameters?

Hi NM, Welcome to the 6th longest thread in CPAPTalk history. I have now discussed fluoxetine with two sleep doctors, a GP and my CBTherapist and none of them has shown the slightest interest in exploring me changing away from fluoxetine in the short term. So my conviction to make the change now is strongly challenged by those I pay to advise me (my advisors?). What should I do? Demand commencement of weaning immediately? Tough call maybe given that I am such a "complex case." (quote 2nd sleep doctor aka BBMD).

BTW, if you read back through this thread you will see that Muffy has suggested on several occasions that it might be beneficial to change my ADM away from fluoxetine. I have been dangling my line but none of the big fish have taken a bite...

p.s. you look vaguely familiar somehow...maybe its the moustache?

CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

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