CompSA, Hypoventilation, PLMs, Bradycardia and Hypotension?

-SWS wrote:My opinion only: I think I'd be inclined to sit tight with the fluoxetine for now. Once I felt improved therapy and especially daytime symptoms leveled off, then I'd re-consider whether a very gradual fluoxetine withdrawal made experimental sense.

I agree. I would get your sleep as good as it can be with fluoxetine on board. Then, if there is still room for improvement, you can consider a slow taper of the fluoxetine to see if it is responsible for any of your sleep issues. And if it happens that there is no room for improvement because things are so fantastic, you can consider going off of it to see if you can maintain the gains without it.

It seems too many things are still in flux now and you want to change one variable at a time, or you'll never know what caused the improvement or decline. And of course, never withdraw fluoxetine except slowly, under the supervision of your doctor.

dsm wrote:Do listen carefully to your wife. Her well being is highly attuned to yours & there is a particular wisdom to considering her advice.

Hi DSM, I remember when I first met my wife-to-be my sister said to me "Always listen to her, she is probably right." My wife had a stable and loving upbringing and developed a good nose for what is healthy as a consequence. My sister's advice (and now yours) has always proved to point me in a helpful direction. Cheers,

-SWS wrote:One question I have is whether your outstanding flow limitations above 10 cm happen to cause any RERA's. Blizzardboy, can you refresh my memory regarding RERA's? Did your PSG team look for those with respect to flow limitations?

Hi -SWS, Good question. I am not sure re: RERAs. I will send an email to my PSG lab to try and find out.

-SWS wrote: My opinion only: I think I'd be inclined to sit tight with the fluoxetine for now. Once I felt improved therapy and especially daytime symptoms leveled off, then I'd re-consider whether a very gradual fluoxetine withdrawal made experimental sense.

To -SWS, jnk, and SU, I think that this is the best approach when I take into consideration my family. As a single man I would dive head first into SSRI withdrawal without a second thought because I know I could cope with any impending hiccups. This is what I suggested to my wife: That I stay on fluoxetine and CPAP for now. That I get active, fit and healthy with good sleep hygiene in place and a tip-top BMI. Then, if everything is chugging along beautifully, I trial fluoxetine withdrawal with HDS monitoring and CPAP DLs to assess. The reality is that my family is in love with the currently-evolving me and just aren't quite ready for me to start rocking the apple cart right now.

The changes in me since using CPAP have been just too profound for me to ignore the possibility of SSRI now being redundant for me. Cheers,

jnk wrote:...fear, to my way of thinking, should not be allowed to override logic in such matters.

Hear, hear. Well said. Cheers,

Yesterday I did the most exercise I have done for a long time. I went for a 1.5 hr walk up a gorge and across some hills. My heart rate peaked over 150bpm and my resp rate over 30bpm. I was breathing hard really when ascending the gorge! The interesting thing that I notice this morning is that I am grumpy and irritable, following more awakenings last night than usual. The exercise was completed nearly 7 hours before bed time. I was wondering if the following explanation might hold:

• I am currently not aerobically fit
• Exercise increased my metabolic rate
• Increase metabolic rate increased PCO2
• PCO2 sitting closer to arousal threshold than prior to exercise
• More arousals during sleep as a result
• Fragmented sleep architecture due to increased arousals
• Wake up grumpy and irritable

I read some interesting articles yesterday about athletes having higher PCO2 arousal thresholds, and how exercise causes the PCO2 arousal threshold to shift to higher PCO2 values. So maybe I am going to have put up with some grumpy days while I get fit until my arousal threshold de-sensitises some.

What do you think?

blizzardboy wrote:Yesterday I did the most exercise I have done for a long time. I went for a 1.5 hr walk up a gorge and across some hills. My heart rate peaked over 150bpm and my resp rate over 30bpm. I was breathing hard really when ascending the gorge! The interesting thing that I notice this morning is that I am grumpy and irritable, following more awakenings last night than usual. The exercise was completed nearly 7 hours before bed time. I was wondering if the following explanation might hold:

• I am currently not aerobically fit
• Exercise increased my metabolic rate
• Increase metabolic rate increased PCO2
• PCO2 sitting closer to arousal threshold than prior to exercise
• More arousals during sleep as a result
• Fragmented sleep architecture due to increased arousals
• Wake up grumpy and irritable

I read some interesting articles yesterday about athletes having higher PCO2 arousal thresholds, and how exercise causes the PCO2 arousal threshold to shift to higher PCO2 values. So maybe I am going to have put up with some grumpy days while I get fit until my arousal threshold de-sensitises some.

What do you think?

Blizzardboy, you're just going to HATE my alternate suspicions:

http://journals.lww.com/aacnadvancedcri ... ia.12.aspx

http://www.suite101.com/article.cfm/fibro_friends/99370

http://www.google.com/#hl=en&q=fibromya ... b898b2787e

Given your positive for 12 fibro pressure points, I have to wonder to what extent exercise intolerance and/or exacerbated muscle pain might have factored into that poor sleep.

blizzardboy wrote: . . . What do you think?

Exercise is good. Once you're used to it, it doesn't make you as grumpy and irritable.

Just take Muffy, for example. She goes running nearly every morning, and now she's NEVER grumpy or irritable!

Right, Muffy?!

jeff

-SWS wrote:Blizzardboy, you're just going to HATE my alternate suspicions...

BB has fibromyalgia?? I must have missed that.

SleepingUgly wrote:

-SWS wrote:Blizzardboy, you're just going to HATE my alternate suspicions...

BB has fibromyalgia?? I must have missed that.

Currently no FM diagnosis... only my suspicions:
viewtopic.php?f=1&t=51063&p=475905&hili ... re#p475905

Perhaps the FM diagnosis would be nowhere near as helpful as some of the management strategies for the symptoms...

-SWS wrote:Perhaps the FM diagnosis would be nowhere near as helpful as some of the management strategies for the symptoms...

Yes, let's put him on a medication that enhances slow wave sleep, what do you think? Do you favor gabapentin or gabitril or should we hit him with Lyrica?

Might investiagate this for pain control: http://www.jacn.org/cgi/content/abstract/21/6/495

Combined with aspirin: http://jem.rupress.org/content/196/8/1025.abstract

Muse-Inc wrote:I take Coromega (emulsified so no burps etcetera) and flavored gel...I like the orange, mom prefers the lemon-lime:

How many milligrams of Omega-3? Can you send me a link to the one you take?

kteague wrote:psssssst... better cpap treatment = worse PLMD/S

Always?

SleepingUgly wrote:

-SWS wrote:Perhaps the FM diagnosis would be nowhere near as helpful as some of the management strategies for the symptoms...

Yes, let's put him on a medication that enhances slow wave sleep, what do you think? Do you favor gabapentin or gabitril or should we hit him with Lyrica?

SU, are you being sardonic again??

Surely you don't think the term "management strategies" refers exclusively to the notion of "hitting" people with pharmaceuticals. I think a pair of key FM management strategies entails avoiding de-conditioning in the first place, if possible---but also physically re-conditioning within the symptomatic constraints of FM.

Two of my most effective pain management strategies for trigeminal neuralgia entail neither pharmaceuticals nor the likes of licorice root:
http://www.amazon.com/Electrode-Platinu ... 843&sr=8-4
-and-
http://www.amazon.com/s/ref=nb_sb_noss? ... in&x=0&y=0

SleepingUgly wrote:

kteague wrote:psssssst... better cpap treatment = worse PLMD/S

Always?

Often enough...