Met with PA about insomnia and got 4th sleep test results

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robysue
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Met with PA about insomnia and got 4th sleep test results

Post by robysue » Sun Feb 20, 2011 11:21 pm

This is an update to my 1000th post.

On Feb. 18 I got the official results of my fourth sleep study in the last six months in my latest appointment with my very excellent PA. I already had been in contact with my PA and she'd already authorized a lowering of my BiPAP settings from 8/6 to 7/4. (And my tummy much appreciates the new lower pressure. Which should help the insomnia.)

The PA and I actually spent most of the appointment talking about how the sleep restriction and the insomnia are going. And at this point she and I are both pleased with my progress in taming the insomnia monster. The most notable positive changes are my own sense of latency to sleep every night is now down pretty consistently to about 10 minutes on all but the worst nights. And on many (maybe 50--60%) of the awakenings after falling asleep, I can get back to sleep within 5--10 minutes. And so I can now go to bed at 1:15 am!---provided that changing the bedtime does NOT increase that self reported latency to sleep. If it does, then I'm back to going to bed at 1:30 am. But if after a couple of weeks of going to bed at 1:15 and successfully keeping the latency to sleep low and the number of troublesome awakenings doesn't increase, I can move the bedtime back another 15 minutes. But of course, I also got the standard (and expected) warning that some setbacks in fighting the insomnia are bound to occur; and to just regroup by moving the bedtime later again if need be. And the next follow up scheduled on April Fools Day. So I'll be keeping logs until then I suppose.

As for the sleep test itself, overall, I'm pretty happy with the results. In addition to the study resulting in a lower pressure setting, the sleep architecture looks far more normal than either of my two previous titration studies and there is finally some real improvement over the sleep architecture in my diagnostic study. In the other two titration studies, the obvious problem of respiratory related arousals had been eliminated/drastically reduced, but several other parameters of sleep architecture remained pretty severely abnormal---including the fact that I didn't get into slow wave sleep on either of the previous titration studies. (I had 9% of my sleep in slow wave on my diagnostic study.) On the Feb. 4 study, 31% of my total sleep time was spent in slow wave sleep. No wonder I've started to feel more rested and relaxed (and "almost refreshed") on a fair number of my insomnia sleep logs in the last 3--5 weeks! There was plenty of REM (24%), although there were only two REM cycles during the night---the first lasted 35 minutes and the second 25.5 minutes. Latency to that first REM was lengthy at 146 minutes, but that 146 minutes contained all the stage 3 sleep during the night. In spite of the 11:35 pm bedtime (which was a worry for me), latency to sleep was only 26 minutes. (I guessed it took me about 30 minutes to get to sleep that night.) That latency time is less than half of what it took me to fall asleep on any of the previous sleep studies. Total sleep time was a bit over 4 hours (249 minutes); I had guessed that I'd gotten somewhere between 3 1/2 and 4 1/2 hours of sleep that night.

The spontaneous arousal index was down slightly to 6 from 7 spontaneous arousals per hour on average in both of the two previous titration studies. But the spontaneous arousal index on my diagnostic sleep study was only 3.5. Of course, with all the hypopneas with arousal on that diagnostic study, maybe there just wasn't that much time left for spontaneous arousals to occur with the untreated apnea. Or perhaps the BiPAP itself is still causing arousals, but not always to waking. Number of awakenings was down to 6 from roughly 15 on each of the previous titration studies. Three of those awakenings were long enough for me to remember---including the one really long one that started about 3:15 AM (about 3 1/2 hours after lights out.) That awakening lasted about 80 minutes and appears to have been triggered by the tech increasing the pressure for the first time during the night. She lowered the pressure back down since I complained about air in my stomach almost immediately upon waking, but the damage had been done and I was wide awake, uncomfortable, and nervous. The pulse rate also went way up during this wake up. But at 80 minutes in length, this extended WASO is much shorter than the 3 hour chunk of WASO that plagued the second titration study. Overall sleep efficiency was 66.7%, which is almost identical to the sleep efficiency on my diagnostic sleep study (69.7%). Of course, the sleep efficiency figure, as well as the percentage of REM both benefited by the tech letting me sleep some 50 minutes longer than the scheduled wake up time of 5:00. And those last 50 minutes were spent completely in sleep and 25 minutes of it were in REM. All the stage 3 sleep occurred early in the night, before the first REM cycle.

So there's some nice concrete data that the restricted sleep schedule I'm using to help fight the insomnia as well as the lower pressures are indeed helping me sleep deeper, sounder, and for longer periods of time between awakenings than I have since starting xPAP therapy and I am now seem to be getting genuinely better sleep all around than before starting CPAP. Last fall, I don't think I was sleeping as well with the CPAP/APAP as I had before starting therapy: While the machine was preventing the apneas, the insomnia triggered by all of the sensory overload created by the machine was more than wiping out any gains provided by treating the apnea at that time.

But the data clearly also show that the insomnia is not fully defeated: An 80 minute wake period in the middle of the night plays havoc with how you feel in the morning. Of course at home, I'd never be in bed lying awake for 80 minutes at one stretch. But there have been nights where I have had to get out of bed for longer periods of time than I would have liked. Fortunately those are have been rare and are getting rarer.

And I found out why I felt so "loopy" when the tech woke me up at ten till six: The morning wake up occured DURING the second REM cycle. No wonder I felt so loopy and disoriented.

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Slinky
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Re: Met with PA about insomnia and got 4th sleep test results

Post by Slinky » Mon Feb 21, 2011 1:26 am

Ahhhhh! A worth-while titration study AND consultation!!! Congratualtions, Robysue. Plus it is always nice to get affirmation of what we already suspect. AND to start getting some decent sleep!! Its always encouraging to see proof of progress, especially when the progress is slow in coming and requires so much "work" on your part (the sleep log and sleep "behaviour" modification).

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