OT: PLMD and Mirapex

We all do what we feel we need to do when we need sleep. Hey, have you looked up all the different meds you are on to see if they are each ok and all ok together for someone with central sleep apnea? Why are you on Clonazepam? Sometimes it is given for limb movements, so if you have to take it for something else, maybe adding Mirapex is not needed. Between a sleeping pill, Clonazepam, and Mirapex, I'm not surprised you're not feeling so great during the day. And you're still not sleeping well. First, I'd want to see that machine data looking the best it can, to make sure events aren't waking you. You can't really evaluate any need for or effect of the other meds until you've optimized your CSA/OSA treatment. As you are finding out, more is not always better. Wish I could help you more, just hoping you get things sorted out.

Speaking of mecication and its side effects, I'd be very very very wary of Clonazepam, which is a Benzodiazepine.
Benzo's are misprescribed, and among the most addictive substances known - worse than the opioids.

http://www.benzo.org.uk -- start from Ashton's stuff.

I first got an Rx for clonazepam about two years ago after a bunch of insomnia due to some depressing events. I pretty quickly got switched to Lunesta and Ambien (not at the same time, of course) precisely because I was concerned about the addictive properties of clonazepam, and took a real antidepressant as well. (I don't take any antidepressants anymore; I've tried a half dozen or so, and none of them seem to do anything good, and some just have negative side effects.)

These days, I only take the clonazepam to try to knock myself out when adjusting to a new breathing therapy. Especially with the BiPAP's high pressures, getting to sleep and staying asleep was incredibly hard. Plus, since I've read that benzos can help with onset of centrals while going to sleep, I figured it wouldn't necessarily be a bad thing. In looking at my nightly data on the CPAP and BiPAP, though, I never found my numbers varied too much if I did or didn't take clonazepam.

I'm not planning on taking it long-term though, and I do take it pretty sparingly (never more than 1 mg a night for 2 weeks at a time -- that kind of thing). I'm actually hoping to drop the clonazepam in the next few days and see if I can get to sleep -- although my aforementioned sleeping problems of late may throw a little wrench in that plan.

P.S. The PLMD diagnosis in my PSG was also with me taking 1mg on clonazepam too. So, I can't tell whether it helps the condition or not, but it definitely doesn't resolve it. I do have a couple contraindications with my meds (e.g., my blood pressure meds and meloxicam, the NSAID), but nothing that's supposed to directly negatively influence the apnea side.

From a PM with ozij

ozij wrote: If it were me, I would also consider the possibility that the PLMs are causing arousals, and those arousals mess up my breathing in a way that gets registered as hypopneas.

Interesting theory. Let me add one additional piece of information, and you and others can maybe chime in and tell me what impact it has, if any. So I mentioned that my AHI with the BiPAP S/T was very high (around 35) when I first got it home. They had titrated me to 20/16, which in the lab appeared to be very stable for the last couple hours of my sleep, so I was surprised to say the least. Most of that AHI was again consisting of hypopneas. If you want to read the long version of my BiPAP saga, it's at viewtopic.php?f=1&t=61719&p=587658#p587658. In a nutshell, by tweaking my settings and lowering EPAP down to 13, I was able to achieve a consistently low (<5 AHI), although I still felt subjectively terrible after use.

Does the fact that I could tweak the BiPAP's pressure settings to achieve a very low AHI invalidate or affect your theory?

Just to make things clear:
PM-ing was initiated by Brian. From my response:

I'm responding to all your points in what follows - I hope you don't mind quoting that part of your questions and my response in public - it is always better to have therapy related discussions in public: we all learn from them, and someone may correct something wrong I say.

BrianinTN wrote:From a PM with ozij

ozij wrote: If it were me, I would also consider the possibility that the PLMs are causing arousals, and those arousals mess up my breathing in a way that gets registered as hypopneas.

Interesting theory. Let me add one additional piece of information, and you and others can maybe chime in and tell me what impact it has, if any. So I mentioned that my AHI with the BiPAP S/T was very high (around 35) when I first got it home. They had titrated me to 20/16, which in the lab appeared to be very stable for the last couple hours of my sleep, so I was surprised to say the least. Most of that AHI was again consisting of hypopneas. If you want to read the long version of my BiPAP saga, it's at viewtopic.php?f=1&t=61719&p=587658#p587658. In a nutshell, by tweaking my settings and lowering EPAP down to 13, I was able to achieve a consistently low (<5 AHI), although I still felt subjectively terrible after use.


Does the fact that I could tweak the BiPAP's pressure settings to achieve a very low AHI invalidate or affect your theory?

Assuming all other condition were equal (medication, etc.) the fact you could lower AHI by changing the settings invalidates theory that the hypopnneas are realated to PLM induced arousals on the BIPAP.

The past couple nights without the Mirapex have been better. That may or may not be coincidence, as I've had a heck of a time getting sleepy (gone to bed around 4-5 a.m. both nights). I've always had a habit of sleeping more soundly when going to bed really late. So, the jury's still out, but for now, I'm keeping the Mirapex off the table.

The past couple weeks have been pretty rocky, so I'm not sure it's the Mirapex that was to blame. I'm not yet at the point where I want to add Mirapex back into the equation as another variable, and I'm trying to get in to see a leading neurologist to can counsel me further. However, in the meantime, I have a question for kteague and others who have been on Mirapex.

Is this a medication that requires lead time to affect your biochemistry, such as an anti-depressant? Or is it one that should have a fairly immediate impact, such as a sleeping aid? I know that you're supposed to take it at least an hour before going to sleep, but what I'm asking is whether there is a "ramp-up" period where you would expect it not to be of help. If so, about how long of a period was that for you?

Thanks!

I don't know that there's a one-size-fits-all on the Mirapex. I've read some accounts of pretty quick relief, others took time. I took time. If I remember correctly, a few weeks with each change. Maybe it depends on the severity of the problem or if an increased dose is going to be required. Why don't you tell the doctors you know someone who is using a TENS instead of meds and getting pretty good results and see if they feel this is an option for you. I'd love to hear what another doc says besides my own. Best wishes.
Kathy

Hi all. Update and question here. So I've left my pressures unchanged roughly since the start of the month About half way through that period, I decided to give the Mirapex another shot -- to have a week of data to discuss the impact with my doc, who I saw today.

My experience was that I didn't get any relief from the Mirapex, and that I felt like it might even be compromising my quality of sleep. I was not resting as deeply, and my total hours of sleep were cut down. I can't conclucively say that the Mirapex was counterproductive, but in light of everything, I want to look at other options.

My doc gave me a new script for Requip. kteague, I know you said you tried it -- did you have any better luck on it than on Mirapex? Or should I run the other way?

I'm seeing a neurologist in a couple weeks, so I'm planning on asking her about a TENS unit as you suggested.

Is there anything obvious that I'm missing?

Thank you again so much for your help!

I was on Mirapex at first for RLS.....I had bad nasal congestion when I took it, so that kind of got in the way of my CPAP use. I used sinus rinse a lot, and there was salty drainage until after a few hours of laying there I would finally be able to get to sleep. Though I had gotten up one night and fluid shot out of my nose and hit my arm. Next morning I was wonder why there was blood on my clothes. Next night the sinus rinse was coming out red.

So ended my trial of Mirapex. Good thing, because I was starting to get pretty miserable from the constipation it had given me too.

I was switched to Requip....so far so good, I still have congestion sometimes...but I've discovered that if I stop eating before I take the Requip....I don't have the congestion.

I wonder if I have some kind of food allergy that the Requip makes worse....wondering if I should get tested.

I did read somewhere that nasal congestion and constipation were among the less common but significant side effects. Insomnia, unusual tiredness, weakness, hallucinations though were among the common side effects. Which I think I had some or all as well.

Requip is also not without its side effects, but they're tolerable (though I did get backed off a bit on dose)...which seems to mean the RLS comes back a few hours before its time again (like right now).

I did wonder if the Mirapex was also interacting with other stuff I'm on.....I'm on so much now that I can't remember it all. I keep meaning to write a recipe card so that when I fill my medication trays, that I'll know that everything got put into it.

My list of prescriptions has 10 things on it....though CPAP is counted as one of the prescriptions I'm on. (so is the Zrytec, which insurance won't pay for...so its not something I think of when I'm getting refills at the drugstore. [or the hormone shots I get at the doctor's office])

The Dreamer.

TheDreamer wrote:hallucinations

It's funny you mention this, because I had my first ones last night. I felt really out of it, and my motor control weakened (kind of like that of a really drunk person). And then I was convinced that my 10" fan that I use for some white noise was playing songs for me. I apparently also sent a strange message to a friend who asked me about it this morning (which is the only reason I even remembered what happened). Very strange.

I too have worried about possible interactions. In fact, after I got done with my sleep doc yesterday, I went down the hall to my GP's office and asked if they could work me in, just so I could run everything by him. He gave the all-clear to my combination of about 8 different prescriptions, but it seems plausible that the Mirapex and the Ambien reinforced each other last night. I've felt a little out of it on Ambien from time to time when I can't get to sleep right away, but never anything like last night!