ASV: Hypopnea Index Remains High

BrianinTN wrote:

deltadave wrote: Your PSGs all showed REM suppression, probably from clonazepam, so I would not necessarily label them "stellar" (but not necessarily call them "non-stellar").

I'm not quite sure why you say this. The klonopin was something I took pretty rarely and in small doses (usually 0.25-0.5mg). I did use it in two of the four sleep studies to try to get to sleep, but still in those low dosages.

Well here's what a normal sleep architecture looks like:



with the first REM period occurring at about 90 minutes into sleep.

I'm still a layman here. Are you saying the periods in the "R" range are what is so abnormal? And that you suspect the klonopin to be causing them? What does the "R" even mean?

OK, so you had 6 studies? This all of them?

deltadave wrote:OK, so you had 6 studies? This all of them?

4 so far. The diagnostic, the CPAP titration, the BiPAP S/T titration, and the ASV titration. I haven't yet had a new study at Stanford. If it would be helpful to see PDFs of those four, and all the data I've amalgamated, feel free to send me a PM. If love your input, and you know I respect your opinion inmensely.

Right, R is REM. You can clearly see how REM is delayed to about 3 hours (one period missed) in the fourth study and totally destroyed in the second.

I think the first thing to do would be fill out a sleep log for 2 weeks:

http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf

It's fairly self explanatory.

There are suggestions of poor sleep hygiene in your previous posts, so a visit to BleepingBeauty is in order.

Those PLMs are bitter.

Some interesting reading may be found in:

http://www.journalsleep.org/Articles/280720.pdf

BTW, most ADMs make PLMs worse.

OK, a few parameters of sleep for analysis:



Also, what is your current measured height and weight?

Current medication list (including supplements)?

deltadave wrote:There are suggestions of poor sleep hygiene in your previous posts, so a visit to BleepingBeauty is in order.

And on cue:

I'm Back! (OK, Not Really)

Moron Sleep Hygiene

I miss the triplets...

Those were the good ol' days...

Wow. You did some digging to put that together. Thanks -- I'm impressed.

Height: 5'10". Weight: currently about 212. The BMI around 30 is a little misleading; I have fairly broad shoulders and decent upper body strength, and the upper part of my ribcage is visible. Obviously I should still shed some pounds, of course; I'm about a size 36 waist now, and think of a size 34 as my ideal. I haven't weighed less than 180 since I was a teenager, and even at 185, I look very thin.

Medications:
* Lisinopril/HCTZ 20/25
* Amlodipine 10mg
* Welbutrin 300 XL
* Occasionally and as needed: Ambien 5-10mg, Lunesta 3mg, Clonazepam 0.5mg-1mg. Since I'm not using the CPAP most of the time these days, I usually don't need to take any of these, unless my mind is racing.
* Psychiatrist recently had me on Prozac 40mg and then Cymbalta 20mg, but as of a couple days ago I'm off the Cymbalta (since my depression had spiked severely in the last week or so). Prior to October when starting school, I hadn't been on any ADMs for several months, including the Welbutrin.
* OTC stuff: Centrum multivitamin; Vitamin C; ibuprofen/acetaminophen as needed

I'll start the sleep log tonight. I can tell you off the bat that my sleep hygiene has historically been somewhere between poor and mediocre (grad student right now, so some of that is unavoidable, but most is my own fault). I'll try to follow your advice and make it more routine during these two weeks -- as much as is possible, anyway. I'll cut out the naps and caffeine, although given my exhaustion and difficulty focusing, that's going to suck. And move my work/computer time out of the bedroom.

BrianinTN wrote:I can tell you off the bat that my sleep hygiene has historically been somewhere between poor and mediocre.

This is certainly demonstrated by your uploads, showing very late bedtimes, very late rise times. long TSTs and high variability:

Summarizing some of those nights:



Can you post the last few months on nightly compliance data? I think those will be quite helpful.

The body has a number of biorhythms, as shown by these authors:



So the next thing to do will be to match up the sleep pattern shown in the compliance data with what your body naturally seeks.

OK, so we already know they don't, but this will make the point in a somewhat stronger way.

BrianinTN wrote:Psychiatrist recently had me on Prozac 40mg and then Cymbalta 20mg

Great. Those medications make PLMs and RLS worse.

BrianinTN wrote:Welbutrin

Great. That medication makes PLMs and RLS better.

BrianinTN wrote:

deltadave wrote: That leg stuff-- have you checked your electrolytes lately?

Nope. Is there a specific test that you'd suggest I have run? Sounds like potassium from your next paragraph -- anything else?

Where is Kathy? She should've swooped down on this like an eagle on a salmon.

Potassium and iron.