Apnea is under control, but now have RLS

From the sleep study:

Fragmented Sleep quality with sleep efficiency of 90.4% and 116 arousals with an Arousal Index of 21.4 arousals per hour of sleep. Sleep architecture is abnormal with an increase in Wake and Stage 2 with a decrease in REM sleep. Sleep onset was early with a latency of 4.3 min. and REM onset was early with a latency of 68.5 min. Patient slept in the supine and left lateral positions during the night. Prior to turning off the lights that patient had complaints of hand wrist elbow guy and lower leg pain, rated at between four and seven on a 10 point scale.

Respiratory events are within normal limits with an overall AHI of 2.2 events per hour of sleep and a REM AHI of 2.5 events per hour. The technician described the patient's snoring as light to moderate. EKGs show the normal sinus rhythm. Baseline oxygen saturation was 95.3% and minimum oxygen saturation was 90.0%.

Periodic limb movements were noted with 128 leg movements and a PLMS index of 23.6 leg movements per hour of sleep. The PLMS arousal index is 6.5.

The patient normally goes to bed at 9 PM and wakes up at 2-4 AM, not feeling refreshed. patient typically wakes up many times during the night and is awake for about 2 min. He admits to reading while in bed. The patient also takes naps during the day that lasts as long as one to two hours but did not mention the frequency of the naps main sleep problem is complaint not sleeping well tired all the time.

Impression

primary snoring versus upper airway resistance syndrome
periodic limb movements in sleep

Recommendation:

The treatment options for snoring and for UARS must be individualized to that particular patient.

1. Most patients respond to a reduction of weight. I am not overweight.

2. Strongly positional snoring may be improved by avoiding sleeping in the supine position, which can be achieved by selling a tennis ball or wiffleball into a pocket and a T-shirt or pajamas top between the shoulder blades

3. Patients with crowding of the oropharynx or nasal obstruction may respond to treatment of chronic congestion use breathe right strips for evaluation by ENT specialist.

4. Use of a dental device to advance the lower jaw may benefit patients especially those with underbite. No underbite

5. Avoidance of sedatives including alcohol may lesson the tendency toward OSA and snoring

6. Evaluation for hypothyroidism if clinically appropriate. Nope

7. patients with only snoring or (UARS) two not usually tolerate nasal CPAP, as they find it more disruptive to their sleep then the apnea and snoring however some patients do find it to be an acceptable treatment, especially if there snoring is causing significant marital discord or daytime sleepiness.

The decision to use CPAP in these patients should be determined after discussion between the patient and the ordering physician. Note: insurance usually will not cover CPAP for an AHI of less than five per hour. Since dropping the pressure to 10 on my CPAP, which I use every night, my AHI ranges between 0.7 to 5.?? it mainly stays in the range of 2 to 3 per hour.

Comments

PLMS may be the cause of the difficulty falling asleep, frequent nocturnal wakenings, and excessive daytime sleepiness. Patients with PLM are usually unaware of the movements during the night and are only aware of poor sleep quality. The cause of periodic leg movements in sleep is not known but may be associated with decreased dopamine levels, ferritin levels less than 60, B12 are fully acid deficiencies, and for uremia and excessive caffeine use. These symptoms may be worsened by the use of antihistamines decongestants antidepressants. These medications should be used with caution in patients with significant psychiatric history and/or contraindications to dopaminergic medications.

My PCP and I talked she recommended I get some calcium and B12 to add to magnesium, potassium, fish oil, garlic, d3, and multivitamins that I take every day just to be on the safe side. I take Cymbalta sinemet, Mirapex, Lunesta, Singulair, Restasis, and Symecort and carry a rescue inhaler.

We also talked in working to stay with CPAP because the CPAP portion of the study may be somewhat flawed because I did not, not use my CPAP machine for three days prior to the sleep study.

I apologize for any confusion my doctor told me it was RLS and has put me on an extra dose of Mirapex before I go to bed.

I am sending the study to my neurologist on Monday so that he has a copy of it.

Nuerontin (Gabapentin) - I don't like how this medicine makes me feel. I did take it before for neuropathic pain issues, it was not that helpful. I have tried Lyrica and Tralaeptal without a lot of success too.

I am going to see a neruopathic pain specialist next month, hard to get into to see him as a new patient, so maybe he can figure something out.

I just get tired of all the pain.

I appreciate y'all and the comments that you had, I will let you know what the neurologist says.

Take care

I'm newly diagnosed with apnea, and RLS. I just switched to a new mask, and I slept the whole night through for the first time last night (7 hours). My husband says my legs still kick, but I've only been on the med (Requip) for 6 days. It takes almost a month to get to the full dosage. My reps therapist says that my husband saved my life by pointing out that I stop breathing at night (married for 18 months). Hopeful that the machine and meds work, thankful that God sent my husband to me!

jacob006a wrote:
Comments
We also talked in working to stay with CPAP because the CPAP portion of the study may be somewhat flawed because I did not, not use my CPAP machine for three days prior to the sleep study.

I am not a medical professional, but just from experience, I'm thinking the CPAP portion of your study is inaccurate. Not because of whether you used it before the study, but because your limb movements compromised your sleep too much for OSA to even have a chance to manifest much. If your legs had been quiet, I'd venture to say you would have seen more apnea events, especially if you had in prior studies. The term for when either OSA or PLMD prevents the other from fully manifesting in a study is called "masking". Anyone who has both OSA and PLMD has reason to be suspect of their results, as getting a definitive picture can be a game of cat and mouse.

Anyone who has both OSA and PLMD has reason to be suspect of their results, as getting a definitive picture can be a game of cat and mouse.

Makes sense to me.

vkeezer59 wrote:I'm newly diagnosed with apnea, and RLS. I just switched to a new mask, and I slept the whole night through for the first time last night (7 hours). My husband says my legs still kick, but I've only been on the med (Requip) for 6 days. It takes almost a month to get to the full dosage. My reps therapist says that my husband saved my life by pointing out that I stop breathing at night (married for 18 months). Hopeful that the machine and meds work, thankful that God sent my husband to me!

Fantastic, my wife pointed out the Apnea and RLS PLMS to me. I never noticed either one, as I was asleep. It is really good to get more sleep. Stick with it, it is sometimes a battle, but well worth it.

jacob006a wrote:My ferritin is at 66, which is good.

22 is min for non-RLS patients. Max is 322.

50 is the minimum the RLS foundation recommends for RLS patients.

In another study they found additional relief by taking it to 90. Ask a sleep doctor about it as most GPs are not aware of the higher levels recommended for RLS patients.

Eghad, something else to think about. Thanks, I am looking into it.

Inflammation is believed to be a key factor when it comes to Restless Legs Syndrome. A new study was published in the January 14, 2012 issue of "Sleep Medicine Review Journal" that supports this theory. You can read that study here:
http://www.rlcure.com/rls_study.pdf

You can view the results of other related scientific studies and learn about some helpful solutions at this free RLS information website:
http://www.rlcure.com

A blog for RLS sufferers with helpful tips can be found here:
http://therestlesslegsblog.wordpress.com

Something I forgot to mention... When my PLMD was untreated and/or ineffectively treated, my pain was torturous every day. The leg muscles rarely got the rest needed to be restored, and the severity of the movements caused my knees, hips, and lower back to be affected too. Add that to sleep deprivation which can make one more sensitive to pain, and I was pretty miserable. It may be that treating the OSA and the legs could improve your degree of pain. Or at least any residual symptoms may be easier to identify the likely cause(s).