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CPAP Basics - 6 - OSA and Insomnia
Posted: Thu Apr 18, 2013 3:03 am
by mollete
OSA and Insomnia - a meta study (of sorts)(and no, "The Answer" will probably not be there, as there is no One Size Fits All...)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854710/
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 3:32 am
by 49er
Mollete,
Thank you so much, this is a great article although unfortunately due to my cognitive issues, it is going to be hard to read. But this is motivating me to find my text to speech software program so I can listen to it and hopefully have better comprehension.
These two exerts stuck me so far:
""Polysomnography is not routinely used in the evaluation of chronic insomnia. However, in cases in which pharmacotherapy and behavior therapy are ineffective in ameliorating insomnia symptoms, patients should be referred for polysomnography to be evaluated for OSA""
According to Krakow, the link between insomnia and SDB orders is quite high. As a result, it seems to be me that OSA should be ruled out first before drugs and CBT are tried. Obviously sleep med should not be a solution of first resort, particularly when they don't have a track record of long term success and don't provide restorative sleep. And while of course CBT doesn't have side effects, in my opinion, it can be harmful if people are incorrectly referred for it.
""CBT has been shown in numerous studies to be effective in improving insomnia symptoms in those with primary and comorbid insomnia.63,64 Nonetheless, CBT is an intensive intervention requiring a high degree of motivation on the patient's behalf. Future treatment studies in comorbid insomnia and OSA are needed. Sequenced studies with
CPAP therapy, CBT, and hypnotics will provide greater insight into the optimal treatment strategies for patients with comorbid insomnia and OSA. Additionally, clinical trials evaluating the effectiveness of the chronic use of nonbenzodiazepine agents on insomnia symptoms in patients with insomnia and OSA are warranted.""
A big fat sigh. Along the lines of providers needing to try the treatments they suggest for patients for weeks, I think the same applies for CBT which often involves sleep restriction therapy. Let's see how motivated these folks continue to feel after restricting their sleep for several weeks.
I am not sure how many more drug trials are needed when already the evidence is in that the meds don't work long term.
49er
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 3:45 am
by mollete
49er wrote:..it is going to be hard to read.
Let me toss this one out there. Right now the hottest name in Insomnia is Thomas Roth Ph.D. He'll be delivering keynote at AASM 2013. This is a recent YT:
https://www.youtube.com/watch?v=8XeqnDom9sw
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 4:09 am
by 49er
mollete wrote:49er wrote:..it is going to be hard to read.
Let me toss this one out there. Right now the hottest name in Insomnia is Thomas Roth Ph.D. He'll be delivering keynote at AASM 2013. This is a recent YT:
https://www.youtube.com/watch?v=8XeqnDom9sw
Thanks, I will check that out.
I am making another attempt to read it as I think this is one of the more interesting citations on SDB and insomnia I have seen.
49er
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 8:12 am
by Drowsy Dancer
Very interesting. At first blush (although I have to print the article out for further study), if I'm understanding this correctly, the authors appeared to be relatively uninterested in whether a category exists of xPAP-induced insomnia, because of a theory that OSA and insomnia were comorbid and the insomnia simply became more notable as a cause of sleep disturbances once the OSA was treated.
I also find it mildly amusing that someone actually did a study to determine that CBT is not effective to treat OSA. No big surprise there.
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 8:27 am
by Drowsy Dancer
So, perhaps this particular topic should be broadened slightly or phrased as the concept: xPAP fixes sleep-disordered breathing, but that doesn't make it a magic automatic fix for disordered sleep. Bad sleep hygiene developed along the way, whether driven by gradually worsening SDB over the years or "merely" comorbid, has to be separately addressed to optimize sleep architecture, and so things like caffeine consumption, irregular bedtimes, irregular rising times, naps, voluntary sleep restriction, etc. should all be reviewed.
In absolute fairness to my own DME, they actually gave me a handout on sleep hygiene along with my initial packet of materials that, as I look at it now, isn't bad. But it was simply there in my packet of materials along with other random stuff. The DME didn't grab me by the lapels, so to speak, and say, "This sounds like stuff your mother says but it's really important, let's go over why." They spent a lot more time telling me how to change my filters and clean my mask. (And in further fairness, a lot of time on mask fit and mask instruction, even though it was my sleep doctor who eventually turned me on to nasal pillows some weeks later).
BTW, I had an idea for Basics - 7, although it's currently being well-covered in a differently-labeled thread right now.
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 1:55 pm
by kaiasgram
This is so important, thanks mollette for starting this thread. You've probably already seen that just in the last 24 hours several people have posted about their insomnia (we need a smiley to represent exhausted/sleep deprived, with two little "x"s for eyes).
I noted in the abstract of that article (in the Methods & Results paragraph):
The use of GABAergic nonbenzodiazepine agents has been associated with improvements in sleep and has little to no effect on the apnea-hypopnea index in patients with OSA.
I've been reading about these meds which include gabapentin (Neurontin) and the newer Lyrica, both thought to increase time in deep sleep. I haven't read the whole article yet but thank you so much for sharing it. My insomnia, if you can call it that, doesn't involve being unable to fall asleep (usually) or even big wakeups in the middle of the night -- certainly no wakeups that I can remember. I fall asleep quickly and then wake up in the morning feeling like garbage. I usually improve some over the course of the day and feel "best" in the evenings. OSA is all fixed, desats ruled out, FLs improved, I'm left with sleep-but-not-deep-sleep insomnia. So I'm researching ways to increase specifically deep sleep. The GABAergic meds caught my attention for this reason.
Please keep up the good work, you're a trusted source of information here.
(p.s., does anyone have a cure for my weird brand of insomnia? )
(p.s. again -- thanks also for the Psychiatry Online youtube link. They have a whole channel of online videos, very cool.)
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 3:18 pm
by SleepingUgly
kaiasgram wrote:My insomnia, if you can call it that, doesn't involve being unable to fall asleep (usually) or even big wakeups in the middle of the night -- certainly no wakeups that I can remember. I fall asleep quickly and then wake up in the morning feeling like garbage. I usually improve some over the course of the day and feel "best" in the evenings.
Hmmm, doesn't sound like "insomnia". I know, super helpful, huh?
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 3:34 pm
by kaiasgram
SleepingUgly wrote:kaiasgram wrote:My insomnia, if you can call it that, doesn't involve being unable to fall asleep (usually) or even big wakeups in the middle of the night -- certainly no wakeups that I can remember. I fall asleep quickly and then wake up in the morning feeling like garbage. I usually improve some over the course of the day and feel "best" in the evenings.
Hmmm, doesn't sound like "insomnia". I know, super helpful, huh?
Yeah, I know -- I was using Krakow's very loose description:
...insomnia, a word meaning you have poor sleep or you are not sleeping when you want to sleep.
from his Sound Sleep, Sound Mind book.
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 6:22 pm
by mollete
Drowsy Dancer wrote:BTW, I had an idea for Basics - 7, although it's currently being well-covered in a differently-labeled thread right now.
Well stick it in anyway! The very nature of this project says there's only 7 important things (although we should make 12 easy), so it's like the forum is a constant waveform.
Then just do a
☛ Look there.
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 6:43 pm
by mollete
mollete wrote:Drowsy Dancer wrote:BTW, I had an idea for Basics - 7, although it's currently being well-covered in a differently-labeled thread right now.
Well stick it in anyway! The very nature of this project says there's only 7 important things (although we should make 12 easy), so it's like the forum is a constant waveform.
Then just do a
☛ Look there.
Unless the other thread is like right here and then you can do a
Look here☟
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 7:39 pm
by avi123
RobySue has a different thought on Insomnia and she has a PhD, and is a full Professor. So why should I listen to a mollete et al?
Check it here:
http://adventures-in-hosehead-land.blog ... er_19.html
Taming the CPAP-Induced Insomnia Monster
So now you're "sleeping" with the mask, only it doesn't feel like you'll ever get sleep (or stay asleep) with the mask on: Taming the CPAP-Induced Insomnia Monster
By RobySue
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 8:44 pm
by DoriC
avi123 wrote:RobySue has a different thought on Insomnia and she has a PhD, and is a full Professor. So why should I listen to a mollete et al?
You're right! Why should you listen to Mollette? I'd put him on your Foe List immediately!
Check it here:
http://adventures-in-hosehead-land.blog ... er_19.html
Taming the CPAP-Induced Insomnia Monster
So now you're "sleeping" with the mask, only it doesn't feel like you'll ever get sleep (or stay asleep) with the mask on: Taming the CPAP-Induced Insomnia Monster
By RobySue
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 11:00 pm
by -SWS
avi123 wrote:RobySue has a different thought on Insomnia and she has a PhD, and is a full Professor. So why should I listen to a mollete et al?
RobySue's career in math is largely irrelevant to the topic of insomnia. Rather, RobySue's first-hand experience with insomnia and excellent research into the topic are ample reasons to read her views IMO.
Similarly, RobySue's math career has absolutely nothing to do with the quality of advice that other posters offer on this message board---including mollete. Rather, I would suggest newcomers pay attention to mollete's posts as well, since he often disseminates excellent information from a sleep professional's perspective.
Re: CPAP Basics - 6
Posted: Thu Apr 18, 2013 11:12 pm
by Drowsy Dancer
mollete wrote:Drowsy Dancer wrote:BTW, I had an idea for Basics - 7, although it's currently being well-covered in a differently-labeled thread right now.
Well stick it in anyway! The very nature of this project says there's only 7 important things (although we should make 12 easy), so it's like the forum is a constant waveform.
Then just do a
☛ Look there.
Why are there only seven important things? Are you keying off the structure of a certain document said to be definitive? We don't really need to be constrained by that, now, do we?
I was actually thinking that the information contained in this thread here
☛ viewtopic/t88353/Wrist-Bracelet-or-Neck ... ndant.html
and this thread here
☛ viewtopic/t88467/Emergency-steps-one-should-take-.html
contain useful information for someone coming to a full understanding of what it really means to have a condition that is fully treatable, but should be treated nightly for the rest of one's life no matter what the circumstances. I've been papping for over two years now, and I've had a medication allergy for over ten, and I
still don't wear medical ID. Because perhaps on some level I don't accept that all this is for realz permanently.