first sleep study - complete waste of time? - Yup!

I just skimmed the article and thought this exert was interesting:

Under the subheading, evidence for efficiency:

In terms of absolute changes, treatment reduces subjective sleep-onset latency and time awake after sleep onset from averages of 60 to 70 minutes at
baseline to about 35 minutes after treatment, and total sleep time is increased by 30 minutes, from
6 hours to 6.5 hours after treatment. Thus, for the average patient who has insomnia, treatment effects
may be expected to reduce sleep latency and time awake after sleep onset by about 50% and to bring
the absolute values of those sleep parameters beloor near the 30-minute cut-off initially used to define insomnia. Treatment effects are similar for sleeponset and maintenance problems, although fewer
studies have targeted the later type of insomnia, particularly early morning awakenings. Overall,
findings from meta-analyses represent fairly conservative estimates of treatment effects because they
are based on averages computed across all nonpharmacologic interventions and insomnia diagnoses
(ie, primary and secondary). On the other hand, although most patients benefit from treatment, only a small proportion (20%–30%) achieves full remission, and a significant proportion of patients continues to experience residual sleep disturbances

I found the part that I bolded in blue very interesting because it seemed to me that while CBT-I was successful in the short term, I have always wondered about the long term results. Obviously, there is always more to the story but I think this needs to be explored more.

I am also curious about the statement that the average sleep time was increased from 6 to 6.5 hours since so many people with insomnia sleep 4 hours or less. How much improvement did these folks have and were any measures of sleep quality tested? If it mentioned this in the article, my apologies.

Thanks for providing this link Mollete.

49er

49er wrote:

On the other hand, although most patients benefit from treatment, only a small proportion (20%–30%) achieves full remission, and a significant proportion of patients continues to experience residual sleep disturbances

I found the part that I bolded in blue very interesting because it seemed to me that while CBT-I was successful in the short term, I have always wondered about the long term results. Obviously, there is always more to the story but I think this needs to be explored more.

I'll take that one!

Only 15% of diets succeed;
Only 10% of alcoholics and drug addicts kick their habits; and
I'll bet the same is true of gambling.

The Big Secret:

Ya Gotta Wanna.

mollete wrote:

49er wrote:

On the other hand, although most patients benefit from treatment, only a small proportion (20%–30%) achieves full remission, and a significant proportion of patients continues to experience residual sleep disturbances

I found the part that I bolded in blue very interesting because it seemed to me that while CBT-I was successful in the short term, I have always wondered about the long term results. Obviously, there is always more to the story but I think this needs to be explored more.

I'll take that one!

Only 15% of diets succeed;
Only 10% of alcoholics and drug addicts kick their habits; and
I'll bet the same is true of gambling.

The Big Secret:

Ya Gotta Wanna.

Uh oh, is this popcorn time?

Hmm, if 10% of cancer treatments worked, would you still be saying ya gotta wanna?

Anyway, I think you essentially confirmed my suspicions.

49er

49er wrote:Hmm, if 10% of cancer treatments worked, would you still be saying ya gotta wanna?

That's an issue of efficacy. The insomnia issues are largely centered around appropriateness, compliance, persistence and reinforcement (2 more examples-- smoking and CPAP).

Anyway, in re: appropriateness, the first thing one must do is figure which of the 11 different types one has:

http://www.aasmnet.org/Resources/clinic ... 040515.pdf

I think if current data is showing some sustained effect of CBT after 24 to 36 months that is very encouraging, and reinforcement may be all that's needed.

Interesting thought:

http://psychiatryonline.org/data/Journa ... 756/19.pdf

49er wrote:I think you essentially confirmed my suspicions.

I hope your suspicions were (and like all the examples) "This is probably a lifelong problem, but with effort and support, I can be in the 10%".

My point is that any treatment that is deemed as psychologically oriented that has a 10% success rate is unfairly blamed on the patient. That is so wrong on so many levels.

Also, the issue is that when a profession has very few answers in treating a medical condition like insomnia, they come up with a one size fits all solution and blame the patient when it doesn't work because they weren't motivated enough.

And before you flame me which I am sure you will do, just remember that this attitude used to exist with conditions like narcolepsy and ulcers before physical reasons were discovered for the condition. i am sure those folks who failed psychological treatments were accused of not trying hard enough.

I am not questioning that CBT I helps some people. But to say it helps everyone when many people developed insomnia after events like menopause which point to physical issues simply falls short.

49er

mollete wrote:

49er wrote:Hmm, if 10% of cancer treatments worked, would you still be saying ya gotta wanna?

That's an issue of efficacy. The insomnia issues are largely centered around appropriateness, compliance, persistence and reinforcement (2 more examples-- smoking and CPAP).

Anyway, in re: appropriateness, the first thing one must do is figure which of the 11 different types one has:

http://www.aasmnet.org/Resources/clinic ... 040515.pdf

I think if current data is showing some sustained effect of CBT after 24 to 36 months that is very encouraging, and reinforcement may be all that's needed.

Interesting thought:

http://psychiatryonline.org/data/Journa ... 756/19.pdf

49er wrote:I think you essentially confirmed my suspicions.

I hope your suspicions were (and like all the examples) "This is probably a lifelong problem, but with effort and support, I can be in the 10%".

49er wrote:And before you flame me which I am sure you will do...

You are incorrect.

So now we know why there are yellow stains on the wall of the boys' locker room!

chunkyfrog wrote:So now we know why there are yellow stains on the wall of the boys' locker room!

See what happens when you Bogart the Bong?

oak wrote:when my doc ordered the sleep study, they put in a script with it for ambien in case I couldnt go to sleep. I took it and it really helped me deal with the foreign surroundings. my sleep study was very similar to Lambeaus. dont worry, they are used to people being a little keyed up and will put you at ease.

For my first sleep test years ago, my sleep doctor gave me an Rx for Ambien and said take a whole tab (10mg) then another half if I wasn't asleep in an hour. When I got to the sleep lab the night of my test, the sleep tech said just take a half a tab (5mg) and that will knock you out all night. Uh sorry, I weigh about 185lbs and one half a tab didn't do squat. I waited a little over an hour and asked the tech what to do. He said take another half tab. One hour later I drifted off for an hour then woke up when the computer in my room fired itself up for a Windows update (they'd forgotten to turn it off). Half an hour later I took another half tab but it was too late because their checkout time was 6am. Naturally I went home and slept all morning which didn't help much. I wish the sleep tech and my doctor had been on the same page. Oh well, I failed to get the required hours of sleep to 'pass' the sleep test and had to take another down the road. Plain ignorance or willful subversion of the medical system. You can draw your own conclusions. Oh BTW, they still billed my insurance for $3500 for my failed sleep test.

Still finding this thread quite interesting. The subject of dreaming thoroughly baffles me as my experience (once again) has me outside the box. When my apnea and PLMD was untreated and/or I was on lots of meds I could explain away my symptoms, but I don't know why at this point I still have full fledged storied dreams before I go to sleep. I can still be aware of conversations around me yet have a whole scene unfolding in a dreamlike state. Oh well, may never understand it it, so it just is what it is. In my MSLT if I remember correctly I slept in all but one nap but needed to reach REM in one more for a diagnosis of narcolepsy, however, it was done when my limb movements were bad so I'm guessing had my legs been quiet I would have met the diagnostic criteria for narcolepsy. It certainly would explain some things, like how I can lose an entire day sitting up in a chair drifting in and out of a stupor. Doesn't happen as often any more since my nighttime sleep has improved, but it still happens.

Anyhow, thanks for all the input on this subject. Good reading.

Often the SOREMs you are describing are the result of sleep deprivation. For many with apnea events or RLS, it'd happen prior to treatment. So many of the symptoms can overlap, and that's why it can take years to diagnose. The doc I met with was giving the other people there that day an earful for simply dismissing it is "oh it's clearly apnea have a cpap!" or "no apnea, have a nice day!" Gotta redo everything since the validity of my first test is questionable - 0AHI seems a little out of place.

Another 2 months till I'll receive any treatment

So it's now been 6 weeks since the "we'll have you approved for a second study in 2 weeks" appointment. Paperwork hadn't even been filed when I called in to check the status on Monday. I'm now told it'll be a month until they hopefully get that setup, then another 2-3 weeks until the actual test, and another 2-3 for the results to be assessed.... ugh.

Stopped at my GP last night for an update, she hadn't received anything except the same results I did, and didn't know what to make of them. I went it to pretty much ask for a low-abuse stimulant that I'd most likely be prescribed with anyway, gota big NOOOOOPE! Best she could do is call them to see why it's taking so long.... Still sleepy at my desk at work, barely have the strength to bike to work, fell asleep in the docs waiting room, waking up 2-3 times a night that I'm aware of.. Only another 2-3 months... Ugh...

FINALLY!

Second PSG results are in. AHI was 10 (16 on my back). 103 arousals over the 6 hours, mostly hypopneas. Lotta shallow breathing. Picking up my trial CPAP tonight. They really botched my original results lol.