7 replies to this topic

[luckyhunny]

my results are as follows: (my dr. appt is next week). If anyone has any insight, please feel free to comment, as I am compiling questions to prepare for my appt.

 

Please feel free to comment on individual sections, because I am scratching my head about several things that were said (my questions are in bold).

***This sleep test was done while using a CPAP machine & taking Ambien.***

 

Sleep Architecture

This full night sleep study demonstrates an increased sleep latency of 35.0 minutes. Sleep architecture showed decreased stage N1 sleep (1.9%), normal Stage N2 sleep (75.1%), normal Stage N3 (Slow Wave Sleep) (8.1%), and decreased Stage REM sleep (13.8%). There was a normal REM latency of 92.5 minutes. There was a total sleep time of 376.0 minutes with a normal sleep eficiency of 88.1%

Respiratory Analysis

The study showed no obstructive sleep apnea with mild sleep fragmentation characterized by an overall Apnea Hypopnea Index (AHI) of 1.0/hour. The AHI's were NREM 0.9/hour, and REM 1.32/hour. The patient had 0 obstructive apneas, 0 mixed apneas, 3 central apneas, 3 hypopneas, and 0 flow limitation events (RERA). Positional influence was not a contributing factor.

Sleep Fragmentation Analysis

There were 61 spontaneous arousals, 1 respiratory arousal, and 15 limb movement arousals leading to a total arousal index of 10/hour.

Limb Movement Analysis

There were 104 limb movements. Limb movements resulted in 15 brief arousals during the night. The PLM Index of 16.6/hour.

Cardiac Analysis

The patient's EKG displayed Normal Sinus Rhythm.

Oxygenation Analysis

Moderate oxygen desaturations were noted with a nadir attained being 86%. The baseline SpO2 was 93. Total sleep time spent below 90% is 0.40%

MSLT Results

MSLT was performed with 5 nap opportunities on CPAP 12. Average sleep latency was 11 minutes with 1 SOREM at 9 minutes.

Physician's Interpretation

No evidence of significant residual OSA on CPAP 12. There are moderate PLM's present. MSLT demonstrates borderline hypersomnia with sleep latency of 11 minutes. Recommend clinical follow-up.

 

Ok, here are my questions:

What are the normal percentages of time spent in each sleep stage?

I woke up spontaneously for no reason 61 times (I only remember waking once). This is my issue nightly-waking up for no reason. What can cause this? This goes hand in hand with my next question, I never knew neither did my boyfriend about my PLM's. I would wake up once a week or so with cramps in my lower legs where it felt like I would stretch and hold it and would wake up from the pain.

MSLT-I remember dreaming more than once. During one nap it seemed like I was having a seizure from jerking, but I will bring that up with the doctor b/c it was all recorded.

The moderate PLM's seem to not bother me too much as the "spontaneous arousals". What causes this?

What is "borderline hypersomnia"?

 

Thank you in advance for your comments/input/knowledge!

[dormir]

From what I know (which isn't a lot), I think spontaneous arousal averages 5-6 per hour maybe?  You had above average, if that is truly a valid average.  This isn't a sleep arousal index, but basically the article says the more arousal you have, the more tired you will be. http://www.sleepapne...dy-details.html   

 

I think borderline hypersomnia could be attached to things like narcolepsy, idiopathic hypersomnia, or other disorders where you may sleep too much and the EDS is not relieved by sleep.  Don't quote me, but that's from what I understand.

 

 

They didn't ask you to stop the Ambien before the sleep study?

[DeathRabbit]

Judging by that data, if I were the doc I would diagnose you with RLS. Which I hope they do because that's a much happier diagnosis than N.

[Megssosleepy]

Judging by that data, if I were the doc I would diagnose you with RLS. Which I hope they do because that's a much happier diagnosis than N.

 

That's what I was thinking as well.  The fact that you had normal latency in each stage of sleep makes me lean away from N, but then again I am no doctor.  I will be interested to see what they say!

[luckyhunny]

HI everyone.  Thanks for your responses.  Yes, he did tell me to take the Ambien that night and do everything "that I normally would do", but I refrained from caffeine later in the day.

I saw the doc today.  He said, basically I have Hypersomnia that is not resolved with adequate CPAP use.  He said, sometimes with CPAP use your brain doesn't "wake up" and realize that this therapy is helping you.  As far as the PLM, he said that it doesn't seem to be bothering me enough to wake me up, so he wants to leave it alone for now.  He prescribed me Nuvigil 150 mg and told me to take only half the Ambien CR at night and to see him in a month.  I didn't let him know that I read the report because I wanted to hear what he had to say.  I was upset leaving there because he really didn't have a lot of answers other than to take those meds the way he said to for a month and we "will see".  He didn't get into the SOREMP during my MSLT and he didn't get into why I am having "spontaneous arousals" all night.

I have a month to try this and think about things.  I just wanted some answers today and I really got none which is frustrating.  I just want to move on and have answers and treatment (we will see how this goes and maybe I will get answers during my next appt) or go for a 2nd opinion.  I am home now and thinking more clearly than I was there.  I just want to have my life back and as far back as I can remember I have been feeling lousy.  Chronic sleep problems are the worst thing to deal with.

His point was that I slept with a high sleep efficiency so he's convinced that I am sleeping well, even though I don't feel like I am.  He said he doubts I slept better at the sleep center than I do at home, so these are the "worst case" results.  I told him I am taking the Ambien which I really want to be off of and to get to the bottom of this.  During my first sleep study my CPAP wasn't running at the pressure it is now and my sleep efficiency was low, along with not hitting REM and having a long SL.  I am curious if I didn't take the Ambien and did these tests what would've happened.  Oh well.  Now, back to the waiting game. 

[SleepyDays]

Did he test you for UARS? Many clinics don't test for it.

I have N with C and I'm going to be tested for UARS because my new sleep doc thinks I may have it on top of the N.

From the reading I've been doing....CPAP isn't always the best treatment for UARS.....a dental device that you wear when you sleep is a better option.

 

Here's some info:

http://www.centerfor...ce-Syndrome.php

 

Symptoms at the bottom of this page:

http://www.centerfor...ystemic-balance

[drago]

Sleep Fragmentation Analysis

There were 61 spontaneous arousals, 1 respiratory arousal, and 15 limb movement arousals leading to a total arousal index of 10/hour.

Limb Movement Analysis

There were 104 limb movements. Limb movements resulted in 15 brief arousals during the night. The PLM Index of 16.6/hour.

 

I woke up spontaneously for no reason 61 times (I only remember waking once). This is my issue nightly-waking up for no reason. What can cause this? This goes hand in hand with my next question, I never knew neither did my boyfriend about my PLM's. I would wake up once a week or so with cramps in my lower legs where it felt like I would stretch and hold it and would wake up from the pain.

MSLT-I remember dreaming more than once. During one nap it seemed like I was having a seizure from jerking, but I will bring that up with the doctor b/c it was all recorded.

The moderate PLM's seem to not bother me too much as the "spontaneous arousals". What causes this?

What is "borderline hypersomnia"?

 

First of all, spontaneous arousals are a natural part of the sleep cycle. How many you have is based on your age, what hour you go to bed, what hour you get up, and probably genetics. I had something like 90 spontanous arousals, which are simply a shift from a "deeper" stage of sleep to a "higher" stage of sleep. They're called spontaneous because they're not related to cardiac or respitory issues -- they just happen. If they last more than 3 seconds, they're considered an awakening, but many people don't remember waking up unless it lasts longer than that.  For my age group, and for me sleeping somewhere new, the 90 spontaneous arousals wasn't a big issue -- I didn't wake up during them; maybe I rolled over, shifted, or my brain waves changed, but I only woke up once during the night, and it was because the electrode thing behind my ear hurt...!

 

In short, spontanous arousals don't necessarily mean anything. They can be drastically changed by going to bed at a different hour (due to circadian rhythms). Doctors look at them when they think a breathing problem might exist -- sometimes you won't have as many respitory-related awakenings directly, but they're somehow appear as spontanous arousals. However, that's less likely than a random arousal just happening...

 

PLM could also be a problem with WHERE and HOW you were sleeping. I brought my own bedding because I don't sleep well without it. (Pillow, comforter, etc.) And with the electrodes on my head, it was hard for me to sleep how I like (on my stomach), so I definitely rolled over more. Is it possible that all the sleep study stuff could have caused some discomfort?

 

Sometimes I get the cramps you describe: people around where I live call them Charlie Horses. They're a kind of muscle cramp that takes place in your calf. However, you can also get them in the arches of your foot, among other places. Dehydration is a common cause, as is a low level of pottasium. Any kind of overexertion (i.e. when I first moved to college and started walking around all day, I got these at night sometimes) or even things like too much caffeine / alcohol (which contribute to dehydration) can give you one of these. Not sure if they're related to RLS at all, but I do know a LOT of people without sleeping disorders who do get them!  I have to take a suppliment w/potassium (or eat a banana a day) and drink a LOT of water... (around 48 - 60 fl.oz. spread out over the entire day) to prevent getting them.

 

As for dreaming during MSLT: There is evidence that we dream at almost every stage of sleep, but the crazy eye-in-the-sky-that turns-out-to-be-a-cow-in-a-haunted-house dreams (the "movie" style dreams) tend to appear in REM. Dreams at other stages tend to be more mundane (like dreaming that you're at home and a strange dog suddenly appears or something)...

 

"Narcolepsy is confirmed when the average sleep onset latency is less than 8 minutes and when the patient has at least two naps associated with a REM (dream) period."

 

To be honest, the data here is a bit confusing. It seems you fell into REM quickly at least once during the MSLT, which indicates a possible problem. Your night time sleep has disruptions, but how many were you aware of? And, does it contribute to you feeling sleepy during the day at all, or is this normal for you?

 

I know you've already been to your doctor, but maybe you should ask about a test without Ambien or something. I'm not sure exactly how Ambien helps people sleep, but I do know it's usually used as a short-term sleep aid, right? Not something you're on for a years? It might affect your sleep study by covering up problems (like not being able to fall asleep) or by creating problems (is there any connection between Ambien and RLS?). Also, if Ambien IS helping you achieve better sleep at night, it could also affect your MSLT. (HOWEVER... my over night results were very good --  I had good sleep efficiency, etc. but my MSLT still indicated narcolepsy... so, Ambien may affect your MSLT, but there's no real way to know for your particular case.)

 

Anyway, I hope you're feeling better!

drago

[Arrow2]

Lots of good info in drago's post. I am glad I found this forum. I have a couple of quick thoughts.

 

I believe drago is correct that REM is not the only stage of sleep in which we dream. Every definition of dreaming I have found indicates that only "most" dreams occur in REM. The common (but incorrect) assumption that dreams occur only in REM creates confusion, especially when discussing MLST results. The ability to dream outside of REM explains so many people (me included) remember dreaming during a MLST nap for which no REM stage sleep was recorded. Dreaming does not necessarily = REM stage sleep

 

I also believe drago is correct about the fact that lots of recorded spontaneous arousals do not necessarily mean one is getting "bad" sleep, especially if you can't remember them.

 

I hope you get your life back soon!