I finally requested a copy of my sleep study from 11 months ago. The reason I waited is because I thought my health would improve, but it has not. I am hoping someone can give me some direction, the Doctors just don’t take the time to connect the dots (or don’t know how to). I am trying to avoid just another prescription for the symptoms, I want to find the cause and treat it.

History:

Male age 44 170lbs non-smoker
I started taking Paxil about six years ago for anxiety, that is when the fatigue started and I just blamed it on the Paxil. I reduced the dosage from 15-20mg to 5mg a day, but no improvement. My wife says I’m just getting old and out of shape, so I started to exercise more but no improvement. Went to the Dr. with my complaints, he did blood tests and found nothing unusual. I have always been a light sleeper so we got a Select Comfort bed and tried some supplements to improve my sleep but still no improvement. I told the Dr. that I started taking pain pills two or three times a day, he found that my testosterone was low, put me on replacement and referred me to a sleep specialist.
After the sleep study I was told to start CPAP, could not sleep more than two or three hours with it. I always sleep on my side and I could not do that with the mask. I tried every night for about three months (did not feel any better). Sleep Dr. said to forget the CPAP and fix the deviated septum and reduce turbinates, had that done in 8/07, waited about two months for healing, but no sleep improvement and still have a stuffy nose (always have had a stuffy nose from allergies, never has been a problem) I was told to go to a ENT for testing and treatment of allergies. I am on the second nasal spray which has not helped.

Current symptoms & medications:

Tired and achy all over, feels like the flu. Need to take naps on the weekends to get through the work week. The pain is fairly constant, rarely have ups and downs.
I am currently sleeping in another room by myself with a white noise generator.
In bed at 9:30pm, up at 6:30pm
Paxil 5mg daily
Testosterone gel 3-5mg daily
Multi-vitamin daily
1000mg acetaminophen/500mg aspirin/130mg caffeine daily
Just started taking fish oil 2 grams daily
Use breathe rite strips (don’t know if it helps)
Using braces retainer for about four years (just at night)

 
Sleep study results:

Sleep efficiency 93%
AHI 6.1
Total sleep time 7:39:00
Stage 1 = 23.4% Stage 2 = 50.2% Stage 3 = 0% Stage 4 = 0% REM = 26.4%
Respiratory events:
On Back – 4:35 hr, 8 Obs. Apneas, 37 Hypopneas
On right side – 3:03 hr, 0 Obs. Apneas, 2 Hypopneas

Arousal Summary:
Respiratory = 0, LM-related = 0, Spontaneous = 137 (108 non-rem, 29 rem)

My thoughts:
Why am I not getting stage 3,4 sleep? (sleep 3 hrs with no arousals)
What is causing all the spontaneous arousals?
Why didn’t they tell me to just sleep on my side instead of CPAP?

 
CPAP/Tiration report:
Sleep efficiency – 82%
Total sleep time 6:57:04
Stage 1 = 50.6% Stage 2 = 41.8% Stage 3 = 0% Stage 4 = 0% REM = 7.6%
Respiratory events:
On back – 5:43:00, 0 Obs. Apneas, 15 Hypopneas
Did not sleep on side

Arousal Summary:
Respiratory = 4, LM-related = 0, Spontaneous = 55 (non-rem)
Final CPAP setting was 10

Still did not get stage 3,4 sleep.

 

Conclusion:

Almost a year later and no improvement, I don’t think I am getting restorative sleep (sleep Dr. never mentioned it). I always sleep on my side, but I get pain in my hip and shoulder which wakes me up and I roll over. Not sure how many times this happens each night. I am starting to look into fibromyalgia supplements for the pain. I need to start reading about non-restorative sleep, may even look into food allergies.  It’s starting to get depressing; my young kids don’t understand why I sleep all weekend instead of playing with them. Luckily I have a desk job. Any suggestions would be welcomed. Thanks to all who took the time to read this.

dfs,  
I am no doctor but it seems to me that if your problems with fatigue started with the Paxil, it may be the Paxil that is keeping you from getting restorative sleep.  Is poor sleep a side effect of Paxil?  Because you are not getting restorative sleep, and haven't been for six years!? you may have developed fibromyalgia or chronic fatigue syndrome.  I guess I wouldn't play around with supplements without being evaluated for fibromyalgia.  You might want to find a good rheumatologist who takes fibromyalgia seriously (not all of them do).  Good luck. I know it's rough trying to figure out why you are so tired, but don't give up.  
Grandma


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I am also trying to learn about causes, and effects, of no stage 3 & 4 sleep, and 57 arousals during 5 hr sleep (11.2 arousal index...i guess yours would be 19?).   See my post re: rec'd report for 24 yr w/cerebral palsey.
The doctor said nothing about this, so I wouldn't have known if I hadn't requested a copy of the report.  My son has been chronically tired for the last 9 years.  Drs say nothings wrong, but it's not normal to sleep both days and nights.  i the both of us can find some answers.  just letting you know you are not alone,



Last edited by embryopathy on Thu Mar 06, 2008 11:04 pm; edited 1 time in total

With that many spontaneous arousals and a doctor ignoring them I'd be looking for a NEUROLOGIST who specializes in sleep medicine. Obviously you are doing better, w/less spontaneous arousals on CPAP so I wouldn't just ditch the CPAP just yet.

If possible I'd find a university teaching hospital w/a good sleep lab as part of their neurology department for further and better evaluation for the cause of those spontaneous arousals.


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I'm not a medical proessional but I wonder both about your pain condition and your pain medication. If it is the 1000mg acetaminophen/500mg aspirin/130mg caffeine formulation I might wonder about whether caffeine might play a role (but I would add that this is gross speculation on my part).

It may be that your pain is contributing to your spontaneous arousals and that this is interfering with your stage 3/4 sleep.
It is possible that your full sleep study would have greater information about this. There does seem to be some research to indicate a relationship between pain and poor sleep architecture. In particular, there seems to be a phenomenom known as alpha intrusions (basically alpha wave activity that disrupt stage 3/4 sleep). Some of this research indicates that the relationship may work both ways. I seem to recall that the artificial disruption of deep sleep in subjects with normal sleep decreased the subjects' pain tolerance. On the other hand, alpha intrusions are a subject of some controversy. I don't believe that there is any clearly established treatment for alpha intrusions either. For that matter, although the great preponderance of what I have read about stage 3/4 sleep would indicate that this is an important part of sleep that should comprise aboout 20% of total sleep, I have known 2 people to report being told by their sleep doctor(s) (I assume this is not the same doctor in both cases, one of these was attached to a major medical center) that beyond childhood srage 3/4 sleep is unimportant. My bet would be that the absence of stage 3/4 sleep is contributing to your feeling poorly. But I would perhaps confront the sleep doctor directly about this to see what the doctor says (personally I would like to know the basis for saying that stage 3/4 sleep is unimportant and whether there is any evidence to support this position).

I would like to add that there is no evidence that your turbinate reduction/septal deviation surgery did anything for your sleep apnea (that would have required a follow-up sleep study), although it may make your CPAP treatment more effective.
I would also encourage you to go back to CPAP both because it does treat what appears to be mild apnea and because it appears to have led to a significant decrease in your spontaneous arousals.

Keep us posted and let us know what your doctor(s) say.

Best wishes,
Bill

Every Dr. I have seen knows I am taking Paxil, if there was a chance it was causing a sleep disturbance I hope they would have told me. The articles I have read state that Paxil will increase serotonin, which helps with sleep.
I knew that caffeine could cause sleep problems, that why I would take the pills right after lunch to get through the afternoons, thinking the caffeine would be out of my system by evening. What I just found out is caffeine can remain in the bloodstream for up to 12 hours. I plan to wean myself off the caffeine, pain killers and Paxil. I am also going to try Active-on to rub on my hips and shoulders for sleeping. Hopefully it’s just a nasty cycle I got myself into. I will post results. CPAP may still be in my future, but I would like to improve the 0% stage 3&4 sleep. If I don’t see improvement soon, it’s back to the Dr. to start over.

I wanted to post an update on my progress so that others with similar symptoms might benefit.
I wanted to find out what was causing the spontaneous arousals. I did weeks of reading and started leaning towards upper airway resistance syndrome. Then I found an article about sensitivity to aspirin and how it can inflame sinuses. This could explain why my sinuses are ALWAYS  restricted. (The ENT said it’s just allergies and gave me two prescriptions for nasal spray, which did not help).
I had been taking the pain pills which contain 1000mg of aspirin daily for over five years. I decided to slowly stop taking the pills, it was rough at first but I started feeling better, my sinuses were clearer. My body wasn’t achy all day, I didn’t have to take naps on the weekend, I didn’t have to go to bed a 9pm. I can now make it through the day without any pain pills or caffeine. I don’t have a sleep study to prove I am sleeping better, but I sure do feel better. I still have allergies so I irrigate daily.
As my sleep study indicates, I have apnea when I sleep on my back but I don’t sleep on my back.
I am hoping this helps others.

Cymbalta works similar to Paxil (Seratonin Reuptake Inhibitors), but is known to be effective in reducing certain pain.
Fibromyagia responds well, lower back too. I have two very close people  in my life who made the switch, one from Prozac (15 years) (almost 2 years on Cymbalta) with chronic back pain, and one from Paxil (10 years) (6 months on) with fibromyalgia. Both of their qualites of life have improved significantly and dramatically. One friend who tried it
didn't notice any improvement so they went back to using Zoloft. Hope this info helps.

Sincerely,
sleepytimebunny

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