Sleep architecture results help

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Sleep architecture results help

Postby Jchaspel » Wed Sep 18, 2013 11:58 pm

Hi,

I had a sleep study done a few years ago and am seeing my doctor again tomorrow morning to see if I need another one. I was just looking at the previous study agan and have some questions.

The study did not find apnea, however I did have frequent sleep arousals as a result of my breathing -- the doctor called it upper airway resistance syndrome (uars). The mechanism (and treatment) is very similar to apnea except that instead of holding my breath, resulting in lower oxygen levels, when I had trouble breathing I woke myself up -- not long enough for me to notice, fell right back to sleep each time. This happened about 12 times an hour -- every 5 minutes. He told me that while this condition does not have the health consequences that apnea does, since my oxygen levels were stable, it could help explain why I am exhausted all of the time no matter how much I sleep.

He did not, however, talk to me about my sleep architecture, and looking again at the results it looks very off to me. I am wondering if this is because of the arousals or if there may be other things in play that also need attention. I'm especially concerned by the fact that stage 4 isn't even on there, which I'm interpreting to mean I literally did not get any. Note: I am on antidepressant medications, which at least partly explains the long REM latency, but it's really really long! In addition I also take vyvanse for adhd (similar to Ritalin or adderall) -- the max daily dose twice a day (so double the max). I can do that, drink a cup of coffee, and pretty easily still take a nap, which I find very disturbing...

Here are my architecture results:

Stage scoring:
N1 - 4 min - .8%
N2 - 270 min - 51.3%
N3 - 193.5 min - 36.8%
Rem - 59 min - 11.2%

Sleep parameters:
Time in bed: 570.5 min
Sleep time: 526.5 min
Efficiency: 92.3%
Wake after sleep onset: 24 min
Latency to sleep onset: 20 min
Latency to persist sleep: 30.5 min
Latency to rem: 391 min
Total arousal index: 15.2/ hour sleep time

I appreciate any info you can provide so I can know what to talk to my doctor about tomorrow. Thanks!
Jchaspel
 
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Re: Sleep architecture results help

Postby Daniel » Thu Sep 19, 2013 4:08 am

Hi & welcome,

I had a sleep study done a few years ago and am seeing my doctor again tomorrow morning to see if I need another one. I was just looking at the previous study agan and have some questions.

The study did not find apnea, however I did have frequent sleep arousals as a result of my breathing -- the doctor called it upper airway resistance syndrome (uars). The mechanism (and treatment) is very similar to apnea except that instead of holding my breath, resulting in lower oxygen levels, when I had trouble breathing I woke myself up -- not long enough for me to notice, fell right back to sleep each time. This happened about 12 times an hour -- every 5 minutes. He told me that while this condition does not have the health consequences that apnea does, since my oxygen levels were stable, it could help explain why I am exhausted all of the time no matter how much I sleep.


The awakenings are known as millisecond awakenings. As a general rule of thumb awakenings of less than 3 seconds are not remembered.
Personally, I think anything that disrupts your sleep needs attention, but your doctor has the full sleep study report and is in the best place to advise you.

He did not, however, talk to me about my sleep architecture, and looking again at the results it looks very off to me. I am wondering if this is because of the arousals or if there may be other things in play that also need attention. I'm especially concerned by the fact that stage 4 isn't even on there, which I'm interpreting to mean I literally did not get any. Note: I am on antidepressant medications, which at least partly explains the long REM latency, but it's really really long! In addition I also take vyvanse for adhd (similar to Ritalin or adderall) -- the max daily dose twice a day (so double the max). I can do that, drink a cup of coffee, and pretty easily still take a nap, which I find very disturbing...


Stage 4 doesn't exist anymore......it has been replaced by Stage N3 (which is the old stage 3 plus stage 4)
I think it important to discuss your medications with your doctor and their possible effects on sleep.

Here are my architecture results:

Stage scoring:
N1 - 4 min - .8%
N2 - 270 min - 51.3%
N3 - 193.5 min - 36.8%
Rem - 59 min - 11.2%

Sleep parameters:
Time in bed: 570.5 min
Sleep time: 526.5 min
Efficiency: 92.3%
Wake after sleep onset: 24 min
Latency to sleep onset: 20 min
Latency to persist sleep: 30.5 min
Latency to rem: 391 min
Total arousal index: 15.2/ hour sleep time


In a perfect world you might expect the following (there may be a variance for age and other factors). I have put your figures in brackets:

Stage N1 5% (.8%)
Stage N2 55% (51.3%)
Stage N3 20% (36.8%)
REM 20% (11.2%)

Your sleep efficiency was pretty good.
REM latency was very extended.
Stage N3 sleep needs to be looked at. This is our deepest and most restorative sleep.
Reduced REM Sleep.

Usually, reduced Stage N3 sleep leads to excessive sleepiness.....however yours is extended ??? Something to discuss with your doctor.

If you are having another sleep study, make sure to compare both reports.

Best of luck.

Daniel.
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Re: Sleep architecture results help

Postby mollete » Fri Sep 20, 2013 8:10 am

Jchaspel wrote:I am on antidepressant medications...

Which ones?
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Re: Sleep architecture results help

Postby Jchaspel » Fri Sep 20, 2013 11:27 pm

I'm taking cymbalta 60 mg. plus vyvanse for ADD. At the time of the test I was also on a small dose of abilify.

Saw my doctor the other day. We talked about the sleep architecture -- interestingly, when we started the conversation, he was looking at a different sleep study I had done almost 10 years ago that apparently had very similar results because we had gone through most of it before we figured out we weren't looking at the same info. His interpretation of my high level of deep sleep was that it suggests I was sleep deprived and trying to catch up. The scary thing about that is I took the more recent test while unemployed and was sleeping 10-14 hours a day! Sometimes even more. If I can sleep that much and still be sleep deprived I think something must be very wrong.

While I could get tested again for narcolepsy and hypersomnia (which I did the first time, but not the second. He said the first results may not be accurate, however, because I was on all my meds at the time. If I retake it he would want me off everything for 2 weeks before), even if I turned up positive for one of them I'm basically already doing the treatment so it wouldn't accomplish much.

He did have one new suggestion at the end, after I insisted that I can't go on like this. He said I could try a trial of xyrem for a month to see if that helps. Unfortunately even if it does, my insurance is unlikely to cover it without a narcolepsy diagnosis, and aside from fatigue I don't show any symptoms of it.

All in all I'm very frustrated. I definitely appreciate any ideas you have about anything that could help. I'm also going to a rheumatologist in a few weeks to see if maybe I have fibromyalgia, but since I've also tried most of the treatments for that already as we'll not too optimistic.
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Re: Sleep architecture results help

Postby mollete » Sat Sep 21, 2013 6:23 am

If you go off medications, you might want to keep the PSG date flexible. Duloxetine withdrawal can be horrendous, and the PSG results could end up being worthless:

http://www.fda.gov/downloads/AdvisoryCo ... 172866.pdf

There are quite a few ADMs that enhance SWS (including aripiprazole), so the increased SWS could be faux.

All 3 of those drugs (lisdexamfetamine, aripiprazole, duloxetine) are known to be sleep disruptors, so there may be value in looking at what time of day you took/take them, then look at the Sleep Hypnogram and Arousal Graphs to microanalyze the night's sleep. It may be that the first part of the night is totally destroyed, while the last part becomes somewhat normalized as the medication wears off (this is suggested by that big block of REM at the end of the night).

Interestingly, there is some evidence that says 80 mg. of duloxetine results in less sleep disruption than 60 mg.

If you're thinking FBM, closely examine the SWS. There is a high incidence of alpha intrusion in the SWS, and that might explain continued EDS in the face of ++SWS.

BTW, are you sure this is EDS, and not fatigue? What's your Epworth Score?

Doing the MSLT would also (in addition to allowing the REM to appear in it's normal spots) differentiate EDS from fatigue.

Ever have a bad head injury, especially one that resulted in coma (for however long)?
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Re: Sleep architecture results help

Postby mollete » Sat Sep 21, 2013 6:47 am

Jchaspel wrote:His interpretation of my high level of deep sleep was that it suggests I was sleep deprived and trying to catch up. The scary thing about that is I took the more recent test while unemployed and was sleeping 10-14 hours a day! Sometimes even more. If I can sleep that much and still be sleep deprived I think something must be very wrong.

IMHO you might want to take a long hard look at your depression Rx and see if that's appropriate.

Also, that much sleep could result in sleep inertia, and your daytime mentation is just like TFUed.
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Re: Sleep architecture results help

Postby mollete » Sat Sep 21, 2013 6:58 am

What is somewhat inconsistent is that you had 133 arousals, but only 4 minutes of NREM1 sleep. It seems to me that that many arousals should have resulted in more sleep disruption that what those numbers suggest.

However, a look at the Hypnograms may offer answers (or perhaps more likely, spawn more questions).
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Re: Sleep architecture results help

Postby mollete » Sat Sep 21, 2013 7:04 am

Daniel wrote:The awakenings are known as millisecond awakenings. As a general rule of thumb awakenings of less than 3 seconds are not remembered.

BTW, those "awakenings" are not "millisecond awakenings", they are "arousals", and "awakenings of less than 3 seconds" are "nothing".
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Re: Sleep architecture results help

Postby Rick4Sleep » Sat Sep 21, 2013 10:02 am

I suspect that most sleep apnea (all sleep problems for that matter) & depression can be resolved through a combination of exercise (especially aerobic) and eating whole unprocessed foods. As a nutritionist specializing in sleep problems, a client came to me with asthma and sleep apnea. I recommended drinking more water, juicing with organic vegetable juice, and extra fibre in his diet. Both his asthma and sleep apnea went away. I got involved in the field because I had severe insomnia and asthma for 18 and 16 years respectively. I beat both conditions through nutrition and exercise. You would be amazed at what can be done to improve your health with a similar approach.
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Re: Sleep architecture results help

Postby Jchaspel » Tue Sep 24, 2013 2:18 am

I take the cymbalta in the morning, and when I was on abilify took it just before bed (dosage varied from 2.5 to 5 mg). My printout of the histogram is kind of hard to read, but from what I can tell I progressed from n2 to n3 very quickly - maybe 20 minutes. Was in n3 pretty solidly for about 2.5 hours, with only a couple of arousals. At around 3:30 the arousals started and I bounced back and forth between stages 2 and 3 pretty quickly until about 7 am, when I had my first round of rem sleep. St around 7:30 I went back to stage 2 with some arousals and short bits of stAge 3 sleep, then reentered rem a little after 9 until I woke up.

I'm not sure of the difference between eds and fatigue. I definitely have bad sleep inertia In the morning -- immense difficulty waking up, and sometimes after I get easy and jump in the car I'm afraid I'll fall back asleep at the wheel because I'm not up yet. I can press snooze for hours, even though I have to walk across the room to turn the alarm off. However, even once I'm up and the inertia passes, I just feel tired, unfocused, and unenergetic for most of the day. If I don't take a second vyvanse at work around lunch time, by 4 pm I'm pretty much toast and can't accomplish anything.

Is there a way to post images here? I could show you the actual histogram if that would help.

Thanks for all your input so far, you all are great!
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Re: Sleep architecture results help

Postby mollete » Tue Sep 24, 2013 7:29 am

Jchaspel wrote:Is there a way to post images here? I could show you the actual histogram if that would help.

Scan the document, upload it to a third party server like photobucket and post the link within img brackets.
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Re: Sleep architecture results help

Postby mollete » Tue Sep 24, 2013 7:41 am

Jchaspel wrote:I'm not sure of the difference between eds and fatigue.

Image
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Re: Sleep architecture results help

Postby Jchaspel » Wed Sep 25, 2013 1:07 am

I've posted the chart to photobucket, but when I try to add it here I get an error saying my account does not have permission to post links or domain/page references!
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