Abdulfakih - Therapy Thread

[Abdulfakih]

Good morning everyone.

I live in Venezuela and medicine here isnt good. I initially did 2 polisomnography examns, and both show i should use a CPAP. However, i recently saved some money and travelled to Colombia to do another exam. I got the results, but my doctor prescribed me some antidepressants instead of CPAP. He told me he doesnt think i need it, however i have been taking the pills for like 2 weeks and i still cant sleep properly. I was hoping someone could please take a look at my results and perhaps give me a second opinion?

Sorry, the results are in spanish

[Sleeprider]

Your files describe a split diagnostic and titration study. During the diagnostic portion, you experienced no apnea, but had a hypopnea index of 6.1 per hour, with desaturation of oxygen mainly 90% and above. While AHI is mild, you have a very high arousal index, mostly not respiratory related, and there is a periodic leg movement (PLM) that resulted in 14 arousals per hour. There was no REM sleep during the diagnostic portion of your test. Hypopnea was clustered in both supine and prone sleep positions, mainly in N1 and N2 sleep. In the second half of your study, CPAP was titrated between 5 and 12 cm-H2O, with apparently very good results at 9-10 cm pressure. Thee was an anomalous high event rate at 8-cm pressure that is not explained by the study, but appears during prone sleep and REM sleep.

You appear to benefit from CPAP, and given the nature of your sleep disordered breathing being mainly hypopnea, your best solution would be a device like the Resmed Airsense 10 using exhale pressure reduction (EPR) to obtain some bilevel pressure therapy. That would likely extinguish most or all respiratory events, however a significant portion of your sleep disorder is related to PLM. It appears that your doctors have prescribed an antidepressant for the PLM which makes up most of your arousals, and ignored your sleep disordered breathing. The problem with that approach is it leaves the sleep disordered breathing untreated, and potentially worse if the antidepressants have a respiratory suppression effect. If you want to import CPAP from the U.S. a company called CPAPspecials delivers new PAP internationally at a significant discount. You can search for that company and decide if it is within your financial means. It appears you will benefit from CPAP or BPAP, however much of your arousal issue comes from PLM and finding the most effective therapy for that could take some trial and error, and I can't say whether your prescribed medication can be of much help in that regard. If you obtain CPAP, setting a pressure range of 9 to 11 with EPR 3 looks like it should work well, or in bilevel, EPAP 7 PS 3 IPAP 10 cm.

[Abdulfakih]

Hello Sleeprider, thank you so much for your reply. The doctor prescribed amitriptiline half dose of 15mg, but i am still not sleeping properly. I am unsure on what to do, but I am desperate to get some good sleep and I dont know what would be the best route for me to take. Please advise

---

Hello Sleeprider, thank you so much for your reply. The doctor prescribed amitriptiline half dose of 15mg, but i am still not sleeping properly. I am unsure on what to do, but I am desperate to get some good sleep and I dont know what would be the best route for me to take. Please advise

[Sleeprider]

You are young for such problems, but poor sleep is very common, and there is a great deal about you and your health that is unknown. Starting with good nutrition and ensuring you have a vitamin D3 and iron supplement can be important in PLM. Sleep hygiene can be a solution to create a good habit out of falling asleep and staying asleep. The advent of Covid shots and vaccines seems to have coincided with a lot of complaints of sleeplessness and brain fog, so stay away from that. There are sleep aids and anti-anxiety drugs that are more effective at promoting sleep than Amitriptyline, which is also not a therapy I know to be used for restless legs or PLM. It just seems like the wrong path. Maybe pursue a more direct temporary therapy for insomnia, and once the anxiety over sleeping is resolved, get back to sleeping without drug intervention. Your hypopnea is very clustered, and we have a wiki that helps you resolve your sleeping position as a cause of positional obstruction. Read this and try to avoid sleeping in positions that cause your chin to tuck or turn your head to acute angles like with prone sleeping. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[Abdulfakih]

Thank you very much for the advice. For a bit of context, I am 26, i am active in the gym, i am 1,7m tall and i weight 69kg. I have hipertension and i take amlodipine of 2.5mg each night. I went to a cardiologist and she said my numbers go high during the night (while im sleeping mostly). Again I am a bit slow and Not sure what to do. Please give me the next steps to follow

[BigWing]

What an outstanding and detailed summary of the test results....AND guidance on how to start solving the problems. That advice would have cost a fortune through a private sleep consultant!

Well done yet again, Sleeprider!

[Abdulfakih]

The advice is good, I am just slow and still dont know what to do

[Sleeprider]

What an outstanding and detailed summary of the test results....AND guidance on how to start solving the problems. That advice would have cost a fortune through a private sleep consultant!

Well done yet again, Sleeprider!

And I'm even bilingual in Spanish! Abdul is doing really well with our English for a tired guy.

[Abdulfakih]

I am still lost

[BigWing]

Please correct me if I am wrong, Sleeprider, but I believe his advice can be boiled down to:

 * study the guidance regarding "Positional Apnea" and try to do what it suggests
 * purchase a ResMed Airsense 10 Autoset S10 Auto CPAP (with a mask of your choosing)
 * set it to: pressure min = 9; pressure max = 11; EPR = 3 full-time
 * after a few days of use, post the results back here