Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
Hi all - I've posted here a few times the last month as I was recently diagnosed with mild OSA and severe PLMD (67 limb movements an hour). My cognition has gone down the drain to a frightening level. I am 25 years old and want to do a lot in my career, but feel like I simply cannot achieve those goals. I can barely look at a computer screen without getting foggy. That being said, I am foggy in general - I have derealization, meaning reality is distorted and everything feels somewhat fake. I have anxiety. Obviously extremely tired.
Honestly, this post is for no more than seeking validation. All I really want to know - Can such severe symptoms be caused by my mild OSA + severe PLMD? I'm thinking more and more that I may have screwed my brain with psychiatric medication and that it is not these sleep issues, but I also don't think super rationally sometimes with this stuff because I am so frustrated.
Has anyone had these issues (severe cognitive deficits/dissociation issues) and seen major improvement with CPAP/PLMD treatment? I have only been able to sleep over half of the night one time with my CPAP, so definitely haven't been able to see what it can truly do for me. I am also planning on lowering my antidepressant dose to help improve my PLMD.
I guess I just not need some encouragement that these symptoms really can be caused by these sleep issues and to continue to comply with CPAP, etc.
Thank you all so much!
11-14-2023, 11:13 AM
(This post was last modified: 11-14-2023, 11:14 AM by gainerfull.)
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
I've personally never experienced disassociation but have had noticeable cognitive issues prior to figuring out the source of my problem. In my case, and maybe yours I was experiencing gradual increase of REM / sleep architecture fragmentation over a year or more even when 100% compliant w/ CPAP. You'd be surprise by the different symptoms you can experience when you're not getting proper REM sleep on a nightly basis. I am not well versed in period limb movement but if those movements are associated with micro-arousals then we are in the same boat for different causes.
Have you ever had your data reviewed here? Are you taking medication for the PLMD? Have you shared your sleep study at all?
11-14-2023, 03:08 PM
(This post was last modified: 11-14-2023, 03:09 PM by gohoos1998.)
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
Hey, thanks a lot for the response. The periodic limb movements are absolutely associated with arousals. I think about half of those or so resulted in an arousal (I will post my sleep study here once I'm home), but those are the numbers I remember. My AI (Arousal Index) is 35/hr, MOSTLY coming from these limb movements. Some, but less, are coming from the sleep apnea, and then there were also a few of an unknown cause. I know anything over 15, especially for a 25 year old, is much too high.
I tried ropinirole for my PLMD, but I learned that it there is a good chance that the meds make it worse in the future. Also tried gabapentin, and it felt like I slept deeper, but I was just as tired/foggy. I will now decrease my antidepressant because these drugs are known to increase or even cause PLMD. They are also known to make people fatigued and foggy in general, so I think it makes sense to try this.
Your point about REM/sleep fragmentation is a good one. I know for a fact my sleep is extremely fragmented (as I said, arousal index is 35/hr). I go to the bathroom 3 times a night. According to my sleep study, the percentage of REM I got was relatively high, especially for someone who takes antidepressants for anxiety (these medications suppress REM sleep) The amount of deep sleep I got was dreadful (about 5 percent of Total Time Asleep, iirc).
You very well may be onto something here. What did you do to remedy your sleep fragmentation despite being CPAP-compliant? Would be very interested in what you have to say.
Again, really appreciate the response.
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
(11-14-2023, 03:08 PM)gohoos1998 Wrote: Hey, thanks a lot for the response. The periodic limb movements are absolutely associated with arousals. I think about half of those or so resulted in an arousal (I will post my sleep study here once I'm home), but those are the numbers I remember. My AI (Arousal Index) is 35/hr, MOSTLY coming from these limb movements. Some, but less, are coming from the sleep apnea, and then there were also a few of an unknown cause. I know anything over 15, especially for a 25 year old, is much too high.
I tried ropinirole for my PLMD, but I learned that it there is a good chance that the meds make it worse in the future. Also tried gabapentin, and it felt like I slept deeper, but I was just as tired/foggy. I will now decrease my antidepressant because these drugs are known to increase or even cause PLMD. They are also known to make people fatigued and foggy in general, so I think it makes sense to try this.
Your point about REM/sleep fragmentation is a good one. I know for a fact my sleep is extremely fragmented (as I said, arousal index is 35/hr). I go to the bathroom 3 times a night. According to my sleep study, the percentage of REM I got was relatively high, especially for someone who takes antidepressants for anxiety (these medications suppress REM sleep) The amount of deep sleep I got was dreadful (about 5 percent of Total Time Asleep, iirc).
You very well may be onto something here. What did you do to remedy your sleep fragmentation despite being CPAP-compliant? Would be very interested in what you have to say.
Again, really appreciate the response.
I have severe sleep apnea and was diagnosed with an AHI of 85 but only noticed positive changes once I started CPAP in 2014. Back then, I was on a wide range of pressure using APAP but my sleep apnea was reasonably well managed at around 2-3 AHI per night consisting mostly of central apneas and hypopneas. Fast forward to 8 years later and I experienced a sudden loss in cognition / short term memory which was my first warning that something was up. I found this forum, and with help from the knowledgeable people here I was able to further tune my CPAP machine and started getting better results. All of my doctors looked at my 1 or 2 AHI and immediately dismissed sleep apnea as contributing to my memory loss problems and this was around 2020 and then my memory got better.
Fast forward again 2 years later and I started experiencing additional memory issues and went through a full battery of tests and saw way too many doctors with everything checking out. Doctors told me, "maybe this is your new normal" or "would you like to trial an anti-depressant for sub-clinical depression you might have?" but I kept pushing.
Finally, I found the work of Dr. Steven Park talking about how to treat UARS and the wealth of information that Dr. Barry Krakow has on youtube. Dr. Krakow focuses on engineering "normal flow rate" in sleep disordered breathing patients and consolidating REM as much as possible. I was working with a new sleep doctor who was pretty terrible and I would show them the arousals they scored in REM on my hypnogram and ask how we solve these arousals and they threw their hands up. I was able to push them to get me on bilevel and spent the next months titrating myself and centering the titration based upon how I'm feeling when I wake up.
I started on APAP 5-20, EPR off and today I'm getting great sleep, dreaming every night and wake up feeling incredible on IPAP 15 / EPAP 7 and routinely get an AHI of 0.00.
If you'd like to share your OSCAR data with the board I'm sure we can point you in the right direction. Another helpful thing is going to google and typing "site:apneaboard.com plmd" and reading all of the old threads of people searching for and finding answers themselves.
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
Thank you so much for this. During the time I have been able to use the CPAP, I've been at 2-3 AHI per night, largely consisting of CA's and hypopneas as well. I also echo the sentiment about your bad sleep doctor - he is not interested in asking the right questions and to delve deeper. I will definitely look into Dr. Park and Krakow.
As you say, you are on APAP 5-20 and IPAP 15 / EPAP 7. This is on the bilevel? I imagine that is a silly question, but I am still very new to this stuff. What did you say to make a case for bilevel?
I forgot to post the study last night as it was a hectic night, but I will try to get a good OSCAR sample tonight and post it tomorrow.
I actually have taken a look at some of the past PLMD posts and they were definitely helpful in giving me an idea of how the condition can affect sleep.
I am pretty desperate at this point - as I said, I'm only 25 and feel like my life is wasting away. It's a tough feeling, but I will keep pushing.
Lastly, I am extremely happy that you have found a solution to your issues. Must have been a long, frustrating road. Probably makes it that much sweeter.
Again, really appreciate the response, and I will post some OSCAR data tomorrow assuming I can get a good dataset.
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
(11-15-2023, 11:41 AM)gohoos1998 Wrote: Thank you so much for this. During the time I have been able to use the CPAP, I've been at 2-3 AHI per night, largely consisting of CA's and hypopneas as well. I also echo the sentiment about your bad sleep doctor - he is not interested in asking the right questions and to delve deeper. I will definitely look into Dr. Park and Krakow.
As you say, you are on APAP 5-20 and IPAP 15 / EPAP 7. This is on the bilevel? I imagine that is a silly question, but I am still very new to this stuff. What did you say to make a case for bilevel?
I forgot to post the study last night as it was a hectic night, but I will try to get a good OSCAR sample tonight and post it tomorrow.
I actually have taken a look at some of the past PLMD posts and they were definitely helpful in giving me an idea of how the condition can affect sleep.
I am pretty desperate at this point - as I said, I'm only 25 and feel like my life is wasting away. It's a tough feeling, but I will keep pushing.
Lastly, I am extremely happy that you have found a solution to your issues. Must have been a long, frustrating road. Probably makes it that much sweeter.
Again, really appreciate the response, and I will post some OSCAR data tomorrow assuming I can get a good dataset.
Looking forward to seeing your data! The 5-20 was on Resmed Autoset 10 via APAP mode and the 15/7 is on a Resmed Aircurve 10 VAUTO Bilevel
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
Thanks for the response. As promised, here is my OSCAR data from last night. Slept my mask on for over 6 hours which is my second best day yet.
As we talked about, still between 2-3. Improvement, but not quite where we want to be yet. Again, really appreciate it. So thankful for this board!
11-16-2023, 10:36 AM
(This post was last modified: 11-16-2023, 10:36 AM by gainerfull.)
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
1. A good place to start is leak control because each of those spikes is likely causing an arousal. According to your profile you're using a full face mask so you'll want to experiment how to get the best fit but you're likely causing leaks as you shift positions while sleeping. Ideally you'll want to test & tune with mask tightness & position until you're consistently getting 95% leak rate of 0.00.
2. Turn off the ramp feature, it doesn't provide therapy during the ramp process.
3. Increase your minimum pressure to 7cmH20 and turn EPR to 3.
Try these settings for 1-3 nights and let's see more charts. Given how "ratty" your flow rate looks it seems like you're dealing with more hypopneas than are scored. I'd expect your flowrate graph to look better at higher pressure and more pressure differential with EPR.
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
Awesome. Will make those changes tonight and see how it goes for a few nights. I actually use nasal pillows because I don't mouth-breathe (or at least I don't believe I do!) - are you able to change profile info? I didn't notice an edit option, although I may have looked over it.
As for the ramp feature, I'll turn that off. I'll also increase that min. pressure to 7 and see how it goes.
I'll see you back here in a couple of days with some charts! Thanks again.
RE: Can Mild OSA (AHI of 9) + Severe PLMD be Responsible for severe symptoms?
(11-16-2023, 11:02 AM)gohoos1998 Wrote: Awesome. Will make those changes tonight and see how it goes for a few nights. I actually use nasal pillows because I don't mouth-breathe (or at least I don't believe I do!) - are you able to change profile info? I didn't notice an edit option, although I may have looked over it.
As for the ramp feature, I'll turn that off. I'll also increase that min. pressure to 7 and see how it goes.
I'll see you back here in a couple of days with some charts! Thanks again.
Sounds good, since you're using nasal pillows then you're likely leaking from your mouth. You might consider trying cloth medical tape or whatever tape you feel comfortable with and start taping your mouth if you're not taping already. For me, I purse my lips and then apply the tape and make sure I cover the corners of my mouth so when I relax my lips it's a solid seal. I use the tape you can buy from Walgreens / CVS / Target for $3 or so, good luck!
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