How to identify arousals? PLM?

[permabear]

   

   

[permabear]

@Geer1, I guess I am sensitive to leaks indeed. Although I hardly ever wake up at night, I feel worse after a night with higer leak rate.
As in my case PS doesn't seem to have an impact on the grassyness of the FR graph and I'm sensitive to pressure in general, I will give a lower PS a try.
In the mean time I'm giving up on coffee, dairy an wheat. Alcohol wasn't on my list anymore. It gave me instant fatigue and restless legs in the evening so I quit drinking a few months ago.

[kappa]

Good that you could reduce RLS by avoiding alcohol. Do you have measurements of your Ferritin and Transferrin Saturation? Is the RLS significant and/or present still?

Is the sleep study saying that PLM is a consequence of breathing events, or vice versa? Or just that they are associated without attributing causation? (My Nederlands is negligible despite both parents speaking it to varying degrees).

In my case I see respiratory events driven by PLM, along with changes in heart rate (rapid increase of 8-15 bpm, dropping back down fairly quickly also). Your PSG appears to have significant heart rate variation during the intervals that are marked as PLM. This HR acceleration is what I'm mostly trying to manage and measure (I also measure leg movements directly).

[permabear]

Hi Kappa,

Nice to hear you have some connection to The Netherlands!
I almost never have RLS. Although, sometimes when fatigue has been really bad and I've been lying on the couch a lot, I have this annoying nerve pain starting in my lower back and radiating all the way to my heels. At those days I experience some kind of RLS. I doubt if it is true RLS but it's this tingling feeling in your calves. Fortunately this happens only once every 2 months and lasts only a couple of days. Long story short: I don't really suffer from RLS. I can evoke it instantly by drinking alcohol (which I don't do). 

I had my Ferritin levels tested a while ago, but these were all good. 
2017: Ferritin 315 ug/l (ref. 30-400), Transferrin Saturation not tested.
2006: Ferritin 252 ug/l (ref. 22-275), Iron 21.3 umol/l (ref. 9.5-29.9), Transferrin 2.53 g/l (ref. 1.9-3.2)
For reference: I suffer from fatigue for 25+ years now and in 2017 it has been very bad (not able to work). So I might ask my GP for testing again but I don't expect anyting spectacular from it. 

The sleep study says that lots of the PLMs are associated with a breathing event. It means as much as they happen simultaneously. The report does not further specify the correlation between both events. 

I recall from earlier PSGs that heartrate variation was something mentioned. Also in my first PSG dated 2006. I linked it to OSAS/UARS.

Just wondering, what do you do in order to prevent PLM? Do you have any recommendations for natural remedies, e.g. Valerian, Glycine, Taurine, lifestylechanges, etc? Tbh I'm not all that keen on prescription drugs yet.

[Geer1]

If you look at page 7 you can see plm marks and compare to hypnogram. Most of the plm occur in nrem and most occurred during one period of time along with the majority of hypopneas.

Out of curiosity do you also have anxiety and/or depression? If so would you consider it chronic and clinical (rather than situational)?

Regarding diet changes especially if you have gastrointestinal issues it is worth a try. Try removing troublesome foods as is possible and eliminate for 6-8 weeks to see if that helps then slowly reintroduce to see if symptoms start coming back.

One word of caution, try to make minimal changes at one time so you can determine what was actually causing improvement, if you make too many changes and something helps it can then be tough to determine which one helped and sometimes this can cause setbacks.

[permabear]

Fortunately I never suffer from anxiety or depression. 
What difference does it make whether PLMs occur during REM or non-REM?

[Geer1]

Not sure plm being rem vs nrem has much significance. I believe it usually occurs more so in nrem though.

I was curious about the anxiety/depression as I have similar heart rate fluctuations and my SNRI helps smooth them out. It is something I noticed a couple years ago when I was first on it. I imagine similar heart rate variations can be caused by a number of things though.

[kappa]

Hi permabear. I don't know that there is any definition of "true RLS". It's a clinical diagnosis based on described symptoms rather than something that can be tested for directly. Your tingling feeling in your calves sounds compatible with the description of RLS, and presence of PLM, which is often associated with RLS, would seem to support that. Good that the RLS is not a regular thing for you (same for me).

Those Ferritin levels look great. While the reference range is very wide, there are recommendations for higher minimum target for those with RLS/PLM (some say 50, some 75, some 100... there's a lot of different viewpoints out there!).

I get the reluctance to go down the pharmaceutical route - I'm currently on Pregabalin 150mg once/day, which seems to be helping. One thing I noticed was that I have particularly bad nights after large and/or late evening meals, so I've started eating earlier and less in the evening meal.

Heart rate variability is an interesting topic. On the one hand, low heart rate variability is considerd bad, but it also seems that a large variation durig NREM sleep is also bad and indicative of arousals (perhaps due to apnea, LM or spontaneous). In my case I'm trying to manage/limit AF progression, which I suspect is related to PLM driven heart rate acceleration - my cardiologist isn't conviced due to lack of research so is sticking to the OSA association, but my OSA is quite mild in comparison to my PLM (and my mild OSA is easily controlled with CPAP).

[permabear]

Last night I gave Valerian a try (drops from local drugstore). It might be a coincidence but Oscar showed lot more leaks and I woke up with a fuzzy head (more than the usual). I guess the Valerian might have been relaxing my facial muscles, leading to additional leak reate. Does this make sense? And is improvement to be expected over time or is this a clear sign this this doesn't work for me?
As for the grassyness of my FR chart I mentioned no difference.

And what about zinc? I read different stories about it. Some are saying it could be of help (like magnesium and calcium) but others say it could exacerbate PLM on the contrary. Did any of you give it a try?

[kappa]

I think PLM is quite variable both within an individual day-to-day, as well as between people with regard to what helps. I suspect that if you search for just about any intervention being helpful for PLM you will get some hits. To some extent you need to experiment with different things and find out what works for you. As Geer suggested, don't change multiple things at the same time, also give time for things to work.

Maybe minerals, herbal treatments, removing dietary elements, etc will help, maybe they won't. It's all very specific to you. The earls/rlsuk forum on healthunlocked has lots of discussion on different things people have tried, both pharmeceutical and other.