Rls and plmd

[sheepless]

sounds similar except I am not aware of any of it. the respiratory response to the kick often indicates arousal and that seems to happen scores of times a night, but I do not awaken enough to be conscious of plm. of my very fragmented sleep, some but not all sessions end in the midst of plm. even when awakened by plm (inferred from the flow rate and/or reports from my wife) I am not aware of it. IDK if this makes any sense but by self inflicted / not 'real' flow limitations, I mean they're kind of a secondary (respiratory) reaction to abrupt physical movement, as opposed to the consequence of an innately restricted airway. one might say the flow limitation that follows plm is once removed (by plm) from a more innate cause like a sleep-weakened airway. however, the source doesn't effect the machine response so it's probably a distinction without a difference. I can't know what the flow limitations would have looked like if the machine pressure support didn't rise to meet them but they still show up as flow limitations so they aren't fully resolved by pressure. I assume a grunt-caused flow limitation, for example, would be more forceful than floppy tissue-caused flow limitation, more like chin tuck-caused flow limitation, and therefore maybe not as responsive to pressure. so maybe not 'real' is misleading and what I really mean is that pressure support reacting to these plm related flow limitations is insufficient, given the cause, and therefore unnecessarily contribute to disturbances, arousal and leaks. sorry if that's not very clear. it's speculation and difficult to describe.

[PaulaO2]

Many people experience PLM as a result of an apnea event. The body twitches in an attempt to wake you up enough to breathe. Throat muscles are voluntary muscles so the blockage can only be opened by either correct xPAP pressure or waking (arousals) even just a little bit.

On the flip side, arousals can be caused by the independent PLM event. You twitch, you wake.

[PaulaO2]

Paula, Shift worker, many thanks for the prompt replies and encouragement/hope on keeping on trying solutions out of supplements. Actually, I am currently taking Mg (dimalate 500mg), K (cytrate 100mg), lithium orotate (5mg), and iron (ferritin has already bumped from 54 to 77.1 ng/ml, last lab two months; maybe more today). Yes, indeed, those metals, combining with fine tuning on flow limitation controls, might have been producing some very minor improvements; looking forward closely.

Is your doctor (all of them) aware of all the supplements you are taking? I'm particularly interested if the doc knows about the lithium orotate. Lithium prescription can cause PLMD and restless leg.

[sheepless]

"Many people experience PLM as a result of an apnea event." you may be right but that doesn't make sense to me. I thrashed a lot - and I mean a lot - fighting to breathe before cpap but that's different than plm. for the quoted sentence to make sense, the fact that plm is periodic would imply the apnea causing the movement is also periodic, which obviously is not the case. in my experience leg/body movement is a common response to apnea and while that can be wild, it is not periodic.

[mper6794]

Paula, Shift worker, many thanks for the prompt replies and encouragement/hope on keeping on trying solutions out of supplements. Actually, I am currently taking Mg (dimalate 500mg), K (cytrate 100mg), lithium orotate (5mg), and iron (ferritin has already bumped from 54 to 77.1 ng/ml, last lab two months; maybe more today). Yes, indeed, those metals, combining with fine tuning on flow limitation controls, might have been producing some very minor improvements; looking forward closely.

Is your doctor (all of them) aware of all the supplements you are taking? I'm particularly interested if the doc knows about the lithium orotate. Lithium prescription can cause PLMD and restless leg.

Paula02,
Just one of them is aware of iron only, the one who put me on ferritin boost. Other supplements are all by myself, including lithium orotate. I have been taking this very low dose of lithium 5 mg for 1year aiming at brain issues(anti Alzheimer, in particular, etc), have stoped and come back sometimes; have not noticed any effects on PLM's. Anyway, thanks for your alert; I am going to investigate it further.

GL

[PaulaO2]

Your doctors should all know all your medications as well as supplements. Even if it has nothing to do with their specialty. Your pharmacist should also know so they can catch issues between the supplement and the medication.

Periodic Limb Movements are routinely noted on sleep study reports. They note if/when they happen and if they were related to any event. Mine were mixed. My largest twitches were directly related to the largest events. The others did not seem to have a connection. I don't think they were mentioned in the titration sleep study report. So I either didn't have them (doubtful) or they weren't necessary for the report.

[mper6794]

Hi Paula 02, and all

Following up things right above...
First, it would be eventually worth posting this yesterday private answer to Sheeppless

"Hi, Sheepless
Glad to know this! Sorry delay. I am still struggling with the blog, regard localizing things, etc. Let us try to improve together.
In my last post somewhere, I've made a short summary of my case; lots of back and forth in addition I've wrote there. Aiming at setting a common base for discussion, I will post you my current situation on Oscar charts, as soon as I learn how to do it exactly. I have been getting some minor improvements by myself. Currently, I am still struggling on minor improvement on FL (putting some more EPAPmin; the idea is to move from 6.8 today to some 8.4 to see what happens; beyong this blog,  recently I have read an 2015 article suggesting this may work; FL may require even more pressure than OA).
After some three months of extracting and analysing Oscar outcomes daily (particularly looking at grahs FR, FL, Leak, and tidal volume, I think I am able to discriminate and plot the number of awakenings related to FL/Rera and PLM's. And also the time I stay awake during my rigorous 6.5 hrs in bed (mignight to 6;30 am). Based on this information I build what I called "SleepEfficiency_SE", which is the % of sleep time. There has been a rather good correlation between SE, and daily life quality (I have created a scale for HDYF life quality, from 1 to 5 for this, which include side effects from medications). In general, SE > 90% (i.e 0.65 hours) led me acceptable (but not good) life quality, scoring some  4.4(oscilates a lot) without any medication, as these days. Best results with medications up to now came with Clonazepam 0.6 bedtime (HDYF most of the time above 4.8 up to 4.95). Clonazepam has power to improve SE, however, you know, it would be much better without any medication.  Tried Pregabalin (maximum HDYF of some 4.4, with side effects much worse than Clonazepam's); primapexol (awful, like pregabalin is able to reduce number of PLM's, however keeping me strangely as being wake up somehow).
Then, summarizing: increasing EPAP min, trying to reduce FL arousals to some < 0.5/hour, and see what next with my 3 to 4.5 arousals/hr due to PLM's.
all the best"

[mper6794]

So, Paula02, as I said I investigate further and quit with lithium 5mg for while. I am taking only Mg 1000mg (500 morning + 500 23;00hs) , and K (200 to 300 mg daily).
As I mentioned Clonazepam 0.6 mg has been giving me rather acceptable life quality, leading me to go through PLM's (either not waking up or return to sleep). Trying not keep with Clonazepam in the long run, I have been investigating some alternative supplements or herb, which would ending up with similar Clonazepam's effects (you know, action on GABA, etc). Then, last night have re-introduced the VALERIAN herb, 1000mg at 11:40 pm, under my current context of pressures and PS. Too early to say, but it appears having some positive similar yet mild effects on going through PLM's (3 awakenings/hr yesterday, and SleepEfficiency of 72%). This rather low non acceptable number came mainly because I wake up at 4:02 am; this has been one of my drawbacks for several years, i.e., waking up too early. Therefore, like I did with Clonazepam in the past, I am going to split Valerian (there is good paper available on this herb) into two doses during  the night. Keep myself hopefull.... let us see!!
Trying advantage of this, I have tried to insert my first image on this Forum, to give you an idea the world I have been living these days.

all the best.

[PaulaO2]

Valerian is one of those herbs that can really mess with prescription meds. Let me check that though.

From Mayo Clinic:

Dosage is unclear. Valerian seems to be most effective after you take it regularly for two or more weeks. Because dosages varied in studies involving valerian and some studies weren't rigorous, it's not clear what dose is most effective or for how long you should take a particular dose.

Side effects may occur. Although valerian is thought to be fairly safe, side effects such as headache, dizziness, stomach problems or sleeplessness may occur. Valerian may not be safe if you're pregnant or breast-feeding. And it has not been evaluated to determine if it's safe for children under 3 years old. If you have liver disease, avoid taking valerian. And because valerian can make you drowsy, avoid driving or operating dangerous machinery after taking it.

Drug interactions are possible. Valerian may increase the effects of other sleep aids. It also increases the sedative effect of depressants, such as alcohol, benzodiazepines and narcotics. Valerian can interfere with some prescription medications. And it may interact with other dietary supplements, such as St. John's wort.

Talk to your pharmacist if you can't get in to see doc. I take Ambien and love it. I don't wake up feeling drugged, either. There is an extended release version of Ambien that kicks in x hours after taking. This is for people who wake up at 2 or 3am and can't go back to sleep. I don't need that. I just can't shut my brain up. The trick to Ambien is to take it and go to bed. The longer you are "up" after taking it, the more likely you'll have side effects like sleep walking.

[mper6794]

Thanks, Paula 02,
So far, so good...better this last night, It appears counting on the sedating effects of Mg+K+Valerian1000mg at bed time. Ferritin boosted to >100 ng/ml. Got expected three REM cycles (in general, has been Very very hard to get the third one around 4:15 am) . Pressures7.2, max 12.8, PS 4.2. Keep myself hopeful succeeding whithout something more strong, other than the standing by and safe harbor of clonazepam 0.6.
On the contrary of you, I have no problem on falling sleep, counting on a disciplined sleep hygiene.