periodic leg movement

[Damiansd]

Good luck. I'll be watching eagerly.

[mper6794]

Hi, Guys

_ a RLS (dominant, at night, in particular)/PMLS (much less significant) sufferer downhere;

_Currently on no medications, except for 1000mg Mg, and CBD oil (2% CBD, 0,1% THC). Disciplined sleep hygiene.

_ after a first period on CBD, some 3/4 months ago, maybe rather masked by Clonazepam 0.5 and melatonin, I re-starded CBD (this time clear plain) on last August 13th.

_ maybe too early, however results look promissing, thus far: lesser periods of RLS by some 22;00hs as used to be; shorter periods of awkenings/wake ups, and more stable sleep in general;

_question: could your refresh your experiences with CBD oil?

_ nice Forum on RLS/PLMS: https://healthunlocked.com/search/posts?...munity=140

good  luck

_

[sheepless]

how many mg of cbd do you take? idk how much stock I put in this claim but I read somewhere that it takes at least 15mg to notice an effect. I don't remember exactly what for but suspect it was in relation to pain.

I don't use cbd very often & then only in small quantities. my wife thinks it helps with sore strained muscles but I haven't noticed any effect.

I don't think it reduces my plm but I ingest a small amount of indica rso concentrate that's high thc to help me sleep through much of it. some strains keep me awake & too much rso leaves me sluggish the next day but the right dose seems to help.

I'll be interested to hear the experiences others have had with cbd.

has anyone noticed any triggers for rls & plm? so far mine seems entirely random, meaning I haven't even a hint of any lifestyle factors that might cause or worsen rls/plm.

[mper6794]

hi, sheepless

_ still titrating: Doctor put on 3 mg daily, to start up. Currently I am on some 7 mg and increasing....probably I would not go more than some 25 mg daily.
_ I have read CBD could work from 3 mg up to some 1.500mg;
_ for me, alcool (even just one glass of wine), and caffeine, more than just a cup in the morning.

good luck

[jcrocketman]

I want to thank everyone who has contributed to this thread! What a great resource.
 
Recent sleep study indicated 83 PLMS with an index of 16.2/hour and 4 PLMS arousals. I wake up on average about a dozen times a night that I am aware of anyway. I have had to go back to ask my Docs for help in addressing PLM since the sleep clinic and my primary didn’t address other than providing me with a APAP for my respiratory issues and titrating me at a pressure that was useless. Learning that there isn’t a lot of resources out there for PLM, at least where I live. Anyway, a lot of great information here that will help me prepare for a discussion with my Docs and hopefully help mitigate the PLMS.

[sheepless]

good luck with your discussion with your docs, jcrocketman. I hope you will report back anything you learn, positive or negative. I for one am not satisfied with my treatment to date (previously gabapentin, now ropinirole); effectiveness seems partial and inconsistent at best.

glad to see you pop in mper6794. I owe you credit for inspiring me to switch from asv to vauto and to limit max ipap to the sum of pressure support and min epap to mitigate ineffective and disturbing high pressure caused by plm induced flow limitations.

[jcrocketman]

good luck with your discussion with your docs, jcrocketman. I hope you will report back anything you learn, positive or negative. I for one am not satisfied with my treatment to date (previously gabapentin, now ropinirole); effectiveness seems partial and inconsistent at best.

glad to see you pop in mper6794. I owe you credit for inspiring me to switch from asv to vauto and to limit max ipap to the sum of pressure support and min epap to mitigate ineffective and disturbing high pressure caused by plm induced flow limitations.

I will sheepless. I probably already learned more from this thread and your posts than I will though my local Docs. I don't think Gabapentin is going to work for me as I was on it for over 3 years for nerve pain and damage associated with two back surgeries. I don't think it had any effect on my PLMS during the time I took it. Looks like if I have any hope of getting this addressed I will have to travel to Phoenix at a minimum. Still waiting on my local VA Primary care to respond to my email and offer a plan ahead, referral or recommendation.

[2SleepBetta]

sheepless,

A most interesting thread, sharply focused and bringing out a lot on a difficult problem from you and so many others. 

I can't offer help on plm, but the FR, FL and motion disturbances from plm, and insights here about this mix, is deeply interesting.

In earlier post exchanges here, sheepless, you provided me about a 1-minute view-span of the whole width of OSCAR FR window. It showed a repeating pattern of 4 breaths and every 4th breath was a larger one. Would you post two such views with only about 6 to 8 breaths across the width of the OSCAR screen and with the FR wave amplitude of about 1.5 inch? One view to include at least one FL near the middle, the other no FL (if you have ones like those). I'd like to see the pattern of deformations in FR inhalation peaks from a period where breathing and plm is a stable pattern in your continuing sleep, such as it is. Do what you can to accentuate any irregularities in the peaks of the inhalation flows (whether approximately 6 or 8 breaths or 1.5 inch amplitude). If all peaks are rounded at all horizontal and vertical scales, I'm chasing rabbits.

Irrelevant side "notes" of levity: Reviewing this thread and your earlier replies to me, tonight, I was really struck by your regular four beat FR pattern. In at least one view I could "hear" the opening--though not a musician and I only have a taste for "meat and potatoes" classical music--could hear the opening notes of Beethoven's 5th Symphony: ta ta ta taaah, ta ta TAAAH ....---shouldn't inject that into the quest for deeper sleep, just couldn't resist.  That FR series might be a good choice if you post something.

2SB

[sheepless]

2SB, see if these will do.  very close views from the middle of a plm episode, one with a flagged flow limitation, one without.  plus a shot at a 10 minute scale for context.  let me know if this isn't what you're looking for and/or if there's anything else you want to see.

second guessing myself: because the resmed apap, asv and vauto (if max ipap is not capped) all raise pressure during these episodes, I have assumed that it's in response to flow limitations.  I haven't tried to confirm this though and your inquiry forced me to look for them between the larger inhales.  I notice, at least very recently, there are few flagged flow limitations between the sharp inhales.  otoh, there are lots of unflagged flow limitations throughout my nightly flows and both unflagged and flagged breaths between the larger inhales during plm are abbreviated in comparison.  however, idk if the machines respond to unflagged flow limitations & that makes me wonder whether my theory about plm induced flow limitations triggering runaway pressure and swinging pressure support holds water.  it clearly happens but the question is why. I'm certainly curious about the mechanics of all this but in the end I suppose it doesn't really matter, as a practical matter, as my current vauto setup with what amounts to fixed epap and ipap is much less exhausting than any other machines and settings I've tried. something makes the machines raise pressure in the midst of my plm.

[2SleepBetta]

sheepless, you wrote "... there are few flagged flow limitations between the sharp inhales.  otoh, there are lots of unflagged flow limitations throughout my nightly flows and both unflagged and flagged breaths between the larger inhales during plm are abbreviated in comparison" and I assume (correctly?) that you intended to use  "flow limits" rather than "breaths".

In any case, were it not for the plm factor and my ignorance about it, your comments about flagged (FL) and unflagged (fl) flow limit frequencies, and differing extents in plm and non-plm segments of sleep, I'd say your misshapen peaks are independent of plm and would impair your sleep to some extent, as you know. 

Of the deformations getting the most research I've seen (and getting 2018 ResMed patent attention), your "M" shaped inspiratory flow peak seems to be the most troubling of some 47 shapes that have been classified into 3 categories of sleep effects and seriousness.

My other impression of your new FR views, in light of your comment above, was a wish to know if the density of deformed peaks within their space along the time line was the same in plm and non-plm sleep. I think you observed that in plm sleep either or both the scale and the duration of FL and fl instances were reduced vs. the same in non-plm sleep. If either lessening is true that tends to support my impression that (in my breathing, anyway) the "Norwegian sigh" could be a breathing defense against fl that have increased to near the critical level where, say, the VAuto will flag it. The sleep sigh is either a defensive respiratory design feature or a useful bystander on the breathing scene. 

Unlike the M tips that are followed by a FL within the next breath in the super majority of my many instances of it, the sigh is followed by a FL in about 1/3 or more of my many instances of it every 5 to 15 minutes. Wary of confirmation bias, I believe that within the 4-6 breaths that precede the sigh, I see greater deformation effects overall and in the first couple of breaths after the sigh there is a reduction in deformations--not always, but often. If I understand your observations, you are or may be seeing a similar fl-clearing effect from plm FR spikes--accordingly, my question about FL and fl density along their respective time lines. 

This rather obscure topic is below the horizon of present machine flagging and medical treatment, but a lot of attention has been (Tero Aittokallio, et al. Finland, 2001 and  subsequently) and is being given to it and I would not be surprised to see/hear of some emerging help in new machine designs--even if it's hidden foundational stuff, for refinements and marketing strategies to build upon (stories about "jailbreak" come to mind).

For the here and now, it seems an AHI-like index, an M index, could well be useful as a guide to efficacies in making changes to whip fragmented or unrestful sleep of those who either never had SA or those who've reduced AHI below, say, 1.0. Until new machines or some DIY algorithm add-on, say, to OSCAR, comes along, the MI would be manual work, if worthwhile (and I'm not quite there yet).  

2SB