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Permalink Reply by Mary Z on November 3, 2010 at 12:43pm

I'd say this is an instance where that person might need a good interdisclinary team, including perhaps a sleep psychologist as well as a good sleep doc and team.

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Permalink Reply by 99 on November 3, 2010 at 6:56pm

prioritise
which one is the most pressing to your needs
or
ask the doctor to prioritise

different people have different proritys

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Permalink Reply by RockRpsgt on November 3, 2010 at 9:06pm

Jnk is right you must treat the SBD first and wait. if your PLMs are connected to your apnea they will probably clear up within six months. The best thing to do is get re-evaluated within six months of treatment initiation.

j n k said:

My take as a fellow patient: Treat the SDB first. Make sure the treatment is optimal (low leak and tweaked pressure for lowest machine-estimated AHI) so it has a good chance of success. Give that a reasonable amount of time. Then see what remains that needs treatment.

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Permalink Reply by Mike Burns on November 3, 2010 at 11:53pm

For ant sleep disorder you need a Dr. Boarded in sleep medicine they have the knowledge to handle your PLMD which could controlled by cpap therapy controlling the OSA. If that does not control it then the Dr. knows what medicine works.
Mike B RCP,psgt

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Permalink Reply by Mike Burns on November 3, 2010 at 11:58pm

Just make sure the lab the Dr. Uses is ACCREDITED by the AASM nobody should use a non accredited sleep lab if they don’t have to.
Mike B RCP,psgt

Rock Hinkle said:

Jnk is right you must treat the SBD first and wait. if your PLMs are connected to your apnea they will probably clear up within six months. The best thing to do is get re-evaluated within six months of treatment initiation.

j n k said:

My take as a fellow patient: Treat the SDB first. Make sure the treatment is optimal (low leak and tweaked pressure for lowest machine-estimated AHI) so it has a good chance of success. Give that a reasonable amount of time. Then see what remains that needs treatment.

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Permalink Reply by Mike Burns on November 3, 2010 at 11:59pm

Get a Dr. boarded in sleep the you will get your answer

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Permalink Reply by RockRpsgt on November 4, 2010 at 7:21am

Actually CPAP can't control PLMS. that is a myth. If your PLMS are connected to your SBD then they probably are not true PLMS and will clear up with CPAP. True PLMs and apnea do not have a common generator.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Dis...

J Sleep Res. 1999 Sep;8(3):211-6.

Periodic limb movements and obstructive sleep apneas before and after continuous positive airway pressure treatment.
Carelli G, Krieger J, Calvi-Gries F, Macher JP.

FORENAP (Institute for research in Neurosciences and Neuropsychiatry, Secteur 8, CH Rouffach, France.

Abstract
Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two common sleep disorders. The similarity in periodicity of periodic limb movements (PLMs) and obstructive sleep apneas (OSAs) led us to hypothesize the existence of a common central generator responsible for the periodicity of both OSAs and PLMs. In order to test this hypothesis, we compared apnea periodicity before continuous positive airway pressure (CPAP) treatment with PLMs periodicity during CPAP treatment in 26 OSA patients, consecutively recorded and treated in our sleep laboratory. The investigation on CPAP was performed twice, once during the initial evaluation and once during a follow-up evaluation after 3 months of home treatment with CPAP. Our results showed that, in this sample, 16 patients out of 26 had an association of OSAS and PLMS, defined as the occurrence of at least 5 PLMs per hour of sleep. The mean apnea interval - measured as the time between the beginning of two successive apneas - was 43.1 s (+/-15.2, SD) and the mean PLM interval - calculated in the same way - was 29.6 s (+/-15.2) during the baseline night, 28.5 s (+/-15.7) during the first CPAP night, and 29.8 s (+/-14.8) during the second CPAP night. Thus, the periodicity of the two phenomena (apneas and PLMs) was different, both before and after CPAP treatment (P< 0.05). When considering the interval between the end of an event (apnea or PLM) and the beginning of the next one the mean apnea interval was 19.5 s (+/-11. 6), and the mean PLM interval was 28.1 s (+/-15.3) during the untreated night, 26.6 s (+/-16) during the first CPAP night and 27.9 s (+/-15) during the second CPAP night. The shortening of apnea intervals with this method of measuring intervals reflects the longer duration of apneas as compared to PLMs. Again the intervals between PLMs were not different between each other but the intervals between apneas were different from the intervals between PLMs (P< 0. 05) These results show that the periodicity of PLMs is different from that of OSAs, suggesting that sleep apneas and PLMs are not generated by a common central generator.



Mike Burns said:

For ant sleep disorder you need a Dr. Boarded in sleep medicine they have the knowledge to handle your PLMD which could controlled by cpap therapy controlling the OSA. If that does not control it then the Dr. knows what medicine works.
Mike B RCP,psgt

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Permalink Reply by 99 on November 4, 2010 at 9:47am

OK

Rock Hinkle said:

Actually CPAP can't control PLMS. that is a myth. If your PLMS are connected to your SBD then they probably are not true PLMS and will clear up with CPAP. True PLMs and apnea do not have a common generator.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Dis...

J Sleep Res. 1999 Sep;8(3):211-6.

Periodic limb movements and obstructive sleep apneas before and after continuous positive airway pressure treatment.
Carelli G, Krieger J, Calvi-Gries F, Macher JP.

FORENAP (Institute for research in Neurosciences and Neuropsychiatry, Secteur 8, CH Rouffach, France.

Abstract
Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two common sleep disorders. The similarity in periodicity of periodic limb movements (PLMs) and obstructive sleep apneas (OSAs) led us to hypothesize the existence of a common central generator responsible for the periodicity of both OSAs and PLMs. In order to test this hypothesis, we compared apnea periodicity before continuous positive airway pressure (CPAP) treatment with PLMs periodicity during CPAP treatment in 26 OSA patients, consecutively recorded and treated in our sleep laboratory. The investigation on CPAP was performed twice, once during the initial evaluation and once during a follow-up evaluation after 3 months of home treatment with CPAP. Our results showed that, in this sample, 16 patients out of 26 had an association of OSAS and PLMS, defined as the occurrence of at least 5 PLMs per hour of sleep. The mean apnea interval - measured as the time between the beginning of two successive apneas - was 43.1 s (+/-15.2, SD) and the mean PLM interval - calculated in the same way - was 29.6 s (+/-15.2) during the baseline night, 28.5 s (+/-15.7) during the first CPAP night, and 29.8 s (+/-14.8) during the second CPAP night. Thus, the periodicity of the two phenomena (apneas and PLMs) was different, both before and after CPAP treatment (P< 0.05). When considering the interval between the end of an event (apnea or PLM) and the beginning of the next one the mean apnea interval was 19.5 s (+/-11. 6), and the mean PLM interval was 28.1 s (+/-15.3) during the untreated night, 26.6 s (+/-16) during the first CPAP night and 27.9 s (+/-15) during the second CPAP night. The shortening of apnea intervals with this method of measuring intervals reflects the longer duration of apneas as compared to PLMs. Again the intervals between PLMs were not different between each other but the intervals between apneas were different from the intervals between PLMs (P< 0. 05) These results show that the periodicity of PLMs is different from that of OSAs, suggesting that sleep apneas and PLMs are not generated by a common central generator.



Mike Burns said:

For ant sleep disorder you need a Dr. Boarded in sleep medicine they have the knowledge to handle your PLMD which could controlled by cpap therapy controlling the OSA. If that does not control it then the Dr. knows what medicine works.
Mike B RCP,psgt

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