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Permalink Reply by RockRpsgt on March 22, 2010 at 10:07am

There is a ton of stuff on those topics Renee. Could you be a little more specific about your wants or needs here. It would help me sort through the research and pull up things that would be helpful to you.

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Permalink Reply by Judy on March 22, 2010 at 10:49am

And, Rock, do you think in this type of situation that a sleep neurologist might be a better choice than say a sleep pulmonologist?

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Permalink Reply by Mary Z on March 22, 2010 at 10:53am

Renee,
I have been told that alpha intrusions can happen with chronic pain.

Mary Z.

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Permalink Reply by RockRpsgt on March 22, 2010 at 10:55am

I think that the best situation for sleep would be a neurologist referral to a pulmonologist for a sleep study. This way both sleep and respiratory issues are covered adequately. Depending on what is found in the PSG a cardiologist might be brought in as well. It would all depend on how well educated your PCP is in the characteristics of sleep and SBDs. I have seen some family practitioners that really know their stuff.

Judy said:

And, Rock, do you think in this type of situation that a sleep neurologist might be a better choice than say a sleep pulmonologist?

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Permalink Reply by Renee on March 22, 2010 at 11:13am

Hey Rock ~

On the clinical side, I have too little S-3 (SWS) and REM - alpha intrudes JUST as I am about to go into REM.

Below is a breakdown of the % of my stages of sleep from my initial sleep study and 2 sleep titrations. I also had a 3rd titration on 2-23 after I started CPAP treatment at home on 12-15 and I will be getting the results of my 2-23 titration later today, but I understand that they are similar to my previous results so I am posting this now rather than waiting for that data.
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Sleep Stages – S-1 . . . .S-2 . . . .S-3 . . . REM
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12-7-09
2nd Titration
WITH CPAP . . .42.9% - 50.2% - 6.3% - 0.6%

9-15-09
1st Titration
WITH CPAP . . .68.2% - 18.6% - 6.5% - 6.7%

9-8-09
1st Sleep Study
W / OUT CPAP 35.6% - 35.9% - 20.2% - 8.4%
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Normal Sleep
Architecture . . .5-10% - 45-55% - 20-25% - 20-25%
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With CPAP, my events are down from about 6 AI and 40 AHI per hour to around 0.8 AI and 3.8 AHI per hour.

And I happen to have a really good sleep doctor: Omar Burschtin, M.D., F.C.C.P., F.A.A.S.M., Dipl’ A.B.S.M., Director, Sleep Consultation Services, Sleep Medicine Associates of NYC and Assistant Professor of Medicine, NYU School of Medicine. He is good with his patients but, alas, I am being found to be a clinically “difficult” patient because my lack of SWS and REM continues, and without restorative sleep, my fatigue remains.

One possible solution is under way - about 3-1/2 weeks ago, I started taking 100 mg Neurontin (gabapentin) at bedtime and since it did not seem to be achieving the desired result (and also was not causing any ill side effects) this last week, it was increased to 200 mg at bedtime. Haven’t noticed any effect as yet, but it’s only been a few days.

Hope this provides clarity and insight about what I’m looking for and for whatever you might think of that might help.

Thanks Much !
Renee

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Permalink Reply by RockRpsgt on March 22, 2010 at 11:37am

Are you on anti-depressants or anti-anxiety meds? Both of those types of meds would supress deep sleep. Pain from something like fibromyalgia (SP), or spinal injury could cause alpha intrusion along with different types of pain medication.

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Permalink Reply by RockRpsgt on March 22, 2010 at 11:39am

If this will open it may help

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Permalink Reply by Renee on March 22, 2010 at 11:39am

Hello Mary ~

Yep, you’re right. I have read a good deal of literature about the connection between chronic pain and alpha intrusion causing lack of REM. Sometimes people can get some good results through RX in that case but I still find it a shame that they have the pain.

I have also read about a strong correlation between (CFS) chronic fatigue syndrome and alpha intrusion and I may try going down that avenue – but that would mean finding a GOOD and EXPERIENCED CFS expert – which is a pretty tall order – and, even with that, CFS is still such an “iffy” thing to diagnose and treat, that I would prefer to extend my search as thoroughly as possible in the sleep medicine field first.

By the way, below are some excerpts regarding CFS with the url’s for the full texts.

Thank you for taking the time and interest in answering my post.

Best to you,
Renee
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http://journals.lww.com/smajournalonline/Abstract/1994/04000/Alpha_...

Alpha-Delta Sleep in Patients With a Chief Complaint of Chronic Fatigue

Alpha-delta sleep was not significantly correlated with fibromyalgia, CFS, major depression, or primary sleep disorders, but was significantly more common among patients who had chronic fatigue without major depression. We conclude that primary sleep disorders are relatively common among patients with chronic fatigue and must be diligently sought and treated. Alpha-delta sleep is not a marker of fibromyalgia or CFS, but may contribute to the illness of nondepressed patients with these conditions.
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http://immunerecoverywellness.com/pdfs/cancer/CFIDS_Brain.pdf

Open Your Mind to the Possibilities: L.A. Conference Explores the CFIDS Brain

. . . alpha-wave (light sleep) intrusion in delta-wave sleep (deep sleep) may cause CFIDS symptoms.

. . . The alpha-wave intrusion in deep sleep results in non-restorative sleep. Up to 80 percent of growth hormone (GH) is secreted during deep, non-rapid eye Movement (nREM) sleep. GH is responsible for repairing and refreshing the body.

Information processing deficits can be seen in the EEG, a very crude measure of electrical activity in the brain. "There is a distinctive fingerprint in the EEG. The striking finding was a very early attentional component where information may be processing, and [PWCs] may not be consolidating this information well because something is being perturbed in the early information processing stage." By linking the EEG activity with memory deficits as seen on psychological assessments, Dr. Sandman can "separate normal controls from CFS patients 100 percent of the time."

I FOUND THIS TO BE A REALLY INTERESTING AND EXCITING TEXT THROUGH AND THROUGH !
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Permalink Reply by RockRpsgt on March 22, 2010 at 11:41am

For some reason I can'tget it to open. I can get it to open on my PC, but not for SG.

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Permalink Reply by RockRpsgt on March 22, 2010 at 11:47am

Medication Chart (partial list)
Trade name Generic Name Trade name Generic Name Trade name Generic Name Trade name Trade name
Benzodiazepines Non-benzodiazepine Hypnotics Tricyclic Antidepressants Antihistamines
Halcion Triazolam Ambien Zolpidem Tofranil Imipramine H1 Antagonists H2 Antagonists
Xanax Alprazolam Sonata Zaleplon Elavil Amitriptyline Benadryl Allegra
Ativan Lorazepam Lunesta Eszopiclone Doxepin Actifed Claritin
Prosom Estazolam Effects on Sleep
Restoril Temazepam Crosses the BBB Does NOT cross BBB
Klonopin Clonazepam Causes sedation No effects on sleep
Valium Diazepam BBB = Blood / Brain barrier
Effects on Sleep Effects on Sleep Effects on Sleep
Increase Stage 2 sleep Increases Total Sleep Time Improves Sleep
Increase Sleep Spindles Decreases Sleep Latency Increase Total Sleep Time
Increase Total Sleep Time Decrease REM
Decrease Sleep Latency Exacerbate PLM's
Decrease Delta Sleep (stage 3 & 4)

CNS Stimlants
Ritalin, Concerta Methylphenidate Amphetamines Caffeine coffee
Provigil Modafinil Adderall Dextroamphetamine Mountain Dew
Cocaine Dr. Pepper
Nicotine Etc…
Effects on Sleep
Increase Sleep Latency Acute Increase Sleep Latency
Decrease Total Sleep Time Decrease Total Sleep Time Decrease Total Sleep Time
Decrease REM Decrease Delta Sleep (stage 3 & 4) Decrease REM
Decrease REM Decrease Delta Sleep (only 1st 1/2 of night)
Withdrawal
Increase Total Sleep Time
Increase REM

Serotonin Reuptake Inhibitors Monoamine Oxidase Inhibitors Ethanol
Prozac Fluoxetine MAOI's Alcohol Beer
Zoloft Sertraline Nardil Phenelzine Wine
Effexor Venlafaxine Parnate Tranylcypromine Whiskey
Paxil Paroxetine Etc…
Effects on Sleep Effects on Sleep Effects on Sleep
Increase Stage 1 Sleep Decrease Total Sleep Time Acute
Decrease Total Sleep Time Decrease REM severly Increase Total Sleep Time 1st half of night
Decrease REM May Eliminate REM completely Decrease Total Sleep Time 2nd half of night
Slow Eye Movements (Prozac Eyes) Decrease REM 1st half of night
Exacerbate PLM's Increase Delta sleep
Chronic
Decrease Delta sleep
Withdrawal
Decrease Total Sleep Time
Decrease Delta sleep Increase REM

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Permalink Reply by RockRpsgt on March 22, 2010 at 11:49am

Not quite the way I wanted to see it. It was my much more organised in my word document. if anyone could get it open in it's original form please let me know how.

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Permalink Reply by Renee on March 22, 2010 at 11:52am

Hello Again Rock ~

Thanks so much for the "Meds Effects" chart - it's a great reference. I don't imbibe and I don't drink coffee, but sometimes tea. Amongst the meds - 150 mg Effexor, which I have been advised could be a culprit and on your chart it’s indicated that it could increase Stage 1 Sleep, decrease total sleep time and decrease REM. In my case – it doesn’t decrease total sleep time – but, could be increasing Stage 1 and decreasing REM – BUT – DO YOU THINK THAT DRASTICALLY ?

Thanks,
Renee

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