Tossing and turning?

[kristin]

I know that I have RLS, but have never sought treatment for it. Its pretty mild and I don't have to get out of bed that often. I do, however, have problems sleeping through the night. I usually wake up 3-6 hours after I fall asleep and feel unrested. Sometimes I can fall asleep again right away and other times I toss around for up to 3 hours. When I do fall back asleep, it is a restful sleep and I feel good once I wake up again. I just can't afford the luxury on work days and usually cut my sleep short. Its stressful. I'm wondering if this is related or RLS or something else? Thanks.

[jumpyowl]

Request your doctor to send you to a sleep lab. You need that information.

[Guest]

Request your doctor to send you to a sleep lab. You need that information.

The two most daunting words in the English Language. Sleep Lab. An oxymoron really. The last thing you will find me doing in a sleep lab is sleeping. I'm one of the lightest sleepers ever. The only thing they'd learn about me is that I CAN'T sleep with things plugged into me and that I get REALLY grumpy when don't sleep.

I'll think about it.

[jumpyowl]

I understand your hesitancy. For about 12-13 years I resisted undergoing the test. They were trying to get me into one in the early nineties. It has changed a lot since then.

What it is now is a taking a polysomnograph. This measures on several channels the brain waves, muscle twitching on various parts of the body, the relative oxygen saturation of the haemoglobin in the blood (by a neat noninvasive method). They also monitor your heart (EKG) all night long.

Takes about 20 minutes to place all the electrodes all over your skull and all over your body. All these wires go into a black box near you. So if you have to leave (to go to the bath room or whatever) only one cabel has to be disconnected.

Almost all the people they have undergoing the test have sleep problems. They know exactly how to handle any problem that may come up. Both my daughter and eventually I went to the same clinic.

A lot depends on the technician. Ours was not only well trained, he was flexible and made sure that e.g. my daughter eventually went to sleep, even though she was told not to take any of her 12 medications prior to going to the lab. He actually gave her a drug that did not falsify the results in the somnograph.

Here is the story I posted the time when I returned home from the test:

Azalea sleep center in Tyler, Texas. Well, they let me out at 5:30 am. this morning. It was still dark. I had a nice chat with Jan, the technician, who is well read and has a lot of enthusiasm and pride in what he is doing.

It took him almost 30 minutes to place and glue all the electrodes to my skull, torso and legs. I had my pijamas on. He asked me not to take any medications and I promised him that I will stick it out as long as I can and will let him know when I can't do it I had a couple of hydrocodone and a Topamax hidden in the upper pocket of the pijama. just in case.

I immediately turned off the TV and actually dosed off before he came in to connect me. He asked me to go to the toilette one last time. Then heturned of the light.

I slept fairly well under the circumstances. I tossed and turned a bit and once even landed on the distributor box. He then came in and fixed it, we then exchanged a few words.

I woke up a bit after five and he came in (they can tell from the brain waves when you wake up.) . Even though a couple of wires lost contact, there were plenty others that took up the slack so the test was a success.

He showed me the wiggly lines and told me the good news: I do not hve sleep apnea. The bad news: I snore at a sound level #5 on a scale of 0-10. At this point he was glad to learn that my wife was not sleeping with me. The snoring also brought me close to awakening but I was not conscious of it.

He found plenty of incidence of nocturnal myclonus and the accompanying interruption of deep sleep (186 times that night). Interestingly he distinguished between that and RLS. He stated that the latter occurs during waking hours. The last night I experienced very little paresthesias and only some quite tolerable leg pain.

The other good news was that the oxygen saturation of hemoglobin was always in the nineties (no sleep apnea - no anoxia of brain, heart etc.) Since my heart was monitored I asked him about my pulse which was normal exept the beats occassionally doubled up. (I will post on this later, when I find out what is going on as recently I had some cardiac episodes -prolonged tachycardia).

The way he explained it that the head of the sleep lab, Dr. J. (a pulmonologist) would treat my RLS via my family physician. Well, we shall see how that will work out.

Here is a copy of the letter containing my sleep results:

CLINICAL DATA: 69 year old male, 70 inches tall, 228 lbs. The patients complains of excessive daytime sleepiness and snoring that disturbs others (I did not complain of snoring). Medical problems include hypertension, cholesterol, acid reflux disease occasionally. (The truth is that I do not have hypertension even though I was treated for it for 20 years, I have slightly elevated cholesterol, and no acid reflux disease, so much for medical record accuracy). The patient has had prior tonsillectomy (true at the age of 4, the doctor thought I would gain weight better )

EPWORTH SLEEPINESS SCALE SCORE: 9 (I have no idea how they determine this and what it means)

MEDICATIONS: Hydrocodone qhs, lorazepam 0.5 mg bid prn, propranolol prn for tachycardia

DESCRIPTION: patient was studied overnight at the sleep center with multichannel polysomnography attended by a poly somnographic technician. He was in bed 382 minutes and asleep 341 minutes for sleep efficiency 89%. Latency to sleep onset was 5 minutes was 5 minutes. All (5) stages of sleep were recorded. Sleep architecture was normal. There were 3 brief REM episodes during the study.

The technician reported moderate snoring (5/10) with occasional snore arousal. No bruxisms. (not at this time).

There were no apneas or hypoapneas recorded during the study. Oxygen saturation stayed at or above 94%.

No PVCs were recorded.

The most remarkable finding during the study was frequent periodic limb movements of sleep causing arousal (self-diagnosis proven!)

IMPRESSION:

Normal sleep architecture with no evidence of sleep apnea. (you may bring on the opioids )

Moderate snoring and occasional snore arousals.

Severe periodic limb movements of sleep. (PLMS)

Chronic leg pain inadequately controlled with hydrocodone (just as I told my doctor prior to the sleep test)

RECOMMENDATIONS

Neurontin 300 to 600 mgs qhs for periodic limb movements of sleep.

Relaxation techniqes and soaking legs in warm water before bed time may be of benefit.

Conditional or alternative pain medication to adequately control leg pain.

Oral appliance for mandibular advancement can be used for snoring, or uvuloplasty by an ENT surgeon would be an alternative. However, patient's snoring and breathing do not appear to be his primary problem interrupting his sleep. Treatment would be cause matic (sic) (cosmetic)only.

A week later I went down to Tyler and asked for a copy of my full report. They were glad to comply. It was about 6 pages but as I had no sleep apnea, several pages contained no data. [There were some additional things of interest in it including the hand-written scribble of the doctor]

Some more information from the full report. I found especially the sleep stage statistics of interest:

I spent 8.1% in stage 1, 59.6% in stage 2, 16.8% in stage 3, and 8.3% in stage 4, which is the deep restorative sleep. (out of a total sleep time of 341.5 minutes, 5 hrs, 42 minutes). My REM sleep was 7.2%.

Actually the oxygen saturation of haemoglobin as a mean was 96% and the range 94-98%.

I spent 79% of sleep time on my right side, and the rest prone.

I had PLMS jerks 181 times, jerks with arousal 103, no jerks with wake, jerks with no arousal 78. I even had jerks during the REM period (3).

Technologist Comment: Restess leg movements during awake, isolated leg movements, PLMS, and associated arousals were present.

Physician's comment: (handwritten):

No OSA, 'something' oxygen (probably plenty of), severe PLMS.

Keep in mind Kristin that this is really the only objective test for RLS/PLMD and for several other sleep problems.

Make sure you have insurance covering the cost because the test ain't cheap.