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Results of Sleep Study. Please Help.


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Attached is the results of my sleep study. I did not have sleep apnea but I never suspected I did. I am constantly fatigued through out the day despite getting adequate sleep and keeping relatively good sleep hygiene. 

The PA went over the results with me but he didn't seem to explain that much and didn't really have any recommendations about how to deal with my daytime fatigue accept to say "keep consolidating your sleep time." Needless to say I was a little disappointed that no answers were found as to why I am fatigued. But he said my REM sleep was abnormally low and I did seem to move my legs a lot. I take effexor so that might be inhibiting REM sleep and I also take gabapentin for RLS but I still thrash and move through out the night. My blankets often end up on the ground but he said this wouldn't be a cause for fatigue. 

I was wondering if anyone could give their thoughts on my results. Looking for a second opinion and maybe some suggestion on how to deal with my constant fatigue. 

Thank you.

Sleep Study 1.JPG

Sleep Study 2.JPG

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Idk how to interpret the results, but I do think a second opinion would be a good idea.

For my constant fatigue my neuro prescribed modafinil.  It helps me out a lot.  I still get tired in the day, but at least I am not falling asleep while I'm eating (or doing whatever else).

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Interesting. Yea I have heard of that drug. I wanted my p-doc to prescribe it to me so I could see if it helped but she wouldn't.  The thing is I think I have more fatigue than sleepiness. What I mean is, I don't fall asleep while doing things but I feel tired a lot of the time. I can EASILY lay down and fall asleep. I pretty much nap everyday because I am only working part time now. I couldn't imagine falling asleep while eating, are you narcoleptic? I just get very tired and have the ability to sleep basically whenever during the daytime if I so choose, but wouldn't just fall asleep doing something. I mean maybe listening to a lecture or waiting for something I could. 

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7 minutes ago, Crazycutup said:

What I mean is, I don't fall asleep while doing things but I feel tired a lot of the time.

This was also a problem for me too.  The feeling tired a lot led me to fall asleep doing almost anything.  I felt like I needed a bed next to me all the time.

8 minutes ago, Crazycutup said:

I wanted my p-doc to prescribe it to me so I could see if it helped but she wouldn't.

Do you see a neurologist?  That is who prescribes the modafinil for me.  My pdoc wouldn't either.

9 minutes ago, Crazycutup said:

I couldn't imagine falling asleep while eating, are you narcoleptic?

Idk if I am.  The only way for me to be tested for narcolepsy (sleep study) is to be off of ALL my meds for at least 2 weeks.  There is no way I can go off my meds without becoming severely psychotic and out of control so I could not be tested for it.

I do have something similar though ... Idk what my neuro diagnosed me with, but it is similar to narcolepsy and I get approved for more than the allowed dose for modafinil (that is covered by insurance ... it requires a prior authorization to get the amount I take).

 

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My sleep study showed I have pretty good sleep and no apnea. I apparently had a lot of periodic limb movements but the sleep doctor said the movements didn't interrupt my sleep at all so weren't a cause for concern. I kind of figured I moved a lot in my sleep based on how my covers look in the morning and I used to kick my sister in my sleep when I was young and we shared a bed on vacations.

My issue is being tired/easily fatigued during the day and sleeping 12+ hours a night. After going over my sleep study results, the sleep doctor offered that I could see one of their sleep psychologists at the sleep center and that I could eventually do a MSLT sleep study if I ever got on a "normal" sleep schedule and wasn't such a night owl. At the time, I couldn't do the sleep psychologist thing because I was still trying to work at a full-time job and there were scheduling issues.

In any case, based on the sleep study, normal brain MRI, and some other testing and specialists that didn't reveal much, my psychiatrist felt comfortable trying me on nuvigil, then ritalin, and now adderall. Adderall has really helped me to sleep less at night, rarely take daytime naps, and has overall been very helpful. I think the sleep doctor mentioned that she would only consider stimulants in rare circumstances and I would definitely have had to do the MSLT first (she was the one to mention stimulants, not me, as I was actually concerned about taking stimulants at first because I thought it might make my anxiety issues worse). My pdoc however didn't have any issues with prescribing me stimulants at this point since I had already been through several specialists including a rheumatologist and endocrinologist (the endocrinologist had me collect my pee in a big red jug at home for 24 hrs; that was fun.) And I was treating the only physical issues that were found, low ferritin and vitamin D.

I don't think my pdoc thinks I have narcolepsy since we went over some of the symptoms and they didn't quite seem to fit with my issues. (Although back when I was working, I would be so tired I would get really afraid of falling asleep at the wheel when I'd be stopped at a red light on the way to/from work). But I think that was because I was so sleep deprived (not being able to fit in at least 10-12 hours of sleep a night) and the stress of work was exhausting. I think my pdoc currently has one of my diagnoses as idiopathic hypersomnia.

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MSLT is considered the gold standard for narcolepsy dx. Kinda surprised they didn't want that after seeing a relatively normal sleep study, since your issue is daytime sleepiness.

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22 hours ago, melissaw72 said:

This was also a problem for me too.  The feeling tired a lot led me to fall asleep doing almost anything.  I felt like I needed a bed next to me all the time.

Do you see a neurologist?  That is who prescribes the modafinil for me.  My pdoc wouldn't either.

 

 

I feel that way about the bed, and the problem is I work from home (at my parents house) and in my room where my bed is literally next to me. So hard to not lay down and nap. So it's not like I 'fall asleep' doing stuff because I nap when I feel really tired. I haven't seen a neurologist just my p-doc who wants me to get off Effexor and start taking Fetzima but the problem is when I go down on Effexor I feel like I am going insane and need to go back up because I can't function. Thinking I may take a week break from work and try it then....IDK i get BOMBARDED by REM sleep when I go down on it and my dreams and reality start to blur together so I don't know which is which. It is really messed up. 

 

Thank you so much for your reply!

Edited by Crazycutup
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21 hours ago, aquarian said:

My sleep study showed I have pretty good sleep and no apnea. I apparently had a lot of periodic limb movements but the sleep doctor said the movements didn't interrupt my sleep at all so weren't a cause for concern. I kind of figured I moved a lot in my sleep based on how my covers look in the morning and I used to kick my sister in my sleep when I was young and we shared a bed on vacations.

My issue is being tired/easily fatigued during the day and sleeping 12+ hours a night. After going over my sleep study results, the sleep doctor offered that I could see one of their sleep psychologists at the sleep center and that I could eventually do a MSLT sleep study if I ever got on a "normal" sleep schedule and wasn't such a night owl. At the time, I couldn't do the sleep psychologist thing because I was still trying to work at a full-time job and there were scheduling issues.

In any case, based on the sleep study, normal brain MRI, and some other testing and specialists that didn't reveal much, my psychiatrist felt comfortable trying me on nuvigil, then ritalin, and now adderall. Adderall has really helped me to sleep less at night, rarely take daytime naps, and has overall been very helpful. I think the sleep doctor mentioned that she would only consider stimulants in rare circumstances and I would definitely have had to do the MSLT first (she was the one to mention stimulants, not me, as I was actually concerned about taking stimulants at first because I thought it might make my anxiety issues worse). My pdoc however didn't have any issues with prescribing me stimulants at this point since I had already been through several specialists including a rheumatologist and endocrinologist (the endocrinologist had me collect my pee in a big red jug at home for 24 hrs; that was fun.) And I was treating the only physical issues that were found, low ferritin and vitamin D.

I don't think my pdoc thinks I have narcolepsy since we went over some of the symptoms and they didn't quite seem to fit with my issues. (Although back when I was working, I would be so tired I would get really afraid of falling asleep at the wheel when I'd be stopped at a red light on the way to/from work). But I think that was because I was so sleep deprived (not being able to fit in at least 10-12 hours of sleep a night) and the stress of work was exhausting. I think my pdoc currently has one of my diagnoses as idiopathic hypersomnia.

Wow we have a VERY similar issue I think. I have a ton of limb movement so much so the technician doing the sleep test needed to reattach the wires on my legs several times during the night. I also have low ferritin and low vitamin D. And I have been taking Adderall prescribed by my physician because I told her my last physician had prescribed it for me (which is true but that was like 2 years ago). And the adderall has been helping but I feel like I gain a tolerance to its affects. I am on 30 mg instant release and take 20 mg in the morning and 10 in the afternoon. I wake up by myself in the morning (super hard) and shower and such and then I take the 20 mg because I could easily go back to bed. But when I take the adderall I feel awake for like 2-3 hours and I think "is this what it feels like to not be tired?" it's not an uplift in mood per say because i have been on it for 3 months, but more of "OMG I'm not tired, this is so wonderful". But then later I get tired again and usually nap but at least for shorter than I would without the medication. How many mg are you on?

9 hours ago, dtac said:

MSLT is considered the gold standard for narcolepsy dx. Kinda surprised they didn't want that after seeing a relatively normal sleep study, since your issue is daytime sleepiness.

Frankly I don't think my PA was that good. I felt like I had to pry information out of him. He asked me "did the technician wake you up to attach the wires or did you call for him?" How do they not have that stuff noted down? Then when I asked about MSLT he said they could do that but since my REM percentage was so low and it is super rare he said I should try to keep "consolidating my sleep schedule" even though I've been doing that for the last 3 f'ing months. He also gave me Ambien to take the night of the sleep study, which I thought was odd since I am complaining about sleeping too much. But I took it because I thought screw it maybe I will feel more refreshed.....that was not the case. 

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On 5/8/2017 at 7:30 PM, Crazycutup said:

And the adderall has been helping but I feel like I gain a tolerance to its affects. I am on 30 mg instant release and take 20 mg in the morning and 10 in the afternoon. I wake up by myself in the morning (super hard) and shower and such and then I take the 20 mg because I could easily go back to bed. But when I take the adderall I feel awake for like 2-3 hours and I think "is this what it feels like to not be tired?" it's not an uplift in mood per say because i have been on it for 3 months, but more of "OMG I'm not tired, this is so wonderful". But then later I get tired again and usually nap but at least for shorter than I would without the medication. How many mg are you on?

I'm on a tiny amount--5mg once a day--and have been for quite some time (at least a year?). I've actually been thinking about maybe moving up to 10mg soon. I usually only take one dose because even though it seems to wear off after 3-4 hours, if I take a second dose after that, I have a hard time falling asleep at night. So I try to plan anything productive I want to do in the first part of my day so that it actually has a chance of getting done. My pdoc writes the Rx for 20mg/day so that one Rx lasts me 4 months.* And there are some days I don't take any adderall just to take a "break" from it. Probably the most helpful thing for my fatigue though has been an iron pill every other day and 5000 iu daily vitamin D. In fact, maybe the adderall is not even doing much anymore at 5mg, but who knows. I seem to be pretty sensitive to some meds.

*Edited this because I realized my math was bad. Although now my pdoc has changed the Rx to 20mg 2x/day since (after talking to pdoc) I'm probably going to try upping my dose to 10mg/day and still would prefer the Rx last several months rather than one month.

Edited by aquarian
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2 hours ago, Crazycutup said:

and my dreams and reality start to blur together so I don't know which is which. It is really messed up. 

Oh, man, I hate when this happens.  It is one of the worst things when you can't figure out reality from dreams.  Or reality from anything.

FWIW ...

Vitamin D is fat-soluble, so make sure when you take the supplement you take it with food that has fat in it for better absorption.

http://www.medicaldaily.com/vitamin-d-benefits-are-enhanced-if-meal-contains-fat-absorbing-more-supplements-311248

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16 hours ago, melissaw72 said:

Oh, man, I hate when this happens.  It is one of the worst things when you can't figure out reality from dreams.  Or reality from anything.

FWIW ...

Vitamin D is fat-soluble, so make sure when you take the supplement you take it with food that has fat in it for better absorption.

http://www.medicaldaily.com/vitamin-d-benefits-are-enhanced-if-meal-contains-fat-absorbing-more-supplements-311248

Yea it is super freaky.

17 hours ago, aquarian said:

I'm on a tiny amount--5mg once a day--and have been for quite some time (at least a year?). I've actually been thinking about maybe moving up to 10mg soon. I usually only take one dose because even though it seems to wear off after 3-4 hours, if I take a second dose after that, I have a hard time falling asleep at night. So I try to plan anything productive I want to do in the first part of my day so that it actually has a chance of getting done. My pdoc writes the Rx for 20mg 2x/day so that one Rx lasts me 4 months. And there are some days I don't take any adderall just to take a "break" from it. Probably the most helpful thing for my fatigue though has been an iron pill every other day and 5000 iu daily vitamin D. In fact, maybe the adderall is not even doing much anymore at 5mg, but who knows. I seem to be pretty sensitive to some meds.

Does anyone else eat at night too? I try to stop but my severe RLS and nighttime eating make it so I get horrible sleep. My whole body seems more relaxed in the afternoon and I can sleep a lot better. It feels like I actually get REM sleep then as well. Like I am parched for thirst and can finally drink from a giant well lol.

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7 minutes ago, Crazycutup said:

Does anyone else eat at night too?

Yes, I do.  It seems like for me that my body is opposite ... I eat more at night (broken sleep)/early morning, but during the day I am not as hungry.  With drinking water is usually the same ... more at night/early morning.  I want to stop and get on a regular cycle, but I just get much more hungry at night/early AM.

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3 hours ago, melissaw72 said:

Yes, I do.  It seems like for me that my body is opposite ... I eat more at night (broken sleep)/early morning, but during the day I am not as hungry.  With drinking water is usually the same ... more at night/early morning.  I want to stop and get on a regular cycle, but I just get much more hungry at night/early AM.

Yea I feel you about wanting to stop. I try really really hard. But the feeling I get of hunger in the wee hours of the night is so voracious. Do you feel the modafinil has been helpful? At this point adderall seems to up and down for me. I hate taking it TBH. I am getting off my Effexor this week and hopefully wont go too crazy as I get on fetzima. 

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2 hours ago, Crazycutup said:

Yea I feel you about wanting to stop. I try really really hard. But the feeling I get of hunger in the wee hours of the night is so voracious. Do you feel the modafinil has been helpful? At this point adderall seems to up and down for me. I hate taking it TBH. I am getting off my Effexor this week and hopefully wont go too crazy as I get on fetzima. 

Idk about the modafinil helping ... I take it to help keep me awake during the day.

I totally get the voracious appetite ... it sucks so badly.  I am on naltrexone and wellbutrin for that, which really help me out a lot.  It cuts down on the cravings I get.  They aren't just for eating at night, but overall.  Without those meds I eat continuously and voraciously ... day and night.  One of those things where I am stuffed to the max and am thinking about the next thing I want to eat.

I hope things work out for you with the meds.

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22 hours ago, melissaw72 said:

Idk about the modafinil helping ... I take it to help keep me awake during the day.

I totally get the voracious appetite ... it sucks so badly.  I am on naltrexone and wellbutrin for that, which really help me out a lot.  It cuts down on the cravings I get.  They aren't just for eating at night, but overall.  Without those meds I eat continuously and voraciously ... day and night.  One of those things where I am stuffed to the max and am thinking about the next thing I want to eat.

I hope things work out for you with the meds.

 

Wow that sounds worse than me. I just get hungry at night. Anyways I think i'm going to order Adrafinil off the interwebs since it is legal here in the U.S. I want to see if that will help with my fatigue instead of Adderall. Because adderall only helps for a coupe hours, my tolerance is just too high I guess. Like for real I can sleep on 20mg if necessary lol.

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10 minutes ago, Crazycutup said:

 

Wow that sounds worse than me. I just get hungry at night. Anyways I think i'm going to order Adrafinil off the interwebs since it is legal here in the U.S. I want to see if that will help with my fatigue instead of Adderall. Because adderall only helps for a coupe hours, my tolerance is just too high I guess. Like for real I can sleep on 20mg if necessary lol.

I hope everything works out for you.

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