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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by meffect on July 24, 2015, at 2:26:59
I'm having major day time sleepiness that has been getting progressively worse over the years. I have insomnia and I need meds to sleep. I notice that every time I go to sleep without my meds; I dream instantly and like crazy. My sleep doc told me this is a sign of narcolepsy. also I did a night + all day sleep study and I entered REM sleep extremely quickly all times during their day test.
I'm confused though, because I cant tell i'm getting REM rebound or I actually have narcolepsy. I'm finding myself falling asleep in doctors offices but not at work yet.
i cant take provigil very well because it gives me extreme irritability. lyrica seems to help me stay asleep at night
i take lots of benzo's just to knock me out at night or i cant sleep
i feel like im losing it
Posted by rjlockhart37 on July 26, 2015, at 1:32:13
In reply to Can mediation imitate early signs of Narcolepsy?, posted by meffect on July 24, 2015, at 2:26:59
there's this stuff called Xyrem.....
http://www.xyrem.com/it's used for narcolepsy and associated, the traditional medications for nar. are the amphetamines....and provigil.....but if you can't take those due to stimulant side effect, ask about Xyrem
r
Posted by phidippus on August 5, 2015, at 11:09:33
In reply to Can mediation imitate early signs of Narcolepsy?, posted by meffect on July 24, 2015, at 2:26:59
Benzos are a terrible idea for sleep. They destroy sleep architecture. Also, they can cause dementia.
Try Suvorexant.
Eric
ps. do you have sleep apnea?
Posted by meffect on August 5, 2015, at 19:21:56
In reply to Re: Can mediation imitate early signs of Narcolepsy? » meffect, posted by phidippus on August 5, 2015, at 11:09:33
I know what you mean about the benzos. I wish my doctor never prescribed them to me. I never asked for them. I would stop taking them but I get major insomnia without them. I tried quitting before, i went 4 days with very little sleep and then I had to go to work the next day so I had to start taking them again. I hate benzos with a passion, the worst drug on the planet. A drug a person can never stop taking because the addiction is the worst of any drug on the planet? Given to me without even asking or telling me the risks. Wish the stupid government would do something about this. Like, I literally probably need 30 days off work just to get past the insomnia. Who knows what other side effects i'll have. Yes government, I want you to create a program that gives me the ability to take 30+ days off work overcome an addiction that you allowed me to get so easily. I feel like my life is ruined and is slowly being stipped away from me from these god damn benzos. I am noticing myself to be a much more forgetful person lately as i've been taking benzos for at least 5 years now. I want to quit before its too late. i hate this whole situation i and many other people are in
I'm not sure if I have sleep apnea or not... i guess maybe I do? I kind of got the impression that I went to a CPAP salesman because they really pushed the CPAP there. I told them many times that the CPAP was not working out for me and that I would like to try a dental appliance. But they instead pushed that I need to try different CPAP masks. I did that, but I still cant stand the darn thing. It makes my insomnia worse and also falls off my face in the middle of the night 95% of the time. I have a couple full face mask because I'm a mouth breather. I haven't tried the chin strap with a nasal mask yet. Not sure if it would make it any more tolerable
Here's my study, sorry if there are any errors, I had to scan a crappy copy of it and then do an OCR on it. I fixed a lot of errors in the OCR already but I might have missed some
My Sleep Study Says
Indication:
[My Name] is a 30 (I'm 31 now) year old male with a BMI of 23.4 and a medical history of mood disorder complaining of symptoms of snoring, fatigue, and excessive daytime sleepiness with an increased Epworth Sleepiness Scale score of 18.
The above patient underwent an attended Polysomnogram using standard sleep apnea montage. The sleep staging was assessed with 17.EG channels F4-MI, C4-M1, 02-MI, LOC, ROC, and chin EMG. Limb muscle activity was assessed with electromyogram of bilateral anterior tibialis muscle. Modified precordial lead was used to monitor electrocardiogram. Laryngeal sound recording was obtained from microphone placed on the anterior neck. Air movement was recorded with a nasal-oral How thermistor. The respiratory pattern was assessed with both abdominal and thoracic inductance plethysmography. Continuous oxygen saturation was measured using digital pulse oximeter. Apnea was defined as the cessation of airflow for at least 10 seconds. Hypopnea was defined as an abnormal respiratory event lasting at least 10 seconds associated with at least a 30% reduction in thoracic abdominal movement or airflow as compared to the baseline, and with at least a 3% decrease in oxygen saturation or if the event is associated with an arousal. RERA was defined as a sequence of breaths lasting at least 10 seconds characterized by increasing respiratory effort or flattening of the nasal pressure waveform leading to an arousal from sleep when the sequence of breaths does not meet criteria for an apnea or hypopnea. The apnea hypopnea index (Al 11) was defined as the number of apnea and hypopnea events per hour of sleep. The respiratory disturbance index (RDI) was defined as the number of apnea, hypopnea, and RRRA events per hour of sleep. The protocol and definitions used for this study were based on the American Academy of Sleep Medicine (AASM) established guidelines.
Sleep Analysis:
Baseline sleep architecture revealed that the patient slept a total of 354.5 minutes, out of the 445.1 minutes recorded. This gave a sleep efficiency of 79.6%, which was mildly reduced. Sleep latency was 86.0 minutes, which was increased. Stage R sleep latency was 75.0 minutes, which was reduced. The amount of Stage R sleep was reduced and the amount of Stage N3 sleep was normal. A total of 42 stage shifts and 5 awakenings were noted. The amount of wake after sleep onset (WASO) was 4.6 minutes
Cardiac Analysis:
Significant arrhythmias were not seen.
Leg Movement/Abnormal Behaviours Analysis:
Significant periodic leg movements were not seen. No abnormal parasomnia like behaviour was noted.
noted.Respiratory Analysis:
Respiratory analysis revealed mild to moderate snoring. In addition, a total of 9 obstructive apneas, 1 central apnea, 2 mixed apneas, and 20 hypopneas were noted. The longest apneic event was 26.6 seconds in duration. The longest hypopnea was 37.2 seconds in duration. The lowest oxygen desaturation was 89.0%. The apnea/hypopnea index (AHI) and respiratory disturbance index (RDI, which is the combination of AMI and RERA index) was 5.4. This indicated a mild form of obstructive sleep apnea syndrome. It should be noted that the patient had increased events while in the supine position and during Stage R sleep with a supine AMI of 7.9 and a Stage R AHI of 11.9.
CPAP/BPAP Analysis:
CPAP was not initiated because the patient did not meet the AASM required criteria for obstructive sleep apnea within the first two hours of the study, based on the severity of obstructive events or reduced sleep efficiency or both.
IMPRESSION:
1. Mild obstructive sleep apnea syndrome with AHI and RDI of 5.4 and lowest oxygen desaturation of 89.0%. Increased supine and Stage R related OSA with a supine AHI of 7.9 and a Stage R AHIof 11.9.
2. Mild to moderate degree of snoring was noted.
3. Abnormal sleep architecture characterized by reduced sleep efficiency, increased sleep latency, reduced Stage R latency, and a reduced amount of Stage R sleep.
RECOMMENDATION:
1. Treatment options include CPAP/BPAP, surgical options, mandibular advancement devices, hypoglossal nerve stimulator, and Winx oral negative pressure therapy. If the patient is agreeable to trying CPAP therapy, start CPAP at a pressure of 6.0 cm for outpatient acclimation and then schedule the patient for a full night CPAP titration to document the best pressure requirement.
2. Educate regarding the importance of good sleep hygiene and adequate duration of 6-8 hours per night.
3. In view of higher risks associated with surgery and general anesthesia, notify surgeon and anesthesiologist about OSA diagnosis prior to any surgeries.
Posted by phidippus on August 6, 2015, at 16:46:49
In reply to Can mediation imitate early signs of Narcolepsy? » phidippus, posted by meffect on August 5, 2015, at 19:21:56
What benzos do you take and what kind of dosage?
Suvorexent is a viable alternative and won't be addicting like benzos.
From your sleep study you have Mild obstructive sleep apnea syndrome. They recommend CPAP, mandibular advancement devices, hypoglossal nerve stimulator, and Winx oral negative pressure therapy. You also have abnormal sleep architecture characterized by reduced sleep efficiency, increased sleep latency, reduced Stage R latency, and a reduced amount of Stage R sleep.
Have you ever done any CBT-I?
Eric
Posted by meffect on August 6, 2015, at 21:03:40
In reply to Re: Can mediation imitate early signs of Narcolepsy? » meffect, posted by phidippus on August 6, 2015, at 16:46:49
I managed to get it down to 1mg of Klonopin at knight. 100mg of trazadone at night. 1-2mg of xanax if the klonpin and trazadone arnt working. 5-10mg of ambien if all else fails.
At first I was excited about Belsomra (before it was released). Not so sure now based on the reviews. But good news, it's covered by my insurance for only $276.84 a month! I worry about the fact that it says it's 'covered' because I am guessing that might be the insurance companies way of avoiding prescription drug prior authorization (PA's) requests from the doctor.
Next time I go to the sleep doc, I'm going to ask him if they can elaborate on my diagnosis in a more comprehensive way than the report did.I have not done any CBT of any kind. I going to make an appointment soon because everyone seems to recommend CBT
Posted by phidippus on August 7, 2015, at 8:52:09
In reply to Can mediation imitate early signs of Narcolepsy?, posted by meffect on August 6, 2015, at 21:03:40
Has Seroquel ever been a part of your arsenal?
You want CBT-I specifically.
Eric
Posted by meffect on August 7, 2015, at 15:06:31
In reply to Re: Can mediation imitate early signs of Narcolepsy? » meffect, posted by phidippus on August 7, 2015, at 8:52:09
Seroquel, Yes. It tends to make me very withdrawn and anti-social and depressed to some extent, especially the serquel SR version, wow.
But it is the only anti-psychotic that doesn't give me Akathisia, which I understand is commonly known that seroquel is the only anti psychotic that has a low chance of causing Akathisia for people who are sensitive to it. I got unbearable Akathisia from Latuda (40mg at night) and uncomfortable Akathisia from Abilify (1mg a day)... so I think i'm pretty sensitive to it. It's a shame because I actually felt pretty good on Latuda. By pretty good I mean my mood was more consistent and I wasn't depressed. I thought the idea of taking beta blockers for the restlessness and urge to move would only lead to permanent akathisia. so I took myself off it
It's funny though because if I take provigil or welbutrin i tend to feel like sh*t (for lack of a better word). even at really low dosages. I get really aggravated kind of feeling. Like snappy and angry. just not a good feeling inside. its hard to explain
Actually i feel pretty depressed and crappy in the morning when I wake up. I think it's the trazadone 100mg at night. I have to force myself out of bed and drink lots of caffeine before I pull out of that mode
But at least i'm not hypomanic .. which happends to me a lot because of the viibryd im taking. I get periods of hypomania
I also get periods of anger disorder where I cant control myself and I get so angry i make bad decisions
im really messed up honestly. Before I started taking any meds at all, i was a very emotionally sensitive . thats why I started on SSRI's and beyond, because i couldnt control my emtions and it was leading to all kinds of problems at work and home. And by at work, I mean my first full time job out of college. I said to myself, I can't keep this up.. i cant controll myself , if I dont do something, im going to get fired
Honestly i'm much better than I was with emotional sensitivity. Weather that is from the medication im taking or just get older and more world experience, i dont know.
with my current meds.. i feel mostly in control. I kind of go off and on the viibryd .. for some reason I want to stop taking it every day. I'll have to write down why because I cant remember.
The main issue I have though is the insomnia, but actually.. i've been taking 125mg of lyrica at night and that seems to make me more refreshed in the morning. I also stoped taking ambien around the same time.. so that could have something to do with it
Hmphh...
i'll try and get CBT-I specificly
Posted by phidippus on August 11, 2015, at 17:11:25
In reply to Can mediation imitate early signs of Narcolepsy?, posted by meffect on August 7, 2015, at 15:06:31
>would only lead to permanent akathisia. so I took myself off it
Tardive Akathisia is pretty rare.
>lot because of the viibryd im taking. I get periods of hypomania
How much Viibryd do you take?
>I also get periods of anger disorder where I cant control myself and I get so angry i make bad decisions
this is probably just a part of the hypomania
Are you on a mood stabilizer?
Eric
Posted by meffect on August 19, 2015, at 21:29:03
In reply to Re: Can mediation imitate early signs of Narcolepsy?, posted by phidippus on August 11, 2015, at 17:11:25
> >would only lead to permanent akathisia. so I took myself off it
>
> Tardive Akathisia is pretty rare.
>
> >lot because of the viibryd im taking. I get periods of hypomania
>
> How much Viibryd do you take?
>
> >I also get periods of anger disorder where I cant control myself and I get so angry i make bad decisions
>
> this is probably just a part of the hypomania
>
> Are you on a mood stabilizer?
>
> EricWell, I went back to viibryd, with no mood stabilizer. I feel really good at the moment. I'm going to try and control my hypomanic mood rather than stop taking viibryd like I usually do.
When I stop taking viibryd I get really really depressed. Like, crying all the time, saying I want to kill myself, etc. I honestly cant believe the difference. If I stop taking viibyrd, in about 2 days, I will start a downward spiral until I am a complete mess. I think everyone hates me and I cry at the slightest depressing thing. However I take just 10mg of viibryd and I feel like .. alive, and no depression whatsoever. I dont understand it.
My goal now is to stay on the viibryd and control my overly happy and confident attitude. I tried the alternative (not taking viibyrd), and its soul crushing.
I have some trileptal but it makes me fat, bloated, and constipated. I have tried lamictal in the past, and it seem to make my head feel like it was on fire. Havent tried an rx of lithium.
I'm thinking my problem with viibryd consistence is that... eventually with viibyrd i do or say something stupid and end up dwelling on it and feel I need to take myself off it because im going to get fired from my job. then i go into a deep depression until I cant stand it anymore and go back on the viibryd.
infact I took so long to reply to you because I stopped the viibyrd and I was so embarrassed to reply to you. Now that i'm back on viibryd, I have no problem replying to you and I think my previous thoughts were dumb
sorry im just really messed up and medication compliance is hard for me
Posted by phidippus on August 20, 2015, at 6:15:03
In reply to my issues, posted by meffect on August 19, 2015, at 21:29:03
> >I also get periods of anger disorder where I cant control myself and I get so angry i make bad decisions
> I'm going to try and control my hypomanic mood rather than stop taking viibryd like I usually do.
>I get periods of hypomania
Its clear from the above that you have bipolar disorder and you're treating it with an antidepressant when you should be treating it with a mood stabilizer first. You can keep the Viibryd, just add something like carbamazapine or lithium. There's also depakote.>My goal now is to stay on the viibryd and control my overly happy and confident attitude.
This tells me the Viibryd is treating your depression but is triggering hypomanic or manic symptoms. If you were on a mood stabilizer, you would not become 'overly' happy and you would not have to worry about controlling yourself.
>I'm thinking my problem with viibryd consistence is that... eventually with viibyrd i do or say something stupid and end up dwelling on it and feel I need to take myself off it because im going to get fired from my job. then i go into a deep depression until I cant stand it anymore and go back on the viibryd.
The problem with Viibryd is that it is destabilizing your mood and making you hypomanic, a state in which you lose a modicum of self-control.
You most likely have bipolar 2 disorder, so your depressive symptoms are prominent and you experience hypomanic states not straight out mania-hypomania is the 'overly' confident and happy feelings you get.
>sorry im just really messed up and medication compliance is hard for me
When you're bipolar it is hard to sort out the symptoms from the effects of the medication-its easy to blame the med and quit it.
Eric
Lithium 900 mg
Abilify 30 mg
Vyvanse 70 mg
Primidone 150 mg
Xanax 1mg as needed
Posted by SLS on August 20, 2015, at 8:07:27
In reply to my issues, posted by meffect on August 19, 2015, at 21:29:03
I agree with Eric that you need something to prevent the appearance of mania. It is bad to pulse antidepressants on and off or cycle dosages. So, adding a second drug to prevent mania makes sense. I happen to prefer Trileptal to Tegretol. Tegretol is more sedating and is more likely to produce agranulocytosis. Lithium had been considered to be the first choice in Bipolar I disorder for a long time. For bipolar II, Depakote was more likely to be the first drug chosen. I am still reluctant to go with high-dose lithium because of its potential to cause long-term damage to thyroid and kidney function at dosages that prevent mania. Besides, it makes me feel more depressed with flat affect and apathy. I take low-dose lithium 300 mg/day to help with depression and to possibly reduce the risk of contracting Alzheimer's Dementia.
It is no crime to take more than one drug at a time. Right now, no single drug has all of the pharmacological properties of the two drugs you might need to take. People who rail against polypharmacy don't seem to take this into account. People with severe hypertension sometimes need to take three or four drugs; each with a different mechanism of action (diuretic, ARB, CCB, beta-blocker). If one chemical substance did all four things, polypharmacy would might not be necessary. However, there is one major problem with this approach. It produces an inability to fine-tune the actions of each property separately.
Given your descriptions, I think you would do best leaving the antidepressanst in place and adding an anticonvulsant other than Lamictal, which is rarely sufficient for treating mania.
Actually, you might do well with a combination of Trileptal and Lamictal if you opt to discontinue the antidepressant.
Good luck.
- Scott
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