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Anxiously Awaiting Results Of Psg And Mslt


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#41 DeathRabbit

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Posted 21 January 2013 - 05:02 PM

I'm not entirely comfortable with my diagnosis, but I'm tired of playign the Doctor hopping game for now. Just gonna try to knuckle down for the next little while.



#42 dormir

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Posted 27 January 2013 - 09:04 PM

I hope you get a diagnosis you feel is totally appropriate.

 

 

Do any of you have suggestions for me when talking to my regular doctor about what I know about the MSLT and the doctor wanting me to wear an actigraphy watch?  I don't know anything about the PSG and I don't know if they faxed anything to my doctor (I'm guessing no) so we may not be able to talk about the entire sleep study.  

 

 

I'm wondering about the psych evaluation because I have been reading about nightmare disorders and so many of them tie back to schizophrenia or PTSD.  I'm almost 100% positive I don't have either or else I have had one or the other since I was a child.  

 

From what I understand about schizophrenia, it progressively gets worse.  My regular doctor is both trained in family medicine and psychiatry and I think she would have mentioned that by now, but I also don't want the sleep doctor to slap me in a psych disorder category especially if I don't have any disorders beyond what my regular doctor has already diagnosed me with (SAD and ADHD).  

 

I definitely do not believe I have PTSD because while I did not have the healthiest of childhoods, unless I have had PTSD from the beginning of time, nothing major to trigger PTSD by the age of 6 has happened to me that I can recall.

 

 

Do you think it's worth asking about both seeing a neurologist and possibly getting a psych exam?  Do you think it's worth mentioning the what I feel may be cataplexy even though the sleep doctor doesn't seem to buy the stories?

 

 

I also don't consider my dreams nightmares, just extremely vivid, bizarre, interrupting dreaming.  I very rarely wake up in fear and can always fall right back asleep.  I don't have problems differentiating between reality and dreams.  I now know how to deal with the HH and SP, though I would like those to go away.



#43 DeathRabbit

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Posted 28 January 2013 - 02:34 PM

It seems like Psych diagnoses can be a bucket doctors turn to when they're stumped. IE: I can't find why you are having issues so it must be all in your head.



#44 dormir

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Posted 06 February 2013 - 01:31 AM

I saw my doctor today.

 

She reassured me that I am not schizophrenic and kind of hinted that any diagnosis similar to that would be completely wrong.  With her being a psychiatrist, she said she would have said something by now had she suspected something like that.

 

I asked if she thought a preemptive psych evaluation would be worth it and she said no because she doesn't feel it would have any bearing for the sleep problems beyond the anxiety/ADHD/SAD that I have been diagnosed with.

 

She said I should wait until my follow up before she gives me a referral to a neurologist because she said that sometimes pulmonologists will do that themselves.  If I don't get a referral from him, then she said she would definitely give me a referral.

 

I told her what the doctor said about "making the dreams stop" and she was frustrated that he didn't say more about that.  She is requesting any of the sleep records that I have so far so she can review them herself.

 

My doctor increased my Ritalin dose strength, but I hate that Ritalin gives me a crash so I will have to play around with when/how to take it so the crash doesn't make me fall asleep.  I'm back working third shift part time and need to sleep right away when I get home which can be hard.  My job involves a lot of manual labor.  I definitely appreciate the energy and focus from the Ritalin.

 

 

I guess I feel a little bit better going forward, but I still don't know what will end up happening and I'm still having SP, HH, vivid dreaming, and EDS.  I guess since I have lived with it for this long, I can live with it some more, but I'm tired!  My follow up with the pulmonologist is in April.   :)



#45 munky

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Posted 07 February 2013 - 01:11 AM

I'm sorry you have to wait yet again, but at least you know you're on the way to figuring this thing out! It sounds like the doctor you saw today may be your best advocate, other than yourself, in getting things figured out. I don't understand why she would want to wait to see if the pulmonologist will give you a referral, but that may be normal procedure ... I have other neurological issues, so my primary care doctor sent me straight to the neurologist to rule those out, I never saw a pulmonologist at all.

 

Waiting is hard, I know, but compared to how long you've been dealing with it so far, this wait time is an eyeblink. Just try not to let it get you down. Remember: you're a step closer to figuring it out, and every step helps, no matter how long it takes to make them or how little you seem to find out.



#46 dormir

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Posted 07 February 2013 - 06:56 PM

The hospital that I'm working through tends to go faster with referrals from and to hospital doctors versus an outside doctor referring a patient to the hospital specialist, she said.  I guess I will take her word for it.   :D  I don't really have any other options right now since I don't have insurance.

 

 

This is kind of off topic, but do any of you experience vertigo, usually when falling asleep?  I searched the forum and only found vertigo mentioned in a few places.  

 

 

I lose my balance a lot because I feel dizzy, but can re-orient myself quickly.  The vertigo I feel when falling asleep doesn't happen all the time, but I have had it my whole life.  

 

The sleep vertigo seems unaffected by medication.  The daytime dizziness/balance issues may be related to medication, but I'm not sure.  

 

The Ritalin sometimes makes me feel lightheaded, but that is usually if I take it on an empty stomach.  I have been taking metformin for about four years and the dizziness/lightheadedness didn't start until the past year or so.  I sometimes feel dizzy when I'm sitting down, too.  My husband has noticed me losing balance for no apparent reason, too.  I will usually lose balance or feel weak in the legs when I'm standing on both legs, not moving anywhere.  I don't know why it happens when I'm sitting.  It isn't like I'm spinning around or standing on one leg.    

 

 

 I just never thought to mention it to a doctor.  For so long I have believed these sleep problems are all in my head (and have been told that since the beginning), but now I'm realizing, that maybe they're in my head, but it's not because I'm imagining things.  I wonder if there is a legitimate problem.  



#47 lkl

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Posted 08 February 2013 - 04:21 AM

This might be something you've already checked, but the fact that your on metformin makes me think that maybe your blood sugar levels are going too low? Have you even checked your blood sugar level at the times you are feeling dizzy?

 

The other thing that would be good to check, is to get your doctor to do a lying/standing blood pressure, as blood pressure can change in different positions, which can cause dizziness. Low blood pressure often causes dizziness, but even it is not particularly low, the change can still cause dizziness sometimes.

 

Having said that though, I do get dizzy at lot too, but I've always put it down to being related to my migraines (which is a common cause of vertigo) or being sleepy- like feeling dizzy is my brain's way of telling me I need to sleep right now (But haven't heard of that being a medical cause, it's just what seems to happen to me).

 

The other common cause of vertigo is Ménière's disease, which is an inner ear problem that can be caused by an autoimmune reaction. Different Autoimmune things seem to happen together, so just speculating, but there could be a link to narcolepsy there? Maybe have a look at http://www.menieres....au/symptoms.php and see if that matches up with your symptoms.

 

I too was told for a long time that my sleep problems were "in my head", so I know the hesitation of bringing up more things that might be "just in your head"- but your doctor seems really nice, so I think it is worth mentioning it to her, even if it is just for re-assurance.



#48 dormir

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Posted 15 February 2013 - 02:28 AM

Thanks for the reply!

 

 

Dizzy Gillespie:

I have definitely considered metformin being part of the dizziness component.  I also tend to have low blood pressure so this could be another dizziness component.  

 

 

The vertigo I feel at night has been with me my entire life.  I came across the Menier's disease, too, and a lot of it makes sense.  I never attached the loud ear ringing that happens usually simultaneously or immediately following the vertigo before sleeping, but I definitely think they're connected now.  The loud ear ringing will also happen when I get a dizzy spell during the day.  It is extremely loud ear ringing.  I have allergies, so if I really have Menier's, that could be the culprit or part of the culprit.  

 

 

Now that I'm thinking more about it, the weakness/need to sit/numbness/knees shifting (and very rarely leg collapse) I sometimes feel with laughter or upset has a different head feeling than the vertigo dizziness.  I feel an urgency to sit, but my head feels heavy versus feeling light when I feel the vertigo.  I don't know if that is important or if I'm making sense.  

 

 

nap time:

 

I took a nap today and it was like everything happened at once:  I had to sleep at that moment, I had nightmares the entire time I slept (I had 3 or 4 very vivid nightmares or bizarre dreams,all unrelated, and slept for about 1 hr 30 minutes), I had the weird vertigo/ear ringing thing, I had HH (although only one and I was really annoyed because it was also with SP), and really bad SP!  I haven't had SP that badly in a long time.  

 

Now that I know it is SP, I don't get scared, but I was getting slightly concerned this time because I couldn't get out of it as easily as times past.  I normally go back to sleep to try to get out of the SP, but every time I would do that, I would wake up again quickly, still unable to move.  I hadn't taken any medication in over 12 hours or eaten anything within 3 hours so it was pretty bizarre. 

 

I sometimes notice that the less sleep I get at night, the weirder/more horrible my naps tend to be.  This isn't always the case because the last time I kept a sleep journal (before the sleep study), I was sleeping at regular times and I still averaged about 3 episodes of SP and/or HH a week.  The vivid dreaming and waking up was every night and that doesn't change no matter how bad or good my sleep may have been the prior night.  



#49 dormir

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Posted 22 February 2013 - 07:29 PM

I caved and am on my very last "treating myself" thing that I can think of:  light therapy.

 

I am on day 2 and so far, nothing noticeable, but I am not expecting instant results, either.  I'm sitting in front of it right now because I work third shift tonight.

 

 

I don't expect this to help with the vivid dreaming, HH, or SP, but am hoping to get some relief with the SAD/maybe some energy benefits for the EDS.



#50 Rainbow

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Posted 26 February 2013 - 01:21 PM

I am also anxiously awaiting the results.  I am worried because I did nap but most were at least 10 minutes into the nap but I did dream in all of them.  I have a hypnotic jerk that delayed one nap.

 

I was surprised that I did nap all three because especially the last three I wasn't especially sleepy until the lights went out.

 

I have been treated for IH for about 1.5 years but my night time sleep is horrible. Inspite of being asleep for over 8 hours every night I feel crushing sleep inertia.  If I take modafinil I get alert, for sure and can get ready but in about 1 hour or so I start to feel physically tired and anxious.

 

i think I had a cataleptic attack in front of the technologist but he thought it was because I just stood up and asked me if I wanted my blood pressure to be checked.  I couldn't argue with him because my ability to be coherent is compromised when it happens.

 

I asked my doc if my frequent sense of muscle weakness is cateplexy and he looked bewildered.  I took prednisone and it relieved the cataplexy.   I have had so many accidents in my life, I will have periods of time where I can't be in the kitchen because I drop knives and things.  I fall off my bike.  It happens usually if I am tired.  If I am alert, it doesn't.

 

I am a bit off kilter because all the things I did to hide the problem are still happening. I don't drive while I am tired (reasonable, right?) and so I don't make appointments at bad times, or too many in a day so then I arrive looking just fine.  But they don't know how hard it was to get ready or that I will go to sleep later that day.



#51 dormir

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Posted 08 March 2013 - 05:56 AM

Rainbow, do you have any updates about your sleep study?

 

I meet with the pulmonologist on April 1.  I'm still nervous about it.  I'm going to hold my doctor to the "we can make the dreams go away" phrase because I feel less vivid dreaming is key to helping me feel more alert during the day.

 

 

 A lot of new stress has been introduced to my life and my sleep is worse. The vivid dreaming is still there, but there are a lot more instances of SP than my normal few times a week.  HH have slightly increased, too, but not as much as the SP.  I'm also experiencing some insomnia.

 

 

There have been a few times at work where my knees started to buckle (my job is very labor intensive, fast paced, and can be stressful) so I don't know if it was because of just being tired, but I've had to catch myself a few times. I think it might be both the physical demands and part stress.  My boss yelled at me last week (and later apologized), but while he was yelling at me, I started feeling really heavy and had to force myself to stay alert and focused about what he was yelling about.  

 

 

I haven't been using my light box consistently so I need to stay on that.  

 

The ear ringing and vertigo comes and goes unchanged.  



#52 dormir

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Posted 02 April 2013 - 09:37 PM

The results are in.  I need help with how I feel about this.

 

 

SUMMARY VERSION:

 

 

- Tentatively diagnosed with IH, nightmare disorder, possible chronic insomnia.  

 

- Narcolepsy is not ruled out because of long term, ongoing SP, HH, vivid dreaming, fragmented sleep, EDS, reported extremely vivid dreams/nightmares within 10-15 minutes of initially falling asleep at night and naps at home on at least a weekly occasion   

 

- May need another sleep  study (dread, dread, dread, $$$).

 

- Take this clonazepam at bedtime and let's hope it decreases the vivid dreams.

 

- We think Provigil would help you, but you can't afford it.

 

 

 

DETAILED VERSION:

 

 

- Total recorded time:  359 minutes

 

- Total sleep time:  214 minutes

 

- Sleep efficiency:  59% 

 

- Sleep onset latency:  34.5 minutes (super unusual for me)

 

- Wake time after sleep onset:  109 minutes

 

- Total number of arousals from sleep:  114

 

- Arousal index:  32.

 

- N1: 42 minutes (19% of TST)

 

- N2: 112.5 minutes (53% of TST)

 

- N3: 6 minutes (3% of TST)

 

- REM latency:  229 minutes 

 

- REM sleep: 54 minutes (26% of TST)

 

- 1 obstructive hypopnea

 

- AHI index:  0.3

 

- Mean oxygen saturation:  96%

 

- No periodic leg movements

 

- Alpha intrusion in NREM sleep

 

 

 

 

MSLT RESULTS:

 

 

Reported only 3 out of 3 naps.  Slept all 3 naps.  Sleep latency: 17 minutes (I KNOW!) and no SOREM.  

 

 

 

MOST CONCERNING TO ME:

 

 

- Low sleep efficiency.  

 

- N3 sleep time.  That seems really, really low.

 

- Alpha intrusion on NREM.  I have chronic pain, but not usually to the point I'm constantly agonizing.  I have been diagnosed in the past with general depression and ADHD.   Can PWN have alpha intrusion?   

 

- Both techs reported that I said all of my sleep experiences were totally normal and consistent with what I usually experience.  I said the exact opposite and more than one time!  I'm kind of upset about that.  My sleep and naps were so unusual the sleep study night/day! 

 

- I had 5 naps.  I'm positive I had 5 naps.  Why say there were only 3 naps?  I know I didn't sleep for 2 of them.  Maybe that is why?

 

- The sleep doctor initially told me to go for a psychiatry consult, but when I met with him yesterday he said that wasn't needed and he said depression wouldn't be causing my bad sleep so that is totally inconsistent with what he wrote in this initial report from December.

 

 

 

 

CLOSING ARGUMENTS:

 

 

I can't afford another sleep study.  I can't afford a second opinion.  I don't know what to do about all of this.  I plan on trying the clonazepam to try to suppress the dreaming, but my PCP and I talked about benzos and anxiety a long time ago and we both agreed benzos are not a good long term solution.  I guess I'm glad the pulmonologist didn't completely swear me off to psychiatry, but I can't afford to keep going back to him for follow ups.  There is no one cheaper that I can see either.  I am considering calling a university here that has a highly regarding sleep clinic to see if they would be willing to work with me and my no insurance problems.  

 

 

I also never said my sleep was normal!  I don't know where that came from.  I told them I was amped with anxiety, had a difficult time falling asleep  which is really uncommon for me, and didn't dream like I normally dream.   

 

I asked the doctor what else SP and HH could be attached to since that isn't part of insomnia, nightmare disorder, or IH, and he said SP and HH could be problems because of sleep deprivation. 

 

I had an incident with totally numb arms and hands during an argument with my husband  and had to sit down because my knees felt weird.  I mentioned this to the doctor yesterday and he just shrugged.  After that reaction, I decided not to mention the vertigo and dizziness.  

 

I told him about falling asleep after taking Ritalin sometimes and he said that sometimes, for people with ADHD, the Ritalin has a calming effect (it does for me) and sometimes the calming effect is too good.  Haha!  My doctor also said that was possible and that Ritalin isn't usually effective for long if just given for energy/alertness.  

 

He was also laughing with his nurse about my tentative diagnoses because they kept saying, "your symptoms are like narcolepsy, but the sleep study was inconsistent with narcolepsy.  We don't know what to do with you!  Let's just call your sleep problems IH and nightmare disorder for now.  You should try to take a scheduled nap sometimes, too.  HAHA!"  

Wow.  So funny.  Everyone's a comedian.   ;)

 

I don't know what to make of the alpha intrusion.  Does anyone have any hints about it?

 

 

Any other thoughts?  I'm sorry about the long post.  I just wanted to fill everyone in.  



#53 dormir

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Posted 04 April 2013 - 08:51 PM

Should I start a new thread?  Is my post too long?  Anyone?  Class?  Anyone?  Bueller?

 

;)

 

 

 

 

 

You know what I was mulling about today?  I was looking at that incredibly terrible REM latency and even with that and only 214 minutes of TST, REM still managed to make up 26% of my sleep time.  That seems like a lot to me.

 

 

The other thing I was reviewing is that the doctor initially suggested that if I really have chronic insomnia that may be due to ADHD.  ADHD people tend to have a lot of sleep interruptions and can also have alpha intrusion.  However, the ADHD does not explain the vivid dreaming, SP, or HH.  It may partially explain the EDS, but I don't know.  I'm just a hot mess.  Please, anyone!  Let me know what you think of the sleep study results.  I'm not good at finding big problems and apparently neither is my doctor.  



#54 MINItron

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Posted 05 April 2013 - 11:11 PM

It is hard to separate ADHD from sleep disorders. ADHD can cause sleep disruption, and sleep disruption can cause ADHD like symptoms. Also, just because one has N it doesn't mean that one doesn't have ADHD. This can complicate things. PWN often have comorbid conditions that can seriously complicate diagnosis.

 

Add that to the fact that many, many people find the whole sleep study process very anxiety inducing. This leads to increased sleep latency and even REM latency.

 

On the flip side of that there is the possibility that sleep deprivation from other causes truly can cause SP, HH, and of course, EDS. 

 

As for the Alpha intrusion I wouldn't be surprised if a lot of PWN have some level of Alpha intrusion since N is a function of the inability to regulate the sleep/wake transition. That Alpha intrusion is probably increased during the sleep study due to the anxiety factor.



#55 BurningCandles

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Posted 09 April 2013 - 01:25 PM

It is hard to separate ADHD from sleep disorders. ADHD can cause sleep disruption, and sleep disruption can cause ADHD like symptoms. Also, just because one has N it doesn't mean that one doesn't have ADHD. This can complicate things. PWN often have comorbid conditions that can seriously complicate diagnosis.

 

Add that to the fact that many, many people find the whole sleep study process very anxiety inducing. This leads to increased sleep latency and even REM latency.

 

I didn't think I would be nervous before the sleep study but here I am very nervous. It feels like the only chance to prove having a sleep disorder.



#56 MINItron

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Posted 09 April 2013 - 10:02 PM

I didn't think I would be nervous before the sleep study but here I am very nervous. It feels like the only chance to prove having a sleep disorder.

 

It happens to a lot of people. I am lucky that my emotions are very much held in check. Sometimes so much so that people who don't know me well think that I am cold and emotionless. 

 

The problem that I had with the PSG and MSLT was actually the electronic noise from the EEG leads. I am sensitive to ultrasound, and the EEG hum intruded into my sleep.



#57 dormir

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Posted 11 April 2013 - 02:53 AM

Burning:

 

I can usually keep my anxiety in check, but I knew this was like a one shot deal without insurance and I would literally be at the mercy of whatever doctor happened to get my case because it's a teaching hospital.  I used to have panic attacks back in the day before I started therapy and I felt like I had an all night panic attack at the sleep study.  It was terrible and very unusual for me, at least at this time in my life.

 

I ended up getting one of the "regular" doctors on staff.  His nurse is really cool, which is good, but I know getting a narcolepsy diagnosis will not be easy with them.

 

I hope you will be able to get through your first sleep study without problems and get a good diagnosis or treatment plan so you can get restful, restorative sleep.

 

 

MIN:

 

Thank you for the feedback.  I have been reading a little bit more about ADHD and sleep problems and they seem to go in circles.  

 

The doctor initially suggested kind of what you did, which was it is possible I don't have ADHD, but have narcolepsy and the narcolepsy manifests like ADHD because of the poor sleep quality.

 

I could bet all of the money I have (which isn't a lot right now) that my anxiety interfered with the sleep study and MSLT pretty badly.  

 

I never considered that sleep deprivation not related to narcolepsy could cause SP, HH, but the EDS is definitely a common sense conclusion.  

 

I guess that would mean that sleep deprivation could cause IH, too?  I don't know what would be causing the vivid dreaming.

 

 

 

Let's say that I don't have narcolepsy and have ADHD that makes me sleep deprived and have hypersomnolance.  With the other symptoms (SP, HH, EDS, vivid dreaming, alpha intrusion, maybe very mild cataplexy), would Xyrem be too crazy to ask the doctor to consider prescribing?  I sense that he wouldn't like to do that, but  would it be worth talking about?  So far the clonazepam has helped me stay asleep a little bit better after each vivid dream, but I'm still having multiple vivid dreams that I remember and SP/HH/EDS.



#58 MINItron

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Posted 11 April 2013 - 07:54 AM

There are no documented cases of cataplexy without narcolepsy that I am aware of. The other symptoms can all certainly come from other sources, like ADHD. They are not supposed to prescribe Xyrem without a narcolepsy diagnosis. Some do, but it is pretty tightly regulated.

 

Personally I am very leery of the benzos like clonazepam. They can become physically addictive, and don't really address the REM issue. It also has an extremely long half life, up to 50 hours. If you are taking it every day it can actually start to build up. 

 

There are antidepressants that supress REM more directly that can be effective in reducing vivid dreaming. They don't keep you asleep they just allow you to sleep better by limiting the amount of time you spend in REM.

 

Also, it's more like IH causes sleep deprivation. The word ideopathic means that the cause is unknown so you are sleepy without a detectable cause.



#59 BurningCandles

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Posted 11 April 2013 - 11:23 AM

It happens to a lot of people. I am lucky that my emotions are very much held in check. Sometimes so much so that people who don't know me well think that I am cold and emotionless. 

 

The problem that I had with the PSG and MSLT was actually the electronic noise from the EEG leads. I am sensitive to ultrasound, and the EEG hum intruded into my sleep.

 

It is good you were able to keep your emotions in check. I wish I was able to. I apparently only slept for six hours during the PSG.

 

Burning:

 

I can usually keep my anxiety in check, but I knew this was like a one shot deal without insurance and I would literally be at the mercy of whatever doctor happened to get my case because it's a teaching hospital.  I used to have panic attacks back in the day before I started therapy and I felt like I had an all night panic attack at the sleep study.  It was terrible and very unusual for me, at least at this time in my life.

 

I ended up getting one of the "regular" doctors on staff.  His nurse is really cool, which is good, but I know getting a narcolepsy diagnosis will not be easy with them.

 

I hope you will be able to get through your first sleep study without problems and get a good diagnosis or treatment plan so you can get restful, restorative sleep.

 

 

MIN:

 

Thank you for the feedback.  I have been reading a little bit more about ADHD and sleep problems and they seem to go in circles.  

 

The doctor initially suggested kind of what you did, which was it is possible I don't have ADHD, but have narcolepsy and the narcolepsy manifests like ADHD because of the poor sleep quality.

 

I could bet all of the money I have (which isn't a lot right now) that my anxiety interfered with the sleep study and MSLT pretty badly.  

 

I never considered that sleep deprivation not related to narcolepsy could cause SP, HH, but the EDS is definitely a common sense conclusion.  

 

I guess that would mean that sleep deprivation could cause IH, too?  I don't know what would be causing the vivid dreaming.

 

 

 

Let's say that I don't have narcolepsy and have ADHD that makes me sleep deprived and have hypersomnolance.  With the other symptoms (SP, HH, EDS, vivid dreaming, alpha intrusion, maybe very mild cataplexy), would Xyrem be too crazy to ask the doctor to consider prescribing?  I sense that he wouldn't like to do that, but  would it be worth talking about?  So far the clonazepam has helped me stay asleep a little bit better after each vivid dream, but I'm still having multiple vivid dreams that I remember and SP/HH/EDS.

 

I am sorry you felt that it was your only chance. I started to feel that way too at the beginning. I can't imagine how stressful of an experience it would have been if I had to know I was paying for all of it. I am sorry you had to go through that. My sleep study went pretty terribly. I only slept six hours during the PSG. I kept worrying and couldn't get comfortable. I didn't know I was awake as long as I was though. I also woke up coughing a couple times which has never happened before. During the MLST I didn't sleep at all. My first nap was an hour and fifteen minutes after I woke up. Then the second one was an hour after that one ended. Then after the second nap the sleep tech told me I only needed to stay for two more naps. Which really stressed me out! I mean if they ruled out narcolepsy already, what could it be?



#60 SleepyRaffie

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Posted 11 April 2013 - 04:01 PM

BurningCandles,

 

As far as I know, if they are administering the MSLT correctly, there are only two reasons that you would not have to stay for the fifth nap.  1. You had no SOREMs after four naps.  2.  You had two or more SOREMs in the first four naps.  It is possible that you had SOREMs in both of those first two naps and therefore they knew they did not need to keep you.  I doubt that them telling you that you only needed four naps means that they are ruling out narcolepsy.  It is possible that you did fall asleep even if you did not think you did.  I thought I did not sleep in three of my naps and I did.