valnagy

What Were Your Mslt Results & Diagnosis?

64 posts in this topic

Reading other PSG-MSLT results helped me make sense of mine, so I'm including mine.

 

PSG: Fell asleep in 18 minutes, went into REM in 96 mins, relatively normal sleep architecture - within normal for all sleep stages, except slightly elevated stage 2 sleep. 

Total arousals: 141 or 21.9/hr (respiratory arousals: 10; LM arousals: 5; spontaneous: 126), 11 awakenings

No apneas, normal occasional hypoapneas, no significant periodic leg movements

Sleep efficiency "slightly reduced" at 89.7%, apparently due to my insomnia (life has to be a comedy to have both narcolepsy and insomnia). I was also formally diagnosed with delayed sleep phase syndrome (my PSG started at 11PM).

 

MSLT, 4 naps:

Mean sleep latency of 4 naps: 3 min (quickest: nap 2, asleep in 1 min; slowest: nap 4, asleep in 5.5 min)

REM occurred in all 4 naps, average latency 10 min from sleep onset (quickest: nap 2, 4 min; slowest: nap 1, 15.5 min)

Interesting to note: In nap 2 (where I fell asleep in 1 min), I had sleep paralysis and a hallucination halfway through. It was recorded as: went into REM after 4 mins asleep, stayed in REM for 4 minutes, brief arousal, then into n1 stage for 2 min, arousal (when I "pulled" myself out of sleep paralysis and woke up from the hallucination) for 1 min, n1 for 2 min, and back into REM for remainder of nap.

 

MSLT was rough. There was another patient, a teen boy, in the room across from me and he clearly did not have narcolepsy so they should have just sent him home immediately out of sensitivity for me ;). Here I am desperately trying to find the one corner of the room where the camera can't see me so I can sleep for just one second without getting caught. Meanwhile, he's laying in bed, watching cartoons like it would never put him to sleep, even though the bed is comfortable and warm and the cartoons can kind of sound like a lullaby if you close your eyes for one minute. When the tech asked for his sleepiness score, he replied, "Can I just say 0? I feel great."

At the end, they made me sign a paper saying that I would contact them if I decided to go on a road trip before my next appointment, and that I should probably refrain from operating any machinery in the meantime.

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my 2009 diag for MSLT  was 4 min 52 seconds, no SOREM.  I don't have my baseline for the first test but I think my AHI was 17.  Received a pathological sleepiness and Obstructive sleep apnea diagnosis...  I've been on a down hill slide that seems to be accelerating as of late...

 

About 2 months ago I had another baseline and mslt because the nurse practitioner make sure my apnea was eliminated by my UPPP(she was thinking I'm lying about how bad my daytime sleepiness is and I'm actually a pill head)

 

Normal sleep efficiency of 86.9%

Sleeping for 456 min out of 525 minutes.  Latency to sleep was short at 6.5 min with a normal rem of 62.5.  (did my 4 hour nap 2 hours before my sleep study throw this off?)

5 distinct rem periods during night.

0 obstructive apneas

0 mixed apneas,

4 central apneas

10 obstructive hyponeas

mean O2 96%

min 90% during sleep

0% below 90%

0 limb movements

MSLT

2 SOREM's  with sleep onset at 2 min 45 seconds. (4 nap study only)

My obstructive sleep apnea was resolved after my UPPP surgery

 

My test is consistent with PARTIAL narcolepsy????????????????????????????????????????

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my 2009 diag for MSLT  was 4 min 52 seconds, no SOREM.  I don't have my baseline for the first test but I think my AHI was 17.  Received a pathological sleepiness and Obstructive sleep apnea diagnosis...  I've been on a down hill slide that seems to be accelerating as of late...

 

About 2 months ago I had another baseline and mslt because the nurse practitioner make sure my apnea was eliminated by my UPPP(she was thinking I'm lying about how bad my daytime sleepiness is and I'm actually a pill head)

 

Normal sleep efficiency of 86.9%

Sleeping for 456 min out of 525 minutes.  Latency to sleep was short at 6.5 min with a normal rem of 62.5.  (did my 4 hour nap 2 hours before my sleep study throw this off?)

5 distinct rem periods during night.

0 obstructive apneas

0 mixed apneas,

4 central apneas

10 obstructive hyponeas

mean O2 96%

min 90% during sleep

0% below 90%

0 limb movements

MSLT

2 SOREM's  with sleep onset at 2 min 45 seconds. (4 nap study only)

My obstructive sleep apnea was resolved after my UPPP surgery

 

My test is consistent with PARTIAL narcolepsy????????????????????????????????????????

 

I don't have a lot of experience with many "sleep" doctors, but you might consider seeing a different one. I originally went to mine for what I thought was sleep apnea, and she told me that if sleep apnea or anything that would cause EDS shows up during the PSG, they would cancel the MSLT because many other sleep disorders can cause EDS. You had a normal night sleep, so ideally you were supposed to be well-rested the next day, and thus would have no need for naps. That, and primarily the 2 SOREMs, indicate you have narcolepsy (I don't know what partial narcolepsy is, but I'd be suspicious of that kind of diagnosis, as well), and you may have just been developing it in 2009. Regardless of all of that, if you think the nurse suspects you're fabricating your symptoms, you need to find a new doctor whom you are comfortable with. If that is not possible (I don't know where you are located), you need to work that much harder to be your own advocate. Finding a treatment for narcolepsy that works for you is a long-term process, so fight for the treatments you would like to try (regardless of whether it "looks" like you're a pill-popper or not).

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Her opinion has changed significantly after the results has restarted the not-so-merry-go-round of different meds and dosage. Appts now for a psychiatrist and neurologist who both specialized in sleep disorders. A new family doctor I'm seeing is wanting to make sure I'm not having TIA's and some weird kind of epilepsy / seizure disorder. I couldn't catch the name. The doctor who reads the sleep results declared the results partial narcolepsy not the specialist. She is supposed to be getting clarification on the partial part as she doesn't even know where that came from... they me to start on xyrem at some point in the near future.

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In the overnight study, I had sleep onset in 4 minutes.  Normal is 8-15 minutes.

REM sleep onset in 60 minutes.  Normal is 90-120, so that is also significant.

I spend 13% of my time in the lightest form of sleep, N1.  Normal is 4-5%

I spend 35% of my time in the more restorative N2 sleep.  Normal is around 50%.  I stole N2 time to spend it in N1.

Total % of stage N3 deep sleep and REM is about normal.

 

My squirmy legs moved around 24 times an hour and caused arousals 5.2 times per hour.  That means I have moderate periodic limb movement disorder.

Total arousal index was 28 per hour.  So, about every other minute or so, my sleep gets interrupted by something.

 

The multiple sleep latency test (MSLT) showed an average sleep onset of 5.4 minutes,  indicative of severe hypersomnia.

In only one of the 5 naps did I enter REM sleep, 4.5 minutes after falling asleep.

 

I saw my sleep neurologist yesterday and she gave me the idiopathic hypersomnolence diagnosis.  She gave me a coupon for one month of nuvigil free while we wait for the approval from my insurance company.

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I wouldn't be concerned about a 60 minute REM onset, the average is around 90 minutes, many start sooner, and given the PLM issues, disturbed sleep building up from past night would likely be causing it.  I don't think many consider REM onset to be an issue until it's under 20-30 minutes.

 

Good luck with the nuvigil!

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Nap#1  SL 2 Min  LR 5 Min

Nap#2  SL .36 sec Min  LR 3 Min

Nap#3  SL 3 Min  LR 4 min

Nap#4  SL 6 Min  LR 9 min

Nap#5  SL 4 Min  LR 6 min

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I had a PSG the first night - they observed mild sleep apena (AHI 14.2 / REM AHI 31.5) and REM Latency of 41m (sleep latency was 63m) and slept ~6 hours with sleep efficiency of 74.4%. It did take me a really long time to fall asleep - sleep latency was 63 minutes. I always have trouble going to sleep...well, at night, when I'm supposed to.


 

My MSLT results from the next day were:

Nap 1: Latency to sleep onset   6m  No SOREM

Nap 2: Latency to sleep onset   9m  No SOREM

Nap 3: Latency to sleep onset   4m  SOREM 5.5m

Nap 4: Latency to sleep onset   9m  SOREM  5m

Nap 5: Latency to sleep onset   9m  No SOREM  

 

Sadly after seeing these results I remembered telling the tech during the MSLT that I didn't sleep during 2 of the naps...I did admit to 2 dreams, one about my nephew falling down the stairs and one about work, not realizing I wasn't supposed to be dreaming. He had a great poker face. And... never confessed that I fell asleep in between one of the naps when we weren't supposed to be sleeping.  :blink:

 

So..diagnosis was narcolepsy and mild OSA. Now fighting for balance with the medication and the CPAP.

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So I haven't gotten the official results from my MSLT yesterday, but I talked to the tech after, and here's what he told me:

 

Nap 1: no sleep

Nap 2: 10 minute latency, 2 mins sleep

Nap 3: no sleep

Nap 4: no sleep

 

However, what I remember happening:

 

Nap 1: 10 mins latency, 3 microsleeps with dreams, <2 minutes

Nap 2: 10 minute latency, 1 microsleep sleep, with dreams

Nap 3: 10 minute latency, 1 microsleep, with dreams

Nap 4: no sleep

 

after each of the microsleeps I got an adrenaline burst or something and couldn't fall back to sleep.  Adds a whole new element now.  So looks like N can't be diagnosed at this point :(

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Sorry you didn't get the answers you were looking for.  :(

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Meh, it's exactly what I told the doctor would happen.  Seems like nothing's ever simple.  Gotta wait for the consult, be told everything looks relatively normal (despite my first PSG results being all over the place), and figure out how to treat my condition on my own.  Fun.  Thanks for all your support and advice, it's helped thus far!

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Meh, it's exactly what I told the doctor would happen.  Seems like nothing's ever simple.  Gotta wait for the consult, be told everything looks relatively normal (despite my first PSG results being all over the place), and figure out how to treat my condition on my own.  Fun.  Thanks for all your support and advice, it's helped thus far!

What answer seems to make the most sense to you? You have previously mentioned events which could be mild Cataplexy. Have you discussed this with your doctor.

 

For me, even after 2 SOREMs, my doctor was still reluctant to dx me until we began discussing Cataplexy- that was the clincher. The Cataplexy was so clear that it could only happen in the context of N and my MSLT supported an N dx.

 

If you think you have been  experiencing Cataplexy, then it may help support an N diagnosis.

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Not really; no.  Due to the nature of my visits - that is, people doing their sleep medicine fellowship dealie, much of the actual conversations with the doctor have been through someone else with me listening, and the odd question.  

 

To me, I feel like N is the correct diagnosis based on my lifetime symptoms, the mild C (which I don't even know if that's what it is!), the quick microsleep attacks.  I feel I couldn't sleep because I was trying too hard and couldn't relax during the MSLT.  When I did, I woke up abruptly and was highly alert for a few minutes - perhaps adrenaline... I've been fighting these sleep attacks for so long, maybe I go into panic mode when I do.  N makes sense, I don't have the whole "woe is me, my life is worthless" symptoms of depression; I have no interest in doing fun things because I'm so damned tired.  I'm generally happy, and don't have anxiety issues for the most part until something bad triggers it, which is maybe once a month, if that.

 

The tech saw my previous PSG hypnogram and said it was highly unusual, so I really have to wait to see what was on the second one.

 

Regardless though, wouldn't treatment be the same regardless?  A low dose of provigil to boost my alertness?  As I've stated many times, I really don't want another anti-depressant, I'm really sensitive to chemicals.. SSRI's made me manic, NRI's made me even more tired, and a tricyclic would boost my appetite which is already massive.

 

Maybe I'm just thinking about things too much.  Thanks Hank.

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Sleep was adequate in quality and quantity. She was observed for 462 minutes of which 398 were spent sleep for a mildly reduced sleep efficiency of 86.3%.

Stage 1 : 6.6%

Stage 2: 45.9%

Slow wave sleep at 19.6%

With rem 17.9%

Sleep and rem prolonged at 26.5 and 137minutes

Moderate degree of sleep fragmentation

Eeg demonstrated spontaneous arousals for an indexof 26 per hour. Emg demonstrated no periodic limb movement of sleep. Ecg was unremarkable.

Restless throughout the night study

3 episodes of nocturia

Mslt finding: each trial fell asleep in 1.5 min

No onset rem was noted on any trial

Abnormal hypersomnolence

Finding may be suggestive of narcolepsy.

Was told I have excessive daytime sleepiness best explained by narcolepsy

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