Hello again,
 Thanks to this forum and in particular "Ram Sleep" and "Chrohnie too" I started to examine my sleep disorder a bit more. Ram mentioned PLMD and Chronie said that it stood for Periodic Limb Movement Disorder.
I vaguely recalled the sleep study that I had years ago when the young nurse in attendance mentioned that I had a lot of leg movement that she had noted. They put me on a  light tranquilizer for that and I have been taking them every since.
A sharp increase in API occurences caused me first to look at pressure settings and things like a standard Leak rate on my particular mask.
I use a Res Med Mirage full face  mask . (By the way if I don't have it tight Chrohnie, or itt squeaks and hollers all night )  and a Respironics Remstar Auto with pressure set at 9.5cm.
I read the the API every morning at around 11a.m. and mark it on a graph chart. I was hoping to find some interesting pattern to the graph over the year but like all graphs it just has its "ups and downs"   although I just  found something that is interesting. I shed some blankets and  now sleep with a very light cover. (It is OK in summer here).
My API rate over the past month has shown a steady decline from around 9AHI to 4.2 this past few days.
The PMLD is still active and I still wake up at times as if I have played soccer or climbed all night.
The reason for this post is that outside elements probably affect sleep as much as Apnea in others too and the cause of disturbance of the mask in sleep. A friend said to try Vitamin E for the jumpy legs. I will give that a go too.
 Thanks John

John,

There are two main kinds of limb movement during sleep.  During an apneic event, there is limb movement due to futile attempts to breath.  As apnea is compensated with the use of CPAP, the effort to breath is eliminated and the limb movement decreases.

Periodic Limb Movement Disorder (PLMD) is the sleeping cousin to the awake Restless Legs Syndrome (RLS) and these are both neurological disorders.  There is a circadian cycle to RLS/PLMD which is why the symptoms of RLS are worse at night.  Not all people with RLS have PLMD and visa versa.  You can have one and not the other.  I happen to have both.  With RLS/PLMD, the calmer the body is, the worse the symptoms are.  Since these are neurological disorders they must be treated with medication.  The common first line drugs of choice are low dose anti-Parkinson’s drugs such as Requip or Mirapex.  Second line drugs are benzodiazepines such as Klonopin, but these drugs are addictive.  Additionally, anemia exacerbates PLMD/RLS) so you need to be checked for that.

As you noted, PLMD is itself very disruptive to sleep.  In my case, I was first treated for OSA and a few years later, when I started becoming fatigued again, a sleep study showed PLMD.  I had known quite awhile I had RLS since that is a conscious disorder.

A sleep study with CPAP rules out whether the limb movement is due to the effort to breath or PLMD.  Not only does CPAP eliminate the movement if it is effort related, but this movement is always linked to an apneic event whereas PLMD is random movement.

You can find more information here:

Restlessless Legs Syndrome Foundation

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki,
 I thank you for your reply. I don't have RLS thank goodness. It must be awful for you  to have both
As I get older I seem to get everything else :O)
The "what could be PLMD symptoms" (at that time they just said I had jumpy legs. :O)) were only mentioned away back at my first sleep study session. I was prescribed Clonazepam then and still take one every night seventeen years later. If I didn't, I would be dancing in bed at night. :O) I have awakened at times and realized that I had forgotten to take it and I really hadn't slept at all to that point. So I am addicted to both that and CPAP as I can't sleep without either pill or mask.
All sleep studies are not equal or you would think this would have been mentioned again to me at some point.
It is just another thing to  consider as being a problem in sleeping with a mask.
I am sure that your letter was helpful to others as well as me in this regard
Thanks, John

John,

Although both meds. are not without their pros or cons, you might want to discuss with your doctor slowly weaning off the Klonopin and at the same time, starting Requip or Mirapex.  Just another option.  Like I said, both drugs have pros and cons, but the Requip and Mirapex are not addictive.

I know what you mean about waking up, although I can't even get to sleep if I don't take my Requip early enough.  I also like to go club dancing and usually have a drink once every couple of weeks.  I have to be very sure to take my Requip early those nights because I have found that alcohol severely exacerbates my RLS/PLMD.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Thanks Vicki,
 I will have to ask about the non addictive medication. I have no doubt that the effectiveness of what I am taking is much reduced by the length of time I have taken them.
 Back to the very light covers on the bed though  I am sure that this too is making a big difference to my PMLD and resulting in a lower API count??  I am not wrestling nor tied up in bedclothes in the morning as I was.

Right now it is air conditioning weatherand light covers are fine.  Winter and 30 below C outside temperatures will make a difference :O) It is OK for you in sunny Cal. :O)The wee drink and dance sounds OK. I will try that with the Requip :O)
John

Make sure tonic water is in that drink...because it is said to help with PLMD..though nothing official


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

Thanks Mrs Rip V,
 I can try that too. I believe that once I used some prescribed quinine pills (as in tonic) so you are probably right. Perhaps I didn't give it a chance at that time. Meanwhile I see that am down to 3.7 AHI this morning. We may seem to be straying from the Mask subject , however I am sure that these "arousals" we experience and detected by the CPAP machines are not all caused by air leaks.??
 What is with the lose weight ad ? :O):O) This was another (probably) misconception, that Apnea sufferers were all big people with big necks. I never was and used to snore off the "Richter" scale :O)
 Thanks John



Last edited by Ancient Apnean on Thu Jul 31, 2008 10:00 pm; edited 1 time in total

Sorry Mrs Rip V, Vicki  and others,
I had to post a quick reply here with a caveat.
FDA Bans Quinine For Leg Cramps
Newspaper Columns, Editorial January 22, 2007
John



Last edited by Ancient Apnean on Thu Jul 31, 2008 9:59 pm; edited 1 time in total

I looked up the FDA document.  If you have Adobe, you can read it here:

Questions and Answers about FDA’s Enforcement Action Against Unapproved Quinine Products

If you do not have it, the important part is below.  The issue is two fold.  First, it has been used for nocturnal muscular leg cramps, which is different than PLMD.  But regardless, it has not been shown to be effective.  Secondly, the therapeutic dose (for malaria which is how it is used) is extremely close to the toxic dose:

This is the label that must go on all prescriptions containing quinine now:

"Quinine sulfate may cause unpredictable serious and life-threatening hypersensitivity reactions, QT prolongation, serious cardiac arrhythmias including torsades de pointes, and other serious adverse events requiring medical intervention and hospitalization. Fatalities have also been reported. The risk associated with the use of quinine sulfate in the absence of evidence of its effectiveness for treatment or prevention of nocturnal leg cramps, outweighs any potential benefit in treating and/or preventing this benign, self-limiting condition."

They then go on to say:
"Although adverse events associated with quinine drugs also can occur when it is used to treat the approved indication, because untreated malaria, unlike leg cramps, is life-threatening, these risks may be justified."

BTW, there is a newspaper column called "Ask the Doctor" by Dr. Gott.  For nocturnal muscular cramps (not PLMD), people swear that putting a bar of soap by their feet helps.  Don't ask me what kind or how that is remotely possible because I don't know.  At any rate, it would be safer than quinine.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Hello Vicki,
I only brought quinine into the equation as that is what we used to call tonic water with the gin in the middle east :O) It was however prescribed for me in pill form (before they knew the dangers I guess).
 A thought today about the disturbance of restless legs in the night. On the way home from town I stopped in and had a look at the blanket "holder-uppers" that they use in hospital for people with broken limbs or foot problems. It is an idea I will try tonight. (I just made one :O)
These medical stores are ridiculous with their prices for simple gadgets made in China. :O) Rather like our health care gadget providers of CPAP.
Thanks again for your info, John

Lotsa Leg Movement Last Night :O)
My "blanket holder upper" experiment didn't work at all well, so it is back to the drawing board. I had spread an extra light blanket on top and it finished around my neck like a scarf :O)
 Although I didn't sleep well and know it today, the AHI count was down to 3.2 the lowest of the month Go figure?? :O)

Vicki, if you are still there I will see my doctor about getting the different medication that you suggested if it is available and approved here.
So as the song says "There will be many other nights like this" and we are so fortunate to live in a country where we can do something to help ourselves and others.
I thank both you and Mrs Rip  for your input.  There is lots of good information to be had in this forum.
 John

I was on Mirapex...it is an anti Parkinson's med and was helpful for the overall movements...

I do drink plain diet tonic water...NO NOTHING IN IT...8oz a night a few hours before bed..I am not talking pills here...just the tonic water.  Does it help...in my head it does, but I haven't a real clue.


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

Mrs R,
 There are a few notes about people taking tonic water with good results for leg cramps but there are also a few negatives about it on this site.

http://www.peoplespharmacy.com/archives/pharmacy_qa/tonic_water_eases_cramps_but_not_without_risk.asp

Tonic water was good with gin and had a lot more quinine at one time:O)
  However I see that even the weak stuff  they put out now has an eerie glow under an ultra violet light.

Another interesting thing I found on this site is that a good treatment for leg cramps is to step on an ice cube for immediate relief. I can't wait until the next time I have a full leg cramp to try that one.?? :O) I will probably slip off it go under the bed and forget about the cramp :O) Firstly though when you have a massive cramp how do you get to he fridge to get the ice cube ?  
It is strange that all of the treatments for leg cramps and jumpy legs seem to revolve around Ice cubes and tonic water. Maybe we should try sleeping in a bar :O)
Vicki mentioned a bar (of soap) in the bed. I had read that somewhere too ?? I guess you just have to believe in some things :O)

We used to think a lump of coal at New Year woud bring luck ?:O) (only if it was brought to the door by a fair headed man.  It was bad luck if the someone coming to your door with the coal had crossed eyes. We had a neighbor who came every year...... He had crossed eyes and was bald.!! He stopped coming out of spite because he thought that we were getting too lucky:O):O) But then I am getting off the PLMD subject.  
 Thanks John

John, I too read about the soap thing...if I remember correctly it was not on the internet but in some articles. I have yet to try it.  I find that waking my DH, getting him to jump up instead of me and him stumble in the dark for ice cubes may just be my answer!  Knowing him though...he will stub his toe, think he needs to have his leg amputated then I will have to carry him back to bed!


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.