Re: Sleep Disorder

Posted By Nancy Solo on April 17, 1997 at 16:01:36:

In Reply to: Re: Sleep Disorder posted by Nancy S. on April 08, 1997 at 09:32:06:







: : Benzodiazepine class medications such as Klonapin, and dopamine agonist medications, such as Sinemet, are typically used in
an alternating fashion monthly to treat the very stubborn problem of periodic movements of sleep. Often the use of one agent
by itself is effective for only several weeks, but if you then switch to the other, it is also typically effective for weeks, then also
wears off; luckily, if you then go back to the first medication, it is once again effective for weeks. Regarding your comments
about lack of stage four sleep, unless you have a sleep study that substantiates your claims, there is no way for anyone,
including doctors, to tell whether or not they have reached a particular stage of sleep during a given night. Fibromyalgia and
related similar diagnoses are often associated with significant sleep disturbance, most often secondary to an underlying
undiagnosed anxiety disorder or other significant psychiatric disorder, especially depression, which can cause profound
disturbances in the amount of sleep as well as with sleep architecture. I am assuming that you have been appropriately
screened for such. Many of the medications you have used suppress REM stage sleep; chronic daily use of Klonapin or other
benzodiazepine class medications will eventually result in drug-dependent sleep and ultimately lessen the quality and quantity of
sleep over time. If you have not been evaluated by a neurologist for the treatment of the periodic limb movemenets of sleep, I
would highly recommend doing so, as this is often a stubborn problem requiring treatment by a physician with specific expertise
in dealing with it. Given your multiple diagnoses of three syndromes closely linked to psychiatric illness, I would also strongly
recommend a psychiatric evaluation if you have not already had one, as neglect of underlying anxiety or depression may result
in significant improvements in the symptoms that led to your diagnoses of chronic fatigue syndrome, fibromyalgia, and
myofascial pain syndrome. In response to your final inquiry regarding the "intrusion" of alpha waves on your delta waves, this
does not occur. If you have an alpha rhythm, you are, by definiton, awake; therefore the appearance of alpha waves during
sleep would indicate an arousal, perhaps triggered by one of your periodic movements in sleep waking you up briefly in your
particular case. Also, a lousy night's sleep does not mean you failed to achieve slow (delta) wave sleep during the night--- but
rather only that you had a lousy night's sleep. In the case of chronic fatigue syndrome, such a feeling is quite common. I would
not advise becoming fixated on finding other reasons for your poor sleep until you have corrected the one good and obvious
reason you may be getting a bad night's sleep all the time--- the periodic movements. In medicine, it is always best to treat
actual problems before embarking upon searches or theories about potential problems that have not been proven to exist. I
hope you find some or all of this information useful. If you
would be interested in seeing a sllep specialist at the Cleveland Clinic specifically, the appointment number is 216-444-5559.
Any of our sleep section physicians would be happy to evaluate you and discuss the specifics of your case in more detail.




Thank you for your reply. First I should say that I have been in psychotherapy for over 25 years, and I have just recently
"found" me. I also am on 200 mg of Effexor a day to treat the depression that I have lived with most of my life. The sleep study
that I had performed in April of 1996 indicated severe PLMS, 21% sleep efficiency, and a pathologically low 1.64 hours of
sleep. The Klonopin was Rx'd for the PLMS, but it also helps tremendously with the co-existing anxiety that has accompanied
the depression. I had never heard of alternating meds for PLMS. I am in frequent contact with both my neurologist who
performed the sleep study and my psychopharmacologist who is Rx'ing the meds, and they have also conferred. This has been
a problem for me for over 3 years. If it were simply a lousy night's sleep, I would not be as concerned. I have not worked
since January of 1996, not can I look for work because I never know from one day to the next how I will feel. I do not have
any income and therefore can
not come to the Cleveland Clinic. However, I would appreciate whatever further advice you can give me. Thank you. Nancy
Solo




Can someone reply to this follow-up please?  Thank you.