Sleep Disorder

    
      Re: Sleep Disorder
    


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Posted by CCF Neuro MD on April 08, 1997 at 09:29:42:

In Reply to: Sleep Disorder posted by Nancy S. on April 08, 1997 at 09:28:24:

: This Message was posted by: Nancy -  4/6/97 1:33:27 PM
  Message:
  I have been diagnosed with Fibromyalgia Syndrome and also have Myofascial Pain Syndrome and Chronic Fatigue syndrome.
  My biggest problem has been sleep deprivation. I had a sleep study done which showed sleep efficiency of 21% due to
  Periodic Limb Movements of Sleep. I am currently on 1.5 mg Klonopin at night, and although it has changed my sleep pattern,
  I am still not getting sufficient stage 4 delta sleep and wake in the morning feeling like I've never slept. I have tried Doxepin,
  Trazodone, Elavil, Restoril, Depakote, Sinemet and Neurontin in an attempt to achieve stage 4 sleep. Nothing has been
  successful. Is there an alpha/delta sleep anomaly with these syndromes that is untreatable, and can alpha wave intrusion into
  delta sleep be observed on an EEG.
=====================================================
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.