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Sleep Inertia
#1
Sleep Inertia
I  was calling it Morning Depression,  then thought it was Excessive daytime Sleepiness, then learned it is  Sleep Inertia-never feeling refreshed, groggy and hard to get up and out of the house. I have read the posts related to Sleep Inertia/Sleep Drunkenness. There is no Wiki on this. I found good information on Hypersomnia Foundation's site however it is not practical advice as apeaboard is. I am hoping to learn of a success story. I use good sleep hygiene, new mattress, APAP compliance....

After three years on APAP two home studies  one recent and a Titration a year ago, my Sleep Inertia is worse despite Adderall which I take an hour before I have to drag out of bed. it wears off by 4pm and I fall asleep. I have been to four "sleep specialists" none have even optimized my APAP ( AHI are erratic and even when below 5 I still don't wake up refreshed.
I will next try another Pulmonary Doctor for their tests, try the collar again and am looking to switch to the Resmed Airsense 10 for her...maybe a different algorithm will help?

I am still learning how to use Oscar, it is overwhelming when you are tired and foggy.  I have posted the raw data from LOFTA/ Itamar home study....


Attached Files


Attached Files
.pdf   Lofta 12 30 2020 Data (1).pdf (Size: 952.61 KB / Downloads: 4)
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#2
RE: Sleep Inertia
you've listed periodic limb movement in your profile so you must have reason to think you have it. I've no way to know if it's causing any or all of your problems but I find plm to be exhausting in ways similar to what you're describing. it's an obvious potential cause of your complaints. so far I've found nothing about pap that'll help plm (quite the contrary). treat the plm and I'll bet you will find your sleep significantly improved.
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#3
RE: Sleep Inertia
I suffered from insomnia for years. Then I started CPAP and it aggravated the insomnia. I did conquer it with cognitive behavior therapy for insomnia. You should Google that. I had the help of a therapist, but you could apply it on your own.
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#4
RE: Sleep Inertia
Sounds like our cases are very similar,

Tried switching to Resmed for the exact same reason you want to a couple years
ago and was simply intolerant to the algorithm they use, used it for about a week
and went back to my dreamstation. That doesn't mean it wont be helpful for you
to switch and might be just the thing you need to change.

Going next month also to attempt to get an ASV, it might be the case that even after
using a ASV machine my sleep inertia may never go into remission. Need to
know everything has been ruled out and tried. 

Sorry to find out there is another like me, know just how bad things
can be.

Keep us updated on what happens for you
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#5
RE: Sleep Inertia
hadley....You tried a BiPap and now an ASV? Did they find Centrals?  I wanted a "titration study' that tried Resmed APAP BiPap and ASV....That would be helpful before ordering right? 
Did you have a Study that looked for Periodic Leg Movement? That is a variable that I just learned may be the root of the Sleep Inertia. Look at the Thread on Periodic Leg Movement, just learned there may be a correlation.
I take Adderal l but think its long term use may create other risk factors, it may have caused the PLM or even the Sleep Inertia if it changed my need for dopamine????

I am so frustrated that the last 4 Doctors ignore my questions....My insurance won't cover going to Mayo Clinic but that was a thought for a differential diagnosis.
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#6
RE: Sleep Inertia
RNeil:  Sleep inertia is a different Sleep Disorder from Insomnia. I am glad that CBT helped with it. I go to Stoicism Philospohy Meet ups, CBT was created out of Stoicism.....we need to be our own advocate!
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#7
RE: Sleep Inertia
Hi Shulamet.

Too many different threads here... can we settle on this one?

Are you able to post some OSCAR data? A view of a typical day would be a good start, some zoomed in regions might be useful also.

Do you have any copies of previous studies that measured PLM? The WatchPAT study doesn't really show anything regarding that. Is your PLM index 50/hour? If so that seems high.
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#8
RE: Sleep Inertia
I have no idea what machine was used in this Titration study..... Tech stopped at  8cm of pressure, when for three years my average on APAP have been over 8cm  more like 9.5-12cm with  5-11 AHI varys.... they just reset my APAP to 10cm on the next appointment. Thats why I did another PSG 12/20 but it does not include PLM.
It is only through these threads I learned the PLM may be tied to the Sleep Inertia, a very specific condition. 
My Ferriten and Iron labs were  fine.
I am trying to figure out how to 'whiteout' the patient info on the Titration Data......
here is the last Oscar I was able to do....its not easy for a non techie. I am trying to learn but brain fog is hard.



RESPIRATORY DATA: There were 0 obstructive apneas, 1 mixed apneas, 3 central apneas, 2 hypopneas, and 4 respiratory effort related arousals (RERA). The longest event was a 32 sec mixed Apnea with an oxygen desaturation to 97%. The apnea hypopnea index (AHI) was 1.0 per hour. The supine AHI was 1.1 per hour, and the REM AHI was 0.0 per hour. The respiratory disturbance index (RDI) was 1.7 per hour. In the awake state, the mean oxygen saturation is 97.0%. In sleep, the mean SpO2 was 97.0%, and the lowest SpO2 was 91.0%. SpO2 was ≤ 88% for 0.0 minutes which was 0.0% of the total sleep time. Snoring was eliminated on CPAP 8 cm. PAP TITRATION: Positive airway pressure was utilized from 5 to 8 cm H2O. The pressure was adjusted mainly for snore. The mask used was not listed. Mask leak within normal limits. The patient appeared to tolerate PAP well. Overall the patient did best at a pressure of 8 cm H2O during which time the AHI was 0 and the O2 nadir was 92% with a total sleep time 24 minutes. Supine REM sleep was recorded at this pressure for 7.5 minutes. CARDIAC SUMMARY: The EKG demonstrated normal sinus rhythm The average heart rate was 64. The minimal heart rate was 56, and the maximal heart rate was 84. 

LIMB ACTIVITY: There were 318 total Periodic limb movements in sleep (PLMS) , and the PLM Index was 54.9 per hour. (normal is < 15 per hour) There were 13 total PLMS Arousals, and the PLMS Arousal index was 2.1 per hour. (normal is < 5 per hour)

 Impression: 1. Successful titration on CPAP 8 cm with brief supine REM sleep observed. 2. Excellent sleep efficiency of 95%. 3. Frequent periodic limb movements in sleep. Recommendations: 1. Follow up in the sleep center after 4-6 week trial on PAP therapy. 2. Evaluate for symptoms of restless leg syndrome and/or periodic limb movement in sleep at a follow up visit in the center for sleep disorders. 3. Consider checking iron studies and/or ferritin levels due to PLMS noted on sleep study.


Attached Files
.docx   10-19-20 Oscar Summary.docx (Size: 25.79 KB / Downloads: 2)
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#9
RE: Sleep Inertia
Currently using a Dreamstation Auto BiPAP, my titration using Resmed equipment
at the sleep lab didn't turn up centrals but think they do need to be looking for them.
Someone else more familiar with the titration process may be able to answer how the testing
works when it comes to centrals. It wasn't until looking at the data on my Dreamstation
after some use and analyzing using Oscar that the centrals became evident.

My titration study didn't turn up any issues with periodic leg movement for me. I have
had problems with sleep inertia my whole life and its roots lie in a neurological
problem that has no current treatment. 

I've been down this road ahead of you for a few years now, idiopathic hypersomnia
is my official diagnosis and been through a few doctors as well. None so far have
been able to treat sleep inertia and those that try almost always use a stimulant
and those don't help clear up the brain fog. The only stimulant that is a successful
fog remedy for me is simply caffeine. 

My next move is to try ASV and see if I can't get proper treatment that way,
simply out of options at this point.
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#10
RE: Sleep Inertia
We can't give up just yet..... I may have both conditions and they may not be related....I just think with three years of pursuing a proper protocol I should be further along....I have much to learn on the Oscar data once I figure out how to download it. got the card adapter....
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