Re: Unrefreshed sleep- no snoring
MSLT's are subjective. The best diagnostic tool that you can have is an actual polysomnogram, aka an overnight sleep study. Sleep studies can uncover several things not considered. Such as fibromayalgia--with this disorder, what is called alpha intrusion can be observed in most cases. Alpha is a waveform that is only to occur when awake. If it occurs during sleep, it is most likely caused by chronic pain. Thus, a sleep study is a great tool for confirming or ruling out firbromayalgia.
Also, you could have RLS (Restless Leg Syndrome) only when you are asleep, which in the sleep industry we call PLMD (periodic limb movement disorder). Why would this cause you to feel unrested you ask? There are 4 stages of sleep: stage 1, stage 2, stage 3 (also known as slow wave sleep and delta sleep) and stage REM. Your sleep architecture is suppose to be composed of a specific amount of each stage of sleep per night. For example, if you are middle aged, you should receive approx. 25% of REM stage sleep each night. This does not mean you will remember your dreams. Most of which we do not, but every night we dream.
If you do not receive enough SWS (slow wave sleep) it can cause problems with one's metabolism, even causing weight gain!
Now that I have summarized that information, here is how RLS or PLMD effects your sleep architecture: You will go into the normal cycle of sleep...stage 1, then stage 2, then a leg movement occurs causing your cycle to start all over. This reduces or eliminates the deeper stages of sleep, stages 3 and REM. Which by the way, can also cause depression.
Although your husband reports that you do not snore, does not mean that you do not have sleep apnea. Some people only have it during REM stage sleep. Also, apnea gets worse as the night progresses. Thus, he is most likely in his deeper stages of sleep if you have it later in the night, making him unaware of any snoring that may occur later in the night.
Talk to your physician and request an overnight PSG, MSLTs are not a good screening tool. The only time a MSLT should be ordered is following an overnight PSG at which time PLMD and apnea or other sleeping disorder has been first ruled out. If you did not receive an overnight PSG first, then it was not properly performed. The normal protocol is if the overnight PSG rules out another sleeping disorder, then they will not perform the MSLT the next day.
Another thing to consider, is where you are having your sleep study performed. I suggest that you make sure that you are having the sleep study at a facility that is accredited by the AASM (American Academy of Sleep Medicine). The reason is because the results of study are subjective because only the AASM facilities uses a standardized set of rules for performing the tests as well as for analyzing the tests, also known as "scoring". For example, some labs may not even score leg movements or associate arousals to leg movements. This is because sleep studies are no longer a diagnostic tool for RLS, disregarding the fact that they can cause severe disturbances in one's sleep architecture! There are also sleep labs who use people who are not registered or trained properly to score their records! Also, when you have a sleep study, you must sleep on your back with only one pillow under your head. The reason is because, some people only have OSA when then are on their backs. Sleeping with more than one pillow under your head can mask the severity of OSA so that a person who needs treatment is disqualified from treatment. A lot of sleep labs do not use this as a protocol out of, well, laziness. If you cannot find an accredited sleep lab in your area, at least find one who uses the AASM guidelines/protocols.
You need to also ask them if they use the AASM's "alternative" scoring rules for hypopneas or one of the "reccomended" rules. The alternative is the better one, as it is less likely to eliminate people with mild apnea from receiving treatment.
BTW...I have both (mild) apnea and (severe) PLMD thus can relate to the agony of feeling unrested! I use CPAP and I also have 10 years experience in sleep medicine as an owner of a sleep lab and as a Polysomnographic Technologist (aka Registered Sleep Tech.) Thus, I have seen it all; from OSA, nocturnal seizures, to sleep eating disorders!
Good luck to you, and I hope that this was useful information. If your results indicate PAP treatment is needed, you can count on me to give you all of the treatment information needed as well. I am the queen of CPAP treatment!
Last edited by NonBlondeNC; 03-25-2010 at 03:33 AM.