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I got my results from the sleep study today. FINALLY, after 3.5… 
10th-Apr-2008 01:19 pm
I got my results from the sleep study today.

FINALLY, after 3.5 weeks of waiting, mulling about (and losing sleep over?) the "gosh I guess you do have sleep apnea" comment by the nurse, I got to go in and talk to the doctor.

In about 8 hours of down-time, I slept for about 7. I can't analyze the percentage in whatever level I was at because I don't know what the percentages "should" be. Since she didn't comment on them, I assume they're "within normal parameters".

There _were_ actual obstructive sleep apnea events. 7 of them. That averages 1 per hour, so they don't care. (If it's not over 5, it's not a problem that they'll care about.)

I kicked too. 9 times. An average of 1.2 times per hour -- again if it's not over 5, they don't care.

However, I _did_ wake up 187 times. That averages out to every between-2-and-3 minutes. The nurse on duty while I was trying to sleep told me that most of my "arousals" were related to my teeth grinding.

I'll believe that. I know I'm a grinder, and the TMJ got so bad 10 or 12 years ago that I've been religiously sleeping with a bite splint (and yes, I wore it to the sleep study) since then. But while it prevents me from destroying my teeth so fast, (and keeps me from the "I can't insert even one knuckle between my teeth" phase) it does nothing to prevent me grinding.

What are the options? That's a good question. She mentioned some drugs, but said that they are used to help a person fall asleep... which isn't my problem. And I wasn't terribly excited about taking a sample pack of Valium, and she didn't push. She said that she supposed someone could inject botox, but I use those muscles for eating, so it seems really foolish to immobilize them. The only real option she left me with was to call the (unfortunately named) Drug Abuse and Mental Health hot-line on the back of my insurance card to see about getting hooked up with someone who'll do bio-feedback on my jaw -- but that that will probably take quite a bit of shopping, because that's not common. *sigh*

Someone had suggested that maybe what I needed was to go on Prozac -- that maybe that would chill me out and prevent so much grinding, but the doctor said that that particular drug (and all but one in its class -- and she did not recommend going on that) actually increases incidence of grinding. (Dammit -- I wanted a solution! A quick-and-easy one preferably.)

I'd also wondered if a light box would work the magic on me that it has worked on others. She said that what the box does is to regulate the (I forget her words) "It's time to sleep" centers of the brain -- and again would be more related to getting TO sleep than staying there. (Dammit -- if not a magic pill, a magic gadget would have been appreciated.)

Oh, before I forget again, the nap study (even though I fell asleep 3 of the 4 times they put me down for a nap) did NOT show that I was significantly sleepy. She didn't say it in so many words, (and I didn't think to ask) but I think that "not significantly sleepy" in this test rules out narcolepsy.

So the bottom line is:

     I might have a problem.
     They have no clue what to do about it.
10th-Apr-2008 05:40 pm (UTC)

I'd ask the TMJ doctor if TMJ specialists have run into sleep problems/waking up due to tooth grinding, and see if he/she has any suggestions. The problem may not be so uncommon in that specialized population; even if biofeedback is the only suggestion, your doc may know someone familiar with the problem.

As to the obstructive sleep apnea part, with that few episodes, and jaw problems, trying to sleep with a mask on all night might aggravate the jaw more than it helps the other...I keep adjusting my mask, trying to keep it tight enough to not leak (much) (the air pressure has to go toward your lungs to work, not out the side of the mask), but loose enough not to cause headaches and ruin my sleep (and my next day) thereby.

But I wish the medical profession was more open to people trying things like the CPAP machine to see how they work, rather than collecting statistics so an insurance company can use low numbers to justify saying "we won't pay for that treatment".

I don't blame you for being frustrated.
10th-Apr-2008 06:54 pm (UTC)
Thanks. "TMJ doc" is my dentist. And yeah, I'll talk to him the next time I'm in. (I know he wears a bite splint, but with him, the act of putting it in relaxes his jaw, so it keeps him from grinding rather than just helping to protect his teeth.)
10th-Apr-2008 07:17 pm (UTC)
:-P Sounds particularly annoying.

Bio-feedback does sound like a promising path. You might also look into cyclobenzaprine (Flexeril), which is a muscle relaxant as well as a sleep aid.
10th-Apr-2008 08:30 pm (UTC)
Thanks. I'll keep the drug in mind (and thanks for the link). I've also had massage of the jaw suggested, but at this time (I blame exhaustion :-)) I cannot remember by whom.
11th-Apr-2008 02:58 pm (UTC)
My understanding of the MSLT (daytime study) is that they are not looking at whether you fall asleep for the naps, but _how_ _fast_ you fall asleep (and, IIRC, how fast you got into dream-state). For the record, Daniel? averaged falling asleep in 5 minutes (usual, 10 minutes or so), and hit dream-stage every time - together was enough to confirm the previous diagnosis of narcolepsy.

Did they tell you what your O2 sat levels were doing thru the night, in different positions? Daniel didn't have any obstructive episodes, but his O2 levels dropped pretty drastically when he was asleep on his back, hence the trial with a CPAP/BiPAP (neither of which seemed to make any difference, but there you are). He normally sleeps on his side, so it's not much of an issue, anyhow.

Re: the teethe-grinding: yes, check with your dentist about what's going on for you - it may be worthwhile to do some adjustments on the bite plane/night guard to see if that makes a difference (you may need a bit of a different angle to help things relax a bit more). You might benefit from a different appliance altogether. If he doesn't have a clue, or seems lost, ask about a referral to a specialist there, as well (hey, if it's for medical reasons other than dental issues, it should be covered by major medical coverage). There are TMJ specialists out there - perhaps at the university (I don't know if there is a dental school there or not)? Physical therapy and/or alternative treatments (perhaps accupuncture) might be an option as well (I ended up in PT last summer for TMJ issues, although IIRC, they made sure to code it as something other than TMJ for the insurance).

I've also noticed the jaw problems are MUCH worse when I am stressed - anything that might help reduce stress may be helpful as well.

Feel free to drop me a note if there may be any other thoughts I may be able to contribute :-)
11th-Apr-2008 03:35 pm (UTC)
Don't know if they noted O2 levels -- I got a copy of one of the reports she had, but haven't studied the whole thing yet. They didn't SAY anything about that sort of problem, so I'll hazard that that wasn't an issue.

UM does have a dental school, but not everything said about them has been good.

Anything to reduce stress? Wonder if I can get a scrip for a weekly bottle of medicinal-of-course rum. (Kidding. Don't tend to drink all that much.)

Thanks for the offer.
12th-Apr-2008 10:53 pm (UTC)
You can talk to me, anytime, as well.

Do you grind your teeth only at night? Do you ever find yourself clenching your teeth while you are awake?

Like Spiritdance, I tend to grind/clench under stress. Sometimes it's the first sign that I've reached past a healthy limit. "Stress" is not limited to stuff coming at you from outside, by the way.

If this is your case, there are other ways, beyond meds and devices, to deal with what causes you to respond this particular way to stress.
15th-Apr-2008 05:54 pm (UTC)
I don't notice myself clenching my teeth when awake -- although I have been known to set my jaw -- the teeth touching their opposite parts, but not pushing. I usually only note that within the first half hour or so of getting up. (When I notice, I'll stick out my tongue, or waggle the jaw from side to side to make myself stop.)

Oh, and I was wrong. The apneas I experienced were none of them obstructive. I haven't translated the medicalese to determine what the types that were noted mean.

Thanks very much.
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