Deb, if i could pick your brain for a moment. you are someone with a lot of experience with sleep studies, and i have been considering having one (after i check with insurance). there are multiple possibilities for why i can't sleep well and always go around looking like a raccoon. i understand that the sleep study will help evaluate whether i have sleep apnea, but can it also tell if i have GERD or get hot and cold at night due to fluctuating hormone levels and/or blood sugar? in addition, don't you have patients who just can't get to sleep in the strange environment of a medical office being hooked up to all sorts of gizmos?
lastly, do you find that the sleep study usually leads to some successful treatment for the patient, or is it the case that the sleep study might not get to the bottom of the problem?"is weight more important than A1C..." this is such an interesting, important question. probably where you gain weight needs to be put in the picture. i gain weight on my abdomen- i always have, not just because i am perimenopausal. i have seen it written in so many places that having a big waist circumference (i forget the exact inch parameters) is associated with all kinds of nasty things like heart disease, cancer, diabetes. but then so is poor blood sugar control! so can you have a fat belly but good bg control, and so have a lesser risk for all those nasty things? my paternal grandmother who lived to be 94, and up until the end lived independently with her 92 year old husband, was not thin, but she was a pear shape, which is supposed to be protective. my maternal grandmother died of a stroke at 72 (no diabetes that we know of) and my mom died of breast cancer at 78 (insulin dependent type 2, fairly well controlled- no neuropathy/retinopathy/renal issues). they both had the apple shape like me. so my feeling is i have to pay attention to both bg control and weight.
i was wondering about sleep apnea and why we would even have this disorder in humans. i found a very interesting article. just more incentive to maintain or lose weight.
http://www.slate.com/articles/health_and_science/science/2012/08/sleep_apnea_evolution_and_breathing_masks_an_excerpt_from_david_k_randall_s_dreamland.2.html
I found a low carb high fat diet to be really helpful. And walking is a great exercise. I do think it is harder to manage your weight when you take insulin and unfortunately the advice you get from so called "professionals" is often unhelpful.
My Doc is using weight gain a major indicator, in her argument, that I'm, taking too much insulin. I was using it as a justification for why I needed to take more insulin. We just adjusted down, so it will be a while before I see any weight change, but she says that if I decrease my dose, weight will come off. And, honestly, I have decreased Lantus by 3 units so far and have had no increased incidence of high blood sugar, almost none at all, so she might be right. Note: I'm a type one. But, its a interesting discussion.
Does that indicate too much insulin? Sorta seems like it. Should, ideally, be stable for 4-5 hours. It shouldn't trend low, right?
I worked in Sleep Disorders for 13 years and the profession includes more than sleep apnea, you are correct. Hormonal changes, cannot be indicated by the equipment in a sleep study but your sleep disruption can be calculated as well as muscle movement. What I have found in my observations is that women of the classification, middle aged, menopausal or post menopausal, has increased activity in their muscles, particularly the legs (PLMS or NPLMS) that disrupts sleep if there is the lack of apnea. Certain medications may be useful to treat that sleep disorder.
With respect to the sleep deprived we seen rather often, yes, some people had some issues in the lab environment but not many. People are urged to bring their own pillows, reading literature, white noise machines, etc...to make the comfortable. Usually I urged the televisions be cut off at the time of the study start due to the flashing lights and sounds having a direct impact on the quality of a person's sleep. There is also a substance called Melatonin that is produced only in COMPLETE darkness and is hampered even by a nightlight.
I have been out of sleep disorders for 3.5 years now but I have experienced myself body temperature fluctuations that cause me to question if it is glucose vs. pre menopause. I just do not know that difference for myself so rely on bloodworm from my healthcare pros.
I am not sure this helps answer your questions but hope it does answer some.
Also, pH monitors have to be swallowed to indicate reflux with a positive diagnosis however reflux MAY be indicated throughout the study with an increase in the chin EMG channel.
I fluctuate depending on my activity and my food intake which are high variables where I work. :-(
WOW! That is interesting and good information to share mohe0001. I have a new point to think about. Perhaps I will decrease mine a little to see if it is a positive change in the right direction.
Before I was treated if I exercised real heavy, I would experience a rocket like hyperglycemic event that left me sickly for hours. Some say this is because I did not have enough insulin in my body. Moderate to light exercise, like weight lifting or walking would cause my levels to fall. Now since all of these adjustments and adding insulin, my A1C is great and so is everything but my weight. Finding the balance in that respect I still have to master...but we can learn from each other and that is what makes this a great portal.
I still get giant increases during exercise - 300 or 400 points in a couple hours. Hope to work on that once I have the basal down. We'll see.
Deb, thanks for all the info.
one thing i know for sure is that the lack of good sleep really affects my memory, so i am motivated to use my thank god good health insurance to at least rule out some stuff. before i thought i would just live with feeling like a zombie, but now reading that sleep apnea can cause irreversible changes in cognitive function, i am going to act and get a sleep study. thanks again!
There is a strong correlation between sleep apnea and diabetes. The stress hormones induced by sleep apnea raise blood sugar and blood sugar impedes good sleep. Despite my use of a CPAP, I still struggle with sleep issues. As 1DebY indicates, Melatonin is important, I take 3 mg Melatonin every night to help me stay asleep. My CPAP has gotten the number of times I stop breathing from more then 30 times an hour to less than 5 an hour (considered in the tolerable rage).
Despite that I've worried about continued sleep problems. I still suffer from ongoing fatigue issues and my body temperate is constantly depressed. All I can do is just try my best to have the best sleep hygiene. I never watch TV or read books in bed, I basically get in bed and "blammo" (sorry for the technical term) I am asleep.
Yes, please put your mind at ease by visiting your center during the day and look at the surroundings, ask about the wire applications and get an idea of what would make you more comfortable. There are some people that I sent to the ER because of other issues that needed immediate attention...such as CHF with difficulty breathing and low oxygen. Having someone watch over your safety is a comfort if you can view it like that. Please ask about the experience of the technologists performing your test. Those are a few things that can help you relax.
Yes, mine used to jet up 300+ points in 30-45 minutes of heavy exercise. I would get very short of breath and very tired. It took several hours to recover. I do wish you the best mohe0001.
I stumbled on this article today that might answer your question about weight gain. http://www.joslin.org/info/why_did_i_gain_weight_when_i_started_taking_insulin.html
For me at 5'10" I lost about 45lbs several months before I was diagnosed as a type 2. After spending several days in the hospital from a bad DKA episode. The doctor that was treating me started me on meds. After several months on the meds I gained the 45lbs back. During the 8 years afterwords, my weight stayed around 200lbs. Never could lose the weight no matter how much I diet and exercised. Last April I started on insulin after being correctly diagnosed as a type 1. After 2 months on insulin my weight dropped down to 165lbs. Just started on the pump first of this year. So far, my weight has been holding around 165lbs. I'v been keeping track of how many carbs I intake during the day. Averaging around 125g or less a day. Seems I eat more carbs on a work day than I do on off days.
My experience has been very similar. I was at a great weight at diagnosis, but gained quite a lot since starting insulin over two years ago. Have tried low cab, but have not seen good results. Though less active in winter, I am not sedentary. I maintain a good diet, similar to what I've had through a long period of successful weight loss and management, though fewer carbs and probably fewer calories overall. I ride a bike nearly every day except the past couple winters, but all I've been able to do is keep from gaining more - no real progress with weight loss since starting insulin.
Got a pump in November, which lowered my TDD a bit - I'm hoping that will help tip the balance a bit in my favor, but will have to wait and see when the weather improves (though I am still hitting the gym in the winter).
Thanks 1Deb. You too. I am taking FAR too much insulin. It has led to glycemic instability. I think the weight gain is my body trying to protect itself. How did you manage to overcome the exercise highs? There aren't a lot of people who have those. Those patterns are kinda rare, I think.
brian, besides your breathing stopping, are there other factors that affect your sleeping? do you have temperature changes at night that wake you up? a stressful job? are you more sensitive to blue light? do you use a light box?
For those that were on a "high" dose of insulin and gained wt....have you lost any of the wt when you started to taper down the dose on your pump?