ptsd Sleep Apnea,ptsd,plmd

[qwiksting]

I had a polysonogram and got my results back. I had an actigraphy done by the Veterans Administration which led me to a private Dr. The VA just issued me a CPAP machine,(october 5) I never saw a Dr., just a technician to explain how to use the machine. So anyway, I thought it might be a good idea to get a real sleep doctor to help me figure out why I feel so tired all the time and why I have a cpap machine to use? I know it sounds backwards, but, its the VA....I just thought maybe it was the meds I am on to help with ptsd.

My results from my private Doctor polysomnogram are as follows:

I was recorded for 511 minutes and slept for 429 minutes. Sleep latency was 7.5 minutes: with a REM latency of 289 minutes. The sleep efficiency was 93.7%. Sleep architecture was fragmented with 45.5 minutes of stage N1 at 9.6%, 290.5 minutes of stage N2 at 67.7%, 70 minutes stage N3 at 16.3%, 27.3 minutes of REM at 6.4%, 24.5 minutes of wake with 21 minutes of wake after sleep onset.

There were a total of 14 apneas (obstructive) and 25 hypopneas, for an Apnea and hypopnea index of 5.5 per hour. Respirtory events were elevated during REM sleep and while supine with an index of 8.7 and 7.9 per hour. The longest event was 33 seconds. Oxygen saturation baseline was 95% with a lowest SaO2 of 91%. Snoring was severe in association with sleep-disorder breathing. There were 333 periodic limb movements with a periodic limb movement arousal index of 5.31 per hour. There were 36 spontaneous arousals with a spontaneous arousal index of 5 per hour. The EKG showed normal sinus rhythm, few ectopic beats with mean heart rate of 66 beats per minute during NREM and 64 beats per minute during REM sleep with a mean wake heart rate of 78 beats per minute.

I am an Iraq vet (04-05), PTSD, on meds. Lorazapam, quitiapine,sertraline and trazadone since 06. I am 47 and i smoke. I am 64 inches tall, weigh 191lbs.

I am still waiting on a Claim from 2008, its at the AMC, via BVA. I am considering claiming this as secondary to ptsd medication. I am not obese or overweight, however, after researching medications that I am to help me sleep, I am considering filing a claim as secondary to ptsd medication. Any thoughts/advice? I am currently seeing a Board certified neurologist and have an appointment on monday. Will be asking for an IMO.

[71M10]

Don't take this the wrong way.

VA will bring weight into this because your BMI is 32 plus with 30 and up being considered obese. Never mind that the BMI table was not created by a medical doctor, it was created by a French mathematician.

Since you are apparently well past your ETS date you might plan on getting that IMO/IME, the physician will need to state the apnea started in service and cite the evidence why he/she came to this conclusion or they will need to link it to an already rated condition and cite the reasons and basis of that conclusion.

Also be sure to have as complete a copy you have available of your SMR's and Cfile for the Doctor to review and ensure that they indicate they reviewed.

Best regards,

[qwiksting]

Sorry typo i am 6ft 4in. That is 76in sorry drs notes was flubbed. 23.2 BMI. I am rated 70% ptsd. Thank you for the reply

Edited December 5, 2012 by qwiksting (see edit history)

[broncovet]

For SC for OSA, (as well as everything else) you need:

1. In service event or injury. Yes, secondary to a SC condition will work

2. Current diagnosis of a disease or injury. If you dont use the CPAP, dont be suprised if the VA either does not sc you for OSA or reduces you later.

3. A "nexus" by a doc between the two.

Ok. A sleep doc had to "order" your CPAP..its a medical device and the doc had to at least "sign off" on it. So you have #2, a current diagnosis, assuming you USE the CPAP.

The hard part is getting a doc to both provide a nexus AND show how you PTSD or other SC meds/conditions contribute to your OSA. The doc will have to provide a "medical rationale" as to why he opines your OSA is "at least as likely as not" caused by meds for your PTSD. If you look up those meds and a side effect of any of those he prescribed is OSA, then that would make sense. To do this all you have to do is google

"side effects trazadone" ....for each of your meds.

Edited December 5, 2012 by broncovet (see edit history)

[qwiksting]

Thanks broncovet. Yea I use it. at least 60% of the time. thats what the Private neurologist stated in her report. I brought in my "card" from the cpap machine on my initial visit with her. She also stated "Ptsd,anxiety and depression were inteferring and contributing with sleep. The findings on my report that were interprested by her were OSA exacerbated in REM and Periodic limb movement disorder. I see her again on Monday, she is a board certified neurologist.

[broncovet]

Also, you dont need to "run" from 71M's idea.

Obstructive Sleep apnea often occurs in overweight people. The excess adipose tissue (fat) in the throat obstructs the airway when you sleep. This is not the ONLY cause of OSA but it is a major one.

So, again look at your meds. If any of these list "weight gain" AND you have gained weight consistent with going on your meds, well that connection is obvious. But..the VA wont connect these dots. You have to point it out to your doc, and ask him to supply you with a nexus. Something like this:

Doc B, I noticed when I started taking ........x.x.x.x drugs, back in 2008, I weighed 160 pounds. Now, I am at 240 pounds and have sleep apnea. According to .......(list the website), the pharmaceutical company says that this med can cause weight gain. Do you think, Doc B that taking these meds caused this weight gain and, the OSA?

If Doc B says, "YES", then ask him to write down this "nexus" in your records along with medical rationale. (Im guessing it should suffice if the pharmaceutical company admits, on their website, that a side effect of their drug is that it causes weight gain). If Doc B says "No" or "maybe", then you will need another doc to make a favorable opinion or you are unlikely to get SC for OSA. No Nexus = No Service connection for OSA.

You can do the same thing, asking the doc if PTSD and OSA are related, if you think the connection is more "direct" rather than the meds. Ask the doc what he thinks!

The "nexus" you are looking for is something very similar to :

"The Veterans weight gain from 2008, when he began trazadone for his PTSD is 64 pounds. According to (pharmaceutical company), (or PDR), this drug causes weight gain. Since the Veteran now has OSA after gaining this weight, this is consistent with his OSA diagnosis. Therefore, it is at least as likely as not that the Veterans OSA was secondary to his medications for his service connected PTSD".

Edited December 6, 2012 by broncovet (see edit history)

[qwiksting]

Yea, I wish I could gain weight....I am 6 foot 4 and weigh 191lbs...definately not overweight. I have been losing weight because of gerd. I have a case at AMC now..waiting on them. The most I weighed was before I deployed to iraq..215lbs...and now 191. I have googled the meds. Lorazapam causes increase in sleep apnea. I take it for SC ptsd. So it would be like a SC condition making a non SC condition worse. Also Severe GERD, which I am waiting on the AMC to adjucate for SC causes Sleep apnea.

[john999]

I take toprimate, oxycodone, clonazepam, cymbalta, fentynal, losartin, and a statin. I think I have gained much weight in last 5 years and most of these drugs aggravate my apnea. I have DMII from AO and PN that makes many activites difficult. My Bpap only works sometimes for me. I am 60% for Heart and 70% for schizophrenia/panic/PTSD and depression combined. I should be 100% for mental conditions, but because I don't hallucinate 70%. Since I went on TDIU I have gained 40 lbs because pain has gotten worse and activity level is down and I am older. What the hell! I am as fat as I have ever been in my life. I have PN in all four limbs. Do I have a case for SC apnea? Now private doctor is saying I have narcolepsy too. I really don't want extra money, so much as some help with these snowballing conditions.

Clonazepam, valium, xanax and all narcotic pain meds make OSA worse in my case just on their own because they relax the throat muscles.

John