Fatigue, Sleep and , Decreased Concentration Problems (Anne & Jeanie)

[Guest guest]

WARNING - This is a very LONG message - WARNING

Greetings Anne!

A very good reply, indeed!

As I understand it, based on conversations with my neurologist, our

doctors attempt to rule out possibilities. And sometimes repeating a

test can be important. My friend has MS, and some of the telltale signs

did not appear until a couple of years after first talking with her

neurologist. So, periodic repetitive testing is warranted.

Anne & Jeanie:

It is very important to have that sleep study done. Be certain to TALK

with the sleep specialist. Find out if the doctor is board certified

(requires additional study and internship, as I understand it). When

possible work with a sleep specialist that comes from neurology rather

than pulmonology background.

Anne, bring your husband to be the sleep witness, during your

doctor/patient interview. And Jeanie, be certain to attend your

husband, as the sleep witness. Be certain you mention the issue of

degenerative neurological disorder. The spouse needs to report and

verify the symptoms of any sleep problems. Lots of movement, muscle

twitching, snoring, gasping, etc. THIS step is crucial. Having my wife

with me helped the pulmonologist understand that my sleep was terrible,

in spite of my CPAP. She described some of the symptoms, which included

periodic episodes of just stopping breathing (central sleep apnea).

There was no gasping, snoring, etc. Those episodes worried my wife more

than any other.

This then caused my pulmonologist, who was open to the possibility of

neurological problems, order a new sleep study. He insisted an a top

notch technician for the study, and then poured over the test results.

The technician noted that I seemed to stop breathing AGAINST an elevated

pressure. He then switched me to BiPAP. My sleep improved. And my

pulmonologist CLEARLY noted an improved quality of sleep with BiPAP.

The moral of the story, as with any doctor/patient relationship, be

certain your symptoms are clearly heard, and both of you can help convey

some important sleep information during the initial interview.

Another note. It appears that many people with a degenerative

neurological disorder also suffer from fragmented sleep. The

fragmentation occurs for no known reason. Other symptoms can trigger

some of the fragmentation include periodic limb movement disorder

(PLMD), REM Sleep Behavior Disorder, obstructive sleep apnea, central

sleep apnea, vocal cord stridor and paralysis, etc.

http://rxlist.com/cgi/generic/traz.htm

I personally use Trazadone about 1 hour before sleep. I sleep much more

fully with it. Usually 50mg is the starting dosage, though I use 100mg.

Trazadone is an older antidepressant, which as a side effect encourages

sleep, and appears to decrease sleep fragmentation. It is not used at

an efficacious level to act as an antidepressant.

http://rxlist.com/cgi/generic/theosr.htm

Theophylline SR (Theo 24, as an example) appears to help improve the

respiratory drive if some central sleep apnea is an issue. Other drugs

(used for battle problems with altitude sickness, pardon me I do not

remember the name at the moment) help combat this, but have greater

potential toxicity (causing liver damage as an example).

http://rxlist.com/cgi/generic2/modafinil.htm

Fatigue can be fought with Ritalin or ProVigil, which has fewer side

effects than Ritalin. ProVigil was created to help patients with

narcolepsy, and is fairly effective.

http://rxlist.com/cgi/generic/buprop.htm

In addition to just feeling very tired (fatigue), there is also a brain

fog/confusion (concentration) issue. A quick test on fatigue can be

found at:

http://www.sleepnet.com/sleeptest.html

I have severe problems with concentration. To help counter this, I use

Wellbutrin. Again, it is an antidepressant, which has the side effect

of acting as a mild central nervous system stimulant. From the

" Clinical Pharmacology " section of the above site:

Bupropion produces dose-related central nervous

system (CNS) stimulant effects in animals, as

evidenced by increased locomotor activity,

increased rates of responding in various schedule-

controlled operant behavior tasks...

Warning with Wellbutrin and MSA patients:

However, MSA patients taking Sinemet (levadopa), must be very careful

with Wellbutrin:

Levodopa: Limited clinical data suggest a higher

incidence of adverse experiences in patients

receiving concurrent administration of bupropion

HCl (Wellbutrin) and levodopa (Sinemet).

Administration of bupropion HCl to patients

receiving levodopa concurrently should be

undertaken with caution, using small initial

doses and gradual dose increases.

Now, please remember this is all based on my own personal experience. I

do not take Sinemet. I tend to have a very low problem with side

effects, unless there is a very high probability it will occur.

Jeanie, please convey one clear concern to your husband. Please do not

medicate to mask problems. Have the sleep study done to at least

eliminate a whole host of problems. Be certain to talk with the sleep

specialist, don't just get a final report. There is a LOT of

information the specialist needs to interpret the report.

For example, the sleep study generally records some EEG activity, some

EKG activity, eye [electro-oculographic (EOG)] and jaw muscle activity,

some measurement of breathing through the mouth and nose, chest and

diaphragm expansion, blood oxygen saturation and heart rate (which is

used to infer CO2 levels, which actually drives respiration), movement

of limbs, sound and visual recording. All of this helps the sleep lab

determine what level of sleep, heart and breathing rates, obstruction or

central apneas, limb movement, and of course oxygen saturation.

I know this is probably obvious, but the sleep study (a polysomnograph)

records FAR more information than you or Jeanie can provide.

Also here are some sites I found helpful in the past:

http://www.aasmnet.org/ American Association of Sleep Medicine

http://emedicine.com/neuro/topic566.htm Polysomnograph Overview

http://emedicine.com/neuro/topic443.htm Polysomnograph Scoring

http://emedicine.com/neuro/topic444.htm Normal Sleep, Sleep

Physiology and Sleep Deprivation

http://emedicine.com/neuro/topic419.htm Obstructive Sleep Apnea

http://emedicine.com/neuro/topic523.htm Periodic Limb Movement

Disorder

http://emedicine.com/neuro/topic524.htm REM Sleep Behavior Disorder

http://emedicine.com/neuro/topic418.htm Insomnia

Note: Neurologic disorders - Include Parkinson

disease and other movement disorders, as well as

headache syndromes, particularly cluster headaches,

which frequently are triggered by sleep.

Side Warning: Sonata or Ambien should NOT be

used for chronic insomnia, since over time it

also interferes with normal sleep over extended

periods of time. (It and other medications can

cause rebound insomnia).

Please also note: ... Small amounts of sleep loss

(eg, 1 hour per night over many nights) have subtle

cognitive costs, which appear to go unrecognized by

the individual experiencing the sleep loss. More

severe restriction of sleep for a week leads to

profound cognitive deficits similar to those seen in

some stroke patients, which also appear to go

unrecognized by the individual.

And if you have not seen these:

http://emedicine.com/neuro/topic671.htm Multiple Systems Atrophy

http://emedicine.com/neuro/topic282.htm OPCA (MSA-C)

http://emedicine.com/neuro/topic354.htm SND (MSA-P)

Thoughts on when to stop normal daily activities (including work):

We are almost there. If you stayed with this so far, my thanks. This

has been a major brain dump, and might help both of you and others as

you search for answers to this.

For driving, when I noticed and accepted too many inputs were confusing

me, I decided to stop driving. This was most pronounced for me at

intersections. Driving is a privilege and responsibility. Failure to

stop driving is abuse of that privilege. Failure to stop driving is

irresponsible, since it can clearly put lives at risk. Yes, it is a

VERY hard decision for any of us.

For work, my own tests will be similar. At this point, with medication,

I can continue to be effective. I work with a business critical group,

so failure on my part can literally cost another company millions of

dollars (if not hundreds of millions for some banks). Yet, practicing

medicine is far more important with lives at risk.

How to tell if concentration is so impaired it may cause serious impact

upon job performance. Here neuro-psychological testing might help. I

do not know if standard tests exist for concentration. However, I do

know that if I reach the end of the day, did not accomplish what I set

out to do, and am not sure where the time went, I am impaired. Most

jobs require a certain level of concentration. When that is impaired,

job performance is compromised. If that risks others, then it is time

to seriously consider Long Term Disability. It is not a fun prospect to

face, but better than missing a key sign.

I will go as long as I can. But if I can no longer function on the job,

I will seek Long Term Disability coverage.

Wow! Has this been long enough, or what? My apologies for being

verbose.

Regards,

=jbf=

B. Fisher

[Guest guest]

,

I knew I could always count on you for a helpful response. My husband has

already had a sleep study done at Univ. of MI with Dr. Gilman last year.

He's just now beginning to feel fatigued and I remembered you had mentioned

a drug that helped you.

Thanks a million,

Jeanie

>

>Reply-To: shydrager

>To: shydrager >

>Subject: Fatigue, Sleep and , Decreased Concentration Problems (Anne

>& Jeanie)

>Date: Sat, 22 Jun 2002 17:01:16 -0400

>

> WARNING - This is a very LONG message - WARNING

>

>Greetings Anne!

>

>A very good reply, indeed!

>

>As I understand it, based on conversations with my neurologist, our

>doctors attempt to rule out possibilities. And sometimes repeating a

>test can be important. My friend has MS, and some of the telltale signs

>did not appear until a couple of years after first talking with her

>neurologist. So, periodic repetitive testing is warranted.

>

>Anne & Jeanie:

>

>It is very important to have that sleep study done. Be certain to TALK

>with the sleep specialist. Find out if the doctor is board certified

>(requires additional study and internship, as I understand it). When

>possible work with a sleep specialist that comes from neurology rather

>than pulmonology background.

>

>Anne, bring your husband to be the sleep witness, during your

>doctor/patient interview. And Jeanie, be certain to attend your

>husband, as the sleep witness. Be certain you mention the issue of

>degenerative neurological disorder. The spouse needs to report and

>verify the symptoms of any sleep problems. Lots of movement, muscle

>twitching, snoring, gasping, etc. THIS step is crucial. Having my wife

>with me helped the pulmonologist understand that my sleep was terrible,

>in spite of my CPAP. She described some of the symptoms, which included

>periodic episodes of just stopping breathing (central sleep apnea).

>There was no gasping, snoring, etc. Those episodes worried my wife more

>than any other.

>

>This then caused my pulmonologist, who was open to the possibility of

>neurological problems, order a new sleep study. He insisted an a top

>notch technician for the study, and then poured over the test results.

>The technician noted that I seemed to stop breathing AGAINST an elevated

>pressure. He then switched me to BiPAP. My sleep improved. And my

>pulmonologist CLEARLY noted an improved quality of sleep with BiPAP.

>

>The moral of the story, as with any doctor/patient relationship, be

>certain your symptoms are clearly heard, and both of you can help convey

>some important sleep information during the initial interview.

>

>Another note. It appears that many people with a degenerative

>neurological disorder also suffer from fragmented sleep. The

>fragmentation occurs for no known reason. Other symptoms can trigger

>some of the fragmentation include periodic limb movement disorder

>(PLMD), REM Sleep Behavior Disorder, obstructive sleep apnea, central

>sleep apnea, vocal cord stridor and paralysis, etc.

>

> http://rxlist.com/cgi/generic/traz.htm

>

>I personally use Trazadone about 1 hour before sleep. I sleep much more

>fully with it. Usually 50mg is the starting dosage, though I use 100mg.

>Trazadone is an older antidepressant, which as a side effect encourages

>sleep, and appears to decrease sleep fragmentation. It is not used at

>an efficacious level to act as an antidepressant.

>

> http://rxlist.com/cgi/generic/theosr.htm

>

>Theophylline SR (Theo 24, as an example) appears to help improve the

>respiratory drive if some central sleep apnea is an issue. Other drugs

>(used for battle problems with altitude sickness, pardon me I do not

>remember the name at the moment) help combat this, but have greater

>potential toxicity (causing liver damage as an example).

>

> http://rxlist.com/cgi/generic2/modafinil.htm

>

>Fatigue can be fought with Ritalin or ProVigil, which has fewer side

>effects than Ritalin. ProVigil was created to help patients with

>narcolepsy, and is fairly effective.

>

> http://rxlist.com/cgi/generic/buprop.htm

>

>In addition to just feeling very tired (fatigue), there is also a brain

>fog/confusion (concentration) issue. A quick test on fatigue can be

>found at:

>

> http://www.sleepnet.com/sleeptest.html

>

>I have severe problems with concentration. To help counter this, I use

>Wellbutrin. Again, it is an antidepressant, which has the side effect

>of acting as a mild central nervous system stimulant. From the

> " Clinical Pharmacology " section of the above site:

>

> Bupropion produces dose-related central nervous

> system (CNS) stimulant effects in animals, as

> evidenced by increased locomotor activity,

> increased rates of responding in various schedule-

> controlled operant behavior tasks...

>

>Warning with Wellbutrin and MSA patients:

>However, MSA patients taking Sinemet (levadopa), must be very careful

>with Wellbutrin:

>

> Levodopa: Limited clinical data suggest a higher

> incidence of adverse experiences in patients

> receiving concurrent administration of bupropion

> HCl (Wellbutrin) and levodopa (Sinemet).

> Administration of bupropion HCl to patients

> receiving levodopa concurrently should be

> undertaken with caution, using small initial

> doses and gradual dose increases.

>

>Now, please remember this is all based on my own personal experience. I

>do not take Sinemet. I tend to have a very low problem with side

>effects, unless there is a very high probability it will occur.

>

>Jeanie, please convey one clear concern to your husband. Please do not

>medicate to mask problems. Have the sleep study done to at least

>eliminate a whole host of problems. Be certain to talk with the sleep

>specialist, don't just get a final report. There is a LOT of

>information the specialist needs to interpret the report.

>

>For example, the sleep study generally records some EEG activity, some

>EKG activity, eye [electro-oculographic (EOG)] and jaw muscle activity,

>some measurement of breathing through the mouth and nose, chest and

>diaphragm expansion, blood oxygen saturation and heart rate (which is

>used to infer CO2 levels, which actually drives respiration), movement

>of limbs, sound and visual recording. All of this helps the sleep lab

>determine what level of sleep, heart and breathing rates, obstruction or

>central apneas, limb movement, and of course oxygen saturation.

>

>

>

>I know this is probably obvious, but the sleep study (a polysomnograph)

>records FAR more information than you or Jeanie can provide.

>

>Also here are some sites I found helpful in the past:

>

> http://www.aasmnet.org/ American Association of Sleep Medicine

>

> http://emedicine.com/neuro/topic566.htm Polysomnograph Overview

> http://emedicine.com/neuro/topic443.htm Polysomnograph Scoring

>

> http://emedicine.com/neuro/topic444.htm Normal Sleep, Sleep

> Physiology and Sleep Deprivation

>

> http://emedicine.com/neuro/topic419.htm Obstructive Sleep Apnea

> http://emedicine.com/neuro/topic523.htm Periodic Limb Movement

>Disorder

> http://emedicine.com/neuro/topic524.htm REM Sleep Behavior Disorder

> http://emedicine.com/neuro/topic418.htm Insomnia

>

> Note: Neurologic disorders - Include Parkinson

> disease and other movement disorders, as well as

> headache syndromes, particularly cluster headaches,

> which frequently are triggered by sleep.

>

> Side Warning: Sonata or Ambien should NOT be

> used for chronic insomnia, since over time it

> also interferes with normal sleep over extended

> periods of time. (It and other medications can

> cause rebound insomnia).

>

> Please also note: ... Small amounts of sleep loss

> (eg, 1 hour per night over many nights) have subtle

> cognitive costs, which appear to go unrecognized by

> the individual experiencing the sleep loss. More

> severe restriction of sleep for a week leads to

> profound cognitive deficits similar to those seen in

> some stroke patients, which also appear to go

> unrecognized by the individual.

>

>And if you have not seen these:

>

> http://emedicine.com/neuro/topic671.htm Multiple Systems Atrophy

> http://emedicine.com/neuro/topic282.htm OPCA (MSA-C)

> http://emedicine.com/neuro/topic354.htm SND (MSA-P)

>

>

>Thoughts on when to stop normal daily activities (including work):

>

>We are almost there. If you stayed with this so far, my thanks. This

>has been a major brain dump, and might help both of you and others as

>you search for answers to this.

>

>For driving, when I noticed and accepted too many inputs were confusing

>me, I decided to stop driving. This was most pronounced for me at

>intersections. Driving is a privilege and responsibility. Failure to

>stop driving is abuse of that privilege. Failure to stop driving is

>irresponsible, since it can clearly put lives at risk. Yes, it is a

>VERY hard decision for any of us.

>

>For work, my own tests will be similar. At this point, with medication,

>I can continue to be effective. I work with a business critical group,

>so failure on my part can literally cost another company millions of

>dollars (if not hundreds of millions for some banks). Yet, practicing

>medicine is far more important with lives at risk.

>

>How to tell if concentration is so impaired it may cause serious impact

>upon job performance. Here neuro-psychological testing might help. I

>do not know if standard tests exist for concentration. However, I do

>know that if I reach the end of the day, did not accomplish what I set

>out to do, and am not sure where the time went, I am impaired. Most

>jobs require a certain level of concentration. When that is impaired,

>job performance is compromised. If that risks others, then it is time

>to seriously consider Long Term Disability. It is not a fun prospect to

>face, but better than missing a key sign.

>

>I will go as long as I can. But if I can no longer function on the job,

>I will seek Long Term Disability coverage.

>

>Wow! Has this been long enough, or what? My apologies for being

>verbose.

>

>

>Regards,

>=jbf=

>

> B. Fisher

>

>

>If you do not wish to belong to shydrager, you may

>unsubscribe by sending a blank email to

>

>shydrager-unsubscribe

>

>

>

>

>

[Guest guest]

,

thank you for all of this information and links.

Deborah aka Tenacity

_________________________________________________________________

MSN Photos is the easiest way to share and print your photos:

http://photos.msn.com/support/worldwide.aspx

[Guest guest]

I want to thank you for taking the time to post about Sleep and for giving us some sites to learn more .I had already noted that you are the sleep expert for this group .I wonder if I could prevail upon you to give me your opinion on taking sleep meds over a prolonged period of time? I have taken oxazepan 30mg for over a year now,still sleep poorly,but it gives me enought sleep to function the nextday .However my Doc is getting uneasy about my taking it for so long so I may have to try something else .Do you have any suggestions? I do take Celexa but in the AM as my pharmasist said it could be a stimulant. any advice gratefully recieved.

yours Marg Manson

" B. Fisher" wrote: WARNING - This is a very LONG message - WARNINGGreetings Anne!A very good reply, indeed!As I understand it, based on conversations with my neurologist, ourdoctors attempt to rule out possibilities. And sometimes repeating atest can be important. My friend has MS, and some of the telltale signsdid not appear until a couple of years after first talking with herneurologist. So, periodic repetitive testing is warranted.Anne & Jeanie:It is very important to have that sleep study done. Be certain to TALKwith the sleep specialist. Find out if the doctor is board certified(requires additional study and internship, as I understand it). Whenpossible work with a sleep specialist that comes from neurology ratherthan pulmonology background.Anne, bring your husband to be the sleep witness, during yourdoctor/patient interview. And Jeanie, be certain to attend yourhusband, as the sleep witness. Be certain you mention the issue ofdegenerative neurological disorder. The spouse needs to report andverify the symptoms of any sleep problems. Lots of movement, muscletwitching, snoring, gasping, etc. THIS step is crucial. Having my wifewith me helped the pulmonologist understand that my sleep was terrible,in spite of my CPAP. She described some of the symptoms, which includedperiodic episodes of just stopping breathing (central sleep apnea).There was no gasping, snoring, etc. Those episodes worried my wife morethan any other.This then caused my pulmonologist, who was open to the possibility ofneurological problems, order a new sleep study. He insisted an a topnotch technician for the study, and then poured over the test results.The technician noted that I seemed to stop breathing AGAINST an elevatedpressure. He then switched me to BiPAP. My sleep improved. And mypulmonologist CLEARLY noted an improved quality of sleep with BiPAP.The moral of the story, as with any doctor/patient relationship, becertain your symptoms are clearly heard, and both of you can help conveysome important sleep information during the initial interview.Another note. It appears that many people with a degenerativeneurological disorder also suffer from fragmented sleep. Thefragmentation occurs for no known reason. Other symptoms can triggersome of the fragmentation include periodic limb movement disorder(PLMD), REM Sleep Behavior Disorder, obstructive sleep apnea, centralsleep apnea, vocal cord stridor and paralysis, etc.http://rxlist.com/cgi/generic/traz.htmI personally use Trazadone about 1 hour before sleep. I sleep much morefully with it. Usually 50mg is the starting dosage, though I use 100mg.Trazadone is an older antidepressant, which as a side effect encouragessleep, and appears to decrease sleep fragmentation. It is not used atan efficacious level to act as an antidepressant.http://rxlist.com/cgi/generic/theosr.htmTheophylline SR (Theo 24, as an example) appears to help improve therespiratory drive if some central sleep apnea is an issue. Other drugs(used for battle problems with altitude sickness, pardon me I do notremember the name at the moment) help combat this, but have greaterpotential toxicity (causing liver damage as an example).http://rxlist.com/cgi/generic2/modafinil.htmFatigue can be fought with Ritalin or ProVigil, which has fewer sideeffects than Ritalin. ProVigil was created to help patients withnarcolepsy, and is fairly effective.http://rxlist.com/cgi/generic/buprop.htmIn addition to just feeling very tired (fatigue), there is also a brainfog/confusion (concentration) issue. A quick test on fatigue can befound at:http://www.sleepnet.com/sleeptest.htmlI have severe problems with concentration. To help counter this, I useWellbutrin. Again, it is an antidepressant, which has the side effectof acting as a mild central nervous system stimulant. From the"Clinical Pharmacology" section of the above site:Bupropion produces dose-related central nervous system (CNS) stimulant effects in animals, as evidenced by increased locomotor activity, increased rates of responding in various schedule-controlled operant behavior tasks...Warning with Wellbutrin and MSA patients: However, MSA patients taking Sinemet (levadopa), must be very carefulwith Wellbutrin:Levodopa: Limited clinical data suggest a higher incidence of adverse experiences in patients receiving concurrent administration of bupropion HCl (Wellbutrin) and levodopa (Sinemet). Administration of bupropion HCl to patients receiving levodopa concurrently should be undertaken with caution, using small initial doses and gradual dose increases.Now, please remember this is all based on my own personal experience. Ido not take Sinemet. I tend to have a very low problem with sideeffects, unless there is a very high probability it will occur.Jeanie, please convey one clear concern to your husband. Please do notmedicate to mask problems. Have the sleep study done to at leasteliminate a whole host of problems. Be certain to talk with the sleepspecialist, don't just get a final report. There is a LOT ofinformation the specialist needs to interpret the report.For example, the sleep study generally records some EEG activity, someEKG activity, eye [electro-oculographic (EOG)] and jaw muscle activity,some measurement of breathing through the mouth and nose, chest anddiaphragm expansion, blood oxygen saturation and heart rate (which isused to infer CO2 levels, which actually drives respiration), movementof limbs, sound and visual recording. All of this helps the sleep labdetermine what level of sleep, heart and breathing rates, obstruction orcentral apneas, limb movement, and of course oxygen saturation.I know this is probably obvious, but the sleep study (a polysomnograph)records FAR more information than you or Jeanie can provide.Also here are some sites I found helpful in the past:http://www.aasmnet.org/ American Association of Sleep Medicinehttp://emedicine.com/neuro/topic566.htm Polysomnograph Overviewhttp://emedicine.com/neuro/topic443.htm Polysomnograph Scoringhttp://emedicine.com/neuro/topic444.htm Normal Sleep, Sleep Physiology and Sleep Deprivationhttp://emedicine.com/neuro/topic419.htm Obstructive Sleep Apneahttp://emedicine.com/neuro/topic523.htm Periodic Limb MovementDisorderhttp://emedicine.com/neuro/topic524.htm REM Sleep Behavior Disorderhttp://emedicine.com/neuro/topic418.htm InsomniaNote: Neurologic disorders - Include Parkinson disease and other movement disorders, as well as headache syndromes, particularly cluster headaches, which frequently are triggered by sleep.Side Warning: Sonata or Ambien should NOT be used for chronic insomnia, since over time it also interferes with normal sleep over extendedperiods of time. (It and other medications cancause rebound insomnia).Please also note: ... Small amounts of sleep loss (eg, 1 hour per night over many nights) have subtle cognitive costs, which appear to go unrecognized by the individual experiencing the sleep loss. More severe restriction of sleep for a week leads to profound cognitive deficits similar to those seen in some stroke patients, which also appear to go unrecognized by the individual.And if you have not seen these:http://emedicine.com/neuro/topic671.htm Multiple Systems Atrophyhttp://emedicine.com/neuro/topic282.htm OPCA (MSA-C)http://emedicine.com/neuro/topic354.htm SND (MSA-P)Thoughts on when to stop normal daily activities (including work):We are almost there. If you stayed with this so far, my thanks. Thishas been a major brain dump, and might help both of you and others asyou search for answers to this.For driving, when I noticed and accepted too many inputs were confusingme, I decided to stop driving. This was most pronounced for me atintersections. Driving is a privilege and responsibility. Failure tostop driving is abuse of that privilege. Failure to stop driving isirresponsible, since it can clearly put lives at risk. Yes, it is aVERY hard decision for any of us.For work, my own tests will be similar. At this point, with medication,I can continue to be effective. I work with a business critical group,so failure on my part can literally cost another company millions ofdollars (if not hundreds of millions for some banks). Yet, practicingmedicine is far more important with lives at risk.How to tell if concentration is so impaired it may cause serious impactupon job performance. Here neuro-psychological testing might help. Ido not know if standard tests exist for concentration. However, I doknow that if I reach the end of the day, did not accomplish what I setout to do, and am not sure where the time went, I am impaired. Mostjobs require a certain level of concentration. When that is impaired,job performance is compromised. If that risks others, then it is timeto seriously consider Long Term Disability. It is not a fun prospect toface, but better than missing a key sign.I will go as long as I can. But if I can no longer function on the job,I will seek Long Term Disability coverage.Wow! Has this been long enough, or what? My apologies for beingverbose.Regards,=jbf= B. FisherIf you do not wish to belong to shydrager, you may unsubscribe by sending a blank email to shydrager-unsubscribe

[Guest guest]

Marg,

Ask your doctor about trying something else for sleep like trazadone at

bedtime or benedryl. Neither is for sleep, but both have a side effect

of making you sleepy. Both have been taken in the past by MSA patients

and helped some of them sleep. In fact Charlotte took both at times.

However, it sounds as if it is time for a sleep study to see if there is

a sleep problem also. Sleep apnea could be keeping you awake also.

That is treatable with CPAP or BiPAP.

Take care, Bill Werre

================================

marg manson wrote:

>

>

> I want to thank you for taking the time to post about Sleep and for

> giving us some sites to learn more .I had already noted that you are

> the sleep expert for this group .I wonder if I could prevail upon you

> to give me your opinion on taking sleep meds over a prolonged period

> of time? I have taken oxazepan 30mg for over a year now,still sleep

> poorly,but it gives me enought sleep to function the nextday .However

> my Doc is getting uneasy about my taking it for so long so I may have

> to try something else .Do you have any suggestions? I do take Celexa

> but in the AM as my pharmasist said it could be a stimulant.

> any advice gratefully recieved.

>

> yours

>

> Marg Manson

[Guest guest]

Greetings Marg,

Not an expert, just a fellow patient that knows all to well how hard it can be to sleep.

Here's a web page on Oxazepan:

http://rxlist.com/cgi/generic3/oxazepam.htm

I honestly do not know what to suggest in this case. Here I would recommend you talk this over with your doctor. Be certain to discuss your problems with sleep. You might to mention you know people that use Trazodone or Benedryl to help with sleep, both of which are side effects of the medication. Ask. (I am certainly not qualified to practice medicine!)

Sorry, I can not help more.

Regards,

=jbf=

B. Fisher