Nothings changed, why suddenly tired?

[elader]

Hey experienced people... So my AHI is low (under 5), I watch my data and see nothing new or different. Why am I so damn tired the last week or so? Is it just one of those things that ordinary mortals experience? I am finding it really difficult to not talk myself out of my 40 minutes on the elliptical

Can the 'quality' of an Apnea event change over time? I mean, the machine doesnt report on the duration of an event, right? Ah.. I must be grasping at straws here.


For carbonman -

The whoosh of air marks off the hours of each night,
standing watch for events which I hope will not come.
A splint made of nothing keeps my life intact ,
and allows me to dream once more.

[Debjax]

I'm wondering if there is some type of bug going around. I've had a great month, then suddenly last week, for a few days, I could barely stay awake. This IS a problem when you are in front of a client training him on your company's software and you are practially asleep on your feet.

I though it was leaks from the mouth, but it wasn't, my leak rate is actualy ok, and I've had very low AHI this week. I think there's just some type of crud going around. If this just started this week, maybe it will go away for you in a day or so....I'm fine today.

[roster]

........... So my AHI is low (under 5), .......

So your AHI is low.
If that is so,
how low?
4 is under 5,
but it's hardly alive.
4 AI in 7 hours,
is 28 per night.
28 phone calls per night?
28 chokings per night?
Either is quite a fright!
I'll keep the day job.

[elader]

My apneas are usually 1-2 and my Hypopnias are 2 or so. Inteestingly, I think some of my hypopneas and FLs are NOT related to my airway but are central. I frequently feel when semi awake like I forget to breathe deep and then have some deeper breaths.

Off machine my AHI is 75, so 4 is a definite improvement.

[SleepGuy]

I have my first headcold of the winter so I know exactly why I feel so lousy. CPAP is miserable when you've got a cold....

[dsm]

Don't feel you are alone - it is not at all uncommon to be sailing along very nicely then hit a period where it seems to have gone 'belly-up'.

I traced a couple of such episodes to large leaks - for a few days I just could,'t seem to find why the leaks were so high, then I started
feeling drowsy & by mid day was struggling to stay awake at work I replaced my hose & did a few other things & eventually all came
right again.

I am also wondering to what extent excessive PCo2 retention may affect drowsiness. I can have excellent SpO2 datas but still go
through drowsy bouts in the day. One theory I am exploring is in regard to PCo2 being a cause & why it seems two brands of
machine give what seems like two different results. It caught my eye last week when JNK posted a comment about the Resmed
Vpap Adapt SV that the machine deals with PCo2 and centrals by increasing ipap when tidal volume drops & drops ipap when tidal volume
increases beyond the current target (what SV machines do) but it was the ref to PCo2 and centrals that caught my eye.

For normal cpap & auto users, the issue of PCo2 is no less a problem. Pressure induced centrals appear to come from PCo2
retention being to high.

I am wondering how much we are affected by a poor match between a machine & mask even though it seems to all work
well (but we still go through tired bouts). Undoubtedly there are other matters than can affect or cause a days' tiredness but
over time we can usually figure out when that type of situation has occurred.

All masks have what is called a 'deadspace' and that affects how many & how big the vent holes are. deadspace is the pocket
in a mask where breathed out air will sit just prior to breathing in again, but a certain level of Co2 re-breathing is important.
Too much Co2 retention causes the breathing reflex to be affected and triggers hyperventilation, too little Co2 causes the
breathing reflex to slow right down - breathing will become shallow & can even stop (a central).

DSM

[fuzzy96]

for what it's worth..............

the days are getting longer even though the mean average temperature is just now levelling off from it's seasonal decline.
somehow just as the swallows return every year to capistrano, can it be the seasonal forces and a hidden pre-disposition has us in it's grasp? perhaps it's a psycological-metaphysical reaction to a normal environmental cycle. (it's just that time of year)

ah when we learn so much funny how we realize we know so little.

i'm tired too

got your taxes done yet?

[Wulfman]

Hey experienced people... So my AHI is low (under 5), I watch my data and see nothing new or different. Why am I so damn tired the last week or so? Is it just one of those things that ordinary mortals experience? I am finding it really difficult to not talk myself out of my 40 minutes on the elliptical

Can the 'quality' of an Apnea event change over time? I mean, the machine doesnt report on the duration of an event, right? Ah.. I must be grasping at straws here.


For carbonman -

The whoosh of air marks off the hours of each night,
standing watch for events which I hope will not come.
A splint made of nothing keeps my life intact ,
and allows me to dream once more.

From your profile:
Additional Comments: titrated at 8cm, currently using 9cm-12cm and c-flex

What's your 90% pressure?
Do you actually have the Encore software?
Are you getting ENOUGH sleep?

James Skinner's software (if it works with the A-Flex machine and 1.8 EP) shows the time in apnea.
You probably need to raise your minimum pressure.
Pressure changes may be disturbing your sleep.....not unlike apnea events.
Your AHI is higher than would be acceptable for me. (Especially if I COULD get it lower)

On the other hand, this week (for the first time in about 3 1/2 years) I've been trying to fight off some kind of sinus thing. Not full-blown yet, but some sneezing and a little congestion.....just enough to disrupt my nights' sleep about halfway through. Coincidentally, it seemed to start about the night I switched machines (Feb. 1). I thought I'd try one of the machines I haven't used in over a year and see what differences it would report in my data. The night I started with this one, it didn't feel like I was getting as much pressure out of it as the other one I had been using.

And, yes, there has been some "stuff" going around, too.

Den

[5aces]

Too much Co2 retention causes the breathing reflex to be affected and triggers hyperventilation, too little Co2 causes the
breathing reflex to slow right down - breathing will become shallow & can even stop (a central).

Imperative to have the sinuses in complete state of good health to marginalize the CO2 effect?

Nasal polyposis,sinusitis and allergies affecting the airway path would certainly impact the CPAP effectiveness and are not always realized.

Real crapshoot when it comes to finding a Machine/Mask that truly delivers personally optimal results,truly on your own there.

Lack of information provided on the patient end points many to a long tired road.

Couldn't agree more.

[elader]

Don't feel you are alone - it is not at all unommon to be sailing along very nicely then hit a period where it seems to have gone 'belly-up'.

I traced a couple of such episodes to large leaks - for a few days I just could,'t seem to find why the leaks were so high, then I started
felling drowsy & by mid day was struggling to stay awake at work I replaced my hose & did a few other things & eventually all came
right again.

I am also wondering to what extent excessive PCo2 retention may affect drowsiness. I can have excellent SpO2 charts but still go
through drowsy bouts in the day. One theory I am exploring is in regard to PCo2 being a cause & why it seems two brands of
machine give what seems like two different results. It caught my eye last week when JNK posted a comment about the Resmed
Vpap Adapt SV that the machine deals with PCo2 and centrals by increasing ipap when volume drops & drops ipap when volume
increases beyond the current target (what SV machines do) but it was the ref to PCo2 and centrals that caught my eye.

For normal cpap & auto users, the issue of PCo2 is no less a problem. Pressure induced centrals appear to come from PCo2
retention being to high.

I am wondering how much we are affected by a poor match between a machine & mask even though it seems to all work
well (but we still go through tired bouts). Undoubtedly there are other matters than can affect or cause a days tiredness but
over time we can usually figure out when that type of situation has occurred.

All masks have what is called the 'deadspace' and that affects how many & how big the vent holes are. deadspace is the pocket
in a mask where breathed out air will sit just prior to breathing in again, but a certain level of Co2 re-breathing is important.
Too much Co2 retention causes the breathing reflex to be affected and triggers hyperventilation, too little Co2 causes the
breathing reflex to slow right down - breathing will become shallow & can even stop (a central).

DSM

its funny you bring that two thinkgs that I have been thinking about. I was appalled the first time I saw the cpap system and saw that the mask didn't have an exhaust valve. We are essentially rebreathing the same column of air over and over, with fresh air being bled into it essentially by a controlled leak. Such a system would scare a scuba diver to death. Second thing is that I am a naturally shallow breather. Yawning during concentration as I breathe too shallow, always the last guy to finish his 8cuft scuba tank. I bet I am awash in CO2.

[MrSandman]

Too much Co2 retention causes the breathing reflex to be affected and triggers hyperventilation, too little Co2 causes the
breathing reflex to slow right down - breathing will become shallow & can even stop (a central).

Imperative to have the sinuses in complete state of good health to marginalize the CO2 effect?

Nasal polyposis,sinusitis and allergies affecting the airway path would certainly impact the CPAP effectiveness and are not always realized.

Real crapshoot when it comes to finding a Machine/Mask that truly delivers personally optimal results,truly on your own there.

Lack of information provided on the patient end points many to a long tired road.

Couldn't agree more.

OT - LMAO at 5aces avatar.... Elader,maybe a cold coming on, I have had three in a little over a month or a plateau?

[Wulfman]

And, for me, the Quattro didn't seem to have the amount of airflow that the UMFF has. I felt like I was retaining more CO2 with it.

Den

[dsm]

And, for me, the Quattro didn't seem to have the amount of airflow that the UMFF has. I felt like I was retaining more CO2 with it.

Den

DEN, A possible BINGO here !!!!!!
(but, retaining Pco2 in the blood causes hyperventilation whereas too little causes breathing slowdown. The Quattro mask seems to me to blow too much Co2 off rather than retain more than the UMff does ?)

I had reached this conclusion based on going for close on 8 months with WONDERFUL results with my Bipap Auto SV (the regulars have heard me wax lyrical on the consistent great results), then suddenly went into a steady decline & it recently dawned on me that the decline started at right about the time I switched to the quatro mask from a UMFF mask.

In fact I am just about to revert to the UMFF with the Bipap AutoSV to see if this proves the point. It is why I raised this issue. With the UMFF mask & the Resmed Vpap Adapt SV, I can hardly go 2 nights before quitting the setup but if I use a Quattro mask with the Vpap Adapt SV I get good daytime results but I don't like the combo quite as much as I like the Bipap Auto SV.

In putting 2 + 2 together I figured it had to be the level of PCo2 retention between them that was a likely culprit. If I switch back to the UMFF (will do so tonight) & the Bipap Auto SV returns those same great results, then I will be satisfied is was to do with the mask / machine mix & PCo2 retention that caused the change when switching to the quattro mask. (the quattro fits far better than the UMFF which was why I did it - because of that it helped with the Vpap Adapt SV, but didn't really improve matters when using the Bipap Auto SV (other than what I have outlined)).

If this proves correct imagine how many people may be having cpap therapy with bad mask/machine combinations & if that is causing excessive PCo2 blow-off, that would explain why so many of us go into slides. It seems to be a rationale for why some people go onto cpap therapy & start experiencing lots of flow-lims & hypops & even PCo2 induced centrals.

This is an interesting line of investigation & if anyone else has any stories re switching masks (esp Resmed quattro & Resmed umff) & noticing a significant decline in therapy effectiveness, pls mention it.

DSM

[Wulfman]

And, for me, the Quattro didn't seem to have the amount of airflow that the UMFF has. I felt like I was retaining more CO2 with it.

Den

DEN, A possible BINGO here !!!!!!
(but, retaining Pco2 in the blood causes hyperventilation whereas too little causes breathing slowdown. The Quattro mask seems to me to blow too much Co2 off rather than retain more than the UMff does ?)

I had reached this conclusion based on going for close on 8 months with WONDERFUL results with my Bipap Auto SV (the regulars have heard me wax lyrical on the consistent great results), then suddenly went into a steady decline & it recently dawned on me that the decline started at right about the time I switched to the quatro mask from a UMFF mask.

In fact I am just about to revert to the UMFF with the Bipap AutoSV to see if this proves the point. It is why I raised this issue. With the UMFF mask & the Resmed Vpap Adapt SV, I can hardly go 2 nights before quitting the setup but if I use a Quattro mask with the Vpap Adapt SV I get good daytime results but I don't like the combo quite as much as I like the Bipap Auto SV.

In putting 2 + 2 together I figured it had to be the level of PCo2 retention between them that was a likely culprit. If I switch back to the UMFF (will do so tonight) & the Bipap Auto SV returns those same great results, then I will be satisfied is was to do with the mask / machine mix & PCo2 retention that caused the change when switching to the quattro mask. (the quattro fits far better than the UMFF which was why I did it - because of that it helped with the Vpap Adapt SV, but didn't really improve matters when using the Bipap Auto SV (other than what I have outlined)).

If this proves correct imagine how many people may be having cpap therapy with bad mask/machine combinations & if that is causing excessive PCo2 blow-off, that would explain why so many of us go into slides. It seems to be a rationale for why some people go onto cpap therapy & start experiencing lost of flow-lims & hypops & even PCo2 induced centrals.

This is an interesting line of investigation & if anyone else has any stories re switching masks (esp Resmed quattro & Resmed umff) & noticing a significant decline in therapy effectiveness, pls mention it.

DSM

The only "scientific evidence" I have with the comparison of the two masks is "How I feel". And, I know that when I used the Quattro, I didn't feel as rested/refreshed with it as I do with the UMFF. As I've mentioned before, from my self-analysis of MY situation, I believe my particular root problem with apnea is in my nasal passages. When I get a larger volume (as opposed to pressure) of COOL air flowing in my mask, I can breathe much better because it helps keep my nasal passages open. Consequently, if I'm breathing well through my nose, I'm not mouth-breathing and not having apnea events like my pre-therapy nights.

Reading your post, I got to thinking about why people select which masks. While most of them select them for "comfort" in their preferences to nasal vs. pillow vs. prongs vs. full face rather than how they actually perform. It might be interesting if there was some way that a manufacturer could make a mask that allowed the user to select one for FIT and COMFORT and then be able to select/adjust a Vent Flow Rate (without covering up vent holes or drilling them bigger) to optimize one's therapy. They probably wouldn't sell very well.....for the same reasons that (many of) the DMEs push the cheapest products to the new patients......$$$. But, just as there are auto-adjusting machines, it would seem logical to come up with a line of masks that could be adjusted for performance for the patients.
Hmmmmm.......as I was typing this and thinking of the designs of the UMFF and Quattro (the UMFF having the better modular design of the two), the UMFF has the removable rubber Vent where the exhaust ports are (while the Quattro DOESN'T). Those holes could be modified (larger or smaller)......and they could be changed if a person needed more or less Vent Rate (air flow). I realize were not supposed to be plugging holes (or at least not too many of them), but isn't that what a mask does that has a lesser Vent Flow? (if we retain more CO2)


Den

[elader]

What's your 90% pressure?
Do you actually have the Encore software?
Are you getting ENOUGH sleep?

James Skinner's software (if it works with the A-Flex machine and 1.8 EP) shows the time in apnea.
You probably need to raise your minimum pressure.
Pressure changes may be disturbing your sleep.....not unlike apnea events.
Your AHI is higher than would be acceptable for me. (Especially if I COULD get it lower)\

Den

I do have the Pro software.
I had a lot of issues with 'auto' on the auto machine. I seem to have the lowest AHI with the flattest leak line with the range very narrow - I keep it at 10-12 now. Most of the time it's at 10-11. I do not see the events clustered or dependent on the pressure. I was titrated at 8, and have tried a wider range and really didn't like it. I don't often have leaks that the machine calls large. But I also don't have flat lines. Everything I have tried (masks, liners, taping, etc) seems to not affect the line. It all comes from one side of my face where the bone is lower than the other. I tried the earplug thing, but its not for me. So my leaks are slight but steady at about 40 on the quattro at 10-12cm.

In terms of enough sleep, that's debatable. We have a puppy that pounces at 6:30AM. But from 11-6:30, I seem to be asleep. No other symptoms of severe trouble - no night sweats, no GERD, no waking every 10 minutes, and no mental fatigue. Just that afternoon stuff. But I still manage to drag my ass to the Gym.