CPAP and Fatigue - Kind a long

[Velroc]

I'm a 67 year old male, Height (cm): 180.3 Weight (kg): 92.2 BMI: 28.3, who has been on CPAP for about a month. My main complaint before getting my first sleep test was day time fatigue and depression ( I have taken Cymbalta for several years ).

Since I nap every day after lunch, I don't really have a problem falling asleep during the day while watching TV or driving

My first test in July w/o CPAP showed severe REM-related obstructive sleep apnea syndrome (overall AHI of 9.4, REM
AHI of 59.3, non REM AHI of 1.2, arousal index of 25.8, minimum oxygen
saturation of 83%).

Then I was put on CPAP at 7 to get use to the CPAP, had my 2nd sleep study Sept 10 and is Below at the bottom:
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My questions are:

My doctor, yesterday, in my first consult after my 2nd test, told me the CPAP probably wouldn't help my fatigue, as I should of seen some improvement by now, but CPAP could prevent Cardiac problems down the road. I though that some times it would take several months of CPAP to show improvement ???

He also said that my Periodic Limb Movement was no big deal, and he wasn't going to treat it ?? Is this correct ??

Thanks Bob




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SLEEP ARCHITECTURE:
The study started at 22:04:12 and ended at 06:13:29. Total sleep time was 433
minutes resulting in a sleep efficiency of 90.2% (TRT = 480 m). There were 20
awakenings with a total time awake after sleep onset of 19.0 minutes. The
sleep latency was 28.0 minutes and the REM latency was 103 minutes. The
patient spent 63.0% of sleep time in the supine position. The sleep stage
percentages were 9.3% stage N1, 68.3% stage N2, 0.0% stages N3 and 22.4% REM
sleep. There were 116 arousals, resulting in an arousal index of 16.1. There
were 96 stage shifts.

RESPIRATORY DATA:
This is a CPAP titration study. Snoring was eliminated at a CPAP setting of 9
cmH20. The mean oxygen saturation during the study was 93%, with a minimum
oxygen saturation of 89%.

CPAP-BILEVEL SUMMARY:

IP EP TST REM %Sup Apn Hyp Tot SupIdx AHI RAHI ArIdx Nadr Mean SaO2
7 7 52.5 m 0.0 m 100.0% 0 0 0 0.0 0.0 0.0 13.7 91% 92.0%
8 8 40.0 m 0.0 m 100.0% 0 0 0 0.0 0.0 0.0 6.0 91% 92.0%
9 9 100.5 m 33.5 m 34.8% 2 0 2 3.4 1.2 3.6 10.1 89% 93.0%
10 10 174.0 m 59.0 m 63.2% 1 0 1 0.5 0.3 1.0 16.6 90% 93.0%
11 11 66.5 m 4.5 m 53.4% 0 0 0 0.0 0.0 0.0 22.6 91% 93.0%
LIMB MOVEMENT DATA:
There were 230 periodic limb movements during sleep, resulting in a PLM-index
of 31.8. Of these, 23 movements were associated with arousals, resulting in a
PLM-arousal index of 3.2.

ECG DATA:
The average heart rate during sleep was 60 beats per minute, with a range of
52 to 77. During wake, the heart rate was ranging from 54 to 81 beats per
minute. Frequent premature ventricular contractions and rare ventricular
contractions were noted.

ICSD DIAGNOSIS:
Obstructive Sleep Apnea Syndrome [327.23]

IMPRESSION:
1. The apnea-hypopnea index was normalized at all tested CPAP settings. At a
CPAP setting of 9cmH2O, snoring was eliminated, the arousal index was
improved and oxygen saturations were maintained at and above 89% at this
setting.
2. Frequent periodic limb movements were noted during sleep and wakefulness.
These movements are of uncertain clinical significance in the setting of
OSA/CPAP therapy. The patient did not endorse symptoms suggestive of restless
legs syndrome (RLS) in the provided sleep questionnaire. Clinical correlation
is needed.
3. Abnormal sleep architecture likely due to CPAP titration and first night
effect.

RECOMMENDATIONS:
CPAP 9 cmH20 with humidification.

[Georgio]

I understand many here have taken longer than 4 weeks to feel improvement, myself included. My first signs were I noticed myself being more outgoing, friendly and joking around like the person I once was. You can optimize your therapy with help from this site. List your present equipment in the user control panel by text, not pictures. You will need to get your hands on nightly data to monitor your therapy to be sure it is working for you.

More qualified folks here can offer more help. Stick around and learn all you can here, you have a lot to gain.

Georgio

[sleepycarol]

It was a very slow process for me to stop feeling fatigued all the time. I imagine I had a significant amoung of sleep debt to pay off.

I am at the point now that I can have 8 or 8 1/2 hours of sleep and be good to go. Before I could sleep 12 hours and still feel like I was exhausted. It probably took close to a year for that to happen.

[kteague]

Hello and welcome. First, trying cpap at a pressure of 7 to get used to it when the epressure is not high enough to be therapeutic for your OSA will not give you the results using cpap at your titrated pressure should bring. So, it seems to me your doctor's statement about expectations is premature.

Next, about those limb movements - that number seems significant to me, especially if they were not respiratory related. Some people move with the struggle to breathe and those movements resolve with cpap treatment, but that's not said in your case. Your report negates RLS due to no reported symptoms. There is a segment of the population that has PLMD (or PLMS) independent of RLS. Movements with Periodic Limb Movement Disorder happen while asleep so most aren't aware of them. Your report states they also happened while awake, which leads me to two thoughts... either you do have RLS too, or else I'd want to investigate if these movements are possibly a side effect of a medication. The literature on Cymbalta lists movement issues as being a possible serious side effect requiring prompt attention. I don't know if your movements fit the description or not, but it is my opinion you should not delay in talking with the prescribing doctor about this and maybe even seeing a neurologist. I would not rely on a psych or sleep doc to be up on all the neurologic effects of every med.

There is a possibility that your depression symptoms were at least in part caused by the sleep issues. After some time on cpap they may need to reevaluate your dosages. Whatever happens, there can be consequences to going off these meds abruptly, so be very careful to follow a proper weaning schedule unless there are extinuating medical circumstances.

There are meds for PLMD IF that's what you have, but they are no joke, so I'd be concerned about adding anything else to your mix just yet. If it is PLMD, there's a chance that the better your OSA treatment is, the more limb movements you can have, so your study may not be reflective of how bad your movements really can be. The resulting sleep disruptions could lead you to think the cpap isn't helping. Continue using cpap because it has been proven that you need it. Deal with the movements as a separate issue that may or may not require treatment.

Personally, I'd want to have my sleep study data sent to another doctor who is experienced in movement disorders for a second opinion. Sorry to lay so much to think about on you, but you asked. Keep in mind I am not a medical professional, just a person with RLS/PLMD and one who has had issues with movements due to meds. Best wishes in sorting thru how to best address your needs.

Kathy

[Georgio]

I'm not familiar with your machine, however it is described as a "basic data" machine, which may mean it only records hours used. A machine that records nightly sleep event data would be very usefull to know how and if your therapy is working. Otherwise you can only treat yourself based on waiting to see how and if you feel better (not recommended, unless you have no other option).

Georgio

[OneCatBelleSundance]

Hang in there. I've been on CPAP since mid-July and noticed a difference within a week or so. While I know everyone is different CPAP gave me back my life. I can think again and while I get tired the awful fatigue is gone. Still nap on the weekends. CPAP works!