3 months and still tired, please help!

[jlaber]

Hi, I have been using my APAP machine for 3 months now, and I'm still exhausted. It's helping me a lot in some ways. During my sleep study, my AHI was 88.5. When on the machine, my AHI is under 3. I don't wake up gasping anymore, and don't make a trip to the bathroom every night. So I am getting some benefits from the machine. However, I'm still exhausted every day. I use the machine all night, every night. My compliance for the last 3 months is 99% (I only missed 1 night when the power went out), and I use the machine for 9-11 hours of sleep each night. I even got one of those contour pillows since I'm a side sleeper, which fixed my problem with leaks and reduced how high the pressure goes during the night. But after being awake for only 8 hours, I'm literally falling asleep in my chair and could go back to bed for the night if I wanted to. Anyone have any idea what's going on?

[kteague]

It can be hard to know if more time is needed for continued recovery or if something else is going on too. What things has your doctor already ruled out? There are so many thing that can cause one to feel exhausted - like thyroid dysfunction, diabetes, anemia, nutritional deficiencies, medication side effects - for starters. Does your sleep feel restful or are waking a lot at night? Sometimes other things cause sleep to be non restorative. Hopefully you can sort through the puzzle pieces and make some sort of sense of why you feel like you feel. Best wishes.

[Sir NoddinOff]

Sorry, this isn't a very warm and fuzzy answer, but it's time to start asking about other health issues such as High BP, diabetes, weight gain and so forth. I agree with kteague on this. I would add alcohol usage, diet and exercise to the list also. Could your current medications be a contributing factor? I'm not a doctor but it's totally legit for me to suggest you go see one.

On the psychological side there could be problems with depression, anxiety, brain chemistry etc. Left untreated these will often cause fatigue and general malaise. I don't know how much of your history you want to share with the forum, but we have members of all stripes, sizes, shapes and conditions here. By and large, you're in pretty caring hands at CPAPtalk (tho there are a few harmless cranks about) Anyway, someone may be able to throw some light on your problems. Good luck with your therapy and congrats on your excellent compliance.

[Guest]

Hi, I have been using my APAP machine for 3 months now, and I'm still exhausted. It's helping me a lot in some ways. During my sleep study, my AHI was 88.5. When on the machine, my AHI is under 3. I don't wake up gasping anymore, and don't make a trip to the bathroom every night. So I am getting some benefits from the machine. However, I'm still exhausted every day. I use the machine all night, every night. My compliance for the last 3 months is 99% (I only missed 1 night when the power went out), and I use the machine for 9-11 hours of sleep each night. I even got one of those contour pillows since I'm a side sleeper, which fixed my problem with leaks and reduced how high the pressure goes during the night. But after being awake for only 8 hours, I'm literally falling asleep in my chair and could go back to bed for the night if I wanted to. Anyone have any idea what's going on?

Need more information.

What are your machine pressure settings?
What was your prescribed/titrated pressure?
Do you use EPR and what are those settings?
Do you wake up frequently during the night? (repeating question from "kteague")

.

[Sir NoddinOff]

Hi jlaber, you still there??? Please let us know what's going on.

[jlaber]

Thanks for all the replies, I'll try to give all the requested info here. I do wake up once or twice a night more than half of nights, but not due to lack of oxygen. As far as weight, I've held steady at 255 pounds (BMI 39%) for a year now. High blood pressure managed with one prescription that does not list fatigue as a side effect. No other meds, prescription or otherwise. I used to take generic Prozac for anxiety and depression. I stopped taking it at the beginning of this year, and mentally I feel fine. The med lists fatigue as a side effect, so that seems like a Catch-22 to me. I've never had diabetes, but it's been 2 years since my last blood test. I got a urine test earlier this year and there was no sugar in the urine. I don't use alcohol or illegal drugs. I do drink diet pop with caffeine all day long. My diet is terrible, mainly fast food. As far as the machine settings, it was set up by the DME. The only settings I know are pressure range of 7-20, and humidifier was set to 2 before I stopped using it. I haven't used it in two weeks. I don't know what titrated pressure and EPR are. Exercise is non-existent. I think I will go to the doctor soon and see what he thinks, as well as call the RT at the DME and get her opinion. I think that's everything you guys asked, if I need to provide more info, just ask. Thanks again for the help!
Justin

[Guest]

Thanks for all the replies, I'll try to give all the requested info here. I do wake up once or twice a night more than half of nights, but not due to lack of oxygen. As far as weight, I've held steady at 255 pounds (BMI 39%) for a year now. High blood pressure managed with one prescription that does not list fatigue as a side effect. No other meds, prescription or otherwise. I used to take generic Prozac for anxiety and depression. I stopped taking it at the beginning of this year, and mentally I feel fine. The med lists fatigue as a side effect, so that seems like a Catch-22 to me. I've never had diabetes, but it's been 2 years since my last blood test. I got a urine test earlier this year and there was no sugar in the urine. I don't use alcohol or illegal drugs. I do drink diet pop with caffeine all day long. My diet is terrible, mainly fast food. As far as the machine settings, it was set up by the DME. The only settings I know are pressure range of 7-20, and humidifier was set to 2 before I stopped using it. I haven't used it in two weeks. I don't know what titrated pressure and EPR are. Exercise is non-existent. I think I will go to the doctor soon and see what he thinks, as well as call the RT at the DME and get her opinion. I think that's everything you guys asked, if I need to provide more info, just ask. Thanks again for the help!
Justin

I'm guessing that this is a big part of your problem. You have a wide pressure range and the pressure changes are disturbing your sleep.......leaving you feeling unrested. Even if you aren't consciously waking up, when you're entering a deeper stage of sleep or REM, the machine detects breathing changes and may "think" it needs to bump up the pressure. When this happens, it may disturb your subconscious enough to prevent you from getting the restorative stages of sleep you need.

If you're not monitoring your therapy with software, I'd strongly recommend it. That will allow you to SEE what's going on during the night.

.

[chunkyfrog]

I know it sounds counter-intuitive, but would it be possible to buy a pedometer and start keeping track of your steps each day? Unless your doctor advises against it, a slight increase in physical activity every day could enhance your sleep and help with your energy levels. It can be easier than you would believe.

[hopingitworks]

I don't know what titrated pressure and EPR are

The titrated pressure is what was done when you had your sleep test. That is where the RT came up with your pressures for treatment.

EPR is "Exhalation Pressure Relief". Some people find it hard to exhale against a certain value of pressure. EPR allows a person to lower the pressure when exhaling. ResMed describes it in the following link:

http://www.resmed.com/us/assets/html/de ... c=patients

Have you downloaded the ResScan software to allow you to follow your treatment? If not, you should get it. I have it but don't know how to provide a link to the download. Hopefully someone here will provide a link. I would think that most people on the forum would agree that having access to your treatment therapy data is essential.

[Sir NoddinOff]

Thanks for all the replies, I'll try to give all the requested info here. I do wake up once or twice a night more than half of nights, but not due to lack of oxygen. As far as weight, I've held steady at 255 pounds (BMI 39%) for a year now. High blood pressure managed with one prescription that does not list fatigue as a side effect. No other meds, prescription or otherwise. I used to take generic Prozac for anxiety and depression. I stopped taking it at the beginning of this year, and mentally I feel fine. The med lists fatigue as a side effect, so that seems like a Catch-22 to me. I've never had diabetes, but it's been 2 years since my last blood test. I got a urine test earlier this year and there was no sugar in the urine. I don't use alcohol or illegal drugs. I do drink diet pop with caffeine all day long. My diet is terrible, mainly fast food. As far as the machine settings, it was set up by the DME. The only settings I know are pressure range of 7-20, and humidifier was set to 2 before I stopped using it. I haven't used it in two weeks. I don't know what titrated pressure and EPR are. Exercise is non-existent. I think I will go to the doctor soon and see what he thinks, as well as call the RT at the DME and get her opinion. I think that's everything you guys asked, if I need to provide more info, just ask. Thanks again for the help!
Justin

I'm guessing that this is a big part of your problem. You have a wide pressure range and the pressure changes are disturbing your sleep.......leaving you feeling unrested. Even if you aren't consciously waking up, when you're entering a deeper stage of sleep or REM, the machine detects breathing changes and may "think" it needs to bump up the pressure. When this happens, it may disturb your subconscious enough to prevent you from getting the restorative stages of sleep you need.

If you're not monitoring your therapy with software, I'd strongly recommend it. That will allow you to SEE what's going on during the night..

I concur... a too wide open pressure range kept me partially waking up every time the machine went 'chasing leaks' with hurricane blasts of air. IMO, on an auto machine you should only use the wide open range of pressure setting for a few nights, basically just to determine your initial baseline low pressure (Pmin).

[cosmo]

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[jtmarten]

Cut out the caffeine, if not totally, at least 6hrs before you try to sleep. It will really affect your ability to sleep.

[Julie]

AND it can also cause 'silent GERD", acid reflux which for whatever reason you're unaware of when awake, but which can really affect your sleep... I know someone who had the problem and ended up having to have surgery to get rid of it.

[jlaber]

Sorry it took so long to get back, I've been really busy at work the last few days. Anyways, I am 32 years old. I will buy a pedometer, but I'm scared to see how low the number will be, lol. Probably double digits. I downloaded ResScan and will try to upload photos from the data to see what you all think. I didn't realize caffeine causes acid reflux, I do have that and forgot to mention it. Once I see the data from the card, should I turn up the minimum pressure to something closer to the average pressure I need? Also, I got the machine from a DME and they set it up based on the prescription from the sleep clinic, can I break into the machine and change the settings myself?
Thanks again,
Justin

[archangle]

I find I feel better if I increase my minimum auto pressure a little above the point where my AHI goes essentially to zero. I'm assuming that even though I don't have any outright apneas, my breathing is still less than I need.