Still tired

solejean · Post by **solejean** » Thu Oct 05, 2006 10:01 am

Hi everyone,

Just wondering if anyone has some input on my problem: I have been using CPAP for about 6 months. Just had a check-up with an oximeter and it showed a "normal" test. One incident of 3 minutes and two very short incidents. I just swiched masks to the Mirage Swift (and wasn't that fun getting through Apria - a whole different story). I like it alot so far - two nights... Here's my question - I am still very tired during the day at work. When I am active or doing things I enjoy I'm fine. But put me in front of boring documents and I can't seem to stay awake. Not good since I'm a lawyer Does it sometimes take a really long time to stop being so sleepy? My RT at Kaiser thought I might want to schedule an actual overnight sleep study. Thoughts? I'm just really frustrated and tired... I do feel better than I did six months ago - but if I keep falling asleep while working... not good. I have to bring work home to keep up and to make up lost time. Thanks everyone for any assistance. And if anyone wants to email my address is shelbyo@hotmail.com
Thanks!

Wulfman · Post by **Wulfman** » Thu Oct 05, 2006 10:10 am

Right off the top of my head (since the pulse-ox looked OK), I just have one question. Are you getting ENOUGH sleep?
I know I can still be "dragging" if I get a couple of short nights.....not to the point of dozing off, though.

Best wishes,

Den

Goofproof · Post by **Goofproof** » Thu Oct 05, 2006 10:11 am

The only thing I can gather is you are using a nasal interface, you may be losing treatment through mouthbreathing. If you mouthbreath, you can't maintain the pressure to keep your airway open, that maybe what the O2 destats are trying to tell you.

Without a machine that captures full data, and the software to read it, you are flying blind, like the majority of users, Except for the members here, a large portion of us, take full control of our treatment. Jim

ozij · Post by **ozij** » Thu Oct 05, 2006 12:36 pm

Since Den and and Goofproof have said the important thing, I can be facetious.

But put me in front of boring documents and I can't seem to stay awake. Not good since I'm a lawyer

Who likes boring documents?

And semi seriously: Does your job have documents that interest you? Are the documents really that boring, or are you that tired?

O.

solejean · Post by **solejean** » Thu Oct 05, 2006 1:30 pm

Thanks for the input. I am trying to be more involved in what happens with my treatment - but I will admit that I have not done as much as I should.

I am going to pay better attention to how much sleep I'm getting to see if that could be the culprit - I know the amount needed is an individual thing - maybe I haven't figured out my magic number.

As for the documents - I do sometimes get interesting files - but some are very boring. But I figure I should be able to stay awake to read them...

For those who are more experienced at this - what would you recommend in terms of taking charge of my treatment? Should I get a better machine - I know I got the cheapest one possible with a passover humidifier and horrible mask. I have resolved the mask issue and had my RT order me a heated humidifier. Would a better machine make a difference or does it just make a difference in terms of information?

Thanks again for the help.
shelbyo@hotmail.com

Wulfman · Post by **Wulfman** » Thu Oct 05, 2006 1:39 pm

solejean,

This is YOUR therapy.....so if you want it to be better, you'll have to be the one to get involved with it.

Can you please give us a list of what you have? Make, model, pressure, etc.

Maybe we can give you some more thoughts after that. Make sure you're not "mouth-leaking"......that's a BIG reason for the user's therapy not working properly.

Best wishes,

Den

Alisha · Post by **Alisha** » Thu Oct 05, 2006 2:18 pm

Snoredog wrote: "The only thing I can gather is you are using a nasal interface, you may be losing treatment through mouthbreathing. If you mouthbreath, you can't maintain the pressure to keep your airway open, that maybe what the O2 destats are trying to tell you.

Without a machine that captures full data, and the software to read it, you are flying blind, like the majority of users, Except for the members here, a large portion of us, take full control of our treatment. Jim"

Jim, please correct me if I interpret what you mean by" take full control of our treatment" incorrectly.

Guest, I believe the only way to take full control of my treatment is to use an auto-titrating machine (I'm changing to REMstar M Auto w/smart card and software). The auto adjusts pressure to what is needed with each apnea event as opposed to the cpap which stays at one (same) pressure whether or not you're having an apnea.

The smart card and especially the software will tell me how much mask leakage I had, how many apneas/hypopneas I had, what my oxygen levels were during night, what pressures were needed to control these events, etc. This info will help me and my doctor to know what and if changes should be made, e.g., pressure changes, mask changes (as Jim said, you may need a full face mask), etc.

Another thing which is important to me is the exhale feature called c-flex which the REMstar has. It automatically lowers the pressure when exhaling, making it easier to exhale.

I hope this helps you understand why we believe taking control of our treatment is the best way to start feeling better. I hope you will soon be able to stop nodding off while doing your job.

To everyone: Please correct and/or better explain anything I've written. I am just now trying to learn how to take control of my treatment and need to know if I'm misunderstanding something.

Wulfman · Post by **Wulfman** » Thu Oct 05, 2006 2:43 pm

Alisha,

An "auto" is not the ONLY machine you can use to monitor and tweak your therapy in the Respironics line.
The ones that give detailed sleep data are:
The REMstar Pro 2
The REMstar Auto
The REMstar M Series Pro
The REMstar M Series Auto

They all have the C-Flex option.
As long as you have one of these machines and Encore Pro and the card reader, you can do an excellent job of monitoring your therapy.

Best wishes,

Den

ozij · Post by **ozij** » Thu Oct 05, 2006 2:55 pm

Look at it this way:
You can get a machine - certainly not the cheapest machine - with the capability to record your nightly breathing events. The recording isn't perfect - but it's pretty good.

You can use this machine to discover at which pressure you have the smallest number of apneas, hypopneas, snores etc. and also, when and how much you're leaking. Air leaks that is. Some machines report some of that data on a small window on top of the machine.

If you buy the software with your machine, you'll also be able read pretty neat reports of all that recorded data, and use them to make decisions about the best pressure for you. And if you're a geek, you can sometims export your data to csv files, import that into a spreashee (drool...) and observe for long time trends, statistic, calculations, pie charts - the works.

Until recently, the only machines that did all that were autoadjusting machines, machines that in addition to all the recording, also change the pressure, based on your breathing events.

Now: Some poeple get better treatment with self adjusting machines, and some don't. Self adjusting machines can be set up to work at a constant pressure. Those that are not self-adjusting can't be set to become self adjusting.

So....
You will most probably find your way to the best treatment for you by buying a self adjusting machine (known hereabouts as APAP (from automatic)) with the proper software, and following your own treatment. You might end up using it on auto mode, you might end up using it on straitht. Shoud that be too expensive, the other alternative is a simple (or straight) CPAP, with recording capabilities.

Caveat: Some people - a minority, but myself included - can stand one kind of automatic machine, and not the other. That's because of the different way the machines are programmed to a. identify breathing disruptions b. react to them. Most people do fine on any machine - and I can't tell you who does better with which - I don't know.

O.

Somnambulist · Post by **Somnambulist** » Thu Oct 05, 2006 5:15 pm

I think Wulfman raises an important point... Are you getting enough sleep?

I know that sometimes lawyers work long hours. Are you working long days? In my case, I am sometimes forced to work unexpected overtime, (I'm a Peace Officer). When this happens, it definitely has a negative effect on how I feel for the next several days, (see this link). I'm hoping that the new BiPAP Auto that I just purchased, (and the software that I intend to purchase), will help some in this particular area.

Something else to be considered is whether or not you are practicing good "sleep hygiene", (see this link).

Consider these things along with the suggestions made in previous, (and following), posts in this thread. The people on this board know their stuff and I know that they'll eagerly help you as best they can.

Pleasant dreams!

solejean · Post by **solejean** » Fri Oct 06, 2006 11:51 am

Thanks everyone for the good info! I have the following equipment:

RemStar (couldn't figure out anything else) and it's very basic.
Passover Humidifier
mirage swift nasal pillows
My pressure was at 8 until Tuesday.

I saw my RT on Tuesday and even though my oximeter results were normal she upped my pressure to 10 when I told her I'm still tired.

Also I have done my best to get 8 hours of sleep this week. It's hard because I get home late and by the time I go on my nightly walk and eat dinner it's nearly time to go to sleep. But I have seen an improvement today and yesterday - especially today. Not sure if it's the pressure, the new mask or the better sleep habits. Heck maybe it's a combination of all three.

I appreciate all the helpful information and I will be talking with my doctor about getting a better machine so I can monitor my sleep better.

Hopefully this positive trend continues.

Thanks again everyone...

Wulfman · Post by **Wulfman** » Fri Oct 06, 2006 12:15 pm

Congratulations! Sometimes it's a combination.....but as long as it works.....

Please keep us informed as to how your therapy is doing.

Best wishes,

Den

snoregirl · Post by **snoregirl** » Fri Oct 06, 2006 12:58 pm

I have to add my two cents to the "enough sleep" issue.

I know that issue very well. This past summer I was getting 7-8 hours with my APAP. After that time I would just wake up and think, well I might as well get up because I can tell I am done sleeping.

This fall when the kids started back to school and I have to get up at 6am and can't herd them to bed sometimes before midnight (teenagers) I feel a bit worse. I am sure it is not the failure of the APAP, but the fact that I need just one hour more to sleep, which on a lot of weekdays I just don't get.

So I have to second the comments about making sure you give yourself enough time to sleep since the CPAP can't do it all if it is not on long enough.

Wulfman · Post by **Wulfman** » Fri Oct 06, 2006 1:12 pm

And do whatever it takes to keep from mouth-leaking with those nasal masks, too. If you're losing therapy out of your mouth, you're still going to be tired.

Den

Snoredog · Post by **Snoredog** » Fri Oct 06, 2006 2:34 pm

[quote="Alisha"]Snoredog wrote: "The only thing I can gather is you are using a nasal interface, you may be losing treatment through mouthbreathing. If you mouthbreath, you can't maintain the pressure to keep your airway open, that maybe what the O2 destats are trying to tell you.

Without a machine that captures full data, and the software to read it, you are flying blind, like the majority of users, Except for the members here, a large portion of us, take full control of our treatment. Jim"

Jim, please correct me if I interpret what you mean by" take full control of our treatment" incorrectly.

Guest, I believe the only way to take full control of my treatment is to use an auto-titrating machine (I'm changing to REMstar M Auto w/smart card and software). The auto adjusts pressure to what is needed with each apnea event as opposed to the cpap which stays at one (same) pressure whether or not you're having an apnea.

The smart card and especially the software will tell me how much mask leakage I had, how many apneas/hypopneas I had, what my oxygen levels were during night, what pressures were needed to control these events, etc. This info will help me and my doctor to know what and if changes should be made, e.g., pressure changes, mask changes (as Jim said, you may need a full face mask), etc.

Another thing which is important to me is the exhale feature called c-flex which the REMstar has. It automatically lowers the pressure when exhaling, making it easier to exhale.

I hope this helps you understand why we believe taking control of our treatment is the best way to start feeling better. I hope you will soon be able to stop nodding off while doing your job.

To everyone: Please correct and/or better explain anything I've written. I am just now trying to learn how to take control of my treatment and need to know if I'm misunderstanding something.

Still tired

Still tired

Thanks

Lots of good Ino