Persistent fatigue

Barios · Post by **Barios** » Sun Jul 09, 2023 12:16 pm

I am currently seeing my doctor every two weeks for regular blood tests, and I will discuss this kind of condition with them.

In my case, what would be the concrete effect of using EPR ?

The problem is that in France, we cannot freely modify our machines because they are provided to us for free, and it's the doctor who decides to change the pressure. I will have to do it discreetly and reset the pressure to the default setting every time I wake up. Why doesn't a specialized doctor in this field show concern about the graphs I have, especially regarding obstruction and respiratory instability, when I tell them that it makes me even more fatigued?

Miss Emerita · Post by **Miss Emerita** » Sun Jul 09, 2023 12:29 pm

Here are some of the tests you might want to make sure you've had: tests for B-12 deficiency and anemia, and tests for low thyroid, B-6 deficiency, Lyme disease, autoimmune disease (especially in the connective-tissue disease family), and low testosterone (if you are a man).

What would happen if your doctor learned you are changing your settings yourself? And how does changing the settings back every morning help you avoid detection? In your place, I'd just change the settings and see whether the doctor had anything to say about it. It's sometimes better to ask for forgiveness than for permission.

Flow limitations are limitations short of obstruction somewhere in your airway. If the FLs are in your nose, no changes to your settings will help. Instead you need to address the nasal problem independently. But many FLs are in the pharynx, where the tissues lining the airway sag a little and prevent you from inhaling easily. EPR drops your pressure by some amount when you exhale. By the same token, it raises your pressure when you inhale. If your flow limitations originate in your pharynx, that little pressure boost can support smoother inhalation.

Barios · Post by **Barios** » Sun Jul 09, 2023 12:51 pm

EPR seems like a good idea, and I would like to try this feature on my machine. I have levels 1 and 2 available. Which one do you recommend?

Barios · Post by **Barios** » Mon Jul 10, 2023 3:04 am

I'm getting back to you after my night with a pressure of 7-12 and an EPR of 2/2 (my machine doesn't allow adjustment up to 3). It's hard to say, but I feel like I woke up less frequently than usual, and the moment of respiratory instability coincided with my partner waking up to go to work.

Additionally, I noticed a feature on my machine that I had never seen before, and it caught my attention. I can modify the APAP control option from "Standard" to "Dynamic." Do you know what that means?

https://imgur.com/EBhXgn0
https://imgur.com/DaRaWFu

ozij · Post by **ozij** » Mon Jul 10, 2023 5:29 am

ozij wrote: ↑
Sun Jul 09, 2023 9:56 am

When you make changes, make only one at a time. and stick to the new setting for a week or so -- unless the results are catastrophic.

Barios wrote: ↑
Mon Jul 10, 2023 3:04 am
I'm getting back to you after my night with a pressure of 7-12 and an EPR of 2/2

So now you made two changes at once, and you don't know which of them affected your sleep more....

One big change in your sleep results: you have more (far more) snores/ RERA's last night than you did on the other nights you uploaded.

As for hiding what you do from your doctor - that's absurd.

When I spoke of a sleep lab I referred to having a PolySomnoGraphy in which you resopnse to different pressures is checked by professionals.

https://news.cnrs.fr/polysomnography

Barios · Post by **Barios** » Mon Jul 10, 2023 5:43 am

Sorry, I was excited to try EPR. What do you recommend, should I stick with 7-12 or try EPR?

By the way, I asked ChatGPT what "Dynamic APAP" means, and here's the response:

Dynamic APAP mode: In this mode, the CPAP machine adjusts the treatment pressure in a more responsive and dynamic way based on instant changes in your breathing needs. The pressure is adjusted in real-time based on signals detected by the machine, such as obstructions or restrictions in the airways. This allows for a more precise and personalized adaptation of pressure according to your breathing throughout the night.

In your opinion, is it something worth trying? I'm wondering if it's the feature you described in ResMed machines that I don't have in mine.

Regarding the Polysomnography, I did another one a few days ago with my machine, just to see if the doctor identifies any issues. However, I only used my regular settings for the night; I didn't try any other options.

ozij · Post by **ozij** » Mon Jul 10, 2023 6:00 am

Barios wrote: ↑
Mon Jul 10, 2023 5:43 am
Regarding the Polysomnography, I did another one a few days ago with my machine, just to see if the doctor identifies any issues. However, I only used my regular settings for the night; I didn't try any other options.

During a PolySomnoGram you are connected to many monitoring devices and a professional changes your pressures and observes your responses on those various mode (your breathing, your EEG, your oxygen saturations, your eye movements, your leg movements.
That is not what you had.

Barios wrote: ↑
Mon Jul 10, 2023 5:43 am
Sorry, I was excited to try EPR. What do you recommend, should I stick with 7-12 or try EPR?

If I had all that additional snoring, I'd suspect the EPR was making my exhale pressure too low and I'd cancel it.

ChatGPT did not explain what we want to know: how is "Dynamic" on a Sigma machine different from Standard.

I don't know the Sigman machines.

Barios · Post by **Barios** » Mon Jul 10, 2023 8:39 am

Alright, I'll remove the EPR. Do you think it would be worth trying the dynamic mode just for tonight? It seems to be a more precise and effective mode, so why not give it a try?

ozij · Post by **ozij** » Mon Jul 10, 2023 10:34 am

Barios wrote: ↑
Mon Jul 10, 2023 8:39 am
Alright, I'll remove the EPR. Do you think it would be worth trying the dynamic mode just for tonight? It seems to be a more precise and effective mode, so why not give it a try?

Why not give it a try? Because, once again you'll be adding a new variable.

You have to stick to one change for a number of days in order to see what it does.

Barios · Post by **Barios** » Tue Jul 11, 2023 4:08 am

I'm getting back to you. I did set my pressure to 7-12, but there's something I don't understand from the graphs. Sometimes, I see a peak in the obstruction rate, but my machine doesn't seem to address it. Is this normal in your opinion?

On the polysomnography I had done to check for sleep apnea, it showed an AHI of 35.4 per hour, RDI of 24.4 per hour, and snoring rate of 159.1 per hour, with 33 obstructive apneas and notably 206 hypopneas. I feel like it's the hypopneas that are causing my fatigue due to their significant number, as indicated by the obstruction rate, which may not be fully addressed.

https://imgur.com/1RmD4Sy

ozij · Post by **ozij** » Tue Jul 11, 2023 7:23 am

Barios wrote: ↑
Tue Jul 11, 2023 4:08 am
I'm getting back to you. I did set my pressure to 7-12, but there's something I don't understand from the graphs. Sometimes, I see a peak in the obstruction rate, but my machine doesn't seem to address it. Is this normal in your opinion?

Somebody has to try to google for info specifically about Sigma machines: what their data means, what kinds of algorithm's (rules of interpretation and response) they have.

I see one peak unaccompanied by a change in pressure, but that's when the machine flags central apnea (in blue, a bit after 3:00). A a rule machines are not supposed to raise pressure when encountering a central (i.e. non-obstructive) apnea.

One thing is (relatively) clear: One night of EPR caused more snores, one night without EPR: less snoring.
Are you keeping a long? How do you feel after this night?

If those "obstructions" are (so to speak) "baby hypopneas" then raising the minimum a bit more (in a few days) could help.

Trouble is, we don't know what Sigma means in the "obstructions" chart.

ozij · Post by **ozij** » Tue Jul 11, 2023 7:23 am

ozij wrote: ↑
Tue Jul 11, 2023 7:23 am

Barios wrote: ↑
Tue Jul 11, 2023 4:08 am
I'm getting back to you. I did set my pressure to 7-12, but there's something I don't understand from the graphs. Sometimes, I see a peak in the obstruction rate, but my machine doesn't seem to address it. Is this normal in your opinion?
Somebody has to try to google for info specifically about Sigma machines: what their data means, what kinds of algorithm's (rules of interpretation and response) they have.

I see one peak unaccompanied by a change in pressure, but that's when the machine flags central apnea (in blue, a bit after 3:00). A a rule machines are not supposed to raise pressure when encountering a central (i.e. non-obstructive) apnea.

One thing is (relatively) clear: One night of EPR caused more snores, one night without EPR: less snoring.
Are you keeping a log? How do you feel after this night?

If those "obstructions" are (so to speak) "baby hypopneas" then raising the minimum a bit more (in a few days) could help.

Trouble is, we don't know what Sigma means in the "obstructions" chart.

Barios · Post by **Barios** » Tue Jul 11, 2023 7:40 am

I'm still tired after that night, I don't see any improvement, I don't understand what you're not saying about the CA, the machine reacts well, is that it?

I am treated on another forum in parallel and someone tells me that it could be Intermittent Hypoxia 24/7, to use an o2ring that it would not come from my machine but to check my lungs and my hearts do you think it's relevant?

Barios · Post by **Barios** » Tue Jul 11, 2023 8:48 am

I may have found what you were looking for to understand how the machine works - it's dedicated to SOFT & SMART machines. My machine is the smart MAX, and here's what it says on the manufacturer's website

"As for the max variants, they integrate Bluetooth connectivity and provide full connectivity to prisma CLOUD's telemedicine functionalities thanks to its integrated modem."

So I think it works with my machine too. Here's the link

https://www.docdroid.net/LPC2YQl/prisma ... glish-pptx

Miss Emerita · Post by **Miss Emerita** » Tue Jul 11, 2023 11:52 am

Barios wrote: ↑
Tue Jul 11, 2023 7:40 am
I'm still tired after that night, I don't see any improvement, I don't understand what you're not saying about the CA, the machine reacts well, is that it?

I am treated on another forum in parallel and someone tells me that it could be Intermittent Hypoxia 24/7, to use an o2ring that it would not come from my machine but to check my lungs and my hearts do you think it's relevant?

I looked at your thread on Apnea Board Forum. I have no idea why that one forum member speculated that you are experiencing hypoxia, and when you asked why, he didn't explain. I have zero confidence in that piece of speculation.

Hypoxia is a low level of oxygen in your body's tissues. An O2 monitor measures the O2 levels in your blood, not in your body's tissues. An O2 monitor could provide data suggestive of hypoxemia, which is low levels of O2 in your blood. There's no harm in using one, but there's no reason in your sleep report to think you need to. During your sleep study, you experienced frequent desaturations (drops in saturation levels), as would be expected from your various apnea events, but your O2 sats (blood levels of O2) were fine, with a median of 96 and only one brief drop below 90.

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