much more fatigued w/CPAP, just prescribed Nuvigil

[Toff]

I've been using a CPAP for about 1 1/2 months, and have grown more and more fatigued. A review of the performance shows it has reduced the number of times I stop breathing to a normal level. But now I feel on the verge of falling asleep almost all day long, and it wasn't that bad before. I sometimes have to take naps of 1-3 hours, and even then, no better.

Tough to say if this is necessarily sleep apnea-related, although since it got worse after starting the CPAP, it seems so. I may have polycythemia, for which I'm getting further testing in November. I also have depression, although it is not especially bad at the moment, relatively. And while I do tend to sleep excessively when my depression is bad, it wasn't usually the case with it that I actually feel like I am about to fall asleep or that I absolutely need to go to sleep, that I recall. With the depression, I just want to and am able to, I think.

My Ear, Nose & Throat doctor faxed a prescription for Nuvigil to my pharmacy, although they wouldn't fill it yet because they need a "wet signature" they said. Sounds like it might be helpful, although the side effects are a bit alarming. Provigil sounds possibly better, I'm not sure why he picked the one he did (other than having coupons on hand for it). I have to call back regarding getting a prescription resent that they can fill, so I guess I can ask. I may wait and ask my psychiatrist before starting what she thinks about it or other options, though she hadn't suggested anything last time I saw her despite my reporting this problem. It was her who originally suggested a sleep study.

[Julie]

Hi, with no idea of what equipment you have, it's hard to advise. Go to your member page, click on Profile and fill in some blanks (with text please though, not icons). You could be mouth breathing while sleeping, and need a full face mask instead of a nasal one, or a lot of other things could be going on, so help us help you. And welcome to the forum.

[dkdc]

I tried provigil - worked ok for 2 weeks then I got really tired. I still have the rest of the bottle on my shelf! Could have been some other cause, and your mileage may vary.

[Toff]

Machine: M Series Pro C-Flex CPAP Machine
Mask: Mirage Quattro Full Face CPAP Mask with Headgear

[Guest]

NUVIGIL IS EVIL. I have been on it for three weeks and am stopping because it is making me extremely irritable!! I also drank caffeine on top of it and was just told that using them both is a definite no-no.....I am going to try NOT using it tomorrow and see what transpires.....just my thoughts...

[SuperGeeky]

Hey Toff: I guess several months into my BiPap Therapy came to realization it wasn't about getting better sleep. It's about protecting your heart and brain. If you get a good night sleep and your cells feel rested, that's gravy

Excessive Daytime Sleepiness (EDS) was and remains tricky to me. When I get run down, I don't seem to be aware of it. I'm in fatigued/depressed stupor.

Now on, if I remember, just quickly take the Ellsworth Sleepiness Scale Test. You'll probably remember it from your Doctor and/or Sleep Study. It's a good indicator when you need to call the Doctor or simply start getting more rest.

Having a CPAP Mask on your face is not natural. Probably already stressed out from sleep deprivation, strangled in your sleep every moment or so... Gee, why can't you sleep??

At one point, I could take 300 MG of Provigil, wash it down with lot's of Mountain Dew and then go straight to bed and sleep. It's a very subjective dosage that needs to be taken with common sense. Real simple! Are you tired and can you concentrate to drive and do your job?

Squeaky wheel get's the most oil!! I have to remind myself I'm not feeling well, call the Doctor or Nurse... I'm amazed at what I'm willing to put up with as far as pain, being tired and run down is concerned. I'll drag on for months when a phone call would have solved all the frustration and pain...


Good luck,

SG

[nobody]

Polycythemia can make you feel very tired (and depressed) but it should be easy to solve by taking some blood out. I tried provigil before and it kept me up for almost 2 days so I stopped it. It also took me a while to get my CPAP to a good pressure for me and then get used to it and caught up on my sleep. By "a while", I mean over a year before I really started feeling better. Oh and Provigil and Nuvigil are the same thing (perhaps a molecule or two changed but makes no difference in how it affects you), the company that makes it is just losing patent on provigil and they need to keep raking in those excessive profits.

I've been using a CPAP for about 1 1/2 months, and have grown more and more fatigued. A review of the performance shows it has reduced the number of times I stop breathing to a normal level. But now I feel on the verge of falling asleep almost all day long, and it wasn't that bad before. I sometimes have to take naps of 1-3 hours, and even then, no better.

Tough to say if this is necessarily sleep apnea-related, although since it got worse after starting the CPAP, it seems so. I may have polycythemia, for which I'm getting further testing in November. I also have depression, although it is not especially bad at the moment, relatively. And while I do tend to sleep excessively when my depression is bad, it wasn't usually the case with it that I actually feel like I am about to fall asleep or that I absolutely need to go to sleep, that I recall. With the depression, I just want to and am able to, I think.

My Ear, Nose & Throat doctor faxed a prescription for Nuvigil to my pharmacy, although they wouldn't fill it yet because they need a "wet signature" they said. Sounds like it might be helpful, although the side effects are a bit alarming. Provigil sounds possibly better, I'm not sure why he picked the one he did (other than having coupons on hand for it). I have to call back regarding getting a prescription resent that they can fill, so I guess I can ask. I may wait and ask my psychiatrist before starting what she thinks about it or other options, though she hadn't suggested anything last time I saw her despite my reporting this problem. It was her who originally suggested a sleep study.

[dkdc]

nice picture, nobody

[nobody]

nice picture, nobody

Thanks, that's supposed to be me when I tape my mouth at night and the air fills up my cheeks

[Toff]

I guess I should clarify again, I have no trouble sleeping with the CPAP on at night, and did not have any trouble sleeping before. I could and still can very easily sleep 8 hours or more, waking up relatively few times for a short period of time.

While I was fatigued before, I am really much more so now, constantly feeling like I'd like to go to bed and sometimes feeling on the verge of just dropping off to sleep whether I'm in my car or at school, or whatever. Not good. Often sleeping more like 12 hours now.

Won't know more about the polycythemia possibility until Nov 19, when I get more tests done. Not sure what other possibilities there could be to explain the excess of and small size of red blood cells.

[Toff]

Started taking it this morning. No immediate effects or side-effects that I've noticed. I wonder how long it takes to become active.

[Muse-Inc]

...could and still can very easily sleep 8 hours or more, waking up relatively few times for a short period of time...

When I started getting restful sleep, I often slept 9+ hrs off and on for the first several months before leveling out at 8 hrs. Occasionally, I sleep an extra long night, seldom a short one. Are you allowing enough time each night for sleep?

...Often sleeping more like 12 hours now

Seems excessive but how long have you gone without restful sleep?

...polycythemia...excess of and small size of red blood cells.

I have still above lab range RBC...likely due to the oxygen deprivations from my nightly events, but not so high that it's worrisome to my docs as it is better than it has been. Think my body is trying to take advantage of all the available oxygen by increasing the transport system that delivers O2 to cells -- I understand this condition is characteristic of those who live at altitude. We know from this study that the oxygen deprivation at certain altitudes mimics that of apnea:
http://eon.businesswire.com/portal/site ... ewsLang=en

From Wikopedia: http://en.wikipedia.org/wiki/Polycythemia

Secondary polycythemia is caused by either natural or artificial increases in the production of erythropoietin, hence an increased production of erythrocytes. In secondary polycythemia, there may be 6 to 8 million and occasionally 9 million erythrocytes per cubic millimeter (microliter) of blood. Secondary polycythemia resolves when the underlying cause is treated.

Secondary polycythemia in which the production of erythropoietin increases appropriately is called physiologic polycythemia. This physiologic (meaning normal) polycythemia is a normal adaptation to living at high altitudes (see altitude sickness)...Other causes of secondary polycythemia include...hypoxia...

I hope you find a successful simple resolution.

[mikee]

Per my DR. a small percentage of us with even "treated" OSA will still experiance EDS. I am in that small percentage I was also put on nuvigil and after one week I could not take it any longer. I crashed really bad after 4-5 hours and had bad headaches. Now we are trying Ritalin 10mg 2 x day. The problem with ritalin is it can play havoc with your BP/pulse and i'm already on BP meds. I monitor my BP/pulse every hour and we are hoping my body will adjust to this med, I hope it does because I can now stay awake thru the day at work. Good Luck

[Toff]

Thanks, we'll see!

I'm on the fourth day I think, yesterday my brain felt a bit fiery or something, and at the end of the day I had a headache, not terrible though. I had had a short night of sleep, and I'd had two servings of caffeine so I'm not sure if it was the med. I think perhaps I was not as fatigued during the day. Avoiding caffeine today to see if that makes a difference. Brain feels a little weird still though.

[SuperGeeky]

I'm a 'stay at home' dad, which gives me a lot of flexibility. I perform when needed, but I'm not working a traditional 9-5 job. I only have a seven year old to look after.

After talking to the Sleep Nurse about Provigil and other medications, I decided to ween myself off of ALL medications and only drink a mug of coffee early in the morning. My new titration is working better than expected and suspecting some medications worsened the Apnea.

Furthermore, if I feel sleepy during the day and my son is at school, it's off to bed I go. For the most part, I'm caught up and EDS has subsided. I'll feel fatigued in the afternoon, but so do most folks my age and older.

I think when your body says 'sleep', then go to bed if you can. I'm just getting over the flu, probably H1N1 and can't wait to get up and just completely feel great!! I hope that day comes soon

What I never can get over, how much time it takes to heal from this disease. Unfortunately, our Society doesn't give this disease it's due and not much toleration for nursing fatigue and sleeping frequently.


Take care,

SG