still looking for relief -- next steps?

[awakeinnj]

Hi, everyone. I've been on CPAP since the beginning of the year and I'm hardly feeling better with it. Other dr's have been eliminating the other possibilities for my main problems (fatigue, unrestful sleep, headaches), one by one. The pulmonologist I visit seems to think the CPAP therapy is working as it should, and doesn't seem to think there are any other (sleep-related) problems. I'm not exactly sure what he's looking at, except that he's confirmed what I already know from Sleepyhead (I'm compliant, and my [overall] AHI and leak figures are OK at the currently-prescribed pressure).

Can anyone suggest other things to pursue? (other ways of looking at sleepyhead statistics, add'l questions for the doctor, a second opinion?) I'm really frustrated at this point, but am not sure what to do next. Any advice would be greatly appreciated.

Thanks.

[Pugsy]

Some past history in this thread.
viewtopic.php?f=1&t=99973&p=930688#p930688
usual meds questions and all that.

I assume you are still taking the Cymbalta...it may be a factor in making your fatigue worse...it may also not be a factor.

Fatigue is a tough one because so many things can be a contributing factor and often there's no one single factor that is 100% to blame. Not all fatigue is solely related to sleep apnea and the machine can't fix problems unrelated to sleep apnea.
Wish it were that simple but unfortunately it isn't.
When was the last time you had a complete physical with the standard labs?
Have you ever had vitamin D levels checked?
Hormone levels....like thryoid and testoserone?

Headaches...another tough one. So many different potential culprits.
Cpap straps could be a factor.
Cervical spine issues could be a factor...this one I have personal experience with.
Bed pillow could be a factor.
Do your headaches fade away a couple of hours after awakening or are you stuck with them all day?
Do you get them every day or just some days?
Any of your meds have headaches as a potential side effect?

Not all our questions can be answered by looking in the software reports unfortunately.
You might post a more current detailed report again to see if anything stands out that might be improved upon.

[Finnc]

I would definitely have your thyroid checked. My main issue right now is I feel like I am getting better sleep overall but I am still so exhausted its crazy. But my thyroid labs are all over the place. I get them checked every 6 weeks for the last two years and swing from hypo to hyper but never level. It has been awful.

[awakeinnj]

Hi. Sorry I left this thread dangling all this time. I guess I got sidetracked after posting and then forgot about it. It's been an interesting few months, and I wanted to follow up for anyone having similar issues searching back to this, trying to decide what to do next...

- CPAP therapy -- no change.
Still to do: I'd like to get a full reading of pulse Ox. overnight, but not looking to spend a lot to do so.

- Cymbalta - hard to say whether it's contributing to the problem since I started both CPAP and Cymbalta at about the same time. The fatigue had been persistent for a long time prior, though - which could well be a combination of the physical and mental.

- Lots of relevant labs that are within the normal range but not ideal - Vit. D, B12; iron; thyroid; testosterone; adrenals. Visited an endocrinologist and am on a trial of levothyroxine -- MIGHT be helping so I'm going to continue with it for another few months. Taking Men's 1-a-day. Testosterone/adrenals -- unlike thyroid, hormone supplements not prescribed by Dr - harder to get off and more serious effects.

- Headaches - visited neurologist. Ruled out brain tumor via an MRI. Diagnosis: intractable migraines. The headaches went from taking hours to get over to days. Frequency was that I had a headache more often than not. Am on medication now and when they do happen, things tend to get better within a day again. Still worst in the morning; only sometimes can I "sleep them off".
- Also visited an allergist. Turns out that I tested positive for quite a few things I wasn't expecting. Could be that I began improving just recently since most things are dormant now. At least I did learn about the NeilMed nasal rinse products for when I wake up stuffy (stuffiness certainly wasn't helping the headaches -- not a pleasant solution but certainly helpful). Raising the humidity level on the CPAP machine has helped with the stuffiness also.
Still to do: Test for dust mites and mold in house.

- Lifestyle improvements: Being more regimented about taking acid reflux medicine and sleep hygiene (attempting to sleep the appropriate hours for the appropriate number of hours). Having my wife help me fight harder to get out of bed (things tend to get better after I shower and start living my day; getting started is sometimes REALLY difficult).


Things started coming together for me about two months ago. Since I had no time to experiment with one change at a time, I have no idea what's really working. But I don't care right now; I'm able to work with regularity again and that's what's currently most important to me. I will post again shortly under this thread with more recent Sleepyhead screenshots from a typical night.

[awakeinnj]

Here are the screenshots I had uploaded not long after starting this thread. Nothing significant has changed, CPAP-wise, since then. There were already uploads of a typical night -- here are overall results that I'm not sure contain anything useful:

http://s1265.photobucket.com/user/awake ... 7.png.html
http://s1265.photobucket.com/user/awake ... 4.png.html
http://s1265.photobucket.com/user/awake ... 1.png.html

Qualitative/misc. notes from my log:
- noticed that I sleep better with my neck straightened. new / repositioned pillows help --is it worth trying to but the mattress on a slant or even get a firmer mattress?
- breathing waves (frequency, amplitude, shape) normal?
- sleep study proved that sleeping on back is worst; sleeping on side, in a fetal position, makes my midsection seem crunched and it's more difficult to breathe; continue sleeping on stomach
- how to know if exhalation port is releasing enough air or blocked?

Thanks for any info.