Persistent fatigue, CA

[elikrohner]

Hi,
I have been using the ResMed AirSense 11 AutoSet in APAP mode since early 2024.
Despite acceptable AHI values (<5), I still have persistent fatigue. The machine consistently reports Central Apnea @ 3 AHI with obstructive apnea near zero. I was wondering if treatment- emergent central apnea below 5 AHI is clinically significant when accompanied with symptoms of severe fatigue and what can be done about it. My doctor told me that when it's below 5 AHI ASV is not indicated. See attached for my data.[url][url][/url][/url]

[Pugsy]

Do you take any medications of any kind? If so, what?

Are you sleeping soundly or waking often during the night?

Do you have any physical or mental health issues going on besides the apnea?

Are those leaks waking you?

Have you had a chat with your doctor about your continued fatigue?

Please review this thread and redo you image so that it looks like the examples.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

[elikrohner]

Migraine meds: Ajovy, Propranolol 10 mg, Magnesium 400 mg supplements
Pravastatin 40 mg
Omeprazole 20 mg

I sleep pretty much ok (7 hours). I wake up once a night or a little more when there are significant leaks.

The only significant issue is GERD but it is managed with meds.

Spoke with doctor about fatigue, said 30% of people with good CPAP adherence will still have fatigue.

I am not able to access the website imgur.com due to my filter settings. See link below:
https://sleephq.com/public/teams/share_ ... a9b1e544db

Thanks

[Pugsy]

Short on time at the moment but I did a quick scan through the SleepHQ report and the majority of the centrals/CAs are arousal related and you weren't asleep when they got flagged...so they aren't real asleep centrals.
Instead they are caused by irregular arousal/awake/semi awake breathing and the centrals are a by product of the awakenings.
You aren't sleeping as soundly as you think even if you don't remember a lot of awakenings.
The poor sleep quality is the culprit causing the central flagging but we have no idea what might be causing the arousals.
The machine can't measure sleep....it only measures air flow or our breathing. Irregular arousal/awake breathing will fool the machine when it spots pauses in breathing that it thinks are centrals.

And yes...your doctor is correct in that a substantial number of people who start cpap will still experience fatigue (and/or crappy sleep) for any number of reasons.
Medication side effects is one of those reasons but it isn't the only reason. Sometimes we can't figure out a reason and to fix a problem we really need to know the cause of the problem.

More later when I have a bit more time.

[elikrohner]

Thank you for your help with this! I was not sure how much data can be seen with my link that I sent. How did you determine that the CA flagged events are a result of arousals? Were you able to view data from a wide sample or are you only able to see data from a specific day?

[Pugsy]

I can zoom in on the flow rate using SleepHQ and see each individual breath.
Using OSCAR you have to do the zooming in and then you have to grab a screen shot and load it into Imgur and then post the link. Obviously SleepHQ is easier for both of us.

Again short on time but asleep breathing is nice and regular with no blips, bumps or ragged stuff.

Imgur has screwed up their website "improving" it...so I can't access my normal stash of educational images.
Go here
viewtopic.php?f=1&t=187767&p=1451526#p1451526

I got other examples but I have to leave and go pick up hubby and no time to go hunting them at the moment.

Learning to figure out asleep vs awake/arousal breathing takes a bit of experience and time.

But here's one from your report

sleephqawake.JPG (81.5 KiB) Viewed 4326 times

Prior to 03:43:40 You were asleep...see the nice regular boring breathing?
After that you had a major arousal of some sort arousal until at least 03:52 (don't have after that time frame yet) and none of those flagged centrals are real and they don't mean much except you weren't sound asleep.
Basically anytime you see a blip or spike (even if tiny) it means you weren't sound asleep.

Gotta go....more later.

[Pugsy]

Quick example of "real asleep Centrals"....not from your report
https://imgur.com/a/qx7nPFs


https://imgur.com/jc0SJ2G

Frigging imgur.......I don't have time to fix it right now.

Scroll down a little bit for the image on the links above.

[elikrohner]

Thank you!

[elikrohner]

Pugsy,
Can you please take a look at my most recent data (past few days). I switched to a better mask that leaks less but I am still experiencing the persistent fatigue. Can you see if I am still experiencing a lot of arousals? What else can be causing arousals? Or perhaps I have some other cause for the fatigue like minor flow limitations not being flagged by the machine?
https://sleephq.com/public/teams/share_ ... e718dbdddc

[Pugsy]

Can you see if I am still experiencing a lot of arousals?

Sorry......for some reason your flow rate (breathing) isn't showing up and I need to see individual breaths to try to spot asleep breathing vs arousal/awake breathing. Probably are though. I don't know why they aren't showing up but it isn't there.
Impossible for me to even hazard a guess without being able to zoom in on the breaths.

What else can be causing arousals?

The list is a mile long and sleep apnea events of some sort are only a very small part of that list.

Or perhaps I have some other cause for the fatigue like minor flow limitations not being flagged by the machine?

You are wanting all your problems to be from the sleep apnea stuff and then you want the machine to fix them.
Sorry doesn't work that way.

Want to know what causes fatigue? Google "what can cause fatigue"
want to know what can cause arousals? Google "what causes arousals from sleep"

Why such a tight pressure range??? I am okay with restricted range with a good reason but your settings are WAY tight.
Minimum pressure 5.6
Maximum pressure 7.8
EPR set to 1

Hell even if your machine wanted to go killing something you sure haven't given it much ammunition.

[Nocibur]

There's flow data up until July 2. Wonder if OP is pulling card out before file is completely written.

[Nocibur]

Can you see if I am still experiencing a lot of arousals?

Speaking of July 2, looks more to me (using The Sleep Parameter That We Made Up Because That's All We Got) that half the night isn't even something that one would call sleep.

[Pugsy]

There's flow data up until July 2. Wonder if OP is pulling card out before file is completely written.

Yeah I wondered about that but we do have leak and pressure graphs on the 7th.....and I didn't think we would have those graphs if the SD card got yanked too soon or wasn't left in all night.

[elikrohner]

Please look at this night for some data:https://sleephq.com/public/27ce816d-054 ... 57d1715368
I started with the new mask around the last week of June There should be a couple of nights sometime from 6/ 21-7/8 where the data came through.
https://sleephq.com/public/teams/share_ ... 288d622c58

[elikrohner]

I changed the range to be tighter because I thought the lower max range would help for pressure related arousals. My average pressure is usually: 6.4–6.6

95% pressure: 7.2–7.4