Excessive Daytime Somnolence - Help, please!

[Oldern]

Excessive Daytime Somnolence - Need your advice.

Monday night, I meet with my doctor, a Neurologist, who has been involved with my sleep studies from 1993. The DME, a RT, and a representative from ResMed is expected to be there. (Not just for me-they have other fish to fry as well. Extensive studies in 1993 were inconclusive. Basically, I went untreated until a second go around in 2010. The doctor recognized a Cheye-Stokes breathing pattern in the PSG in 2010 and referred me to the UA in Birmingham, which led to me getting the VPA Adapt SV (Enhanced). I saw this same doctor in Sept-Oct 2010 for a compliance evaluation and have seen him occasionally over the years on other matters.

Settings since July 2010 have been as follows:
Ramp time is 20
Max ramp time is 45, Ramp start pressure is 4.0 , EEP 5, IPAP min 5, IPAP max 10
(From Machine history of changes, “Set CPAP Pressure is 10.0??)
Mask is Mirage Quattro FFM.

Results last 12 months: (I believe the machine is working pretty good.)
Ai - 0.0, Hi - 1.5

(all of following are at the 95th percentile)
Target MV- 7.8, MV - 9.1
Leak - 15 L/min (Max of 44 has to be incorrect. Many times I’ve seen 120), RR - 15 BPM
Pressure 8cm H20, Peak IP 12.6, TV (ml) 701, (Max 2141)
Average daily usage 6.11 hours

(I know the devil is in the details. Ask for them.)

Problem is I have to have several naps everyday. I experience heavy yawning several times during the day and have to relax or go to sleep. I normally yawn heavily 12-15 times, over a period of 3 -15 minutes, then either go to sleep or feeling refreshed, I get up. I never struggle to breathe but every single yawn is a battle. (Can I yawn right this second or must I wait a second or two. It has to be timely. Either I can’t yawn or don’t want to for a period of some seconds even though I feel a great need to yawn and stretch. But the timing of each yawn has to be just right else, I cannot yawn or it is not satisfying. Is this bordering on hyperventilation? Based on my limited knowledge, I believe there is an imbalance between CO2 and O2 levels. (No references to Oxygen Desats during PSG’s that I remember. Limited personal use of Oximeter during one or two days of daytime use several months back was inconclusive.)

I think I do the same thing at night and have a good set of detailed graphs for one recent night for a 45 minute period. (Edited to say, TV and MV heavily spiked.)
I tried to upload the images but couldn’t get them to work. (One site req’d users to be registered. (Edited to add: Of course I was registered.) One wouldn’t accept PDF, and another accepted an image but I couldn’t access it properly.)

Any suggestions for:
1. Questions to ask the doctor, RT and the ResMed Rep, if he shows. The DME works well with me and for me and appears interested in learning more about special cases like mine.
2. Any suggestions re breathing techniques, pulmonary considerations, anything. Btw, Pulmonary Function Test didn’t reveal any remarkable findings.
3. Uploading files.
4. I might be able to sneak in a question about ResScan. I would like to.

Help!
Oldern

[Tom W]

If you could share some general (age, weight, BMI, general cardovascular shape) health info with us it might help.

My TV (Tidal Volume) also spikes over 3,000 but that is mostly when I'm having one apnea after another. I assume you don't have too many back to back apneas/hypopneas with your AHI/HI as low as they are.

Sorry I couldn't be more help.

[Pugsy]

3. Uploading files.
4. I might be able to sneak in a question about ResScan. I would like to

Not sure what your problem with uploading files or images happened to be but I can offer you what I do to get images of my reports posted.
I use Photobucket. It's free and easy.
I take a screen shot of the report and I save it as a jpg file. Upload to my Photobucket account and with Photobucket images you get a a little box with all the various forms of url addresses. The last one in the box is the one to use for posting images here.
It includes the IMG brackets so there is no need to use the editor here in your post.
I just copy the last line...come over to my blank post and paste the addy on the blank page. I see the url addy code but when I click preview I then see the image.

You may be trying the wrong url addy for forum posting. I know there is a way to link to pdf files stored but I have never done it. It was always easier to just post the image of the report and people see it without having to click on a link.

Ask your ResScan questions. Lots of ResScan users here.

Your other questions I am not much help with, sorry.

[JoeP]

What are your RERA #s? Have you researched UARS?

Me personally I had very few OSAs and Hypoponeas but the RERAs were enough to wake me up and fragment my sleep causing EDS but not enough to cause O2 desaturation.

[Oldern]

Thanks for getting back.
1. Cardio- A. Left bundle branch block; B. Left ventricle ejection fraction numbers dropped somewhat but were not alarming to heart doctor. C. Heart Cath, 2005, to see if surgical treatment for prostate cancer would be a problem. None noted. C. Heart doctor prescribed one aspirin/daily as a precaution for mild CAD. GP added in a beta blocker somewhere along then. Overall, cardio was given ok, just careful watching over time.
2. No problem with exercise - maintained a pretty good routine 'til Oct when I over did it with my shoulder. Backed off some but OK.
3. 75 yrs. which is not much if you say it fast.
4. Hypothyroidism for how long-years and years and years,
5. Wt 180, forgot what bmi was but ht 5'8"
6. Lifelong problem with EDS-9th grade biology class around 1:30pm always reminds me how stinking lousy this sleep apnea can make you feel.
ResScan
1. I was throwing this out-in- (equivocating? Who me?) case anyone had any particular questions.
2. One question I have, if the rep will respond, is about losing detail data? Could that be related to option to override or discard duplicate data during download?
3. Other questions I hope to gather before Monday night. But I'd love to hear from others on ResScan. I've done a search of the posts and there is a lot of info. I just haven't had a chance to go through it.
Oldern

[Oldern]

Posting and /or linking to images stored elsewhere.

Sorry, I forgot to respond.
I will carefully read your post again, try again and contact you then. I was so long reading posts about VPAP Adapt SV usage, trying to find posts on EDS, scampering off into a number of other interesting posts and left the problem of posting the image until yesterday. Suffice it to say, "I lost time."

Many thanks.
Oldern

[Pugsy]

There is a video on ResScan. Don't know if you have seen it. It might answer some of your questions. May not be the same version but the basics remain the same.
http://montfordhouse.com/cpap/resscan_tutorial/

I have done both during download when asked for the choice discard or overwrite duplicate data and I haven't had any loss of data. I am not the greatest with ResScan though. Only been using it a few months and actually prefer SleepyHead so I haven't used ResScan all that much. If you are having times of missing data someone else may have some ideas.
Which version of ResScan are you using? Your machine uses the Smart Card and card reader doesn't it? SleepyHead of course won't work with those machines.

[Oldern]

Joep
Anything in particular to be looking for as I search? I'm looking through my PSG's to see if there are references to UARS and RERAs.
Thanks
Oldern

[Oldern]

Pugsy,
Thanks for responding.
Version 3.16. It was a while back when I lost all my detailed data-bummer! I've forgotten the details but I remember reading someone's post discussing the loss of data when you have duplicate data. It was a detailed discussion of how the poster saved data cautioning that he/she preferred saving data in the AM before 12:00 noon. I believe the suggestion was to save the detailed data first then save the summary data and further that if you saved routinely in the AM after arising and before noon, you should be better off. I haven't gotten my mind around that as to why it is preferable.

I have watched that video but it was a few months ago and had forgotten it. Thanks for pointing it out. I watched it again and was reminded again how to change the ranges in some of the graphs to make them more meaningful. The video was instructive in showing how to get the detailed data say in 30 second epochs for comparison with data in the navigation window to show more clearly the relationships. For convenience, in case someone sees this message and misses yours, I’m copying the url from your reply.

http://montfordhouse.com/cpap/resscan_tutorial/


I am wondering exactly what is the best way to maintain data over a longer period of time. Does the data roll off daily or in chunks say if you are beginning to pass the one year mark? Do you ever create a new file and start over? What do others do over a longer period of time? Also, I guess the usual precautions about keeping backups apply.

My questions are gravitating more to "interpretating the data" than the how to maneuver questions. The program certainly "ain't" as intuitive as mainline commercial apps, but hey! It ain't bad and much better than doing without.
Oldern

I was pleased recently, last Saturday, I believe, that I was able to relate events experienced that morning directly to the actions in TV and MV graphs.

Regarding smart card, I use a usb cable to download to my computer. I think the only alternative is to use ResLink, an expensive proposition.

[Oldern]

Joep,

You asked about UARS and RERA.

The only reference to UARS or RERAs was found in a Pulmonary Function Study (SF), May 2010. “There is a bronchodilator response of 49% in the FEF25-75, indicating reactive airways.”

I don’t know the effect of this and the neurologist has had a copy of the report. I will mention it again tomorrow night. I have trouble projecting my voice sometimes but whether this is related or not, I don't know. Lung cancer, emphysema, and asthma have run rampant in my family, due in large part to smoking. I have never smoked and do not have any indications of problems of this sort.

1st and 2nd night of PSG in 1993, there were 25 unexplained respiratory disturbance events in addition to hypopneas, obstructive, mixed , and central apneas, each night. They were not explained then nor mentioned by anyone since 1993.

Your further comments will be appreciated.

Can anyone else suggest any questions to as the Neurologist, the RT, and ResMed Rep?
Oldern

[Oldern]

Update after visiting with my sleep doctor about the excessive sleepiness and to try to get some relief from discomfort in shoulders which I believe is aggravated by side sleeping. Based on the large number of apneas shown in this graph which I think are attributable to sleeping supine, I asked him about raising the pressure in small increments over time to try to control the OSA's. He agreed and wrote a script for the DME as follows: VPAP Adapt SV. EPAP min 5, EPAP max 15, PS min 5, PS max 10. My settings from the final sleep study were: EEP 5, IPAP min 5, IPAP max 10, with a statement that in the non-supine position, no central sleep apnea was seen and no OBA's were seen at these pressures. In the supine position, a few events were noted.

Shouldn't the script simply read: Change IPAP maximum to 15 with no changes resulting in EEP? I can change the settings (in small increments) but I do want to inform my RT with the DME about the change.

He also prescribed Melatonin as an aid to sleep which I will discuss in a separate post.

Any comments will be appreciated.

Many thanks.
Oldern

[Guest]

Bump. Please check my comments about pressure changes ok'd by Doctor.
Oldern

[ddk]

I don't know if my issues are the same as yours but I experience the same symptoms. I can't get through the day without at least 2-3 naps. Before the CPAP machine it was 6+ naps though. And when I say "can't get through the day" I mean brain and body just want to shut down type of tiredness. Physical weakness, dizziness, nausea, inability to focus or concentrate. Caffeine or other stimulants generally don't work and the only thing that seems to alleviate it is lying down for 15-30 minutes.

As for my numbers, I actually just found that I've somehow lost my SD card. I used to take it out and check the data every day but stopped doing it awhile back and just assumed the card was still in there. Now I can't even find it. Oops. But when I was checking the data, I was getting pretty decent numbers across the entire spectrum and there seemed to be no correlation between good/bad numbers and good/bad days. I just feel generally shitty all the time.

[Oldern]

ddk, thanks.

I'm keeping a log of when I go to bed and when I wake up. The average seems to work around 5 + hours, some of which probably can't be classified as sleep. I get very sleepy during the day and generally can get by with several 10-12 minute naps-sometimes not real naps, just completely relaxed and yawning up the yazoo. Then I begin to start feeling better and I'm good to go. I'm retired now but when I worked, it was tough. My ability to remember went to pot years ago. I had to read IRS laws and regulations in my work and I could read them again the next day and not recognize them. Tough! Go to a seminar for eight hours and three days later, the gist of the courses was nowhere to be had.

With the anti-leak strap from Pad A Cheek, I started getting pretty good leak numbers and AHI's were not too bad. But the leaks come and go. The Nasal mask doesn't seem to work at all because of leaks. I am the consummate mouth breather. Recently, due to some eyelid surgery, I have had to sleep without a mask because of an incision on my forehead. I'm going to double down in a day or two and get back to fighting the leaking mask syndrome.

When I discussed with my doctor the need to sleep on my back (because of pain in my shoulders being aggravated by sleeping on my sides), my doctor agreed to raise the pressure some to try to ward off the apneas that come with sleeping supine-Centrals and OSA's. His script said to raise the EPAP (in increments, my decision). I think the Pressure support and Max IPAP ought to be raised. If you look at my chart, the max pressure hits 15 any number of times. Now, whether more pressure will stop the OSA's I don't know. I experienced increased apneas during titration with CPAP resulting in my being treated with VPAP Adapt SV. If you raise EPAP, IPAP maximum will be raised but I don't see the value in raising the EPAP. Someone help me out on this.

The melatonin was suggested as a means to change my habit of getting very sleepy early in the evening, muddling through for several hours,then going to bed only to sleep 4-5 hours.

I often wonder what it would be like to have 7 -8 hours of decent to excellent sleep night after night! Trying to get there may only be something to work for and pester you olks with.

Oldern

Edited to change "sees " to "seems" second sentence.

[kteague]

Just curious, how long would you sleep if you allowed yourself to give in to that first wave of sleepiness and go to bed for the night?