New user.... trying to solve tiredness - graph added

[zonker]

The marketers of the collars typically describe the two most common IFDs as "soft" or "firm".

oh, okay. so you aren't just being pedantic, your saying that it should be a soft foam cervical collar OR a firm foam cervical collar.

i must confess that those two meanings went right past me. truth to tell, i couldn't tell you if i have the firm or the soft version.

anyway, thanks for the clarification.

[kteague]

... 32 days and 100% compliant... 'Jaw Drop'. (Mask goes in my mouth) and excessive tiredness... My first sleep study showed 16+ AHI on my side.... +26 supine and 44+ in REM... continued waking up tired and falling asleep or needing naps is discouraging... Some mornings I get up and feel like I just ran a couple miles, especially in my legs...

I thought I had posted to this yesterday, but I don't see it. I'll try again.

With the mask issues you've been having and not yet getting largely undisturbed sleep, I would not expect much in the way of results. Once you've addressed the functional issues and are sleeping better, you are more likely to feel better.

Assess your sleep position. Make gravity work for you in regards to jaw drop. I found side sleeping on a flat firm pillow helps my jaw to not drop. And if I sleep right on the edge of the pillow with the weight of my head collapsing the edge a bit to cause my face to tilt slightly toward the bed, it naturally prevents any back or downward pull on the jaw, and helps my tongue fall forward to encourage the seal between the tongue and roof of the mouth.

Any chance you are dealing with periodic limb movements? Could explain the legs feeling as you describe and also can fracture sleep and make one not feel rested even with the sleep apnea therapeutically treated.

[Dan_McD]

... 32 days and 100% compliant... 'Jaw Drop'. (Mask goes in my mouth) and excessive tiredness... My first sleep study showed 16+ AHI on my side.... +26 supine and 44+ in REM... continued waking up tired and falling asleep or needing naps is discouraging... Some mornings I get up and feel like I just ran a couple miles, especially in my legs...

I thought I had posted to this yesterday, but I don't see it. I'll try again.

With the mask issues you've been having and not yet getting largely undisturbed sleep, I would not expect much in the way of results. Once you've addressed the functional issues and are sleeping better, you are more likely to feel better.

Assess your sleep position. Make gravity work for you in regards to jaw drop. I found side sleeping on a flat firm pillow helps my jaw to not drop. And if I sleep right on the edge of the pillow with the weight of my head collapsing the edge a bit to cause my face to tilt slightly toward the bed, it naturally prevents any back or downward pull on the jaw, and helps my tongue fall forward to encourage the seal between the tongue and roof of the mouth.

Any chance you are dealing with periodic limb movements? Could explain the legs feeling as you describe and also can fracture sleep and make one not feel rested even with the sleep apnea therapeutically treated.

Thanks kteague. This is a quote from my first sleep study: "Periodic limb movements occurred with high frequency, most of them were not associated with arousals."

I am adjusting to sleeping on my side at the edge of my pillow. My problem is I turn a lot and I have never slept on my back. Quite often now I wake up with the nose of my mask buried at the edge of my pillow. (face down).

What is the remedy for the limb movement? I showed my wife your video and she said "You do that". BTW she is the real reason I had the sleep studies done. She told me I stop breathing in my sleep. And of course I've been snoring for years.

I probably need to post some data from sleepyhead, so someone here might spot something else. Thank you again for your input.

[kteague]

In view of your reported limb movements, I would probably focus on getting your mask issues resolved then looking at your limb movements to address how your legs are feeling. While during your study your limb movements did not cause many arousals, now that you are on CPAP the movements may have worsened. When sleep apnea was causing frequent arousals, the limb movements may not have had much opportunity to fully manifest, like the apneas and the movements were competing to arouse you. In these cases, one could reasonably expect that both your sleep apnea and limb movements could be worse if the competing disorder were not present. Does that makes sense?

Beyond the issue of arousals, when the legs aren't reasonably still at night, the muscles don't get a chance to rest and restore during sleep. There is an accumulating depletion that may be what you are feeling. Mine got so bad I couldn't climb steps, just simply didn't have the strength. Unfortunately, in sleep medicine, the consequences of movements that don't cause arousal are under appreciated. It's one of my pet peeves.

How to deal with limb movements can be complex, as the causes seem to be varied and hard to pinpoint. It may be helpful to go through a ruling out process, such as... Are you on any meds known to potentially cause the problem? Do you have any physical issues that may be nerve related, such as injury, back issues, neuromas on the feet? Has your blood been tested for deficiencies in anything related to nerve and/or muscle function, such as Vitamin D, Magnesium, the B vitamins? Has your ferritin level been checked and is it maintained near 100? People with limb movements are thought to need a higher level than others, so just having it within what is considered a normal range is not enough for us. Often dopamine agonists are prescribed. Before doing that, resolve any ferritin issues as current thinking is those with low ferritin levels have more problems on these meds. If you do decide to try these particular meds, be mindful that not all doctors are current on the recommendation to avoid high doses. Also, some types of meds can help one sleep through the movements but do not prevent the movements. Those meds will still leave you with tired legs, but one may benefit from less sleep disruption. Docs kept trying to prescribe me those and I declined. I saw that as a bandaid approach, not that I wouldn't have relented if it came down to that or no help at all.

Once I got off all the meds that had quit working and even making me worse, I found using a TENS Unit on my lower back before sleep is enough to manage my legs and get decent sleep. Not everyone has found TENS treatment helpful, but who knows, you may be lucky. It may be a multifaceted approach with each thing helping a little that makes the condition manageable. Good luck going forward.

[Dan_McD]

Thanks "K", sorry it took me awhile to get back to you.
Funny thing since I have been on cpap, my wife says my legs haven't been moving/jerking as much. Before pap, it was every night, now it is "not every night".

I used to have Restless legs Syn. It would bother me just sitting on the couch and once in awhile in bed, but it has stopped the last couple of years.

I do take 60 mg of Cymbalta for depression every day, blood pressure meds, cholesterol, and an assortment of supps. Multi vitamin, vitamin D3, magnesium etc. I inject myself...75ml per week of Testosterone-Cypionate and have been for about 10 years.

I had never heard of TENS before. I googled it so I knew what you were referring to.

I'm pretty good about keeping up with labs and I just had them done 2 weeks ago and nothing really out of wack. A1C, PSA, Thyroid, Triglycerides, blood cells etc. all look pretty normal for 76 years old.

I was trying to post the 'sleepyhead' from yesterday, but it did not transfer to 'cpaptalk'. I will though.

[kteague]

Glad to hear you are in tune to possible leg issues. About blood tests, have you had a ferritin level specifically? Was your result near 100? If you ever think your legs are acting up again, that would a test to get.

[Dan_McD]

Glad to hear you are in tune to possible leg issues. About blood tests, have you had a ferritin level specifically? Was your result near 100? If you ever think your legs are acting up again, that would a test to get.

I found a Ferritin test my doctor did in July of this year. I don't know if you meant 100 was high or low. This was the range they gave me back on the test.

FERRITIN 153.2 ng/mL Normal Range 30.0 - 400.0 ng/mL

[Dan_McD]

I don't know if you can read this or not. A magnification to 250% works on my laptop. The big breaks are naps in between sleeping. I don't know what all the snoring is at the end. I got up about 5:30 this morning and then laid back down, I think it was about 10:15 am and all that snoring showed up. I have to have the mask leak dealy fixed. I think I need a small Mirage instead of a medium, might be a start. Any input or advice would be appreciated.

[Jas_williams]

Your cpap data is very good, are you on any medications that could be contributing to your tiredness ?

[kteague]

I found a Ferritin test my doctor did in July of this year. I don't know if you meant 100 was high or low. This was the range they gave me back on the test.
FERRITIN 153.2 ng/mL Normal Range 30.0 - 400.0 ng/mL

It appears you and your doctors have been quite thorough. As your info conveys, even someone with a result as low as 30 could be told by their doctor their result was normal. Even though that would be technically in the normal range, it is recommended to at minimum be closer 100 for those with RLS and/or PLMD. Quite paraphrased here, but it is suspected that problems with blood-to-brain transition of iron are responsible for at least some cases of these disorders. Since iron levels are circadian, a person already low might be more affected by those fluctuations. Not 100% convinced of the validity of all that, just what I've read. Docs do think there's a pattern of those with lower ferritin being more prone to developing augmentation on dopamine agonists. Looks like none of that will apply to you. I envy your 153.

[Pugsy]

Your cpap data is very good, are you on any medications that could be contributing to your tiredness ?

He is.
This was mentioned earlier.

I do take 60 mg of Cymbalta for depression every day, blood pressure meds, cholesterol, and an assortment of supps. Multi vitamin, vitamin D3, magnesium etc. I inject myself...75ml per week of Testosterone-Cypionate and have been for about 10 years.

So Cymbalta...fatigue, weakness, sleepiness to name a few side effects...well known.
It's a SNRI....so google "SNRI and sleep stages" and see how it messes with sleep.
So do SSRIs...same thing.
https://www.everydayhealth.com/drugs/cymbalta
https://www.mayoclinic.org/drugs-supple ... 067247?p=1

We don't know what BP meds but a lot of those also have fatigue as an unwanted side effect.
Plus we don't know why the Cymbalta is being prescribed.

[Dan_McD]

Your cpap data is very good, are you on any medications that could be contributing to your tiredness ?

He is.
This was mentioned earlier.

I do take 60 mg of Cymbalta for depression every day, blood pressure meds, cholesterol, and an assortment of supps. Multi vitamin, vitamin D3, magnesium etc. I inject myself...75ml per week of Testosterone-Cypionate and have been for about 10 years.

So Cymbalta...fatigue, weakness, sleepiness to name a few side effects...well known.
It's a SNRI....so google "SNRI and sleep stages" and see how it messes with sleep.
So do SSRIs...same thing.
https://www.everydayhealth.com/drugs/cymbalta
https://www.mayoclinic.org/drugs-supple ... 067247?p=1

We don't know what BP meds but a lot of those also have fatigue as an unwanted side effect.
Plus we don't know why the Cymbalta is being prescribed.

The Cymbalta is prescribed for depression. I was on fire during the summer working 4 - 6 hour days. Working on tractor, bush hogging, shelving in new garage, and hit a wall about June. Depression and no motivation and terrible sleep, getting up 3-4 times a night. Doctor put me on Cymbalta and we did the sleep study. I have been on and off anti-depressants for 25 years and off for 2 years until June.

Here is last nights graph. I feel much better this morning. Don't know how long that will last.

[Pugsy]

Medication side effects may be a factor in some of your unwanted daytime symptoms.
Probably not all the problem but could be a significant factor.
Sleep quality itself is a big factor and not always reflected accurately in the AHI numbers. Hours of sleep is important but the quality of those hours of sleep is even more important. If you don't get the nice normal progression of the sleep stages and the percent of time in each sleep stage then the restorative powers of sleep simply can't work their magic like we need it to.
SSRIs and SNRIs are known to depress REM and deep sleep...so you can come up short in those cycles. Plus they can cause frequent awakenings (you may or may not remember) and that in turn messes with the sleep cycles.
Recipe for feeling crappy during the day for sure even without sleep apnea being in the mix.

The best cpap therapy in the world isn't going to fix a problem caused by something unrelated to sleep apnea.
No matter how much we want to put all our problems in the sleep apnea basket and have cpap fix them....it just doesn't work out that way.

Even blood pressure meds...known to cause fatigue. My own sister had issues of fatigue and she did some research and the medication she was on for her blood pressure was known to cause fatigue. She got her doctor to change her blood pressure medication and her fatigue went away.

The Cymbalta would be my first suspect though....maybe time to talk to your doctor about getting off it and see how you do.
Depression symptoms often mimic sleep apnea symptoms.
How much of your hitting the wall was because of depression or simply lack of decent quality sleep from the OSA????

We have forum members here who come back and say "I got off the mood meds and the fatigue and excessive sleepiness just went away".

Don't just quit taking any medication though...talk it over with your doctor because some of that stuff have some really nasty withdrawal symptoms they stick you with. Some people can cold turkey quit and some can't. Always discuss it with your doctor.

[Mark55]

Okie and Julie, thanks for the tip on the collars. I will look into that.

realshelby..... from what I understand the nasal mask does not cover the mouth. During sleep I also breath through my mouth and that's where my snoring comes from. I'm new to all of this, but I think I have to have both my mouth and nose covered.

Try this...https://www.walmart.com/ip/Dr-Dakota-An ... op&veh=sem

I'm glad you posted that link, as I saw that here once before and couldn't find the thread again, or remember the name of the product. I want to get one, as I'm starting to have issues with my mouth dropping open again, and I hate the chin strap I used initially. If nothing else I can give it to my mother across town if it doesn't work, as she has a bad habit of going to sleep in her recliner and having her head drop forward for a nap.

[Dan_McD]

Medication side effects may be a factor in some of your unwanted daytime symptoms.
Probably not all the problem but could be a significant factor.
Sleep quality itself is a big factor and not always reflected accurately in the AHI numbers. Hours of sleep is important but the quality of those hours of sleep is even more important. If you don't get the nice normal progression of the sleep stages and the percent of time in each sleep stage then the restorative powers of sleep simply can't work their magic like we need it to.
SSRIs and SNRIs are known to depress REM and deep sleep...so you can come up short in those cycles. Plus they can cause frequent awakenings (you may or may not remember) and that in turn messes with the sleep cycles.
Recipe for feeling crappy during the day for sure even without sleep apnea being in the mix.

The best cpap therapy in the world isn't going to fix a problem caused by something unrelated to sleep apnea.
No matter how much we want to put all our problems in the sleep apnea basket and have cpap fix them....it just doesn't work out that way.

Even blood pressure meds...known to cause fatigue. My own sister had issues of fatigue and she did some research and the medication she was on for her blood pressure was known to cause fatigue. She got her doctor to change her blood pressure medication and her fatigue went away.

The Cymbalta would be my first suspect though....maybe time to talk to your doctor about getting off it and see how you do.
Depression symptoms often mimic sleep apnea symptoms.
How much of your hitting the wall was because of depression or simply lack of decent quality sleep from the OSA????

We have forum members here who come back and say "I got off the mood meds and the fatigue and excessive sleepiness just went away".

Don't just quit taking any medication though...talk it over with your doctor because some of that stuff have some really nasty withdrawal symptoms they stick you with. Some people can cold turkey quit and some can't. Always discuss it with your doctor.

I read your comments on a thread of Cynmatthes. Your comment about AHI and REM sleep is the same problem the sleep studies showed on my tests. On my side was like 16, supine 26 and REM 44. The 2nd / titration test I didn't even get into REM. Pugsy, the 'wall' came first. Tired, exhausted and sleepless. Then the Cymbalta and the sleep apnea studies. I was on Cymbalta for about 8 years and am familiar with its side affects. It is one of the worst drugs to get off of, awful. It was one of the last things I wanted to take again. I don't disagree with you on its tiredness causes. I think it slows the metabolism down and in most cases can be a weight gainer. I go back to my Primary in 3 weeks and if things haven't changed he wants to run some other tests. I see the sleep doctor February 4th. I also have COPD and I believe I'm coughing less and breathing easier than before I started using the cpap machine.

My worst symptom is in my legs and knees in particular, being weak and achy. That in itself I think is causing some of the motivational blocks. I guess in my mind, I thought the cpap would make that better and it seemed to make it worse. I appreciate your input and time. I haven't given up on, there may be something else going on, it just didn't show up in the normal blood and urine tests. BTW - I don't drink any alcohol and quit smoking in '97. Thanks a lot.