Are occasional bad days normal?

[ZBQ]

First off I wanted to say Hello!!

Sorry this is so long for a first post!!:oops:


I was diagnosed a little over a year ago and had a split night sleep study done.

My AHI was 109.5.
Total of 280 obstructive apneas in 159.5 minutes (2.65 hrs)
Mean Oxygen Sat. 88% with minimum of 72%
Zero REM sleep

I have been using my ResMed S8 Elite w/humidifier and Mirage Swift mask religiously since Feb. of 06.

Pressure set at 12 with 5 minute ramp.

Data period Sept. 06 to March 07
(all data since onset of treatment has been reviewed by my Sleep Dr.)

AHI 5.1 events per hour
AI .4 events per hour
HI 4.7 events per hour
Median leak .04 l/sec.

My Sleep Dr. has told me that occasionally having what I call "bad days" where I am having the excessive daytime sleepiness, forgetfulness and "brain fog" are normal for someone like myself despite religious use of CPAP. What I call occasional is sporadic in nature. I might go 3 to 4 weeks with no bad days and then hit a week where I have 2 in the same week. I use Provigil on these days but there are a few that even Provigil doesn't help.

I was recently required to see another Sleep Dr. for an evaluation. He stated that he felt that I needed to be re-titrated because I was still having these bad days. The analogy he used was "If you run from point A to point B everyday and it takes you 5 minutes, then one day it takes you 7 minutes, something changed. Maybe you stopped to tie your shoe. You have to figure out what changed so that you can correct it and get back to 5 minutes." He also stated that split night studies are know to be "fallacious" and that I needed a full night study while on CPAP to be correctly titrated.

In a nut shell he was saying that I should not be having ANY bad days if the CPAP therapy was being administered correctly.

My question is, who is right?

Do any of you guys still have "bad days" even with CPAP?

Just as an interesting side note, these 2 Dr.'s were in the same practice until about a year ago. I have wondered if there might be some animosity between them because the MA's at my Dr.'s office have told me that they took over quite a few of Dr. #2's patients.

I can't afford to have bad days where I work. I work in a prison around inmates in a factory area with 5 ton overhead cranes, 30 ton presses, large trucks, welders, torches and thousands of tools that have to be accounted for down to the last 1/4" socket. The inmates and my co-workers all know when I am having a bad day and the fact that the inmates know that I am having a bad day scares me because I am afraid that they will take advantage of my not being alert for nefarious purposes. It also scares me because I could kill myself, one of my co-workers or an inmate in the blink of an eye because I am not alert.

[kavanaugh1950]

I DO HAVE BAD DAYS STILL BUT THEY ARE FEWER AND FEWER. I UNDERSTAND YOUR WORRY SINCE I WORK ON AN INPATIENT PSYCH UNIT AND HAVE TO WATCH MY BACK ALL THE TIME. IT WILL GET BETTER . I DON'T HAVE A LOT OF SUGGESTIONS JUST TRY TO GET ENOUGH SLEEP AT NIGHT. GOOD LUCK, PAT

[john44077]

Good luck to you guys. I work in the medical field and none of us can afford to be in the fog of this and make mistakes. I know i am feeling better after 4 weeks of cpap. My md says it will get better day after day.

[Wulfman]

ZBQ,

Did you take into consideration that your pressure may need to be bumped up a bit? "Things" change and so do our pressure requirements. If you've been on that pressure for over a year, you may need a bit more now.

Another question..... Are you getting ENOUGH sleep?

ResMed machines (from what I've read) also typically tend to report a higher hypopnea index. And, usually, a higher hypopnea number can be lowered with a bit more pressure.

After a year, you shouldn't need Provigil (but you can't go off of that stuff "cold turkey"). If the pressure adjustment doesn't help, you may have something else going on.
An overnight pulse-oximetry test should give some additional information as to whether your therapy is being effective. Talk to your doctor about getting one. (it's FREE....except for the doctor's visit to get the prescription)

I think most of us have an occasional day when we could say a couple more hours of sleep would help.....

I would suggest bumping your pressure up 1 cm for a week and see if it helps.

Den

[Slinky]

... I have been using my ResMed S8 Elite w/humidifier and Mirage Swift mask religiously since Feb. of 06.

Pressure set at 12 with 5 minute ramp.

Data period Sept. 06 to March 07
(all data since onset of treatment has been reviewed by my Sleep Dr.)

AHI 5.1 events per hour
AI .4 events per hour
HI 4.7 events per hour
Median leak .04 l/sec.

... I was recently required to see another Sleep Dr. for an evaluation. He stated that he felt that I needed to be re-titrated because I was still having these bad days. The analogy he used was "If you run from point A to point B everyday and it takes you 5 minutes, then one day it takes you 7 minutes, something changed. Maybe you stopped to tie your shoe. You have to figure out what changed so that you can correct it and get back to 5 minutes." He also stated that split night studies are know to be "fallacious" and that I needed a full night study while on CPAP to be correctly titrated.

I can't afford to have bad days where I work. I work in a prison around inmates in a factory area with 5 ton overhead cranes, 30 ton presses, large trucks, welders, torches and thousands of tools that have to be accounted for down to the last 1/4" socket. The inmates and my co-workers all know when I am having a bad day and the fact that the inmates know that I am having a bad day scares me because I am afraid that they will take advantage of my not being alert for nefarious purposes. It also scares me because I could kill myself, one of my co-workers or an inmate in the blink of an eye because I am not alert.

First off, welcome to the forum! You're in for a good CPAP education if you want it!

I've gotta tell you, "I" would be delighted to have your 06 Sep to Mar 07 data! "They" consider an AHI of 5 to be "normal" sleep events. That being said, those are averages over 6 months, they don't tell you how things went on a night by night basis. (I started CPAP therapy 06 Oct!!! I'm a month behind you.

I tend to agree w/the second sleep doctor that split nights studies have a tough time, usually, getting adequate data. Note that I said usually. There are those who have "hit the spot" w/just one split night study but I'd venture a guess they are in the minority.

I have the same machine as you do: the Resmed S8 Elite, and I love it. You know, you can keep track of your nightly stats yourself. Its simply a matter of accessing the Advanced Patient Menu. You aren't give access to that menu unless your doctor specifically includes instructions to give you access to it on your order for equipment.

However, since there is no way you can mess up your pressures or interefere w/your therapy its no biggie to tell you how to access that menu yourself.

Press the Left and Right buttons and hold them down for 3-4 seconds. Efficacy Data will pop up on your LED screen. After that it is pretty self-explanatory how to maneuver thru the menu to get your stats for that night. Its just a matter of pushing buttons. Write the results of each screen down as you access it and keep a running file of the nightly data. Most likely you will see fluctuation from one night to the next.

The one caveat is that these machines run on a 24 hour, noon to noon, clock. So you must access your data before noon each day or it is moved into the longer term average data and you will get no info for that night on the LED screen.

My guess would be that you had some large leaks on those nights you feel crappy the next morning. Or had some chest and or sinus congestion.

Since you were recently required to see another sleep doctor for evaluation and he has suggested another titration study WHO IS GOING TO PAY FOR IT? "Will" your insurance pay for another so soon? That is the key in my opinion. If it isn't going to cost you anything, why not have it done??

But keep track of your nightly data yourself and then make up your mind. Just don't rely on only one night's data - except to see if that data explains your grogginess, etc. the night of one of your "bad" days.