DoesCPAP lower fatigue in people without daytime sleepiness?

[arburtus]

I am newly diagnosed with severe sleep apnea and will start CPAP. I do not fit the the 'typical' profile, little snoring and no to very little daytime sleepiness. (never ever fall asleep at daytime or early evening)
In a study published 2001 it was claimed that treatment with CPAP is not effective in patients with sleep apnea but no daytime sleepiness. Essentially none of the study participants experienced quality of live or/and cognitive improvements.
Fatigue and brain fog are my foremost symptoms.
Unfortunately I suffer also from post concussion syndrome, so I am not certain that the fatigue and brain fog are part of my sleep apnea. It it would be 'wonderful' if it is, and that the use of CPAP will bring me beyond the threshold of suffering.

Any share experiences or thoughts are appreciated.

Thanks

[cowlypso]

I question the basic assumptions of that study. Sure, they found that this subset of patients did not see any improvements in quality of life or cognition. But did they have any complaints in those areas to begin with? It's hard to see improvements in your symptoms if you have no symptoms.

Also, you don't mention any discussion in the article about other benefits of treatment. Even if there's no improvement in subjective symptoms, untreated sleep apnea can result in cardiovascular problems, such as high blood pressure.

Think about it like diabetes. Many people who are diagnosed with diabetes don't have any symptoms. If you did a study looking at their quality of life and other factors before and after treatment, you could conclude that it's not worthwhile to treat diabetes. But we all know that untreated diabetes can lead to all sorts of health problems (kidney disease, blindness, amputations).

[arburtus]

Cowlypso, based on your mentioned caveats I would questions the study myself.
Said that it did trigger my questions to the members of the (great) support board rather CPAP can lower fatigue in people without daytime sleepiness?
I will defiantly try to follow through with the treatment, heart disease runs in my family, and I like to keep my own risk low.

Here is the link of the study.: http://www.ncbi.nlm.nih.gov/pubmed/11388814

I did spent a couple of hours looking at some sleep apnea studies, to my surprise I learned that the good cholesterol (HDL) can improve by up to 6 points with successful CPAP treatment. My HDL is very low and stands at about 32.
Did anyone see some positive results with an increased HDL while on CPAP?

[Wulfman...]

I am newly diagnosed with severe sleep apnea and will start CPAP. I do not fit the the 'typical' profile, little snoring and no to very little daytime sleepiness. (never ever fall asleep at daytime or early evening)
In a study published 2001 it was claimed that treatment with CPAP is not effective in patients with sleep apnea but no daytime sleepiness. Essentially none of the study participants experienced quality of live or/and cognitive improvements.
Fatigue and brain fog are my foremost symptoms.
Unfortunately I suffer also from post concussion syndrome, so I am not certain that the fatigue and brain fog are part of my sleep apnea. It it would be 'wonderful' if it is, and that the use of CPAP will bring me beyond the threshold of suffering.

Any share experiences or thoughts are appreciated.

Thanks

You didn't specify whether you have Obstructive Sleep Apnea (OSA) or Central Sleep Apnea (CSA) or Complex Sleep Apnea Syndrome (CompSAS), which is a combination of both. CSA is more neurological in nature (the brain essentially fails to tell the body to breathe) and your "post concussion syndrome" suggests to me that is what you might have. If you have a copy of your sleep study, I would suggest looking it over carefully. If you don't have a copy, I would suggest getting one and studying it. Otherwise, it's hard to answer definitively.......however, various types of this therapy can help if administered and configured properly.


Den

[arburtus]

You didn't specify whether you have Obstructive Sleep Apnea (OSA) or Central Sleep Apnea (CSA) or Complex Sleep Apnea Syndrome (CompSAS), which is a combination of both. CSA is more neurological in nature (the brain essentially fails to tell the body to breathe) and your "post concussion syndrome" suggests to me that is what you might have. If you have a copy of your sleep study, I would suggest looking it over carefully. If you don't have a copy, I would suggest getting one and studying it. Otherwise, it's hard to answer definitively.......however, various types of this therapy can help if administered and configured properly.

Den

Den,, I do not know the type of my apnea, the testing was done at home ( i was equipment with an oximeter by my health provider).
The results showed 35 apneas with oxygen saturation as low as 86%.
I immediately had to requested a formal sleep study in a hospital setting, I am awaiting the date...
Kaiser Permanente, my provider is not very proactive in this regard, kind of a cooky cutter approach here. I had to be persistent. said that that, the do want to outfit me right away with CPAP.
I doubt that I suffer from CSA. this form apnea seems to originate from the brainstem and is seen in traumatic brain injury event. my injuries were multiple mild concussions over many years. Further, I do have a very narrow pallet and huge tonsils and a crowed in tongue.I awake once a night with a sensation something is stuck in my throat. I expect this to be the source of my apnea... but who know, in the end you may be right.If so, I hope that CPAP will address CSA as well as OSA.

[GumbyCT]

I am newly diagnosed with severe sleep apnea and will start CPAP. I do not fit the the 'typical' profile, little snoring and no to very little daytime sleepiness. (never ever fall asleep at daytime or early evening)
In a study published 2001 it was claimed that treatment with CPAP is not effective in patients with sleep apnea but no daytime sleepiness. Essentially none of the study participants experienced quality of live or/and cognitive improvements.
Fatigue and brain fog are my foremost symptoms.
Unfortunately I suffer also from post concussion syndrome, so I am not certain that the fatigue and brain fog are part of my sleep apnea. It it would be 'wonderful' if it is, and that the use of CPAP will bring me beyond the threshold of suffering.

Any share experiences or thoughts are appreciated.

Thanks

How is the fatigue you feel different from the daytime sleepiness, highlighted above?

btw- brain fog and fatigue are symptoms of many things including OSA. I think you are searching for denial?

[arburtus]

Thanks[/quote]
How is the fatigue you feel different from the daytime sleepiness, highlighted above?

btw- brain fog and fatigue are symptoms of many things including OSA. I think you are searching for denial?[/quote]

Searching for denial?1?
It is crystal clear to me that I suffer from sleep apnea.

There is a well defined difference between sleepiness and fatigue,brain fog.
daytime sleepiness is a condition in were the person has difficulties to stay awake in everyday situation (driving a car, watching TV, the urge to take naps etc.
fatigue is a feeling of feeling groggy and exhausted without dozing away.

Anyways... I guess I will find out soon rather my fatigue and brain fog will be positively effected with CPAP. it is an almost disabling symptom for me.

[dtsm]

In a study published 2001 it was claimed that treatment with CPAP is not effective in patients with sleep apnea but no daytime sleepiness. Essentially none of the study participants experienced quality of live or/and cognitive improvements.

Maybe, but I bet you they lived longer

[Jay Aitchsee]

Arbutus,
Be sure to read Janknitz' post: http://tinyurl.com/2arffqx before you get your machine. IMO, everyone should have an auto pap (APAP). You can run it as a CPAP if you want. AND, you need to be able to retrieve detailed data from your machine, one that tells you not only the averages but also when (time of night) the events occured. Your DME most likely will only be interested in how many hours per night (compliance data) you use your machine.

As for beneifits, as mentioned, if you have OSA, and it is controlled with CPAP, you are benefiting whether you feel better or not. My blood pressue has dropped about 20 points since my OSA has been controlled. Another benefit, if your fatigue is not controlled you will know what's not causing it.

[Janknitz]

Kaiser Permanente, my provider is not very proactive in this regard, kind of a cooky cutter approach here. I had to be persistent. said that that, the do want to outfit me right away with CPAP.

I'm a Kaiser patient, and Kaiser--in my region (Northern California) at least is VERY proactive in treating sleep apnea because they recognize that treating it saves them money in the long term. In this region they do only home testing, but not simply with an oximeter. It is a device called an Itamar Watch Pat and it provides many channels of information. It can show apneas, oxygen levels, fluctuations in blood pressure etc. I'm not sure how good it would be for more complex issues like PLMD or RLS, but for basic OSA and CA it does the job nicely, and very accurately (IMHO) since it's in your own bed and sleeping conditions.

Likewise they do home titration with an auto-titrating machine which you get to borrow for a week or so. IMHO, this makes the titration fairly accurate, again, because it's in your own bed and sleeping conditions, and it's a week's worth of data, instead of the snapshot of a single, strange night in a sleep lab.

BUT, unfortunately, my advice about "What you need to know BEFORE you meet your DME" does not apply. This is because you've already met your DME--it's Kaiser. Kaiser decides what you get and that's that. You will have no choice in the matter whatsoever, unless you're willing to pay out of pocket for your own. Kaiser uses DME's as suppliers--Crapria here in Northern California. But Kaiser calls the shots, fits you for your masks, and adjusts your equipment. You have a limited "formulary" of masks and you get whatever machine Kaiser decides you are going to get (in my case it was the top of the line Philips Respironics auto, but many people get only a data capable CPAP pro).

BTW: You don’t say where you are located, but here’s a cautionary tale. One Kaiser member who posted here lives on the Big Island of Hawaii, a few hundred miles (and an airplane flight) from Kaiser’s sleep clinic on Oahu. She was given her machine through a contracted provider on the Big Island—she got a data-less straight CPAP and she wanted at least a data capable machine. So she asked Kaiser for a copy of her prescription. It turns out Kaiser ordered a data capable auto, and the DME played a switcheroo (thereby increasing their profit). They thought they could get away with it, since the clinic on Oahu was never going to see the machine on the Big Island.

So even with an HMO like Kaiser where your choices are limited, make sure you know what’s ordered for you and make sure you get what you’re supposed to.

[SleepingUgly]

Studies indicate that the words "fatigue" and "sleepiness" are not used the same way from person to person. By way of illustration, I never would have defined fatigue the way you did in your last post:

daytime sleepiness is a condition in were the person has difficulties to stay awake in everyday situation (driving a car, watching TV, the urge to take naps etc.
fatigue is a feeling of feeling groggy and exhausted without dozing away.

In my subjective definitions, you described "sleepiness" both when you defined sleepiness and when you defined fatigue. The difference is that in people who fall under your "sleepy" definition have either more extreme sleepiness or higher "sleepability" (the ability to fall asleep rapidly) whereas those in your "fatigue" definition are either less sleepy or have lower sleepability. (Personally I define "fatigue" as physical exhaustion, such as how my body feels after extensive exercise, and it has nothing to do with sleepiness).

Furthermore, there is not a very high correlation between subjective measures of sleepiness and objective measures of it.

I don't know which study you are referring to and how they defined sleepiness to the subjects or how they measured it objectively. But my opinion is that there is a possibility, and perhaps even probability, of improvement with CPAP in the symptoms you describe.

[SleepingUgly]

In a study published 2001 it was claimed that treatment with CPAP is not effective in patients with sleep apnea but no daytime sleepiness. Essentially none of the study participants experienced quality of live or/and cognitive improvements.

Can you post a link to this study?

[arburtus]

thank you for your answers ! it funny, I was outfitted with a CPAP today and wear it as I type. It seems I like to open my mouth to pronounce words while I type, the CPAP right away created this odd underpressure

[arburtus]

In a study published 2001 it was claimed that treatment with CPAP is not effective in patients with sleep apnea but no daytime sleepiness. Essentially none of the study participants experienced quality of live or/and cognitive improvements.

Can you post a link to this study?

here we are:

http://www.ncbi.nlm.nih.gov/pubmed/11388814

[arburtus]

Kaiser Permanente, my provider is not very proactive in this regard, kind of a cooky cutter approach here. I had to be persistent. said that that, the do want to outfit me right away with CPAP.

I'm a Kaiser patient, and Kaiser--in my region (Northern California) at least is VERY proactive in treating sleep apnea because they recognize that treating it saves them money in the long term. In this region they do only home testing, but not simply with an oximeter. It is a device called an Itamar Watch Pat and it provides many channels of information. It can show apneas, oxygen levels, fluctuations in blood pressure etc. I'm not sure how good it would be for more complex issues like PLMD or RLS, but for basic OSA and CA it does the job nicely, and very accurately (IMHO) since it's in your own bed and sleeping conditions.

Likewise they do home titration with an auto-titrating machine which you get to borrow for a week or so. IMHO, this makes the titration fairly accurate, again, because it's in your own bed and sleeping conditions, and it's a week's worth of data, instead of the snapshot of a single, strange night in a sleep lab.

BUT, unfortunately, my advice about "What you need to know BEFORE you meet your DME" does not apply. This is because you've already met your DME--it's Kaiser. Kaiser decides what you get and that's that. You will have no choice in the matter whatsoever, unless you're willing to pay out of pocket for your own. Kaiser uses DME's as suppliers--Crapria here in Northern California. But Kaiser calls the shots, fits you for your masks, and adjusts your equipment. You have a limited "formulary" of masks and you get whatever machine Kaiser decides you are going to get (in my case it was the top of the line Philips Respironics auto, but many people get only a data capable CPAP pro).

BTW: You don’t say where you are located, but here’s a cautionary tale. One Kaiser member who posted here lives on the Big Island of Hawaii, a few hundred miles (and an airplane flight) from Kaiser’s sleep clinic on Oahu. She was given her machine through a contracted provider on the Big Island—she got a data-less straight CPAP and she wanted at least a data capable machine. So she asked Kaiser for a copy of her prescription. It turns out Kaiser ordered a data capable auto, and the DME played a switcheroo (thereby increasing their profit). They thought they could get away with it, since the clinic on Oahu was never going to see the machine on the Big Island.

So even with an HMO like Kaiser where your choices are limited, make sure you know what’s ordered for you and make sure you get what you’re supposed to.

After my visit today at Kaiser (Bay Area, Northern California) I take back my statement abut their lack of being proactive, the session was informative and it seems they outfitted me with a top of a line product (same as your it seems). I also was educated that the home test alongside the data of my equipment is sufficient for a consciences diagnoses.
I must admit that I am not a big fan of Kaiser for multiple reasons, I am considering to form a new group in my firm that allows me to enroll into a PPO. I spoke to my broker today, he stated that I will have a hard time to find a carrier as an individual with my newly diagnosed sleep apnea. This came as a shock to me... !!
I am European,and let me state, the health system here is really discriminating.