Is my cpap causing fatigue?

After many years of snoring, napping a stop lights (and a strong urging from the anesthesiologist who assisted in my recent surgery)... I reluctantly scheduled a sleep study. A week later I met with my sleep doctor who seems very knowledgeable and had great reviews online. She said I had 48 sleep disturbances per hour and a lot of other stuff which I unfortunately do not remember. After that, I met with the sleep therapist who set me up on a new machine, a couple different masks, explained it all, assured me I was going to feel a lot better very soon and sent me home.

First month prescribed 4-10 lbs pressure (not sure that is the proper terminology). Data results show significant improvement with only 3 sleep disturbances per hour, having 5 hours of good sleep per night but I am not feeling any better. I am feel fatigue and joint pain with continued cognitive decline.

Second month prescribed 6-12 lbs pressure. Data results = Only 2 sleep disturbances per hour, having 6 hours of good sleep per night but not feeling any better, fatigue and joint pain worse with weight gain and continued cognitive decline. Doctor advised to be patient, keep wearing mask every day.

Third month prescribed 10-18 lbs pressure. Data results = Only 1 sleep disturbances per hour, having 7 hours of good sleep per night but not feeling any better, fatigue and joint pain affecting daily life, continued weight gain and cognitive decline. Doctor suggested to be more patient and was surprised I didn't feel ANY better YET.

Fourth month prescribed 8-16 lbs of pressure ((I average 15.7)) - Last week I stopped the CPAP, most of the fatigue is gone although I do feel a little sleepy (which is different from fatigue), I do still have joint pain.

It seems to me that my CPAP is causing fatigue. I've talked with several other people who says they felt completely different, like night & day, but I do not. I am disappointed, I thought the CPAP would do the trick. I like my machine, the humidifier and mask. Why don't I feel better?

My AHI is 1.3
Large Leak - None
Periodic Breathing - None
90% pressure - 15.7

Lyonpo wrote:After many years of snoring, napping a stop lights (and a strong urging from the anesthesiologist who assisted in my recent surgery)... I reluctantly scheduled a sleep study. A week later I met with my sleep doctor who seems very knowledgeable and had great reviews online. She said I had 48 sleep disturbances per hour and a lot of other stuff which I unfortunately do not remember. After that, I met with the sleep therapist who set me up on a new machine, a couple different masks, explained it all, assured me I was going to feel a lot better very soon and sent me home.

First month prescribed 4-10 lbs pressure (not sure that is the proper terminology). Data results show significant improvement with only 3 sleep disturbances per hour, having 5 hours of good sleep per night but I am not feeling any better. I am feel fatigue and joint pain with continued cognitive decline.

Second month prescribed 6-12 lbs pressure. Data results = Only 2 sleep disturbances per hour, having 6 hours of good sleep per night but not feeling any better, fatigue and joint pain worse with weight gain and continued cognitive decline. Doctor advised to be patient, keep wearing mask every day.

Third month prescribed 10-18 lbs pressure. Data results = Only 1 sleep disturbances per hour, having 7 hours of good sleep per night but not feeling any better, fatigue and joint pain affecting daily life, continued weight gain and cognitive decline. Doctor suggested to be more patient and was surprised I didn't feel ANY better YET.

Fourth month prescribed 8-16 lbs of pressure ((I average 15.7)) - Last week I stopped the CPAP, most of the fatigue is gone although I do feel a little sleepy (which is different from fatigue), I do still have joint pain.

It seems to me that my CPAP is causing fatigue. I've talked with several other people who says they felt completely different, like night & day, but I do not. I am disappointed, I thought the CPAP would do the trick. I like my machine, the humidifier and mask. Why don't I feel better?

My AHI is 1.3
Large Leak - None
Periodic Breathing - None
90% pressure - 15.7

First of all, it's not "lbs" of pressure......it's centimeters of water pressure......or cm. (much less than lbs.)

I think you're a prime example of what I've been harping on for years......which is the effect of changing pressures on a person's sleep. (using an APAP in a range of pressures)
A person's breathing changes when they enter a deep or REM stage of sleep......the machine misinterprets that breathing change as a need to increase pressure......and the pressure change bumps the person out of that (needed) sleep stage and into a lighter one......leaving the person feeling "unrested" (to put it mildly).

My suggestion is to quit using ranges of pressure and settle in on ONE pressure......CPAP mode instead of APAP mode.
That can be done two ways......by setting the machine in CPAP mode and selecting a single pressure or by leaving it in APAP mode and setting the minimum and maximum pressures to the same pressure.

Are you using software to monitor your therapy? I'd bet if we were to look at your reports, it would show lots of pressure changes during the night. Snores and Flow Limitations are the two main things that trigger pressure increases.

Due to the fact that you've been using lots of different pressure ranges, it's kind of hard to say which single pressure would be optimum.......but, I'd suggest trying something around 12 cm. for about a week.


Den

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Seems quite likely investigation of your data and a bit of tweaking could have you at success. You have nothing to lose by trying a fixed pressure as was suggested. I think you are very close to effective treatment, and now that you're here hopefully you can gather the information you need to make this work for you. In the event your symptoms persist, I would be curious if there is any reason to suspect limb movements. We can revisit that thought if the need arises. Right now I'm guessing your focus on optimizing your treatment will likely pay off for you.

Den

Thanks for the feedback. Yes I don't like the pressure changes either, but assumed this was the normal process until you get to the right pressure. Each time they increased it, my body chose to go to the highest level, so they kept increasing it. At the last appointment I insisted that they decrease the pressure, it was too high.

I will look for my paperwork and see what it says about variations throughout the night. Am I able to select and change the pressure myself? I know I can change the Ramp speed, but I don't think I can change the pressure or ranges.

Lyonpo wrote:but I don't think I can change the pressure or ranges.

Follow the link below in my signature box to the video tutorials -- the last one should help you learn how to access the clinician menu on your machine which is where the pressure can be set.

interesting, never heard that variable pressure is inadequate. I'll give a fixed pressure a go too.

Check the links in my signature line to get the free SleepyHead software to monitor your data. It is enormously superior to SleepMapper. You can then monitor your own therapy results.

You can also find out how to change your own pressure settings there.

Pressure is measured in centimeters of water, or "cmH2O." It's not much pressure. 1 psi equals about 70 cmH2O.

Wulfman... wrote: I think you're a prime example of what I've been harping on for years......which is the effect of changing pressures on a person's sleep. (using an APAP in a range of pressures)
A person's breathing changes when they enter a deep or REM stage of sleep......the machine misinterprets that breathing change as a need to increase pressure......and the pressure change bumps the person out of that (needed) sleep stage and into a lighter one......leaving the person feeling "unrested" (to put it mildly).

.

Looked over my data, I don't see any bumps in pressure (the lower part), for instance:

tan wrote:Looked over my data, I don't see any bumps in pressure (the lower part), for instance:

You won't ever see any sort of pressure increase with a CA flag...that's a central and the airway is already open vs OA or hyponea when the airway tissues have collapsed and blocking the airway.

No apap machine will increase pressure if it things centrals are what is going on. They ignore them.

Any pressure increases anywhere near a CA is because of something else related to the airway tissues collapsing..flow limitations or snores maybe.

Pugsy wrote:

tan wrote:Looked over my data, I don't see any bumps in pressure (the lower part), for instance:

You won't ever see any sort of pressure increase with a CA flag...that's a central and the airway is already open vs OA or hyponea when the airway tissues have collapsed and blocking the airway.

No apap machine will increase pressure if it things centrals are what is going on. They ignore them.

Any pressure increases anywhere near a CA is because of something else related to the airway tissues collapsing..flow limitations or snores maybe.

while I agree that I should have not have used CA for the purpose of demonstration, but all my other events have the same flat pressure level.

real interested post since i'm very fatigued too whereas i'm on cpap.
would you test with a fixed pressure ? do you think the difference in fatigue is far enough from cpap therapyto attribute on Cpap therapie ?

ok, after reviewing a number of days, I have finally found one pronounced case (the session started at 22:38, sleep didn't kick in right away of course, but I typically fall asleep rather quickly):



As an afterthought, this should probably be a different topic

Lyonpo wrote:Yes I don't like the pressure changes either, but assumed this was the normal process until you get to the right pressure.

The pressure reported by SleepMapper and the pressure probably that your doc is eyeballing to make these changes is probably the 90% pressure and that's not where you were at 90% of the time....it's where you were at OR BELOW for 90% of time time. It's sometimes a good number to use for a fixed pressure and sometimes not such a great number because it is easily skewed by a relatively short period of time at the upper range.

It sounds like your minimum pressure isn't sufficient to keep the airway open well and the machine is having to work really hard to fix things. It works better at preventing than it does at "fixing".
When optimally set to a better minimum pressure the machine won't go around wildly increasing the pressures and in fact often the 90% numbers come down when the minimum is more optimally set.

Without seeing some actual software reports and the pressure lines I can't really come up with much of an idea what might be an optimal minimum in apap more or what would work if you chose to use a single pressure that didn't roam around.

With your machine if you switch over to cpap mode your lose Flow limitation flags...now sometimes they are important and sometimes they aren't but there is a way to mimic cpap mode by doing apap mode with minimum pressure equaling maximum pressure. That way you can use a single pressure that is fixed like cpap mode but you don't lose the FL flags just in case they are important and since we don't really have a clue what an optimal starting point for you is...I would want the FL flagging turned on ...just in case.

You might do better with 12 fixed...I don't know that you are for sure going to need that much since you never tried the apap with a 10cm minimum. Heck you might need 14 for all we know. We are guessing right now without seeing the software reports.
I would suggest getting SleepyHead and let's see what those pressures are wanting to do.
Links in my signature line.
How to post images of the reports is explained here along with some examples.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

Otherwise...I would start slow and move up gradually depending on what shows on your reports...
To do the single pressure thing..set the minimum to equal the maximum... I would suggest to start at 10 cm if that is comfortable for you since 8 has been the highest minimum so far in apap mode.
Up to you but I have often seen the maximum pressures used actually drop significantly when the minimum is set more optimally and it doesn't always come anywhere close to that 90% number.
I don't know if it will work out that way for you or not but worth a try.

And yes...just change it yourself. Heck the doc has already said it was okay for the machine to go to 16 with the maximum range... but if you aren't okay with doing the changes yourself...don't...call up the doc and tell him what you would like to do since you feel that the variable pressures are a potential factor in sleep quality.
Don't go automatically to that 90 % number...unless you just like the higher pressures... You may or may not need that much as a single pressure. Most people want to use the least amount of pressure as possible to get the job done but using higher than might be needed really isn't a problem unless it causes centrals and if higher pressures caused centrals in your case I would suspect they would have already popped up and with your low AHI...they didn't.

tan wrote:As an afterthought, this should probably be a different topic

Would be nice to have a separate thread...the discussion will likely be considerable and totally take this thread away from the OP here...and maybe confuse him in the process.

and yes..showing a central and wondering why no pressure change wasn't a good example
Start your own thread and Den will explain "frank" events and the limitations of apap mode.
There's pros and cons to everything...we just have to decide which is more important and less of an evil.

Pugsy wrote:Start your own thread and Den will explain "frank" events and the limitations of apap mode

who is this 'frank' guy, and why does Den keep talking about him? what, was he some friend of Den's that had a horrible childhood experience with an APAP?