CPAP/Bilevel titration studies followed by MSLT

I have used Cpap since 11/2014. 100% compliance, AHI about .6, average 8 hours of sleep per day, basically everything looks great per Sleepyhead. My problem is severe fatigue and it doesn't get any better. My sleep doctor referred me to a specialist at the Stanford Sleep Clinic and my appointment was yesterday. I thought PLMD was the problem but the specialist said no to this and scheduled an overnight repeat titration study using both Cpap and Bipap, followed the next day by MSLT testing. I will be at the clinic from 7pm until the following day at 5pm but not til late June, receiving the results mid August. The doctors are thinking maybe hypoventilation and carbon dioxide levels are the problem. Hearing all this yesterday caught me off guard. I'm happy they are hearing me, paying attention, and ordering tests but even so I am anxious. Anyone else go through these tests when on the surface the Cpap machine appeared to work great? I was too tired yesterday to go beyond my initial surprise at hearing what they had to say to think to ask the right questions. What were they looking at to believe I may have a problem with hypoventilation and carbon dioxide levels? I have gained some weight since starting Cpap but I am not obese. I am wondering what I should do while I am waiting? Provigil is not helping much and they are not recommending iron or other vitamins. Anyone else experience this? Any suggestions?

It could be your medications...hypoventilation, without an obvious underlying lung/mechanical issue, is for the most part (my belief but don't take as absolute fact) due to OHS or a medication that causes respiratory depression - especially when sleeping.

I would stop all medications. If you can't sleep, practice good sleep hygiene and try taking Melatonin in small doses.

Edit: To add, Provigil helps with sleepiness if you're a shiftworker, but it doesn't treat any underlying issues such as OSA. It makes sense that it would actually aggravate them.

When my B-12 levels were low I had severe fatique.

Thank you Matt and Bobby,

Good suggestions.
I have no trouble sleeping at all and none of the few medications I take are respiratory depressants.
Good sleep hygiene is always something to look at and review and I am doing this but overall I'm know I am doing a pretty good job here.
I've checked B12, Ferritin, Magnesium, and Vitamin D recently and the doctors did review my lab work yesterday.
I need something that will wake me up.

Sorry you're having problems. If you haven't already, I would look at my Res Rate, Minute Vent, Tidal Volume, Insp Time & Exp Time, and Flow Rate Chart. For example, My Tidal Volume of 360 MED + or - 20, would be more appropriate for a small women...which I am....some things to think about....good luck

Edit Tv

lilly747 wrote:Sorry you're having problems. If you haven't already, I would look at my Res Rate, Minute Vent, Tidal Volume, Insp Time & Exp Time, and Flow Rate Chart. For example, My Tidal Volume of 360 MED + or - 20, would be more appropriate for a small women...which I am....some things to think about....good luck

Edit Tv

Thanks Lilly,
My Tidal Volume is about the same 360-380 MED. I'm 5'. I'll check the rest out too.

Matt00926 wrote:try taking Melatonin in small doses

Matt, If you are going to recommend melatonin supplements, you need to state the dosage.