Making progress or should I discontinue APAP? Trying to figure out if apnea is the cause of my daily exhaustion

Doce wrote: ↑

Wed Jul 10, 2019 5:07 pm

screenshot-20190710-173635.png

looks like 6.6 is a good place to start on your minimum, so leave that there. you will want to maybe just ride this for a few more nights to see where it goes.

it takes some time to see the benefits of cpap regarding being tired. i'm too lazy to go look, but i take it it you've only been on therapy for 2 months?

and yeah, i know i said "only" and you thinking it's been forever. but leave it alone and see where it goes. you may well adjust to the therapy and start feeling less tired.

also, remember that not every sleep problem can be solved by cpap. there are other contributing factors. i hesitate to say that because i can tell you really, really want the exhaustion to end. and i don't blame you.

but stick with this and let's see where this goes, okay?

good luck!

July 9 looks pretty good. CA's make up 100% of your AHI, but that's because the obstructive events are non-existent.


I suggest you leave these settings and see if your AHI can stay so consistently low.

Take any medications of any kind? If so, what?

Any other health issues going on?

Wake often during the night? If so, why? Spend much time awake in the middle of the night?

Ever think that maybe you need more hours of real sleep consistently??? 5 to 6 hours isn't enough for a lot of people to feel well rested.

kteague wrote: ↑

Wed Jul 10, 2019 3:58 pm

Have you posted copies of your sleep study report? Just thinking that how much you slept, time in each stage, and position in each stage could give you an idea if the data captured is likely to be reflective of your usual sleep. It is not unusual for studies to be short in information and the patient is left making decisions on incomplete information.

I was unable to tell from your posts how consistently you use the machine. Consistent use of optimized settings is the goal. I will defer to the data gurus on here on your machine settings. My non-guru suggestion would be to work on tongue positioning to help with the blowouts. Training the tongue to stay suction sealed against the roof of the mouth transformed my CPAP experience. It enabled me to stop mouth taping and stop using a chin strap. Well, using a flat firm pillow also helped keep my jaw up. To help with tongue position when side sleeping, hanging my head off the edge of the pillow causes the front of my face to tilt slightly downward, putting the tongue in the perfect position to maintain the seal and stay out of the throat.

Have your doctors already checked you for things like anemia, thyroid function, blood sugar, blood pressure, B vitamins, Vitamin D, etc? Have any meds you are on been assessed for side effects that match your symptoms? Your sleep apnea may be all or part of your problem. By using the treatment consistently, at least after some time if your symptoms persist you can reasonably expect to need to look for additional contributors. Deal with the known factors (sleep apnea) and see what you're left with. Not seeing symptom improvement after consistent use does not mean you should stop treatment. It means you should add to it.

If I said all that in your other thread I apologize for the repetition. Good luck with sorting through things.

I have not posted the study but I did edit my post to add some notes from the study. I’m trying the tongue technique and made a little progress last night. Hopefully muscle memory makes it easier over time.

Many blood tests and everything seems fine except for somethings being a little low. Past blood tests have shown low vitamin D, and sometimes low iron but not enough to be anemic. I am hypoglycemic. The doctor doesn’t seem concerned with these things. I’m staring to think apnea is only part of the issue but will see how progress continues.

zonker wrote: ↑

Wed Jul 10, 2019 5:35 pm

Doce wrote: ↑

Wed Jul 10, 2019 5:07 pm

screenshot-20190710-173635.png

looks like 6.6 is a good place to start on your minimum, so leave that there. you will want to maybe just ride this for a few more nights to see where it goes.

it takes some time to see the benefits of cpap regarding being tired. i'm too lazy to go look, but i take it it you've only been on therapy for 2 months?

and yeah, i know i said "only" and you thinking it's been forever. but leave it alone and see where it goes. you may well adjust to the therapy and start feeling less tired.

also, remember that not every sleep problem can be solved by cpap. there are other contributing factors. i hesitate to say that because i can tell you really, really want the exhaustion to end. and i don't blame you.

but stick with this and let's see where this goes, okay?

good luck!

I’ll be sticking with 6.6 for awhile and hopefully see an improvement. That’s is also my concern is that there may be more going on here than just apnea. Restful sleep has been a problem for about 7 years now but I’m not giving up.

Pugsy wrote: ↑

Wed Jul 10, 2019 6:21 pm

Take any medications of any kind? If so, what?

Any other health issues going on?

Wake often during the night? If so, why? Spend much time awake in the middle of the night?

Ever think that maybe you need more hours of real sleep consistently??? 5 to 6 hours isn't enough for a lot of people to feel well rested.

Not currently on any medications. I do take multivitamin, vitamin c and d, and iron.

Excluding the fatigue, headaches, and concentration issues, the other health issues that come to mind are feeling like tasks or objects require more muscle strength than I remembered. A little low vitamin D and iron but not enough to be anemic. I am hypoglycemic. Also, a little maintenance insomnia as I sometimes have trouble returning to sleep during early morning awakenings.

I do wake up several times during the night. More so towards the morning hours. It’s usually itchy skin or some stimuli wakes me up. I seem to be a very light sleeper.

More sleep is definitely needed. I just can’t seem to get more than 6-7 hours before my body wants to get up even though I’m not rested. The time asleep is lower on the Oscar graphs as I sometimes take my mask off to return in to sleep when I have an early morning awakening.

It seems there is a pattern of the second half of the night, around 3 or 4am, is where it feels like my slumber takes a turn for the worse, becoming restless, until it’s time to wake up.

Doce wrote: ↑

Thu Jul 11, 2019 1:51 pm

I’ll be sticking with 6.6 for awhile and hopefully see an improvement. That’s is also my concern is that there may be more going on here than just apnea. Restful sleep has been a problem for about 7 years now but I’m not giving up.

yup. always good to get the apnea well under control. then you will KNOW, if it isn't apnea, that it's something else.

good luck!!

palerider wrote: ↑

Wed Jul 10, 2019 2:58 pm

Wulfman... wrote: ↑

Wed Jul 10, 2019 2:16 pm

At some point, you may want to try a straight pressure rather than a range of pressures. Some people have their sleep disrupted by the changing pressures.

I've heard this allegation but have never seen any reputable evidence that it is the pressure changes that wake people up, it's much more likely that what wakes them up are the breathing events that cause the pressure changes.

Breathing events are documented to disturb sleep. That, plus not being as dead tired as without the CPAP, and the added stimulus of the mask is enough to wake people up enough to blame the pressure for waking them up.

It's really pretty evident looking at some of these charts that when the pressure reaches a certain point, the user wakes up, turns off the machine and restarts it. Could be the pressure or could be the leaking (caused by pressure) that results.
But, I have long been a believer that the pressure changes during sleep can bump the user out of the deeper sleep stages and into lighter ones. That could result in the "not feeling rested" scenario. It did for me.


Den

.

Wulfman... wrote: ↑

Thu Jul 11, 2019 4:16 pm

palerider wrote: ↑

Wed Jul 10, 2019 2:58 pm

Wulfman... wrote: ↑

Wed Jul 10, 2019 2:16 pm

At some point, you may want to try a straight pressure rather than a range of pressures. Some people have their sleep disrupted by the changing pressures.

I've heard this allegation but have never seen any reputable evidence that it is the pressure changes that wake people up, it's much more likely that what wakes them up are the breathing events that cause the pressure changes.

Breathing events are documented to disturb sleep. That, plus not being as dead tired as without the CPAP, and the added stimulus of the mask is enough to wake people up enough to blame the pressure for waking them up.

It's really pretty evident looking at some of these charts that when the pressure reaches a certain point, the user wakes up, turns off the machine and restarts it. Could be the pressure or could be the leaking (caused by pressure) that results.
But, I have long been a believer that the pressure changes during sleep can bump the user out of the deeper sleep stages and into lighter ones. That could result in the "not feeling rested" scenario. It did for me.

I'll grant that *something* bumped you out of deeper sleep stages.

Apneas, hypopneas, snores and flow limitations are DOCUMENTED to do that.

And they also cause pressure to go up.

Side note.
I asked some family if they have noticed any difference with my fatigue levels over the last month or so and they said they have noticed I’m not talking as much about being tired or having headaches or being as lethargic on the couch. I still feel really tired, especially in the morning and throughout work, but this gives me some encouragement.

Have you done an AM CORTISOL SALIVA TEST for adrenals?

These guys can tell you alot more than me as far as the CPAP and apnea angle but as far as what I had to rule out with my exhaustion: Iron, Magnesium, Testosterone and Vit D levels were what the doctor looked for off the bat.


The other thing I think worth mentioning is that a good way to test if fatigue is improving is by testing your exercise tolerance. ( I work as a personal trainer with a Kin degree so I can speak on this subject with some knowledge.)

Doce wrote: ↑

Sat Jul 13, 2019 10:02 am

Side note.
I asked some family if they have noticed any difference with my fatigue levels over the last month or so and they said they have noticed I’m not talking as much about being tired or having headaches or being as lethargic on the couch. I still feel really tired, especially in the morning and throughout work, but this gives me some encouragement.

Some people have a sudden and abrupt improvement.

Others, it sneaks up on them.

I took a break from the machine for a couple of nights, but have a chart from last night's slumber. It seems the minimum pressure setting of 6.6 is a good pressure still.

There were a few times last night I awoke and it felt like I was awake for a long time, or perhaps just a very light stage 1 sleep. The zoomed in screenshots are below and I'm curious about your best guess if it seems I was awake or sleeping by the looks of them. Thank you!

There are some ways you can make it easier to tell in the morning when you woke up at night. One is to turn the machine off, then on, when you wake up. A second is to deliberately spike a leak. A third is to exhale suddenly and forcefully. If you were awake for a while, you could repeat these at intervals.

But one caveat is that the sleep hygiene guidelines say to get up if you can’t fall back to sleep after about 20 minutes. Go back to bed only when you start to feel sleepy.

How did you feel this morning? And could you try to sleep longer as a general rule?

Ograx wrote: ↑

Sat Jul 13, 2019 11:08 am

These guys can tell you alot more than me as far as the CPAP and apnea angle but as far as what I had to rule out with my exhaustion: Iron, Magnesium, Testosterone and Vit D levels were what the doctor looked for off the bat.


The other thing I think worth mentioning is that a good way to test if fatigue is improving is by testing your exercise tolerance. ( I work as a personal trainer with a Kin degree so I can speak on this subject with some knowledge.)

This is very is very interesting because my exercising has become non existent due to feeling fatigued and working out seeming to take so much energy. Could you please explain more about exercise tolerance?

Patriot Partner wrote: ↑

Sat Jul 13, 2019 10:35 am

Have you done an AM CORTISOL SALIVA TEST for adrenals?

I have done a couple AM cortisol blood tests which seemed to come back fine.

Miss Emerita wrote: ↑

Sat Jul 20, 2019 9:04 pm

There are some ways you can make it easier to tell in the morning when you woke up at night. One is to turn the machine off, then on, when you wake up. A second is to deliberately spike a leak. A third is to exhale suddenly and forcefully. If you were awake for a while, you could repeat these at intervals.

But one caveat is that the sleep hygiene guidelines say to get up if you can’t fall back to sleep after about 20 minutes. Go back to bed only when you start to feel sleepy.

How did you feel this morning? And could you try to sleep longer as a general rule?

I usually still feel tired in the morning and crave more sleep or a nap. If I’m able to get in a solid 1 hour nap, I sometimes feel much better for the rest of the day, with a little fatigue sneaking up here and there during the day.

Side note:
I dont know if this is an indication or anything or a clue, but one of the only things that helps me feel a little somewhat rested from sleep in the morning is if I take a prescribed benzodiazepine, such as alprazalam. Though, there is some residual grogginess from the medicine.

I see on the web that alprazolam is fairly long-acting (11-20 hours). You might ask your doctor about using a shorter-acting bensodiazepine drug to help you sleep better. Again from the web, here are the versions that are especially recommended for sleep:

Estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion) are used for insomnia or trouble sleeping.

You might also talk with the doctor about the dosage that would be appropriate to address sleep problems. It might be different from what would address anxiety problems.