Cannot solve daytime sleepyness

Since you have fibromyalgia, you probably are taking several medications for that. Many medications, especially pain and antidepressants, can cause major disruptions in sleep architecture. I had no REM or deep sleep on sleep study. I was tapered off Effexor XR and now am getting 2 hours of REM every night. And just 5 days ago, I stopped feeling sleepy in the daytime in over a year.

Take a good look at the medications you are on. See if any of them are potential culprits. Don't stop taking them unless your doctor tells you too. But it may be time to adjust or change the meds you are on to be more compatible with a good night's sleep.

jwerley wrote:My average AHI is always 5.31 or right in that range......

But of that most of them are centrals.

Pugsy...Almost all of my events are in CA....what does that mean??

Pugsy...The bladder pain wakes me up, I take no meds, I have no trouble falling asleep or getting back to sleep when I do get up.

I get up to pee once or twice a night too...I figure thats just me. I would look into other suggestions..not sleep apnea. My fibro has gone away with my sleep apnea therapy, so obviously that is what caused the fibro... you seem to be the opposite..go figure. I think I would head back to my doctor and find the cause ...he/she is the expert.

Janice,

Some questions:
Have you ever seen a copy of your sleep study?
Do you know whether you had Central Apneas (CAs / aka "Clear Airway" events)?
What was your titrated (prescribed) pressure?
How long have you been using an APAP in a range of pressures?

Some thoughts:
Using an APAP in a range of pressures with Central Apneas is (or can be) a recipe for disaster.
From all the pressure changes on your report, it would appear that you could NEVER get to the deeper sleep stages or REM.
Or, said another way, It would appear that your breathing variations are triggering pressure changes which may be keeping you from entering or staying in those much-needed sleep stages.

Some suggestions:
Set your machine to CPAP mode (straight pressure) at either your titrated pressure or around 12 cm. (to start with) and monitor the results for a week or two. You might also want to try experimenting with your EPR settings (like changing it to 2 or 1) to see if that makes a difference.

Best wishes.

.

Thank you Guest...I very much appreciate your in-put...I will give that a try.

Guest: Forgot to ans. questions....#1 Yes I have a copy of sleep study done 5/12
#2 no centrals
#3 9 is titrated pressure
#4 APAP 4 years

One doctor believes I should be on APAP with a starting pressure of 11.......another doctor thinks I should be on straight CPAP with a starting pressure of 9.

This is why I am taking things into my own hands and trying diferent things......In hopes that I can find the right combination. When I did the second sleep study the doctor gave me a Lunesta to go to sleep....I am thinking that that would not give an accurate test......this was the one above done 5/12. I tried straight cpap with a setting of 9 and it did nothing for the daytime sleepiness, but at that time I was using a brick for a machine...so I will try it again with this machine and see what the numbers say....then take it from there.....Thanks again....Janice

Hmm. First of all...probably should be talking to your doctor about this. Of course you probably already have and they (different docs) point to the other doc as a problem. Urologist says apnea events a likely cause of the over production of urine and the sleep docs don't think that an AHI of 5 (whatever the type of event) is all that big of a deal.

So I got that out of the way.

If it were me I think I would try straight CPAP for a bit and watch the reports. I would try 9 cm CPAP. Gotta start somewhere. I know your APAP wants to go higher and it is going higher due to obstructive event needs...it doesn't respond to centrals. Using straight cpap experiment will likely answer a few questions. If you really need more than 9 cm a lot of the time then you should see and increase in obstructive events. If the pressure increases are perhaps triggering centrals then they should reduce (if they are pressure related). If they don't reduce then maybe they are "awake" events or semi awake events. Perhaps by some chance the variations of the pressure in APAP mode are a disrupting factor to your sleep.
When you wake up with bladder discomfort....is the bladder totally full or just partial. Totally full points to kidneys being in over drive from perhaps apnea events...partial full may point to other bladder issues.

I don't think you can expect to feel much daytime improvement until the fragmented sleep issue is resolved.
So I would work on trying to figure out if those are real centrals with real desats (do you have an overnight recording pulse ox to check) to start with. Obviously the only way to know for sure is with a sleep study but by the process of elimination you can sort of narrow the culprits.

My gut says you likely need a bit more pressure than 9 cm but I think that it bears giving it another go with the data now available so we can see if there is any change in category of events. If those are indeed centrals related to pressure and they totally go away but obstructives take their place then we have to work up to a pressure where the obstructives are reduced and we don't increase the centrals. That's a big IF. With no history of centrals in either of your sleep studies while not impossible to have them show up now...it certainly is not a given either. There are times when you have none at all and your pressure needs are up there.

So...up for a little bit of experimenting by actually starting out with original prescribed pressure?
Goals would be to evaluate any change in category of events and/or number of events along with any changes in sleep fragmentation. Don't expect to hit a home run the first night though...likely it will take some time and you need to keep notes.

Can anyone see any reason from looking at my printout why I still am falling asleep during the day? Thank you in advance for any help!

Janice [/quote]


1) I would first get rid of that silly mask and use a conventional one.

2) Given your many CAs and several OAs, and assuming that the CAs were emerged during PAP treatment, you might be suffering from a Complex Apnea Syndrome. In such a case an ASV machine is called for.

3) According to a French multi center survey, 12% of XPAP users suffer from RES (Residual Excessive Sleepiness) during the daytime, with no cure. You could be one of those. But most of them were younger than you. After excluding confounding factors as depression, and restless legs, the prevalence of RES dropped to 6%.

4) I myself in spite of good treatment of my OSA, have a RES in the a. m. part of the day. From after breakfast till noon. But I can't nap during these times. When I asked my sleep Doc if I should take Nuvigil he said NO because of the stimulative effects of this Rx and me being a senior.

Janice,

With regard to the all the "CAs" being registered in your report, I got to wondering about your (nasal) mask and if it could be a situation where your mouth is falling open, the therapy air is leaking out and being interpreted by the machine firmware as "Clear Airway" events (referred to as Central Apneas). I'm not totally familiar with the newer firmware in the S9s and/or why it wouldn't be considered as a "leak", but it was a thought that might be pursued. If you're not taping your mouth shut, you might try that to see if the "CAs" in the reports are reduced or eliminated.

Your doctors probably aren't taking EPR (exhale relief) into consideration when they came up with your pressure. With EPR, the machine drops the exhale pressure by the setting that is selected......3 cm., 2 cm., and 1 cm. Some people experience apneas at the point where their exhale cycle stops and the inhale cycle begins. For them, having some extra pressure makes a difference at that point. That's why I suggested playing around with the EPR settings. We typically suggest compensating for the pressure drop by increasing the set pressure. For example, if you "need" a pressure of 11 cm. to eliminate your apneas and you want to use an EPR setting of 3, then you would need to set your pressure at 14.......for an EPR setting of 2, then a pressure of 13......and for an EPR setting of 1, a pressure of 12.
This is sort of along the lines with what I suggested as a starting pressure of 12. If you use that pressure (12) and an EPR setting of 3, then you would have an "effective" pressure of 9 at the point where you finish your exhale cycle and begin your inhale cycle.
If you tried a setting of 9 with an EPR setting of 3, then you were only getting a therapy pressure of 6 when you may have needed more.

I'm glad to hear "Centrals" weren't detected during the sleep studies. That may help to narrow the list of the "usual suspects".

Hang in there.

.

Thank you so much....Pugsy, Avi, and Guest and everyone else.....I cannot begin to tell you how much your support helps me...I think I will try the EPR @3 and the pressure @12...(Pressure = 9), for a good week at least, and take daily notes and see if that helps.
I have my sleep study here, so if you need any further numbers I can provide them.
Janice
P.S. I do use tape

Sometimes daytime fatigue is not even sleep related. Many people have afib, allergies, etc.... A good thorough physical seems to be in order.

-Chuck-

jwerley, I'm going on at least 10 months trying to figure out what is causing my excessive daytime sleepiness and how to fix it. Currently my doc is convinced that it is apnea related and I must have higher pressures set on my machine. He also said that I should use a FF mask because my pressures were causing me to breathe through my mouth and I was not getting the sleep I needed. I have to say though that I am doing some better but I'm still sleepy. (I think it could be better with a different mask for me.)

Mostly I just wanted to let you know that you aren't alone in your battles, and I'm sorry to say that I'm glad to see that I'm not either. I could have written your entire post. I'm an XPAP user for many years and have fibro too. Maybe try a FF mask? I think you have some really good suggestions here and I would love to hear if any of them work for you.

Hi Stacy....It is wonderful to know that I am not alone in this quest to find the magic numbers!! I have been reluctant to try straight cpap, as when I do......I wake up gasping for air. The sleep test in 2005 showed that my titrated pressure should be 11...My sleep test this year (where my apnea is worse) shows a pressure of 9, but that was taking a sleeping pill ordered by the doctor. So I have narrowed my auto numbers to 12-15...that seems to cause lots of centrals, which I never had in any sleep test (don't know what that is about). Anyway what I think I might do now is try straight cpap, but with a higher pressure.....my stats show that my auto pressure is around 13+....so with accounting for the EPR set at 3, set the starting pressure at 14 equaling a pressure of 11.......and see what happens.

Thank you for responding to my post.....let me know what you have tried and how you have done and what you are doing now.

Take care,
Janice P.S. just wanted to add that I tape my mouth shut and use a chin strap....NO LEAKS!!!