Excessive Daytime Somnolence - Help, please!

kteague,

I'd sleep an hour, two at the most.
Oldern

If you're interested in my comments then please enter your age, and if you have (had) any of these underlying medical conditions:

1) Depression
2) Heart problems
3) Restless legs
4) Lungs respiration insufficiency
5) Brain lesion from being on CPAP
6) Do you nap during the days ( I think that I see it in above post)
6) Do you take any sleep medications

p.s. you could have covered any of these above but there is too much to go over

Oldern, when you do sleep, is it deep or light and restless?

avi123 and kteague

avi123, an aside-as I started reading your post, here is what I got the first few seconds, "If you're. . .enter your age, if you have any. . . ." I used to be able to read fast-had to. But I haven't quite age-adjusted some of my habits.

age 77 to wit Oldern;
1. Depression, probably so, but nothing unusual (if you don't count Obamacare and a small, everyday type deficit of $17 Trillion-just kidding. But my day time sleepy goes back at least to the 9th grade when Biology class at 2:00pm was absolute torture.
2. Diag with mild ASCAD in 2005, with orders to take a baby aspirin a day and improve diet-done and am doing both. I think I suffered a mild HA in 1987 but can't be certain. Left ventricle ejection fraction was borderline low. Recent evaluation shows not serious but suggests observation and monitoring on annual basis. Exercise, stamina, etc, etc, ok.
3. Nope
4. Nope
5. Nope, not that I know of
6. Yes, several times a day. The unusual thing about them, to me at least, is they generally last 10 min., 15 max. At times, I don't really go to sleep, just relax deeply
6A. Sleep meds.-none. Just prescribed melatonin .5mg at 7pm, 3mg at 10. I just started this but am doing so with some reservation so to speak. According to Mollete, ". . .this makes NFS. I don't know enough yet to understand why or how and certainly not enough to disagree.

My Doctor and I are attempting to re-wire my circadian rhythm (my description, not necessarily Doc's) to thwart my caving in at 7:00 pm and then help me to sleep more soundly when I do go to bed-usually 11:00pm and later. This is part of my quest to avoid excessive day time sleepy and also to get me some relief from sleeping on my side which aggravates a shoulder problem. Sleeping supine brings on the apneas. My machine VPAP Adapt SV (Enhanced) doesn't distinguish between CSA and OSA. His script reads:
EPAP min 5
EPAP max 15
PS min 5
PS max 10,
compared to original order from sleep study:
EEP 5,
IPAP min 5,
IPAP max 10

These numbers were predicated on me sleeping on my sides which I agreed to do. However, this may be or has already led to shoulder pain, which I now am trying to minimize.
Thanks folks.
Oldern

Hi - if possible, you could use someone there to tell you if your naps are in fact 'naps' or just relaxation - the older we get the more common it is to catnap, and if you do it enough, without your machine, you could be setting your therapy back.

Del

Julia,

I haven't changed anything recently. I've had to supplement my therapy by naps from the gitgo, 3 years ago. Average usage is about six hours and how much of that is good sleep is hard to say. I just know it isn't enough.

What is happening now is that we are trying to see if we can tweak the settings someway to prevent CSA's and OSA's from swarming when I sleep on my back. I need some rest (and less aggravation to my shoulders) from sleeping on my sides which is the way I got the best results in my last sleep study.

Thanks.
Oldern

Oldern wrote:My machine VPAP Adapt SV (Enhanced) doesn't distinguish between CSA and OSA.

Adaptive Servo-Ventilation machine like yours absolutely distinguish between central and obstructive apneas.

They treat obstructive events with pressure similarly to the way an ordinary bilevel machine does. But
when a central event occurs, they increase pressure swiftly to stimulate breathing.

ASVs are complicated to properly set up. You really need an expert to get things right.

jdm2857 wrote:

Oldern wrote:My machine VPAP Adapt SV (Enhanced) doesn't distinguish between CSA and OSA.

Adaptive Servo-Ventilation machine like yours absolutely distinguish between central and obstructive apneas.

They treat obstructive events with pressure similarly to the way an ordinary bilevel machine does. But
when a central event occurs, they increase pressure swiftly to stimulate breathing.

ASVs are complicated to properly set up. You really need an expert to get things right.

Comment,

You don't see Central events in the data output from Resmed VPAP Adapt SV machines, because if they did then users would complain that those machines have not done their jobs.

I'm guessing you've probably already been asked this but I figured I'd bring it up anyway so feel free to ignore it if it's an annoying comment.

But have you tried every way possible to sleep on your sides?

I only mention it because I suffer from a similar issue with the shoulder. I'm not sure it's because I sleep on my sides or because of something else but my left shoulder is constantly painful as if a nerve is being pinched. When I walk for long periods of time, the entire arm goes numb. Various doctors have said it's various things but none seem to have figured it out 'cause it's still affecting me even after seven years since I started noticing it.

But I find that whenever I sleep on my back, my apneas get significantly worse and I find breathing with the CPAP significantly harder. Often when I wake up due to the CPAP therapy, it's because I've turned on my back in my sleep and the mask (pillows) are leaking and I'm getting a face full of air and I've gone back to mouth-breathing, ie. choking and suffocating. Readjusting the mask, pressing the ramp button, and going back to my side and I generally am able to get back to sleep again and continue therapy.

From your comments it seems that the choice is between shoulder pain or good CPAP therapy. Maybe you're making the wrong choice?

Oldern, could it be that you used the word Somnolence and not Sleepiness b/c it's Mental Fogginess {changed from Drowsiness} and not Sleepiness? If it would be Sleepiness then you would have taken longer naps. In my case I have Mental Fogginess during the daytimes and naps don't come easy. So my situation could be:

Cognitive Dysfunction

At some point during the course of their lupus, up to 50 percent of lupus patients describe feelings of
•confusion,
•fatigue,
•memory impairment, and
•difficulty expressing their thoughts.

This collection of symptoms is called cognitive dysfunction and is found in people with mild to moderately active SLE {systemic lupus erythematosus}. These symptoms may be clearly documented by neuropsychological testing, and a newer neurodiagnostic test called the single positron emission computed tomography (SPECT) scan shows reproducible blood flow abnormalities.

The reasons for these symptoms are not known. It may have something to do with changes in how a group of chemicals known as cytokines are handled or may be related to certain parts of the brain not getting enough oxygen.

Other tests including:
•Spinal taps,
•brain wave tests (EEG),
•magnetic resonance imaging (MRI) or
•computerized tomography (CT) scans of the brain may all be normal.

Cognitive dysfunction may come and go on its own, so the management of cognitive dysfunction is often frustrating and currently no optimal therapy is available.
•Antimalarials and/or steroids may be useful.
•Counseling, cognitive behavioral therapy and other interventions that assist a person in developing coping skills may be helpful.

jdm from New Joisy, I don't think that you got the hint from my post. Were you a teacher's pat by any chance?

dictionary.com wrote: hint
noun
1. an indirect, covert, or helpful suggestion; clue: Give me a hint as to his identity.
2. a very slight or hardly noticeable amount; soupçon: a hint of garlic in the salad dressing.
3. perceived indication or suggestion; note; intimation: a hint of spring in the air.
4. Obsolete. an occasion or opportunity.

Nope. Don't see anything like that in your post.

With all due respect …

This is a very strange thread.

The discussion seems to be broken up into two different threads,both open and being added to with comments, this one and another one at:

viewtopic/t80568/viewtopic.php?f=1&t=90 ... 01#p828601

called Tweaking pressure to fight OSA when sleeping supine

You are discussing questioning your settings and your Rx in both threads with no resolution.

This thread jumps 10 months with little or no indication as to what was happening.

I have tried to jump back and forth to try to figure out what exactly is going on, and nowhere do I see what your - Oldern's - AHI is, unless I have missed it inadvertently while jumping around. All I see is one hour of apneas from a month ago even though your concerns cover a period of more than a year.

I understand that you are having daytime sleepiness and your doctor would like you to avoid sleeping on your back but it is painful to sleep on your side(s). But I haven't been able to ferret out the extent or quality of your received therapy. Maybe I've missed it. Your numbers are from ten (10) months ago.

Can you give us a few screen shots of your Statistics page(s) over this period of time in either ResScan or SleepyHead?

What is your most recent AHI; your last 7 days average; last 30 days,last 6 months, etc.??? Ditto for how many hours of sleep you are getting on the machine?

Best wishes, Nate