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3 Months on CPAP, still tired despite Dr saying my apnea is controlled
#11
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Regarding nasal sprays, fluticasone propionate (Flonase) is OTC in the U.S. and is fine for long-term  use.   I tend to use it seasonally for nasal congestion.  It is an anti-inflammatory and is good for allergies and general congestion caused by inflammation of any kind.  Read the directions, because there is an introductory period with higher doseage, then a routine one-spray per day.  It works for me.

Try the higher pressure and turn off the 45 minute ramp.  I was not going to go full tilt bilevel on you for a while, but the pressure support coming in behind your effort to help you get over the hump of your upper airway resistance is really the key.  I'll post a chart that shows how mask pressure with an Aircurve 10 Vauto corresponds to respiratory flow to add support at the point where your resistance limits the flow.  It is how fatigue is beaten by letting the machine do a piece of the work near the inspiratory peak.  Let me know if you don't know how to read inspiration and expiration flow. Note the red-line through the flow-rate.  Compare this to your chart.

[Image: attachment.php?aid=37359]
Sleeprider
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#12
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Thank you for sharing that! I haven't been able to ditch the Ramp yet because I find it hard to relax while exhaling against a pressure of 7 with the EPR, but I have been using 10 every night. So far it has brought my 95% flow limitation down to 0.14 most nights but I can still tell by the graph that there is resistance.

It's worth noting that I did have lung surgery last year which has unfortunately left me with what the respirologist calls a "mild restriction" so even during the day time it isn't always easy breathing for me. I don't have COPD or anything, it's more just a result of the nature of the surgery and the intentional chest wall scarring.My lung capacity is lower than it should be.

The neurologist thinks that all of my symptoms I alluded to are because of a functional vitamin b12 deficiency which I will find out after blood work on Wednesday. That could most definitely be the biggest player in my fatigue right now.

One other thing, I also own nasal pillows and noticed that even at the pressure of 8 it seems like there is less resistance when inhaling for me. So I'm wondering if I start using Flonase to keep things clear, the nasal pillows might make my flow limitations even lower.
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#13
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Nearly any condition that restricts your normal pulmonary capacity can benefit from pressure support of bilevel. I would think your respirologist could just write the prescription, especially if you have pulmonary function tests that demonstrate some reduction in lung volume or slower rebound. In general, without a physician's support for bilevel, it is very hard to get, and a sleep doctor generally can't get the prescription through unless he can cite some medical benefit to bilevel. A vitamin B12 deficiency for neurological conditions is kind of a new one on me so I looked up this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078635/ This is out of my wheelhouse, but if that is an issue it sounds like an easy fix.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Thanks. When I speak to the sleep doctor next I will definitely be asking to try a BiPAP

Yea I went deep down the rabbit hole with B12 deficiency and there have plenty of medical negligence lawsuits in the past because it's often ignored when it's in the "normal" range. I was going into all of this expecting to be diagnosed with MS based on the duration and progression of my symptoms in the past 6 months, plus the fact that my MRI did show several lesions but they are nonspecific in nature. As it turns out though, B12 deficiency, especially left untreated, causes demyelination and permanent neurological damage. It mimics a whole bunch of diseases so, I'm hoping that's all it is and I can just starting taking injections.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543499/
https://www.b12deficiency.info/misdiagnosis/
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#15
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Agree with SR. With your lung condition you are screaming BiLevel.

Because of your lung condition I do recommend getting a recording oximeter so you can monitor your SATs and call them to your doctor's attention should they appear to be low, either day or night. These would only need to be periodic cautionary checks unless they are low.
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#16
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
With B12 on board and a bilevel at your bedside, I hope you’ll be feeling rested before long!
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#17
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Thanks for all the support everyone. Much appreciated and I hope to report back here soon with some good news
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#18
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
Flonase is good stuff for allergies and works for a lot of people. You could also talk to your primary care provider/ENT about a prescription for Astelin, a different class of medication, which can be used separately or added to Flonase. Astelin can treat non-allergic congestion if Flonase isn’t doing the trick. Astelin also does not cause rebound congestion the way Afrin does because it is a different class of medication. Finally, consider a saline nasal spray, saline nasal rinse, or xlear for non-medicated decongestion. Keeping the nose clear for much of the day can aid your medicated sprays by clearing out irritants hanging out in your nasal passages. Hopefully all you have is allergic rhinitis and Flonase will take care of it.
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#19
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
I’m wondering if the pressure relief could be playing a factor in the flow limitation?

They way it feels to me is that my inspiration gets weak enough at the top of the breath that the machine thinks that I’m already beginning to exhale so the pressure drops and I struggle to get the full breath.
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#20
RE: 3 Months on CPAP, still tired despite Dr saying my apnea is controlled
I think this is unlikely. So long as you are still inhaling, however weakly, the machine "knows" it's not time to drop the pressure. Instead, the flow limitation itself is probably accounting for your feeling that you struggle to get a full breath.
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