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Can this cause my fatigue?
#1
Can this cause my fatigue?
Hello everyone.

I am rather confused. 
Do I really have sleep apnea, or could a normal-functioning person score this data? (OSCAR attached screenshot) 

Is it time for me to look into something else, than sleep apnea?

What I find interesting about this data, is 8-10 events of OA's coming right after each other. It looks like a strange sleep pattern - but I am really new into interpreting this stuff, so perhaps its just normal this happens for everyone now and then?

And for the Large Leak: Doesn't happen every night. I can see I am breathing while having those large leaks. I always rest my head on my arm, so it could be the mask (full-face) that is getting tipped a bit of my face, and causing a tiny leak. Could maybe still be an contributing factor to my fatigue, but again, This is not happening every night. 

Could be nice with some help - or just thoughts on this.



In advance, thank you.


_____________________

Optional reading
This was intended to be on top of my post, but I figured I would inform you with the most important stuff first. 

A few weeks ago, I asked about my OSCAR results on here. I got a kind answer, resulting in me adjusting my minimum pressure from 5 to 7. I'm still waking up fatigued. And when I get home from work, I can sometimes relieve the fatigue by resting for 1 ½ hour and up to 3 hours. Been like this for years. 
I don't actually fall asleep when I get home. I simply can't, must be some kind of insomnia, but the fatigue is still too invalidating to do any activities with. Even being on the computer. Anyway, I can often manage to get into a "deep rest" and that is relieving the fatigue, or the worst of it. 

In the evening, I do fall asleep for the whole night. 

So a process must be happening in my body during my sleep, I just don't understand it. Why my sleep has an opposite effect. Waking up unrefreshed. Very unrefreshed.


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#2
RE: Can this cause my fatigue?
People with sleep apnea doesn't often know it unless told by a partner that they sound horrible during sleep or until some other revelatory problem comes later and investigation shows that apneas are the likely precursors.  Often people swear they sleep well, but they don't.  Then, they start PAP therapy, to their chagrin, and insist that it is terrible and makes them feel worse. Hard to argue with the numbers if the therapy is reasonable, but we do acknowledge that how a person feels greatly impacts how they feel about the utility of the therapy, and if they'll continue.  It's a tough game.

Your clustering is very typical of people whose sleep is deep at times and the loss of tone, or the position in which this deep sleep is happening, causes the airway to be pinched enough to cause severe flow restrictions or even OSA.  When this happens, we urge the sufferer to purchase and to trail a soft foam cervical collar large enough to prevent the chin-tucking which is often the culprit.  You want to avoid sleeping supine (on your back) and you want to avoid having your head forced forward by a pillow(s) and causing your clusters of apneas.

Your daily report at upper left says you have significant large leaks, but it isn't reflected in the graphic at right.  At least, not as I see it.  Your pressures seem to be reasonable, although you might wish to experiment with a reduced EPR from 3 to 2 or even 1 for about two/three nights each to see what improvements might happen.

Please don't do anything until at least one other person pipes up and agrees, or especially if they disagree and suggest something that you might find more reasonable or palatable.
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#3
RE: Can this cause my fatigue?
Have you had a thorough medical workup to rule out medical issues like the oxygen-carrying ability of your blood and pulmonary deficiencies leading to desaturation events at night?
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#4
RE: Can this cause my fatigue?
Read the positional apnea wiki. This is your pattern of clustered apnea. http://www.apneaboard.com/wiki/index.php...onal_Apnea
Sleeprider
Apnea Board Moderator
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#5
RE: Can this cause my fatigue?
mesenteria

I appreciate any input. I don't think my machine has EPR. (Philips DreamStation, recalled version), but perhaps it is an equivalent to Flex? 
And hey, the idea with using a soft cervical collar is good. They doesn't seem to be that expensive either, so I could as well try. I read all the comments on this post, and it makes sense that this is what could be happening. Not sure if it will actually work. But worth trying for sure. 



(01-24-2023, 03:05 AM)srlevine1 Wrote: Have you had a thorough medical workup to rule out medical issues like the oxygen-carrying ability of your blood and pulmonary deficiencies leading to desaturation events at night?

No I don't think I have? Maybe. I have to take a further look into those things.
I have had a "full" blood panel drawn - though its not really a full one. What we found was:

Hypothyroidism. 
D-defiency. 
B12 defiency. 

Of course I am under treatment for those, and I have had my tests come back normal for the past 2 years. It has never improved my life. That is why I am digging further into sleep apnea now. 

3-4 years ago, I had a home-test done for sleep apnea, and it showed an AHI of 14. That is mild-moderate. So am not sure if such a lowish AHI would cause so much fatigue. 
So I used my CPAP for several months and scored an variation of 3-8 AHI every night. Just like now. When I saw I had hypothyroidism, I finally thought "this is it! that is why I am so fatigue". But the treatment hasn't improved anything at all.

Your suggestion is quite interesting. Something I possible havent looked into, or any doctors might have suggested.  
Thank you



(01-24-2023, 08:35 AM)Sleeprider Wrote: Read the positional apnea wiki.  This is your pattern of clustered apnea. http://www.apneaboard.com/wiki/index.php...onal_Apnea

Thank you for this informative link. It makes good sense, I will get my hands on a soft cervical collar as suggested. If there is a chance that I can regain the ability to feel rested after sleep, then I will do anything. But I am shooting in the dark here.
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#6
RE: Can this cause my fatigue?
Hypothyroidism definitely can cause fatigue and you might want to consult with an endocrinologist as thyroid tests are tricky. My thyroid tests are impacted by amiodarone and need other confirmatory testing.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#7
RE: Can this cause my fatigue?
I completely understand the denial about sleep apnea and the need for cpap. Especially when it doesn't improve the fatigue. 
Something to consider...
An AHI of 14 means your breathing is disturbed 14 times an hour. Likely also affecting your sleep stages.
A sleep cycle is roughly 90mins (N1, N2, N3, REM), if your sleep is disturbed at any point in the cycle it can prevent the essential N3 and REM sleep.

Personally, my fatigue has not improved with cpap.
However, sleep studies have proven I have mildly disordered sleep breathing and cpap improves it.
Cpap certainly isn't the cure-all for me but, wearing the cpap takes sleep apnea out of the equation so my doctors can search for other causes.

The tricky part is finding doctors willing and able to listen and search for other causes of fatigue.
Keep advocating for yourself and search for doctors willing to help.

Also, in the OSCAR chart you posted... leak rate and flow limits are high.
Try to improve your leaks. Maybe a different mask or adjust fit. The machine can't do it's job when there is significant leak.
Check out the Mask Primer in the Wiki for more info.

Hopefully the experts can offer help for flow limits.
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#8
RE: Can this cause my fatigue?
(01-24-2023, 12:19 PM)srlevine1 Wrote: Hypothyroidism definitely can cause fatigue and you might want to consult with an endocrinologist as thyroid tests are tricky. My thyroid tests are impacted by amiodarone and need other confirmatory testing.

I'm sorry to hear that. When one problem is solved, a new one arises, sadly. Hope you are managing it well. 
And you are right regarding hypothyroidism, it's very tricky. Very complicated. Even though they are calling it a "full blood panel" it's far from a full blood panel they are doing. They are looking at my TSH only. 

But there can be more to it. 
T4 is usually converted into T3, the active form of thyroid hormone. People with hypothyroidism are treated with a synthetic T4 hormone, which the enzymes convert to T3. 
This treatment is usually effective, but some people continue to have symptoms even after treatment. And I could most likely be among those. 

To figure that out exactly, then I need to get tested for FT3 and FT4 - It can tell if I have issues converting, and need to add T3, and not only T4/Levothyroxine into my treatment. 
The endo's shake their head from side to side, whenever I bring those tests up.

The good thing is: I have an agreement with my endocrinologist that is, If I don't feel an effect with my current treatment in 6 months, then we can go the T3 route. That is still a long time to suffer. I'm looking for other causes, because it will really suck to wait a half year for something that only possible would work. 
I have no idea if that will work. But you must understand how desperate I am.
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#9
RE: Can this cause my fatigue?
(01-24-2023, 03:08 PM)Brazen Wrote: I completely understand the denial about sleep apnea and the need for cpap. Especially when it doesn't improve the fatigue. 
Something to consider...
An AHI of 14 means your breathing is disturbed 14 times an hour. Likely also affecting your sleep stages.
A sleep cycle is roughly 90mins (N1, N2, N3, REM), if your sleep is disturbed at any point in the cycle it can prevent the essential N3 and REM sleep.

Personally, my fatigue has not improved with cpap.
However, sleep studies have proven I have mildly disordered sleep breathing and cpap improves it.
Cpap certainly isn't the cure-all for me but, wearing the cpap takes sleep apnea out of the equation so my doctors can search for other causes.

The tricky part is finding doctors willing and able to listen and search for other causes of fatigue.
Keep advocating for yourself and search for doctors willing to help.

Also, in the OSCAR chart you posted... leak rate and flow limits are high.
Try to improve your leaks. Maybe a different mask or adjust fit. The machine can't do it's job when there is significant leak.
Check out the Mask Primer in the Wiki for more info.

Hopefully the experts can offer help for flow limits.

Thank you for your reply! It makes sense. 14 x 10 seconds an hour - and an apnea can easilly occur for more than 10 seconds. With that home-equipment, I had to sleep on my back. I'm not a back sleeper usually, I think its uncomfortable to sleep on my back. I'd rather go for sides or stomach anytime. And I think back sleeping makes the results even worse. I have no idea. Perhaps even a normal-functioning person would be able to reach an AHI of 14 while sleeping on their backs, with such equipment? or no?  

And it is indeed something of a task, to find a doctor who will listen - a doctor who is fully dedicated to find the cause and take someone seriously. I feel like a number here. I have  considered finding a private doctor, abroad. But that is just pricey. Even though I would pay anything to get my normal life back, then it wouldn't be fun to waste money if it doesn't work. 

When it comes to mask leaks, it really differs from night to night. I think that leak was caused by my arm, because I usually rest my head on my arm. 
But I have had nights where I wore it fully. With no leaks. Examples attached - and I felt like crap those days too.


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#10
RE: Can this cause my fatigue?
if the collar somehow seems ineffective or irritating, also consider a travel neck pillow, reversed so the thickest region is in front rather than the back. I use one that is buckwheat husk filled and it is real comfortable and keeps my neck from bending up. I sleep on my left side, with my face pointed 60 degrees above horizontal, and my travel pillow basically goes from horizontal to horizontal, though the thickest part is 30 degrees above my facing direction, it still preserves most of the "holding chin in place" effect. only once in a while I feel pressure on my neck as distressing, and in the 5% of the time it does, I just fold the area near my adam's apple so it relieves the pressure, and creates a mound between my chest and chin. I never wake up feeling a chocking sensation.

I wish that "having no apneas" would magically resolve the fatigue. I have not seen much evidence that fatigue is erased or even better once this rattle-jack episodes are fixed.

My own experience is that I experience these rattle-jacks when I drift off to sleep when extremely drowsy (not fatigued) and before I actually get to sleep I just kind of drift into a cease in breathing. And, I never recall having the problems and it does not startle me.

Best of luck to you, and yes, it is helping you, regardless of the fatigue.

QAL
Dedicated to QALity sleep.
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