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Fatigue and forgetfulness after treatment?
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marxxx Offline

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Machine: Resmed S9 Autoset
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CPAP Software: ResScan SleepyHead

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Post: #1
Fatigue and forgetfulness after treatment?
Hi All,

I have a previous thread about ongoing fatigue after cpap therapy posted here
http://www.apneaboard.com/forums/Thread-...y-fatigued

I am posting a new thread to ask some specific questions because my symptoms continue. I have been to numerous Doctors over the last year and they can't figure out what's wrong. I do have other health issues, but have been assured those are under control. My dr whole heartedly believes my issues revolve around sleep. Per my other thread, I did get by resmed s9 esacape replaced with a resmed s9 autoset, and a new mask about that time. I also changed my pressure from 4-20 auto to 9-15 auto. With all that I seemed to sleep relatively good for a few weeks and seemed to feel a bit better, but have since reverted to feeling poorly most (if not all) the time.

Some background -
My actual diagnosis was Mild obstructive sleep apnea exacerbated to the severe degree during REM sleep.
My non rem ahi was 2.5, but my rem ahi was 41.7.
The other concerning #'s were related to O2,
The mean oxygen saturation during the
study was 92.0%, with a minimum oxygen saturation of 73.0%.
Spent 5.7% of sleep time with an oxygen saturation below 90%. The maximum end-tidal CO2 was 59 mmHg and the minimum EtCO2 was 30 mmHg. The patient spent 72.3% of
sleep time with an EtCO2 above 45 mmHg and 23.0% above 50 mmHg.

So, here are my questions.
1.) Could sleep issues to be blame for me feeling poorly even if the ahi is low (ie under 2) considering most of those are likely to occur during the rem phase of sleep?

2.) Assuming my ahi is low, could low o2 still be an issue (or high CO2)? My thought here is even low ahi I could still be getting low o2 levels????

3.) Would replacing my mask cushion potentially help (I think it is about 3 months old, not due for a new mask for 3 more months).

I am having horrible memory issues and not at the age that I should be. Very concerned about that - maybe moreso than the overall fatigue.
I did see another dr who treats sleep apnea, but she had no idea where to start, She referred me to another dr. Took several months to get in there but will be going in the new year.

I appreciate all the great info on the site, and would be grateful for any info that can be shared about these issues.

Thanks!
12-21-2014 04:33 PM
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DariaVader Offline
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Machine: Resmed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10 for Her
Humidifier: H5i humidifier with ClimateLine heated hose
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CPAP Software: SleepyHead

Other Comments: diabetes II, Thyroidectomized, Primary Immune Deficiency, and the list goes on :P

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Post: #2
RE: Fatigue and forgetfulness after treatment?
lots of possibilities exist. there are other sleep disorders for one. sleep apnea related, maybe you are still having events that are too small to count but that still disturb your sleep (RERA or RDI) and it could also be something entirely unrelated to sleep.
12-21-2014 06:03 PM
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Ghost1958 Offline

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Machine: PRS1 Series Sixty Auto Aflex
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Mask Make & Model: F&P Eson
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Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

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Post: #3
RE: Fatigue and forgetfulness after treatment?
Gonna toss this in here. A low over night AHI on SH doent tell the whole story.

Example, Wife got up two days ago feeling like heck with a headache tired all the things you expect from SA. But her overall AHI was 1.5.

Being the curious cat I am I pulled her numbers up on sleephead and looked at her AHI per hours for the whole night. Her last two hours of sleep that night had been a two hour nightmare of OAs Hypops FLs etc. For those two hours she ran a AHI of 10 to 12 then woke up.


Total AHI for the night is a good part of it but you can have several hours where your ahi is really high O2 desats bad etc etc. And you do that most nights you can wind up feeling like doo doo with good over night AHI numbers.

Answer is to have your machine running with enough minimum pressure to be effective and your max high enough to take care about everything no matter what sleeping position your in deep REM etc.

We all have a bad night once in a while but if you run a decent part of the night with a high AHI the other very low you can wind up with a total for the night average AHI that looks very good and still feel like crap.
(This post was last modified: 12-21-2014 06:15 PM by Ghost1958.)
12-21-2014 06:13 PM
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Peter_C Offline

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Machine: System One DS960HS
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Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

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Post: #4
RE: Fatigue and forgetfulness after treatment?
Some random thoughts.

First, is you 'meds' list. What is it, or, are you 100% sure than none of the meds you take will affect your breathing, sleeping, memory, etc?

Then we look at blood work; as in how long was your last complete blood work done? Anemia (example) will do everything in your post, even while on CPAP (ask me about last DEC).

Then heart; have you seen a heart Doc (specialist?)? Ever have a 'stress test', or 'heart cath'? if so, how many years ago?

Diet, exercise, health (body and mind) - all will play a role here, and (sadly) there are many non-OSA related issues that may be at work here.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
12-21-2014 10:47 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
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CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #5
RE: Fatigue and forgetfulness after treatment?
(12-21-2014 04:33 PM)marxxx Wrote:  I have a previous thread about ongoing fatigue after cpap therapy posted here
http://www.apneaboard.com/forums/Thread-...y-fatigued

I am posting a new thread to ask some specific questions because my symptoms continue. I have been to numerous Doctors over the last year and they can't figure out what's wrong. I do have other health issues, but have been assured those are under control. My dr whole heartedly believes my issues revolve around sleep. Per my other thread, I did get by resmed s9 esacape replaced with a resmed s9 autoset, and a new mask about that time. I also changed my pressure from 4-20 auto to 9-15 auto. With all that I seemed to sleep relatively good for a few weeks and seemed to feel a bit better, but have since reverted to feeling poorly most (if not all) the time.

Hi marxxx,

What is the breakdown between Central Apnea Index versus Obstructive Apnea Index?

You can try varying EPR to see if it lowers the AHI.

On an APAP machine, higher Min Pressure and higher EPR may reduce obstructive events like RERA (Respiration Effort-Related Arousal), which are not detected/reported by your machine. RERA events are not counted in the AHI.

The Respiratory Disturbance Index (RDI) includes RERA events: RDI = AHI + the average number of RERA events per hour.

Lowering the Max Pressure or lowering the EPR or turning EPR to zero may lower the Central Apnea Index for some patients.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 12-22-2014 05:17 AM by vsheline.)
12-22-2014 12:31 AM
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AshSF Online

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Machine: PRS1 D560TS
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Mask Make & Model: ResMed P10, Bkup: Airfit F10 & Quattro Air
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CPAP Pressure: 8 - 8 w/ Aflex 3
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Other Comments: Using APAP mode with fixed pressure

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Post: #6
RE: Fatigue and forgetfulness after treatment?
I started on APAP, wide open 4-20 range, 3 months ago. I got my AHI down to < 1 on most nights, 3 weeks into it. But I would sometimes feel not so great in the morning and great the other days. With no correlation to AHI. I raised my pressure to 5-20, then to 6-20 and then to 7-20. With each pressure uptick, my RERA index went down. At 7-20, my RDI (RERAs/hr+AHI) is less than 2 most nights and I feel much better now consistently.

So as Ghost1958 and Vaughn mentioned, AHI is not the complete story. I am using a PRS1 60 series Auto which reports RERAs too so I can track it. Resmed S9 doesn't track RERAs so you may have to just tweak pressures and go with your "feel".

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
12-22-2014 12:44 AM
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marxxx Offline

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Posts: 19
Joined: Feb 2014

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i
CPAP Pressure: auto
CPAP Software: ResScan SleepyHead

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Sex: Male
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Post: #7
RE: Fatigue and forgetfulness after treatment?
(12-21-2014 10:47 PM)Peter_C Wrote:  Some random thoughts.

First, is you 'meds' list. What is it, or, are you 100% sure than none of the meds you take will affect your breathing, sleeping, memory, etc?

Then we look at blood work; as in how long was your last complete blood work done? Anemia (example) will do everything in your post, even while on CPAP (ask me about last DEC).

Then heart; have you seen a heart Doc (specialist?)? Ever have a 'stress test', or 'heart cath'? if so, how many years ago?

Diet, exercise, health (body and mind) - all will play a role here, and (sadly) there are many non-OSA related issues that may be at work here.


Thanks for all the great input!
I am currently taking 180 mg armour, 1000mg metformin, 300 mg neurontin, 5k vit d, b12, 50 dhea, magnesium and either valerian root or melatonin to help me get to sleep (I will lay there for hours and not fall asleep).

I have had complete bloodwork done 4 or 5 times this year. The only numbers that stand out were insulin (high), platelets (borderline low) and cortisol (low). Everything else (including iron) were good, but have not had ferritin tested (which I hope to do next visit) as I understand that can cause issues.

I have not been to cardiologist in several years. I asked my pcp about this last visit and he said it would not be causing my issues. It has kind of stayed in the back of my mind that I should see someone for a checkup though, so I will get that scheduled.

I do cardio as much as I can depending on how I feel. This varies form a few thousand miles on my bycicle one year to very little this year due to lethargy. I still try to get on a stationary bike several times a week, but the intensity and time is lower than previous years, just not much energy to really push it. This is insufficient considering I sit most of the day at work, but have been fairly regular with over the last 6-8 years (the last 2 being the worse).

Diet has changed drastically, I try to avoid processed foods and sugar as much as possible (not so good about that the last couple weeks Smile.... most of the the last year has been a modified low carb diet. I did lose a fair amount of weight early on (when I first started treatment), but have been slowly gaining it back.

I suspect thyroid is contributing to my issues, but both doctors are reluctant to change treatment. I am also going to pursue the low cortisol test from a few months back (2 doctors were reluctant to treat that at all). This is where things get difficult..... I know I don't feel good, but they don't want to treat. They keep pointing at sleep related issues (of course sleep problems could cause low cortisol which in turn can be making my thyroid system inefficient). So, that's why I am here asking the community for help. I really appreciate the time everyone has taken. Truly one of the best forums (of any subject) out there!

Thanks!
12-22-2014 08:04 AM
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marxxx Offline

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Posts: 19
Joined: Feb 2014

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i
CPAP Pressure: auto
CPAP Software: ResScan SleepyHead

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Sex: Male
Location:

Post: #8
RE: Fatigue and forgetfulness after treatment?
[/quote]

Hi marxxx,

What is the breakdown between Central Apnea Index versus Obstructive Apnea Index?

You can try varying EPR to see if it lowers the AHI.

On an APAP machine, higher Min Pressure and higher EPR may reduce obstructive events like RERA (Respiration Effort-Related Arousal), which are not detected/reported by your machine. RERA events are not counted in the AHI.

The Respiratory Disturbance Index (RDI) includes RERA events: RDI = AHI + the average number of RERA events per hour.

Lowering the Max Pressure or lowering the EPR or turning EPR to zero may lower the Central Apnea Index for some patients.

Take care,
--- Vaughn
[/quote]


Thanks for info. I am not familiar with RDI or RERA. I will look into these more.


I have increased my pressure to try and eliminate many of these events. I have reduced my ahi on average. I do feel a little better than I did. Some days I actually have energy for a few hours, but overall still very fatigues and now of course the memory issues seem to be getting worse (or at least more noticeable to others).

There are other nights when there are almost no events, and I seem to feel pretty good after some of these. Example
ahi .14
0 hypopneas, 0 apneas, 1 obstructive, 0 ca.

These seemed to last a few weeks, now more and more are like this
AHI of 1.43, 12 total events. 3 were central, 5 were obstructive, 1 apnea, and 3 hypopneas. The centrals were close to leaks so may not have been real events???

For most of Novemeber I was at or below an AHI of 1. That was the most energy I have had in a long time. The month of december my ahi is back over 1 and don't feel any where near as good.

I guess my initial question was answered - if there is that much difference between and AHI of less than 1 and AHI of say 1.5 - 2. The answer appears to be possibly, and add to that the possibility of events my machine isn't recording.
So, that being said, how do I get a dr to look at this? It is my understanding they are aiming for an AHI less than 5 (5 being normal). I am considerably less than that and still not feeling good.

From what I understand, lack of rem sleep could be causing low hormone levels (cortisol for example). If I get the dr to treat me for low cortisol I am on that medication the rest of my life, and the cause could be sleep. I don't want to do that if that's not the root cause? Is there something specific to ask for? Another type of sleep study that would detect the other events?

Thanks again for all the help!
12-22-2014 08:27 AM
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Crimson Nape Offline

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Post: #9
RE: Fatigue and forgetfulness after treatment?
I know this is probably out in leftfield; but how old is your mattress and pillow? Have you changed your normal sleeping position to accommodate the CPAP hardware?

Statistics prove that people who have more birthdays live longer.
12-22-2014 09:07 AM
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marxxx Offline

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Post: #10
RE: Fatigue and forgetfulness after treatment?
(12-22-2014 09:07 AM)sgearhart Wrote:  I know this is probably out in leftfield; but how old is your mattress and pillow? Have you changed your normal sleeping position to accommodate the CPAP hardware?

Thanks for the idea. My mattress is really old. I asked my dr specifically about that, and he flat out told me that it had no effect!
Keep in mind this is a sleep specialist at a well respected medical facility!
That being said, I dont' wake up in pain or anything. I am not aware of being awakened from discomfort most nights. I actually sleep through night without waking yet feel unrefreshed (most day recently).

Thanks!
12-22-2014 09:25 AM
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