Fatigue and forgetfulness after treatment?

[vsheline]

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.

Hi Marxxx,

A doctor should be reasonably responsive to repeated complaints about daytime fatigue and memory problems. Sometimes can it help to get a new doctor who may have more experience.

I think sometimes doctors focus way too much on a low AHI, as if that gives them an iron-clad legal excuse to ignore complaints of fatigue and daytime sleepiness and memory problems by someone they may think simply complains too much.

Two more things,

1. The length of time spent in an Apnea or Hypopnea will affect how low our blood Oxygen levels (SpO2, the percentage saturation of O2 in the blood as measured with a Pulse Oximeter) will get. Or, if events are separated in time only a little, the individual times may combine in creating low SpO2 levels.

2. If you can manage it, I suggest getting a wrist-worn recording Pulse Oximeter with separate finger sensor so you can comfortably monitor (weekly or monthly or whenever changing meds) how low your O2 saturation drops while sleeping. I've received good service from Supplier #19 in this regard. (A link to Supplier List is at top of all forum pages.)

No prescription is required for an oximeter, but if we are able to get a prescription and the get the purchase pre-authorized by our health insurance, insurance may cover it.

[quiescence at last]

I asked doc to prescribe mine, answer was no. Rather than beg and argue, I went out and bought one. I was in a hurry. anyway, my money grows on trees, no big sweat for me.

Anyway, I love love love having the O2 saturation data to compare on wild nights.

[Peter_C]

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 .... 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!

In the scheme of things, 300 mg neurontin is not that much (many people take up to 1800mg), but still, this med *can* create wonky side-affects. How long have you been on it? If you are looking at your med list as a suspect, this is the one listed that stands out. Just remember, the good a med can do may well outweigh issues it may cause.

Just like there are real down-sides to my heart med (Bystolic), but in my case I see it as a necessary evil. I am in Pain MGNT, and long-term side affects include short-term memory issues, which both my wife and I see on a daily basis. Overall quality of life choices come into play here, and only you can decide if the good is worth the bad.

FYI- as a long time couch potato that almost killed himself, I now ride a recumbent trike. In 2112 I rode bout 2500 miles, trike-camping, tours, rides, metrics. In 2013 I rode about 1700 miles, and overall health really improved, A1C 5.4 with no meds. But due to surgeries, did not ride in 2014 at all, and my overall health is showing for the lack. A1C just two weeks ago is 7.8 (no meds). So for me, the message is very clear, exercise to go forward~!

[Ghost1958]

Over the years ive done about every sort of exercise program you can think of. When young it was brute labor on the farm daylight till dark and in winter before daylight then school then after dark. Played basketball, Football, Ran, Wrestled, did the weight lifting thing for a number of years with my wife.

SA pretty much negated all that once it hit years ago though I didnt know what it was and only recently started Cpap. Some damage done but most is healing.

The best exercise ive found after 56 years?? Walkin. Yep just plain old walkin around a mile a day. On Cpap its a breeze to do. Before it was a challenge. But if one cant bike 2500 miles etc just a mile walk a day will do wonders to take off pounds improve cardio etc.

[archangle]

Post some screenshots of your daily SleepyHead screen.

At one time, I found I feel better if I increase my minimum pressure even if my AHI was near zero. Might be worth at little tinkering.

[marxxx]

I see my pcp today, I will ask about a pulse oximeter and see about changing the meds.
It's really bizarre to me how such subtle things have such a significant impact on how you feel.

Peter,
I to enjoy cycling. I don't ride quite as much as you (usually between 1,000 and 1,500 miles) and it really does make a difference. I hope I feel better this coming summer so can resume riding at a more vigorous pace. This past summer was really rough. 5-10 miles was all I could do, and some of those rides wiped me out for days, far cry from 17-25 mile rides that were typical for me.

Thanks for all the ideas!

[surferdude2]

Hi marxxx! I'll share what happened to me recently in case it may be relevant in your case. I was taking an over-the-counter medication in an effort to shorten the time it took me to fall asleep. It was called SleepAid and the active ingredient is 50 mg. Diphenhydramine HCL. It seemed to be helping so I stuck with it for six weeks. It took me some time to notice that a permanent change was slowly coming over me. I seemed to be losing all the benefits that CPAP was initially giving me and was getting very sleepy during the day and feeling poorly in other things like mental acuity and sociability.

I finally put it all together after doing lots of Googling and found that this medication can cause this "daytime hangover effect" on some people, especially with continuous use at high dosage. I stopped the use of it and immediately felt better the very next day. In retrospect, this pill never did help that much and certainly wasn't worth the misery it later caused.

I hope you find your answer as I did so you can get back to full time benefit from your CPAP sessions. Perhaps your PCP will know if any of your meds can have this reaction.

[Peter_C]

I see my pcp today, I will ask about a pulse oximeter and see about changing the meds.
It's really bizarre to me how such subtle things have such a significant impact on how you feel.

Peter,
I to enjoy cycling. I don't ride quite as much as you (usually between 1,000 and 1,500 miles) and it really does make a difference. I hope I feel better this coming summer so can resume riding at a more vigorous pace. This past summer was really rough. 5-10 miles was all I could do, and some of those rides wiped me out for days, far cry from 17-25 mile rides that were typical for me.

Thanks for all the ideas!

My 'trike' is my reward for all the work, surgeries, habits given up, and changes that I have made. The fact that it also happens to be good for me is an added plus. On a typical day ride on the towpath (a non-paved long MUP close to home) I may *ride* for an hour, or not get back to my car for 8-9 hours. I may or may not be riding that entire time. My Kindle and camera go with me, and I ride and stop whenever I like, for however long I may chose to do so. It's about the ride, not the speed, not the distance, but about being outside, going places I could not (or would not) try to walk to. Walking is still painful, and not fun to me, but riding is.

I no longer work. And from May til Sept or so, I want riding to be my primary day-waster. I am trying to improve my overall health after way too many years just sitting on the couch. I am a slow rider 4-8mph being my norm. I love my rolling lawn chair, as whenever I stop, I have a great place to sit

I have lost about 80 pounds, and at 317lbs, still have a ways to go. I used to see my heart Doc weekly, now I need not see him unless I have an issue, but I still see my regular Doc every 90 days.

OSA, older age, meds we take, etc can all have an impact on this topic. All we can do is be aware, and do what we can to lessen the effects.

[Peter_C]

Oh, and my very first ride was all of 400 feet. True story. Simply the act of getting into my car would get me out of breath enough that I had to sit and breathe for a few moments before I could even put on my seat-belt.

[marxxx]

Thanks again for all the ideas. I have stopped the meds / supps that aren't necessary and there may be been some improvement. I still can't make it through the day without feeling completely exhausted. I'm sure it will take a little time to get out of my system so I am hoping it continues to improve.

My pcp wants me to see a sleep specialist asap. I have an appointment in a few months. He gave me another name and number to see if they can get me in sooner.
I go back after the new year and we will retest some of my labs then. Assuming we don't find the answer he is trying to find me a dr who may be able to better determine the root cause of this (if it's not sleep related).

Merry Christmas everyone (yeah, I know it was yesterday)!