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Fatigue from sleep apnea.
#21
I had been struggling with fatigue for a number of years, and I’ve gotten complaints about my snoring for a long time, mainly from neighbors in my apartment building banging on the walls. My boss is a sleep apnea sufferer, and he had been recommending that I get a sleep study for about a year (I have had a problem with falling asleep on the job). I also have a difficult work schedule that has contributed to my fatigue and I have been unable to get it changed: Fri 12:30 PM - 9:30 PM, Sat, Mon, and Tue 9:30 AM - 6:30 PM, and Sun 7:00 AM - 4:00 PM.

My fatigue suddenly grew worse about three months ago, and my BP increased from 145/90 to 190/102 in just one month. Last month I asked my PCP for a referral for a sleep study. I finally had my sleep study about a week ago but I had a great deal of difficulty sleeping, mainly because my own snoring woke me up repeatedly. The sleep center was much quieter than my usual bedroom, so I did not have the usual background noises to mask my snoring.

I was afraid that I had blown my sleep study, and would be unable to get insurance coverage for another sleep study due to my problems at work. I was also desperate for relief, so I purchased an S7 Autoset on Craigslist and started using it. I had to guess at the pressure, so I spent the better part of the day researching sleep apnea on the internet, and I set the machine to 8-15 the first night. (Thanks for the instructions, Apnea Board!) I woke up repeatedly due to apneas, and gave up on it after about 4 hours, but I noticed that the machine was putting out a pressure of 9.1. Still, it was the best night’s sleep I had had in a long time.

The second night, I adjusted the pressure to 10-15. I have now used it for 4 nights, and I feel far better than I have in a long time. The machine usually sets the pressure to about 11.

I had my follow-up appointment today, and it turned out that there was enough data, after all. I was experiencing about 40 apneas per hour, and the sleep specialist prescribed an APAP with a pressure of 6-16. I’m now trying to get an S9 Autoset, and I plan to change the pressure to 10-16 as soon as I receive it.
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#22
(04-23-2012, 08:24 PM)big_dave Wrote: I was experiencing about 40 apneas per hour, and the sleep specialist prescribed an APAP with a pressure of 6-16. I’m now trying to get an S9 Autoset, and I plan to change the pressure to 10-16 as soon as I receive it.

I don't want to come on too strong here, so please don't blow me off when I tell that you should consider going with the 6-16 for at least a week to see what happens.

I know that we advocate patient empowerment here on Apnea Board, but step back and look at it objectively. Who's in a better position to recommend the starting pressure? Health professionals armed with sleep study results, or a patient who's shooting in the dark?

The thing is, too high a pressure can induce central apneas, making your symptoms worse. See how you do after a week on 6-16. If you're getting an overwhelming number of obstructive apneas, it's a sign that your pressure may be too low.

At that point you can send your data to your doctor and ask him what he thinks of your 10-16 idea. If you trust the doctor enough to prescribe therapy for you, you might want to give him the benefit of the doubt and see if he knows what he's talking about.

If I were a doctor and my patient just ignored my advice, I'd feel insulted.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#23
(04-23-2012, 08:41 PM)Sleepster Wrote:
(04-23-2012, 08:24 PM)big_dave Wrote: I was experiencing about 40 apneas per hour, and the sleep specialist prescribed an APAP with a pressure of 6-16. I’m now trying to get an S9 Autoset, and I plan to change the pressure to 10-16 as soon as I receive it.

I don't want to come on too strong here, so please don't blow me off when I tell that you should consider going with the 6-16 for at least a week to see what happens.

I know that we advocate patient empowerment here on Apnea Board, but step back and look at it objectively. Who's in a better position to recommend the starting pressure? Health professionals armed with sleep study results, or a patient who's shooting in the dark?

The thing is, too high a pressure can induce central apneas, making your symptoms worse. See how you do after a week on 6-16. If you're getting an overwhelming number of obstructive apneas, it's a sign that your pressure may be too low.

At that point you can send your data to your doctor and ask him what he thinks of your 10-16 idea. If you trust the doctor enough to prescribe therapy for you, you might want to give him the benefit of the doubt and see if he knows what he's talking about.

If I were a doctor and my patient just ignored my advice, I'd feel insulted.

Point well taken. It appeared to me that a pressure of 9.1 was inadequate due to the repeated apneas. Also, the machine appeared to settle at a pressure of about 10 if I used the machine while awake (at the 8-15 setting). But you're right that I'll need to discuss it with him.

As an experiment, I'll try backing down the minimum pressure on the S7 and keep a log of what happens. I'll try 9.4 tonight.
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#24
(04-23-2012, 08:48 PM)big_dave Wrote: Point well taken. It appeared to me that a pressure of 9.1 was inadequate due to the repeated apneas. Also, the machine appeared to settle at a pressure of about 10 if I used the machine while awake (at the 8-15 setting). But you're right that I'll need to discuss it with him.

It's not unusual to have a large number of obstructive apneas the first few nights on CPAP therapy. Or a large number of central apneas, too, for that matter. It takes a while for your body to acclimate. They were obstructive apneas, not central apneas, right? The ones you had while you were asleep.

What happens when you're awake is totally irrelevant. You could just stop breathing for 10 seconds while concentrating on a task, and it'll score a central apnea. Or it could score it as an obstructive apnea, depending on how you're holding your tongue and the other muscles in your throat. You need to be asleep. That is, unconsious, to get any kind of meaningful data.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#25
(04-23-2012, 09:01 PM)Sleepster Wrote: It's not unusual to have a large number of obstructive apneas the first few nights on CPAP therapy. Or a large number of central apneas, too, for that matter. It takes a while for your body to acclimate. They were obstructive apneas, not central apneas, right? The ones you had while you were asleep.

I missed that during my research. Do you have any references I can read so I can understand it better?

Definitely obstructive.
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#26
(04-23-2012, 09:08 PM)big_dave Wrote: I missed that during my research. Do you have any references I can read so I can understand it better?

No, it's just something I experienced and noticed others reporting here and in other forums that they've experienced the same or similar things.

Quote:Definitely obstructive.

If that condition persists for a few weeks, it could be a sign that the pressure is too low. Let us know how the numbers look after a week.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#27
It's understandable that our bodies kinda freak and can create more events in the first few days.

The air is doing "nothing more" than keeping the throat open via pressure. And our muscles are stronger than the air pressure.

The muscles of the throat are actually voluntary, meaning we are in control of them. We fall asleep and like every other voluntary muscles, they relax. If they can relax in our sleep, they can also tense up.

After a while though, perhaps only a few days, everything begins to calm down. We "remember" in our sleep what the pressure is and no longer resist it.

It is the same reason why higher pressure can cause central events. Our poor brains are rather confused and decide breathing isn't necessary. We have to slowly increase the pressure (if higher is needed) until the brain gets acclimatized.

You will find there's a lot of theories floating around here. Not that we are all big huge liars nor great story tellers. We're the people who live with these machines and masks and all the fun that comes along with it. We are each our own research facility, coming to conclusions based on our own individual experiences. Then we come here and share those experiences and discover we aren't the only ones having them.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#28
(04-05-2012, 02:30 PM)Dreamcatcher Wrote: Also some people dont get the relief that your thinking of, it can be very suttle. Im 2 years in and still fall asleep watching tv and reading. I told this to my doc and he said sorry but thats just you ??? Not sure what he meant. For me I excercise in the gym which makes me feel alive and I also quit smoking and changed my diet, maybe extreme for some but it worked I dont fall asleep 10 minutes after getting up anymore.

So if your looking for a light switch moment it may never happen but my advice is we are all different so stick with it as you WILL feel better at some point, it just takes time for some of us.

My life has improved dramatically since I had my tonsils out deviated septum fixed and nasal polyp removed, and I am 44. I am now on the cpap for remaining apneas. I was told through three sleep studies that I do not have sleep apnea. Finally, I located a more highly sensitive test called the esophageal pressure monitoring test referred to as the PEZ which is a wire that is run through your nose down into your throat. It saved my life because without it, the traditional sleep study does not register my apneas or son's. We are both on cpaps now and he is so much happier and nicer and mor compliant and easy going. He was being evaluated for suspected Aspergers (autism spectrum), and now his symptoms since his surgeries and now the cpap are virtually gone. My point is that like you I was told I must be just one of those persons who needs lots of sleep. I and my son were diagnosed with ADHD and most of the symptoms have now been eliminated or greatly reduced.

Only three places in the country use the PEZ, so how can any sleep clinic say definitively that the chosen cpap pressure is effectively eliminating your apneas if they are not sure they are catching them all to begin with in the titration study and where you say you are still sleepy even though you are wearing your cpap? Maybe you could look into having a titration study with the PEZ? Perhaps, it will show you require a higher pressure setting than is observed without the PEZ. The University of Michigan in Ann Arbor offers the PEZ, and two other places in the country.

It should be noted that in my experience, your sleep efficiency score and your stage shifting score in particular can be more representative of your condition than ahi in cases where existing apneas have yet to be observed by less sensitive equipment.

I hope you consider the possibility.
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#29
I'm confused. By definition, sleep apnea is the cessation (or "significant" reduction) of breathing while sleeping. How can monitoring the breathing airflow not be sensitive enough to detect sleep apnea? What other mechanism is in play here?
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#30
I can't understand this, either. Arousals and desats would still be detected in a normal sleep study. If there are no desats and no arousals then I don't see how the condition could have an adverse effect on your health or in how rested you feel.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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