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Sanity check on next steps (still tired)
#31
RE: Sanity check on next steps (still tired)
Just for the sake of completeness.... It might be worth explaining to your doctor that you've optimized your apnea treatment but are still fatigued. It always helps to give the doctor some specific examples of what you mean by this, since it's a term people use in different ways. Your doctor should be able to do some screenings for obvious suspects like thyroid problems, testosterone levels, autoimmune disease, and anemia.

Really hope you see improvement, one way or another.
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#32
RE: Sanity check on next steps (still tired)
(08-20-2020, 06:24 PM)Dormeo Wrote: Just for the sake of completeness....  It might be worth explaining to your doctor that you've optimized your apnea treatment but are still fatigued.  It always helps to give the doctor some specific examples of what you mean by this, since it's a term people use in different ways.  Your doctor should be able to do some screenings for obvious suspects like thyroid problems, testosterone levels, autoimmune disease, and anemia.

Really hope you see improvement, one way or another.

Thanks Smile I will be making a followup appointment soon. I go every few years, just to see if there's any advances in tech that allow them to figure out what's going on. The first time I went they found nothing and I was told "some people don't sleep well" - we've come a long way Smile

In terms of my fatigue, I'm just sleepy. I take modafinil, otherwise my eyes burn, I can't concentrate, and my head feels heavy. Especially after lunch.

If I figure out what's going on and get some good sleep, I'll be sure to post here, in case anyone is having the same troubles.
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#33
RE: Sanity check on next steps (still tired)
Hello again,

Quick question to ensure I'm understanding OSCAR readings and the machine functions properly.

Bonjour, I read a post in another thread where you mention that CPAP and APAP don't do anything with central events. I understand that the machine checks for centrals by issuing a puff of air. Is the attachment an example of the machine checking for central apnea?

I added a red box around the mask pressure trend I'm asking about and a purple vertical line for where the CA was highlighted.

Thanks again!


Attached Files Thumbnail(s)
   
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#34
RE: Sanity check on next steps (still tired)
What you highlighted is Resmed's forced oscillation technique (FOT).

Excerpt from Resmed's site:
Quote:ResMed devices also include CSA detection. This advanced technology uses the forced oscillation technique (FOT) to determine whether a patient’s airway is open during an apnea. When an apnea is detected, small oscillations in pressure (1 cm H20 peak-to-peak at 4Hz) are added to the device pressure. If flow is detected, the airway is open and the apnea is from CSA. If no flow is detected, the airway is closed from an obstruction. The device responds by either increasing pressure for an obstructive apnea or maintaining current pressure and recording the event for the patient’s apnea–hypopnea index (AHI) report.
Crimson Nape
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www.ApneaBoard.com
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Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
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#35
RE: Sanity check on next steps (still tired)
(08-21-2020, 05:04 PM)Crimson Nape Wrote: What you highlighted is Resmed's forced oscillation technique (FOT).

Excerpt from Resmed's site:
Quote:ResMed devices also include CSA detection. This advanced technology uses the forced oscillation technique (FOT) to determine whether a patient’s airway is open during an apnea. When an apnea is detected, small oscillations in pressure (1 cm H20 peak-to-peak at 4Hz) are added to the device pressure. If flow is detected, the airway is open and the apnea is from CSA. If no flow is detected, the airway is closed from an obstruction. The device responds by either increasing pressure for an obstructive apnea or maintaining current pressure and recording the event for the patient’s apnea–hypopnea index (AHI) report.

That's great, thank you!
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#36
RE: Sanity check on next steps (still tired)
Hey everyone,

I have a question about Central Apnea. While I wait for a copy of my sleep study, I've been chasing numbers as I continue to feel tired, despite the great advice here helping lower my AHI.

I've made a few changes:
  • I'm using a soft cervical collar
  • I'm using mouth tape
  • I've stopped using one of the two chin straps (because of the mouth tape). I still use one because I find myself awaking and snapping my jaw shut (I have a mouth guard for teeth grinding), and I don't need another reason to wake up Smile
I've noticed that my sleeping position is correlated with my AHI, in particular, with my central apnea events. When I sleep in more of a sitting position, my numbers are better. From what I can gather, central apnea and sleeping position are unrelated, is that true? If it is, perhaps the sleeping position is reducing the number of other events, which keeps pressure more consistent, reducing central events?

I've attached a couple recent OSCAR reports, where I was sleeping in a sitting position.
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#37
RE: Sanity check on next steps (still tired)
TSomm, it'd be helpful to see the charts redone a little. Could you stack the following graphs into one screen shot?

Events
Flow rate
Pressure (not mask pressure)
Leaks
Snores
Flow limitations.

Thanks!
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#38
RE: Sanity check on next steps (still tired)
Sorry about that, here they are.


Attached Files Thumbnail(s)
       
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#39
RE: Sanity check on next steps (still tired)
Rather than decreasing my maximum pressure to minimize the variance between min/max, I increased my minimum pressure a little. It seems to have helped with everything other than central, though this is only one night.

Moving forward, I'll have to see if there's anything I can do to minimize centrals. I'm still tired throughout the day and there's nothing else I can think to do.

I plan on making an appointment with the doc again to see if I can test out an ASV unit. I may not be able to get a prescription for one, but I already used my health benefits on the APAP, so I'll figure out what to do if I can test one and if it makes a big difference in my level of fatigue.

Thanks again to everyone here for your advice and support. I've had sleeping issues since I was in my teens and not understanding them was a big source of stress in my life. The work you're all doing to help total strangers is remarkable. While I'm not 100% certain what's going on with my sleep, I have a much better understanding and I have some next steps to take, which really helps me feel less lost.

You're all fantastic people. Thank you.


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#40
RE: Sanity check on next steps (still tired)
I doubt whether an ASV is what you need. It looks like your problem isn't the CAs themselves but the mini-arousals that set them off. As to what causes them, that's always the million dollar question. Given your relatively active flow limitation graph, I'd say the FLs might be part of the problem. The pressure support/EPR that might help with the FLs might also increase your CAs, though.

Did you ever get a copy of your sleep report? I'd be curious what gave rise to your initial diagnosis of UARS.

Please do also discuss with your doctor other kinds of medical problems that could be causing your daytime sleepiness/fatigue/tiredness. It'd be good if she/he could screen you for some usual suspects.
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