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Sleep Inertia and general Malaise
#1
Sleep Inertia and general Malaise
Hello everyone, looking for some help here. Have suffered sleep inertia for my many years
of using CPAP and then onto BiPap, pulmonologist/sleep specialist hasn't been much help.

Generally feel fatigued all day after my 4 hours of inertia have passed, insisted on another
titration and was bumped up from 10/15 to 11/17 at beginning of September. Caffeine
is the only stimulant that has worked out for me and it does help slightly.

Have periods some of the nights where I am woken right up like being shot out of a cannon
but will fall back asleep within 15 minutes.

Also use a mandibular advancement device as I do have a bit of overbite.

M, 48, 6'0" 200 lbs

Hoping someone here can help me out, appreciate any insight possible.

Thanks Hadley


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#2
RE: Sleep Inertia and general Malaise
Have you undergone a full cardiac and endrocine system workup concentrating on circulating hormone levels? Do you use a pulse-oximeter to check oxygenation levels?
"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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#3
RE: Sleep Inertia and general Malaise
I AM NOT ONE OF THE EXPERTS on this site. But almost all of your events are centrals. They can NOT be treated with a normal Cpap or bipap (which you have). IF that is true you need another type of pap machine.

* ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)

Someone with a lot more knowledge on this will give you some answers and if they can make adjustments to your machine they will.

I hope you get some relief soon!!
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#4
RE: Sleep Inertia and general Malaise
(09-24-2020, 10:24 PM)srlevine1 Wrote: Have you undergone a full cardiac and endrocine system workup concentrating on circulating hormone levels? Do you use a pulse-oximeter to check oxygenation levels?

Have had within the past year a full work up, testosterone was a bit low but everything else
was within normal range. 

Recently had an echo cardiogram to rule out pulmonary hypertension which was clear
and next a (PFT)Pulmonary Function Test and then Pulmonary Stress Test next month after. 

All of this was after my insistence that there is something still very wrong with how I feel even with
BiPap treatment, doctor chalked it up to idiopathic hypersomnia but that didn't do much to satisfy.
That led to me pushing for a deeper dive, it is difficult to be ones advocate when feeling like a
zombie most of the time.  

Have been looking at bluetooth pulse-ox to use with Oscar but haven't made the purchase yet.
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#5
RE: Sleep Inertia and general Malaise
(09-24-2020, 10:52 PM)staceyburke Wrote: I AM NOT ONE OF THE EXPERTS on this site. But almost all of your events are centrals. They can NOT be treated with a normal Cpap or bipap (which you have). IF that is true you need another type of pap machine.

* ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)

Someone with a lot more knowledge on this will give you some answers and if they can make adjustments to your machine they will.

I hope you get some relief soon!!

Funny that my pulmonologist never mentioned ASV, wonder why it wasn't considered.

Seems this type of machine requires cardiac clearance and another titration, if this
is the case that my centrals are causing my problems wonder how to broach this
with my doctor and get it properly looked at.

Going to do a deep dive on all things ASV today and mixed/complex apnea and get
myself up to speed somewhat.

Do appreciate your insight into this!
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#6
RE: Sleep Inertia and general Malaise
If you speak to your doctor about an ASV device, make sure you give them the echocardiogram report as the ejection fraction is one of the screening criteria. You might want to also check with a hematologist to check on the oxygen carrying ability of your blood.

Part of my inertia problem was a combination of low blood pressure (97/67) low heart rate (60) and a slight oxygen desaturation (93%). Are you taking any drugs or supplements?
"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: Sleep Inertia and general Malaise
You are using pressure support at 6.0 with your current 17/11 pressure settings, and that can induce the centrals we are seeing as it pushes you over the apneic threshold and drops PaCO3. How doe as this compare with your previous setting of 15/10 (PS 5)? If CA events have increased, then I would conclude the new settings are not helping, however, it would be interesting to see a summary of your results at the different settings. Also, what is your BiFlex setting?

ASV is preferred for treatment of central and complex apnea, and it is unlikely to be prescribed unless your diagnosis is changed. We really don't know enough about your therapy and why you experience arousals to suggest that is an appropriate solution. At this point, I think you're most significant therapy problem is you are over-ventilated by the high pressure support, and it is likely that your sleep inertia and arousals may arise independently of the BiPAP therapy, and a more complete health workup may be in order.
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#8
RE: Sleep Inertia and general Malaise
(09-25-2020, 08:27 AM)Sleeprider Wrote: You are using pressure support at 6.0 with your current 17/11 pressure settings, and that can induce the centrals we are seeing as it pushes you over the apneic threshold and drops PaCO3. How doe as this compare with your previous setting of 15/10 (PS 5)? If CA events have increased, then I would conclude the new settings are not helping, however, it would be interesting to see a summary of your results at the different settings.  Also, what is your BiFlex setting?

ASV is preferred for treatment of central and complex apnea, and it is unlikely to be prescribed unless your diagnosis is changed.  We really don't know enough about your therapy and why you experience arousals to suggest that is an appropriate solution.  At this point, I think you're most significant therapy problem is you are over-ventilated by the high pressure support, and it is likely that your sleep inertia and arousals may arise independently of the BiPAP therapy, and a more complete health workup may be in order.

Been feeling this way since my first sleep study and cpap 10 years ago, the initial pressure setting
was a 10 cmh20. Always have had sleep inertia as well, do have some data from back when I was
using the 10/15 settings and sleepyhead going back to 2017.

The flex setting it is at 0, cant tolerate biflex at all.

Was diagnosed with COPD a few years back and pulmonologist currently has me using Spiriva and Serevent.

These are the screen shots going back to 2017


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