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fatigue...HELP!
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storywizard Offline

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Machine: ResMed VPAP Adapt S9
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Sex: Male
Location: Vancouver, BC, Canada

Post: #11
RE: fatigue...HELP!
Here is a graph of my AHI data...looks scary...

http://www.mediafire.com/view/t4lajc086qpel53/AHI%20Screen.jpg#


Leaks:

http://www.mediafire.com/view/pvug2nm0er0zn6t/leaks.jpg#

Stephen
(This post was last modified: 07-28-2014 06:39 PM by storywizard.)
07-28-2014 06:30 PM
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Gabby Offline

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Machine: ResMed AirSense 10 AutoSet For Her
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Location: Sunshine Coast, Qld., Australia.

Post: #12
RE: fatigue...HELP!
(07-28-2014 06:30 PM)StephenR Wrote:  Here is a graph of my AHI data...looks scary...

http://www.mediafire.com/view/t4lajc086qpel53/AHI%20Screen.jpg#


Leaks:

http://www.mediafire.com/view/pvug2nm0er0zn6t/leaks.jpg#

Stephen

Stephen, I know how you feel and am still trying to find the reason for my tiredness. Two weeks ago I started with my new APAP machine and have started with higher pressures than the 6 I had been prescribed for the last five months, so I am hoping for something positive to come from this.
My Doctor is sending me to see a Pulminologist tomorrow, just to see if there could be anything else that is causing this dreadful tiredness.
In the meantime it is very early days with you so please be patient and hang in there.
Hopefully with a higher pressure you will reap benefits as well.

I couldn't help but notice you used an app to download your results. Did you do all of this from an ipad or something similar? If so I would be interested to know how you went about it please? It would make my life so much easier if I could download my results via my ipad.

Cheers and all the best to you.

Sleep Tight...
Gabby
07-28-2014 10:31 PM
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Terry Offline

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Post: #13
RE: fatigue...HELP!
(07-28-2014 06:30 PM)StephenR Wrote:  Here is a graph of my AHI data...looks scary...

Well, at least now you know why you feel like crap. 8-)

You have a ton of Central Apneas. I don't think your current machine takes care of those.

Your doc might need to order you a different machine; one that does handle Central Apneas. However now that you've seen your data, they can't snow you and give you some BS answer like "It takes time to get used to it."

Terry



(07-28-2014 10:31 PM)Gabby Wrote:  I couldn't help but notice you used an app to download your results. Did you do all of this from an ipad or something similar? If so I would be interested to know how you went about it please? It would make my life so much easier if I could download my results via my ipad.

Not sure what SW works with an ipad, but considering that this is your health, you might want to pick up a cheap computer just for this purpose. SleepyHead requires very few resources. Even a cheap Windows laptop should work.

Sleepyhead runs on Mac, but I don't know if that includes iPad, or if an iPad even has a card slot.

Terry
(This post was last modified: 07-29-2014 09:48 AM by Terry.)
07-29-2014 09:33 AM
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storywizard Offline

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Posts: 350
Joined: Jul 2014

Machine: ResMed VPAP Adapt S9
Mask Type: Nasal pillows
Mask Make & Model: P10 taped to face
Humidifier: included with machine
CPAP Pressure: CPAP 11cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Vancouver, BC, Canada

Post: #14
RE: fatigue...HELP!
so here is a response from my sleep tech on the stats I sent her:

"you have to remember these app sites are not true reflections of your therapy efficacy. Manufacturer software program have specialized algorithm to measure your indices.
It is common to have elevated CA's on CPAP, this is due to the exchange of gases that is occurring now that didn't previously. With a set pressure and time on therapy, CA's will stabilize. Also, remember there is night to night variances and occasionally you can have a night with increased CA but it is usually not long term.
I looked at each of your nights usage from July 23-28th, with the exception of July 27 & 28, your CA levels have been good (<10). The fact that your CA's are not constantly elevated means this is not Central Apnea.
I will lower your pressure as your obstructive closures are within normal range and see how you feel after a few nights."

So I am confused now....

Stephen
07-29-2014 03:53 PM
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retired_guy Offline

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Post: #15
RE: fatigue...HELP!
What they were saying is we know better than you because we're so smart, and that means you don't have to worry about the CA's or we would have said so. But, we'll lower the pressure and see if we can get them to calm down even though we're really sure they aren't a problem or we would have noticed them before now.

But we'll drop your pressure a little....... Even though they're not a problem.
07-29-2014 04:19 PM
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storywizard Offline

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Posts: 350
Joined: Jul 2014

Machine: ResMed VPAP Adapt S9
Mask Type: Nasal pillows
Mask Make & Model: P10 taped to face
Humidifier: included with machine
CPAP Pressure: CPAP 11cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Vancouver, BC, Canada

Post: #16
RE: fatigue...HELP!
(07-29-2014 04:19 PM)retired_guy Wrote:  What they were saying is we know better than you because we're so smart, and that means you don't have to worry about the CA's or we would have said so. But, we'll lower the pressure and see if we can get them to calm down even though we're really sure they aren't a problem or we would have noticed them before now.

But we'll drop your pressure a little....... Even though they're not a problem.

lol...thanks RG, I needed that...I could not believe what they wrote...
talk about control...

Stephen
(This post was last modified: 07-29-2014 04:31 PM by storywizard.)
07-29-2014 04:25 PM
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robysue Online
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Post: #17
RE: fatigue...HELP!
(07-29-2014 03:53 PM)StephenR Wrote:  so here is a response from my sleep tech on the stats I sent her:

"you have to remember these app sites are not true reflections of your therapy efficacy. Manufacturer software program have specialized algorithm to measure your indices.
There is some truth to this. Neither the Resmed FOT nor the PR PP algorithms are the same as scoring CAs on a real PSG. Nonetheless, your data is showing a lot of CAs scored and it would have been useful for the tech to have actually looked at some detailed data as well as the summary data you post.

Quote:It is common to have elevated CA's on CPAP, this is due to the exchange of gases that is occurring now that didn't previously. With a set pressure and time on therapy, CA's will stabilize. Also, remember there is night to night variances and occasionally you can have a night with increased CA but it is usually not long term.
This is also true. But the question is what does "long term" mean to the tech. you've been PAPing now for over a month and usually if this is all that's going on, the CA will start to go (way) down by the end of the first month or so.

Quote:I looked at each of your nights usage from July 23-28th, with the exception of July 27 & 28, your CA levels have been good (<10). The fact that your CA's are not constantly elevated means this is not Central Apnea.
First statement SHOULD be questioned: Why is the tech choosing to draw the line at a CAI = 10 rather than 5 given that you are feeling exhausted and sleepy?

Second statement probably is true: If you really had a problem with Central Apnea, your CAI probably would have remained exceptionally high on every single night. Unless there's a pressure threshold that is triggering the CAs, and you only go over that threshold sometimes. And in that case, what you are looking at is more properly called Complex Sleep Apnea rather than Central Sleep Apnea.

Quote:I will lower your pressure as your obstructive closures are within normal range and see how you feel after a few nights."
This IS a reasonable thing to do. If the CAs are being caused by pressure, lowering the pressure should reduce the number of them. If the number of OAs and Hs does NOT go up when the pressure is lowered, then that's evidence that you were overtitrated in the first place, which is not that uncommon.

But here's the thing that I wish you had asked the tech to do: I wish the tech had looked at the detailed Flow rate data from one or two of the good nights and compared it to one or two of the bad nights.

In other words, I wish the tech were looking at something other than just the summary data for each night. Because:

1) Sometimes a lot of CAs can be scored at the beginning or end of the night when you're not really sleeping, but you're also only half awake. Likewise sometimes you see clusters of CAs at times when you remember being pretty restless during the night and "fighting" to get back to real sleep. These kinds of CAs would probably NOT be scored on a PSG (because you're not really asleep). And in this case, the best thing really is to assume that the CAs will likely disappear as the PAPer becomes more used to the equipment and starts falling asleep more quickly and more readily with PAP experience. And in this case, the continuing fatigue, exhaustion, sleepiness and/or brain fog may point to additional factors that are causing bad sleep now that the OSA is technically under control. (Real CAs are not part of obstructive sleep apnea.)

BUT

2) Sometimes real pressure induce centrals can be spotted from analyzing the Flow data that shows every breath you took. If there's a 30 minute (or more) period of waxing/waning breathing with CAs scored at the nadir of the cycle and it's not at a time when the person was apt to be semi awake, it's worth looking much more closely at the data on other nights for the same pattern AND it's worth listening to the patient's complaint that the exhaustion, fatigue, sleepiness, and/or brain fog is not getting better OR is getting worse. Because this is the kind of pattern that might not simply get better with time. Prudent watchfulness of the data may be reasonable for another month or so, but if these kinds of patterns continue on more nights than not for 2 or 3 months, its time to start thinking about whether another sleep test is warranted so that if Complex Sleep Apnea might be a real issue that needs to be addressed by changing the PAP machine itself. And note that Complex Sleep Apnea is NOT the same as Central Sleep Apnea.

In other words, examining the Flow graph itself can go a long way in figuring out how likely the machine scored CAs are to be the real thing.

So if you want other patients' opinions on what your data looks like, you could post the Flow rate data from a good night and a bad night.

Questions about SleepyHead?
See my Guide to SleepyHead
07-29-2014 05:15 PM
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storywizard Offline

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Posts: 350
Joined: Jul 2014

Machine: ResMed VPAP Adapt S9
Mask Type: Nasal pillows
Mask Make & Model: P10 taped to face
Humidifier: included with machine
CPAP Pressure: CPAP 11cm
CPAP Software: SleepyHead

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Sex: Male
Location: Vancouver, BC, Canada

Post: #18
RE: fatigue...HELP!
thanks so much for taking the time to do this Robysue...

I will go through my stats and post what you suggest...

thanks again...

Stephen
07-29-2014 05:25 PM
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archangle Offline
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Post: #19
RE: fatigue...HELP!
(07-29-2014 03:53 PM)StephenR Wrote:  so here is a response from my sleep tech on the stats I sent her:

"you have to remember these app sites are not true reflections of your therapy efficacy. Manufacturer software program have specialized algorithm to measure your indices.
It is common to have elevated CA's on CPAP, this is due to the exchange of gases that is occurring now that didn't previously. With a set pressure and time on therapy, CA's will stabilize. Also, remember there is night to night variances and occasionally you can have a night with increased CA but it is usually not long term.
I looked at each of your nights usage from July 23-28th, with the exception of July 27 & 28, your CA levels have been good (<10). The fact that your CA's are not constantly elevated means this is not Central Apnea.
I will lower your pressure as your obstructive closures are within normal range and see how you feel after a few nights."

So I am confused now....

Stephen


Translation: "I don't want to bother with you, so I'm going to ignore the problem and feed you a bunch of gobbledegook and platitudes."

"you have to remember these app sites are not true reflections of your therapy efficacy. Manufacturer software program have specialized algorithm to measure your indices. "

Translation: I have to protect the secret society of doctors and their profit margins/I have no clue

You need to look at your daily results from SleepyHead, especially the flow rate waveform when the machine is flagging your central apneas.

Unless the sleep tech got your SD card data from you, she's doubly wrong because the data sent by the modem doesn't tell you much about whether your CA's are "real" or not.

However, don't be panicked by the term "CA". They're not necessarily more damaging than OA's, just harder to eliminate. That's why you need to look at the airflow waveforms and see how long and how complete the events flagged as CA are.

An AHI of 10 or so is not terribly bad, but you'd like it to be better. Nothing to panic about, but something to work on long term.

However, even if the AHI isn't "urgent," your fatigue is still a real problem.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
07-29-2014 05:30 PM
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Gabby Offline

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Machine: ResMed AirSense 10 AutoSet For Her
Mask Type: Nasal pillows
Mask Make & Model: Philips Nuance Nasal Mask
Humidifier: ResMed AirSense 10 For Her
CPAP Pressure: 8-14
CPAP Software: SleepyHead

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Sex: Female
Location: Sunshine Coast, Qld., Australia.

Post: #20
RE: fatigue...HELP!
(07-29-2014 09:33 AM)tcarmen Wrote:  
(07-28-2014 06:30 PM)StephenR Wrote:  Here is a graph of my AHI data...looks scary...

Well, at least now you know why you feel like crap. 8-)

You have a ton of Central Apneas. I don't think your current machine takes care of those.

Your doc might need to order you a different machine; one that does handle Central Apneas. However now that you've seen your data, they can't snow you and give you some BS answer like "It takes time to get used to it."

Terry



(07-28-2014 10:31 PM)Gabby Wrote:  I couldn't help but notice you used an app to download your results. Did you do all of this from an ipad or something similar? If so I would be interested to know how you went about it please? It would make my life so much easier if I could download my results via my ipad.

Not sure what SW works with an ipad, but considering that this is your health, you might want to pick up a cheap computer just for this purpose. SleepyHead requires very few resources. Even a cheap Windows laptop should work.

Sleepyhead runs on Mac, but I don't know if that includes iPad, or if an iPad even has a card slot.

Terry
Thanks Terry. I have a laptop, I just thought they may have used an ipad or tablet and was interested in how they may have gone about it.

Sleep Tight...
Gabby
(This post was last modified: 07-29-2014 05:40 PM by Gabby.)
07-29-2014 05:39 PM
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