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Lingering fatigue: trust Resmed sleep report? - Printable Version

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Lingering fatigue: trust Resmed sleep report? - gcritchley - 08-11-2019

Hi - I am an Resmed Airsense 10 user, and have been treating my mild OSA (untreated AHI = 8) for about 4+ months. My intense fatigue has lifted a little in that time (it was becoming debilitating prior to CPAP), but an undesirable amount of it still lingers despite treatment, meaning daily naps, lost work time (I'm self employed), and a continued brain fog that is frustrating.

I've never done a titration sleep study to get my settings, (and would rather not if I don't have to due to $$). I bought my CPAP machine myself, and through trial and error, (and some help here), have found my auto set range 6.2 - 7.5 to produce anywhere from 0.5 to 0.0 events (based on the machine's sleep report). I'm not sure if there's a way to do a home sleep study while wearing a mask.

Despite the desirable treated AHI numbers, I've gone a little higher and lower on both the high and lo pressure settings to see if i'd actually feel less fatigue, but if I go much higher, I'm awakened by my mouth and cheeks pushing outward against my taped lips, which isn't helpful. Much lower and my AHI report goes up, which also isn't helpful. (I use a nasal pillow mask and tried about 7 masks before deciding on the nasal pillows with mouth tape).

So my question is this - is the "Sleep report" we see when shutting off the machine something we should be relying on as the final word for therapy effectiveness? IS it reflective of the effectiveness of my therapy and settings? is zero really zero? It is a machine after all.

As it stands, I'm assuming my therapy, (with a sleep report often showing zero events), is working as best as it ever will, and I'll need to continue to search elsewhere for remedies to my fatigue. So far multiple blood tests show everything to be pretty normal. I tried Testosterone replacement (despite normal blood tests) and added b12 injections and vitamin D supplements because blood showed lower levels of those. Thyroid and blood sugar all "normal." My sleep doc even said treating my mild apnea is optional, and that to him he wouldn't expect to see my level of fatigue from that alone. My next stop is something called LDN (low dose naltrexone) a treatment for suspected Chronic Fatigue Syndrome. I don;'t feel depressed, or overly anxious,  although fatigue certainly bothers me.

So - should I trust the sleep report and look more deeply elsewhere for fatigue solutions?  

Thanks all for your insights.


RE: Lingering fatigue: trust Resmed sleep report? - Melman - 08-11-2019

The sleep report on the machine shows only the AHI which does not include RERAs which can also disrupt sleep. It also provodes no information on flow limitations. I see you have sleepyhead which will provide that data. I suggest you download OSCAR, a newly developed replacement for sleepyhead and post some daily charts in the forum. See the links below for how to organize/format and post charts. To get OSCAR go here: https://www.sleepfiles.com/OSCAR/


RE: Lingering fatigue: trust Resmed sleep report? - Crimson Nape - 08-11-2019

(08-11-2019, 10:28 AM)gcritchley Wrote: . . . So my question is this - is the "Sleep report" we see when shutting off the machine something we should be relying on as the final word for therapy effectiveness? IS it reflective of the effectiveness of my therapy and settings? is zero really zero? It is a machine after all.

This report tells you the summary of your sleep session, but it doesn't inform you how it arrived at those numbers. You list SleepyHead in your profile. What information does it provide? If you aren't completely relaxing while you sleep, a zero AHI just means you didn't trigger any of its event flags because you never entered a deep sleep. I had this happen in the early stagees of my therapy. While I had a 0.0 AHI, it was one of the worst night's sleep I have ever had. Don't let your sleep numbers control you. Rather use the "How do I feel?" question instead.


RE: Lingering fatigue: trust Resmed sleep report? - captainsteubing - 08-11-2019

(08-11-2019, 11:47 AM)Crimson Nape Wrote:
(08-11-2019, 10:28 AM)gcritchley Wrote: .  .  .  So my question is this - is the "Sleep report" we see when shutting off the machine something we should be relying on as the final word for therapy effectiveness? IS it reflective of the effectiveness of my therapy and settings? is zero really zero? It is a machine after all.

...  Don't let your sleep numbers control you.  Rather use the "How do I feel?" question instead.

Totally agree with Crimson Nape, in spite of the numbers on the machine; there are other factors that could be in play.

I'm 52 days into treatment and I still find myself suffering with some residual daytime sleepiness. It's not as bad as before. In my case I am of the strong opinion that I am experiencing REM Rebound due to the lack of being able to enter deep sleep prior to treatment. I'm attempting to determine my sleep stages using the OSCAR Minute Ventilation graph (I read a post somewhere but can't seem to find it for reference), and comparing the Minute Vent. graph now to say 45 days ago it seems that I have more and longer periods of deep sleep (If I've correctly understood what I read).


RE: Lingering fatigue: trust Resmed sleep report? - Sleepster - 08-11-2019

You do need to upgrade SleepyHead to OSCAR and look at the data and graphs. There are lots of things associated with CPAP therapy such as leaks and the bother of the hose or mask that can interfere with your sleep. Four months may not be enough for you to have fully adapted. I know it wasn't for me.

Do you take anything to help you sleep such as trazodone? I've been taking it for years, and manage to take it only on nights when I really need it. Have you looked into sleep hygiene?


RE: Lingering fatigue: trust Resmed sleep report? - jaswilliams - 08-11-2019

A low AHI only tells you that OSA/CSA is treated there may be other factors to cause you to feel tired, such as sleep hygiene, medications or othe factors


RE: Lingering fatigue: trust Resmed sleep report? - gcritchley - 08-11-2019

[attachment=14346]Thanks everybody, for the valuable insights and info. I downloaded OSCAR, and organized my charts. Please see attached - details for the last 4 days, and then a couple of charts for the past month and an overview. RERAs look to be almost non-existent. Seems like "on paper" my therapy is fine - but am I missing something? The way I feel I think i must be.

By the way. no other medications.


RE: Lingering fatigue: trust Resmed sleep report? - mesenteria - 08-11-2019

Wow!  You're being exceedingly well served by your machine as it is set.  Do you have to arise to pee?  Do you awaken for other reasons and take longer than 20 minutes to retake sleep?  I didn't remember to look at how long you sleep, but how long have you historically slept typically?  I had 5 hours last night and awoke to learn that it was all she wrote.  Up to make tea.  And, although I was disappointed, I have felt fine all day and haven't found myself flagging at all.

It is VERY common for people to lurk here for a while and then finally reveal that they exist, and that their principal beef is that they don't feel any better on PAP therapy, even though the numbers say their apnea is much better.  Some are really quite desperate, unfortunately, and wonder openly if they should even bother.  It does take a while.  You aren't alone in what you are experiencing, and as disappointing as it may be for you, what you feel is very natural given that your apnea is so well managed at present.

Do you exercise regularly (CAN you)?  It is often the case that aerobic exercise does two things: it busts up the stress hormones (a very good thing) if they are present, and it tends to help to regulate your diurnal cycles better.

Are you dreaming?  Some?  Vividly? More than pre-treatment?


RE: Lingering fatigue: trust Resmed sleep report? - SarcasticDave94 - 08-11-2019

Just like others before, the numbers can only tell so much. They can't really answer how you feel. Certainly I'm no doctor, but 10+ hours of sleep is a lot of time. But how was the quality? Does the fact that your sleep was broken into segments factor in that something else is still not addressed?

I've gotten an AHI of 0 a few times myself. Mostly it'll be followed by a night around 2 to 3 AHI. Believe it or not but the zero left me feeling less rested than the 2 or 3.


RE: Lingering fatigue: trust Resmed sleep report? - gcritchley - 08-11-2019

(08-11-2019, 06:56 PM)mesenteria Wrote: Wow!  You're being exceedingly well served by your machine as it is set.  Do you have to arise to pee?  Do you awaken for other reasons and take longer than 20 minutes to retake sleep?  I didn't remember to look at how long you sleep, but how long have you historically slept typically?  I had 5 hours last night and awoke to learn that it was all she wrote.  Up to make tea.  And, although I was disappointed, I have felt fine all day and haven't found myself flagging at all.

It is VERY common for people to lurk here for a while and then finally reveal that they exist, and that their principal beef is that they don't feel any better on PAP therapy, even though the numbers say their apnea is much better.  Some are really quite desperate, unfortunately, and wonder openly if they should even bother.  It does take a while.  You aren't alone in what you are experiencing, and as disappointing as it may be for you, what you feel is very natural given that your apnea is so well managed at present.

Do you exercise regularly (CAN you)?  It is often the case that aerobic exercise does two things: it busts up the stress hormones (a very good thing) if they are present, and it tends to help to regulate your diurnal cycles better.

Are you dreaming?  Some?  Vividly? More than pre-treatment?

Thanks - I exercise a lot, and daily. Weights. yoga and interval training on a 3 day cycle. I am dreaming, and was dreaming pre-Cpap as well. I am glad to see the apnea is well managed, but I am still confused by the lurking fatigue. Thanks for your insights and support.