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[Health] Extremely fatigued even after 2 months of CPAP
#1
Sad 
Extremely fatigued even after 2 months of CPAP
Hey, I (24F) was diagnosed with sleep apnea in the beginning of March and started CPAP therapy at the end of that month. I’m using a ResMed Airsense 10 and I have a Phillips Dreamwear Nasal Mask with Pillows. My pressures were originally set from 5-15 but I adjusted them to 5-20 since I thought that would make a difference with my fatigue. My EPR was set to off and my humidity level was at 1. My ramp was also set to off and my response was set to Soft. I get about 10 hours of sleep every night, I take 1 mg of melatonin at night and occasionally 25 mg of Trazodone if I’m having a hard time sleeping. On the ResMed My Air app, I usually get a score of 100 with a 20/20 for mask seal. I usually don’t wake up during the night unless I have to pee and when that happens, I fall right back to sleep.

Even though I’ve started Cpap therapy, I still feel dead tired. It’s to the point where I can barely get out of bed. No amount of caffeine, sleep, exercise, sunlight or diet changes help. Yesterday, I had an appointment with my sleep doctor and I asked her a ton of questions like if I need a Bipap instead, if I can be prescribed a stimulant and if I should be tested for hypersomnia. She said she won’t consider prescribing me a stimulant until I’ve used the CPAP for 3 months and that there’s no advice she can give on how to solve the fatigue. She said my pressure settings were too high and that they should be from 5-10 since I’m only having about 1 apnea event per hour with the cpap according to Resmed My Air. She also said I should have my EPR set to 2 since it can help reduce snoring and my humidity level should be at 3 or higher. I made those changes to my CPAP machine with the exception of only setting the humidity level to 2 since I hate waking up with condensation on my nose, however I woke up today still dead tired.

Someone suggested that I start using a SD card and to use the Oscar software. I just did that and looked at last night's data which I'm really surprised about. My AHI was 13.90, when I did my sleep study, it was 7.1. Also, I'm having mostly central sleep apnea events even though I was diagnosed with 0SA. Here is the data:  

Large Leak (LL)
0.62%
Clear Airway (CA)
12.20
Obstructive Apnea (OA)
1.19
Unclassified Apnea (UA)
0.51
Hypopnea (H)
0.00
RERA (RE)
0.00


I have included 3 screenshots which I hoped turned out ok, I couldn't for the life off me get all the graphs to fit on one page, also I'm not the best with computers lol. 

If anyone has any advice on what I can do to feel better, that would be great. I plan on talking to my respiratory therapist about this and also with the sleep center that diagnosed me. I did both an at home and in lab study. I had to do both because when I did the lab study, I couldn't fall asleep at all so I had to then do a at home study since the doc I saw thought I'd sleep better.


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#2
RE: Extremely fatigued even after 2 months of CPAP
So I just looked at my data from My Air, and last night my apnea events jumped from 1.5 an hour on Thursday to 14 an hour. The only thing different from last night was that I slept for 10 hours and on Thursday I only slept for 4. Why the sudden increase?
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#3
RE: Extremely fatigued even after 2 months of CPAP
My Air report for 90 days:

Feb 5, 2023 - May 5, 2023 (within 90 days)
Average usage (days used) 6 hours 49 minutes Days used ≥ 4 hours 28/34 (82.35 %)
Leak 95th % 2.36 L/min Days used ≥ 6 hours 23/34 (67.65 %)
Average AHI 2.31 events per hour
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#4
RE: Extremely fatigued even after 2 months of CPAP
This looks like treatment emergent CSA (Central Sleep Apnea)

I had the same thing transpire on CPAP

Sleeprider might be along soon. The advice I got was to try the following:

Mode: Autoset
Minimum pressure 6.0
Maximum pressure 6.0
EPR full-time setting 1

This did not work for me though, the central events kept continuing.

I have since moved on to an ASV unit and its working much better for me. I am starting to sleep well now.

You might want to read my thread from here: http://www.apneaboard.com/forums/Thread-...#pid470582
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#5
RE: Extremely fatigued even after 2 months of CPAP
IDK why there are so many people who say lowering or turning off EPR will helps with CA's. Raising EPR to 3 full-time STOPPED my centrals. Before I raised EPR to 3, my lungs ached from trying to breathe out against the pressure.

In order to reap all the benefits of EPR of 3, your min pressure must be set to 7 (or above).
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#6
RE: Extremely fatigued even after 2 months of CPAP
How can I get a hold of a ASV? Do I just call my sleep doc and ask to be switched to one? Do I have to wait a while to get one? I have Medicaid for insurance.
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#7
RE: Extremely fatigued even after 2 months of CPAP
FWIW -- I did not have a goal of getting an ASV, but I ended up with one. I had a lab sleep study. I tried the first machine, and couldn't work with it. Another sleep study. Then the second machine I couldn't work with. Another Sleep Study. I tried the 3rd machine, no go. Another sleep study. Then they gave me the ASV. I'm pretty sure it's just the hoops you have to jump through to satisfy insurance picking up the tab. And it took several months to jump through these hoops. I had to wait for the machines to arrive, and then wait for the DME appointment to get me set up, and I had to wait for doctor visits, and I had to wait for sleep lab appointments.
Hopefully, your experience will be better.
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#8
RE: Extremely fatigued even after 2 months of CPAP
Hi,

I wonder if we could start again at the beginning.

Firstly the only charts we need are the ones with the key indicators:-

1.Event Flags
2.Flow Rate
3.Pressure
4.Leak Rate
5.Flow limitations.

* Without zooming this time please!


(Also you can quickly get these go to:- View, Reset Graphs, Standard View.

To get all on one page before upload, use Fn+ F12.

This presentation will give us a good initial status overview.

The only settings I see at this early stage is min pressure 7, EPR 3, and leave max pressure at 10.

Nothing else yet, until you repost. Step by step...

Thanks.
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#9
RE: Extremely fatigued even after 2 months of CPAP
Please do as Expat31 suggests.

It is way, way, WAY too soon to be talking about an ASV machine. CAs often reflect poor sleep with a lot of arousals; the arousals are the root problem, not the CAs. Also, the occasional bad night should not be the basis for changing settings, much less machines.

I'm concerned, however, by your report of persistent fatigue. It's possible it will dissipate once you really get comfortable with CPAP and get more consistently good sleep. But it's also possible that you have two things going on: obstructive sleep apnea, and something else.

Not yet, perhaps, but maybe fairly soon, you might have a conversation with your primary care physician about your fatigue. Try hard to describe it carefully. Are you mostly sleepy during the day? Or do you lack energy? Do you feel worse after exertion? Are you fatigued from the time you get up in the morning, or does the fatigue start later in the day?

When you have that conversation, if it's fatigue rather than sleepiness that predominates for you, some tests you might hope to have would include those that could uncover thyroid disease, anemia, autoimmune disease (connective tissue disease family), vitamin B-12 deficiency, vitamin B-6 deficiency, and Lyme disease. Is it possible you're having long Covid?

Meanwhile, try hard to maintain a regular sleep schedule, going to bed and getting up at the same time each day. Have some kind of wind-down period before you go to bed -- get off screens, maybe read, meditate, take a warm bath. Make sure your bedroom is cool and dark.
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#10
RE: Extremely fatigued even after 2 months of CPAP
I do have a couple of health conditions that can definitely cause fatigue and I’ve really struggled with my health this year. I have non alcoholic fatty liver, chronic gastritis, PCOS and intractable migraines. I’m currently trying to get in to see a liver specialist but my liver labs have gotten better since I’ve been working on losing weight. As far as gastritis goes, I’m on a low FODMAP diet but I still get flairs when I’m super stressed out. For intractable migraines, I see a Nuero. However I’m seriously considering trying to find a do PCP and Neuro since my current ones aren’t the best which just complicates things even more. 

As far as having an autoimmune component, I do have high ANA readings. I saw a rheumatologist a couple of weeks ago though and she said I don’t have anything autoimmune going on, she said just because my ANA is high doesn’t necessarily mean I have an autoimmune disorder. She said I need to see an endocrinologist though since I do have PCOS. I asked my doctor for a referral to one and I’m waiting to hear back from my doc about that. I’m also wondering if I should get a second opinion on having an autoimmune disorder tho?

I also have pretty severe anxiety, depression and PTSD which I know can impact fatigue levels. I’m in therapy and on meds for it, both my therapist and psychiatrist are aware of the fatigue but they both said they think it’s from sleep apnea or some other non specified medical issue. Also, I’m currently dealing with a ton of family drama so my stress levels thanks to them are through the roof. My therapist and psych are aware but unfortunately the drama is going to make things much worse for me.
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