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Still tired and dizzy after 8 months of CPAP
#1
Still tired and dizzy after 8 months of CPAP
Hi All,

First time ever for me to post on any forum.

I do feel better after using CPAP for 8 months, but I still experience general fatigue and dizziness. I recently installed OSCAR, but I don't see anything abnormal there. I was hoping some of you have more experience interpreting the data and could have a look at my screenshots to see if anything stands out... I attached them here, hope I did it right.

Some more key info:
  • I'm 40, male, 6'1, 86 kgs.
  • I was diagnosed last year with an AHI of 35.
  • I suspect I've had apnea for at least 5 years, possibly 10 years.
  • I'm a mouth breather, which is why I opted for a full face mask.
  • I recently (a month ago) turned of the EPR setting as I read it might be causing Central Apnea. My obstructive and central apnea events have been going down since.
  • Dozens of symptoms have all but disappeared since using CPAP (severe fatigue, tingling in my legs, shortness of breath, joint pain, insomnia, twitching etc.)
  • Quit smoking 3 months ago.
Interestingly, I also sleep a lot less now (6-7 hours) vs. 8-9 hours. I would wake up after 6-7 hours of sleep now and that's that.

Thanks everyone!


Attached Files Thumbnail(s)
   
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#2
RE: Still tired and dizzy after 8 months of CPAP
Welcome to the board.  There are flow limits that can and do cause sleep disruption.   You have a flow limit chart, take a look at it.  There are many flow limits and they are all small apnea just the same apnea as the O or H events.

We treat flow limits using EPR To use EPR you need to do the following settings changes.

Min 7
EPR set to full time
EPR 3

That should help your sleeping....
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Still tired and dizzy after 8 months of CPAP
Thank you, Staceyburke! I zoomed in on my flow rate graph (attached) and noticed it's not round the way it's supposed to be. Any thoughts on the shape of my flow rate?

When I turn ERP to 3, how will I avoid Central Apneas from increasing again? That seemed to be happening to me before.


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#4
RE: Still tired and dizzy after 8 months of CPAP
The flattened tops show flow limitation, which is why Stacey suggested using EPR.

EPR should bring down the Flow Limitation, Hypopnea and RERA's, all which disrupt
sleep.

The CA's may be treatment emergent and will lessen in time. It's somewhat normal and many of us have a few CA's now and then.

Try the EPR at 3 and repost. If it looks to be an issue, we can drop it to 2.

When you repost your chart, leave off the Calendar, so we can see all the statistics.
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Still tired and dizzy after 8 months of CPAP
Thanks OpalRose, much appreciate it! Will try doing so and revert in a few days. Noted also on leaving out the calendar.
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#6
RE: Still tired and dizzy after 8 months of CPAP
Hi Laurentdeebee

Any luck resolving the dizziness and tiredness?  I'm 5 months in and still struggling to find what works.  I have my apneas down to virtually nothing, but I am dizzy, irritable, tired, and not doing great.  For me, EPR made it less restless to sleep through the night, but I almost feel like it made my cognitive issues worse.  Still, they aren't great with my EPR back to 1, so I'm seeing if you were ever able to see improvement with this?
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#7
RE: Still tired and dizzy after 8 months of CPAP
Hi wickedsleepy,

It's been quite a journey for me, still finding out along the way what works and what doesn't...

My dizziness finally started subsiding a few months ago, about a year into CPAP. I still have bad days, but very slowly there's fewer of those and more good days.

I turned off EPR entirely... I had the impression it was making me feel worse. Opinions on EPR vary widely... some people swear by it, some feel it makes things worse. It's all very confusing and my doctor hasn't been very helpful. My hunch is that EPR might encourage hyperventilation and central apneas... but that's really just my hunch.

I also don't really obsess about getting my apneas down to 0... my AHI is around 2-3 most nights, and I think that's low enough.

I've worked on improving my overall health as well - quit smoking, eating healthier, sleep hygiene, more exercise... I also seem to feel WORSE when I sleep more than 7 hours a night so I average around 6.5 hours of sleep a night now.

Another thing I've done (about 2 months ago) is to turn off my APAP (I was at 4-10 pressure) and set it to pure CPAP. I started at 10 and have gradually worked my way down to a pressure of 7. My AHI hasn't increased. I figured lower pressure is better, if you can get away with it.

I also "practiced" avoiding mouth breathing... 

I know the whole journey can be confusing, and the way I see it now is that if you've had apnea for a number of years, there's just a lot of damage to repair. E.g. there's research that shows the brain damage alone takes a full year to heal.

Another theory I will look into, is testosterone deficiency, as that's common with apnea and can cause many issues. I do gradually feel better though... one day at a time.

Hope this helps a little. Best of luck on your journey, you can do it!
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#8
RE: Still tired and dizzy after 8 months of CPAP
Laurentdeebee,

Regarding testosterone. Some things I learned from my testosterone supplementation:
1. There are studies that suggest testosterone therapy may increase or accelerate prostate cancer growth and so they'll do annual PSA tests (at least here in the US) to watch for that.
2. My red blood count rose above the normal level and the recommendation is to give blood.
3. My estrogen level rose above normal so the solution was to add another pill to bring it down.
4. Testosterone may also increase risks of blood clots.

I stopped mine because it didn't seem to be "making me feel better" or "increasing my energy." Also, I have AFib and the most recent study out of Australia (I believe) failed to prove a link between testosterone helping that condition and strongly suggested that people with AFib not receive testosterone due to the increased blood clot risk.

I'm not implying not to do it but the downsides caught me by surprise.
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#9
RE: Still tired and dizzy after 8 months of CPAP
Thanks for sharing your findings, spudhorse. Sounds very serious... good you quit testosterone supplementation if it wasn't making you feel any better anyway. I think overall it's definitely preferred not to mess with hormones or at least be very conservative about it
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