[Symptoms] Daytime sleepiness, extreme fatigue. Need help figuring out what's wrong.

[FrustratedSleeper99]

Hey guys,

I have been a CPAP user since 2019. Pretty vanilla, got diagnosed with mild OSA when I was a teenager and started using a CPAP.

In the last few weeks I have been suffering from daytime fatigue. I wake up non-refreshed, often with a light headache. Throughout the day I feel pain behind the eyes and a deep fatigue. One time I was out without my CPAP and had to stay awake, and the fatigue got extremely severe - I was squinting my eyes, felt very heavy in the head. In the last few days I've been having some light headaches too. I haven't felt refreshed or my full self or had a good night's sleep in several weeks now and it's really killing my productivity (and sort of will to live tbh).

I did some blood tests a couple weeks ago that came out fine. I then checked out OSCAR for the first time, and saw big gaps in pressure that I thought might be related. I switched my CPAP from auto on/off to non-auto. It did not help and the same problem persisted. (I later realized that the big gaps in OSCAR are probably just timezone, lol. Since what often happens is I sleep at night, then in the day I get extremely sleepy and nap for a few hours, so the 8 hours of sleep is split up throughout the day.)

I put on an Apple Watch while sleeping and the measures are normal. Oxygen saturation remains 95 and above and heart rate is normal while sleeping. I half expected some crazy spikes but there was nothing.

I have now ordered a new CPAP in case the old one is broken (ouch, bank account hurts) because I'm really not sure what else to do. I'm waiting for that to arrive and I hope it'll solve things...

If anyone has any ideas on what this could be or how to properly diagnose it, please let me know. I will be extremely, eternally greatful.

I have attached some OSCAR data. Two more in the attachments.
Thank you so much.

   

[PeaceLoveAndPizza]

Cheers! First and foremost, please read the link in my signature "Formatting OSCAR Charts". It explains what graphs we like to see in the chart and how to format before posting.

Glad you stopped by before pitching things into the bin. From your explanation and what I see I do not think there is anything wrong with your machine, your settings are just not optimised for you. Having a backup machine whilst a pain in the wallet is worthwhile for peace of mind.

Regarding the charts you did post, if you have been using those settings for 5 years you are a better man than I. You are significantly under-pressurised which is having a ripple effect on problems. Let us get you back to something we can use as a baseline and work from there.

Mode APAP
Min pressure 8
Max pressure 15
EPR 2 full-time
No ramp

That should hopefully be more comfortable and give you a fair go at a good nights rest. Regarding smart-start, some like it and others do not. I would prefer if you start with it off, but if you like it then we can work with it. You can always turn it on/off later.

For now, give those settings a few nights and post some more charts as defined in the link.

[FrustratedSleeper99]

Dear Peace,

When I saw your post, I felt a wave of relief and hope wash over me, so thank you for that.

Today I discovered there were more hidden settings that you could tap into! Didn't know that was a thing.

I went into the advanced settings and reduced max pressure from 20 to 15, increased min pressure from 4 to 8. The Mode choices I have are "CPAP" and "AutoSet", keeping it on AutoSet. I turned on EPR, Full Time, level 2, with Ramp Time Off.

Let me know if I did anything wrong, and thank you so much.

Also: I don't want to come off as presumptive, I'm just a noob. But could it make sense to increase the minimum to something higher, force a lot of pressure through that sucker? Is it ever the case that too much pressure is a bad thing, is there some utility in having a lower minimum?

Thank you.


I have been having consistent headaches and fatigue, pretty strong, for the last few days running. Tomorrow I will update if there's any substantial change. If not I will run these settings for a few days and see if that helps.

[PeaceLoveAndPizza]

Under- or over-pressurising is not a good thing. Let the machine titrate you and figure out what it believes is the best pressure, then we can work from there. 

My philosophy is to have as narrow a range as possible to avoid having sleep disruptions from pressure swings. Letting the machine figure it out so we can find the min and max (I use 95% for max), then add 1 cmH2O to the max so there is a wee bit of room to allow an adjustment if the machine needs to do so.

If things lose the plot tonight, we can do another adjustment tomorrow. Otherwise as you said keep at it for a few nights to allow yourself to adjust to the new settings, then we can review.

[Yılmaz EBEM]

Hello. First of all, the values ​​in the machine settings are not very suitable, minimum 4, maximum 20, this is a very wide range. Do not set the ramp setting to automatic, if you are going to use it, choose something like 5 minutes. If you set the humidification to automatic, it is generally more efficient. If you do not use EPR, I recommend you try it. I use EPR in 3 stages and it is very successful. Ahi value of 0 does not mean good sleep, it looks great in the report but you are constantly sleepy and tired during the day. These would be my suggestions. You can make the best settings by trying. But my advice is to try it as minimum 8-9 and maximum 13.

[Deborah K.]

Do what PLPizza says. He's got it right.

[FrustratedSleeper99]

Preliminary update: 2 nights on the new settings. I can feel more pressure and it's comfortable. My SD card coincidentally ran out of memory so no data yet, I'm getting a new one later and I'll show charts later.

I believe I feel better in the mornings when I wake up. I think there has been an improvement. I was actually extremely optimistic the first moment I woke up because waking up felt different. However I realized throughout the day that the fatigue was still present. I'm still getting the headaches, I'm still feeling this daytime sleepiness and fatigue and pressure behind the eyes. I'm not sure if it's placebo, as placebo can be powerful, but I feel it has improved a little bit. But it's still definitely there.

[FrustratedSleeper99]

I am taking a sleep study at a clinic today to see if they flag something out of the ordinary, will report findings as well.

[FrustratedSleeper99]

Below is the summary report from the sleep study. I couldn't get much sleep during the study, and I was wearning a BiPAP for the sleeping portion.

"Brief Summary: Is a known case of OSA, already using CPAP, Daytime sleepiness, tiredness & Obesity (BMI = 48.9)
Reason for study: Want to recheck OSA
Diagnostic Study (3 Hrs.30 minutes)
Quality of Study: Good
Sleep Architecture was fair, Sleep efficiency was = 70.1%, sleep latency = 16.5 min, REM latency =N/A, slow wave sleep = 28.1% & absence of REM sleep.
Occasional snoring was noted throughout the study.
Respiratory events: AHI= 32.9; RDI =32.9, (Longest apneas = 49.5 seconds) desaturation index= 36.2, Average Spo2 while in awake = 96 % and minimum Spo2 value during sleep= 84%.
CPAP Titration: Done with humidifier with Full face Mask (4 hrs.3 min)
Pressure ranged from 8 to 9 cm of H2O
Quality of Study: Good
Sleep Architecture was good. Sleep efficiency was =82.9 %, slow wave sleep =26 % & REM sleep = 24.8%. Respiratory events: AHI=0.3; RDI = 0.3, desaturation index =0.9, Average Spo2 while in awake = 96 % and minimum Spo2 value during sleep= 93 %
There was improvement in sleep efficiency, increase in REM sleep and sleep architecture with cessation of apneas and improvement in oxygen saturation with CPAP with humidifier use. At the pressure of 8 to 9 cm of H20
Others: EKG- No significant abnormality seen. PLM – No significant abnormality. EEG - Normal
EMG – During REM - Normal
Impression: Abnormal overnight sleep study suggestive of severe obstructive sleep apnoea with oxygen desaturation with good response to CPAP with humidifier.
Advice: Regular use of CPAP with humidifier. At the pressure of 8 to 9 cm of H20. Weight Reduction (Ideal body weight = 83kg)
Continue Medication for other ailments as prescribed by your physician. Avoid sedatives and alcohol and supine position"

[FrustratedSleeper99]

CPAP data with the new settings: https://ibb.co/tC5TG2c

I think I feel a bit less tired but the fatigue is definitely still there. I still feel tired throughout the day and not refreshed when waking up. The headaches are also more noticeable. They're not painful, they're around the edges of my head, the pain level is pretty low. But they're becoming more noticeable, along the back of my head and neck a little bit as well.

I put on my Apple Watch while sleeping last few nights (with CPAP of course as always). Oxygen seems to be normal (94-97) as is heart rate. There's a respiration rate stat which is on the high end (32.1 BrPM) but that has always been high and has been high for longer than the fatigue/headaches.

Not really sure where to go from here