[Treatment] Still fatigued, history, are these CAs real?

[GuyScharf]

While the night before last was fairly good and I felt somewhat refreshed yesterday, last night was a disaster.  Here is what I mean: I had a hard time getting to sleep last night (it took maybe an hour).  I woke up to go to the bathroom.  At that time I felt relatively good.  Then difficulty in falling back asleep, but not as bad as at the beginning.  When I woke up in the morning, I was very groggy.  I had enough energy to go to the bathroom and feed the cat and have a small bite to eat.  My comprehension and understanding were abysmally low; I felt really battered.  So I took a nap (I take naps without a CPAP) which lasted for 3 hours (longer than morning maps usually do, but I was worse than usual when I got out of bed).  I feel somewhat tired now and probably will throughout the day.

I looked at the chart.  The night was split into two sessions.  The first had no events.  When I looked at the flow graphs, I did see subtle waxing and waning some of the time.  The attached graph is the worst from the first session.  The next session is filled with CAs: 14 of them.  I see nights with this many CAs two to four times a month.  This chart looks to me about the same as the one you examined and added all the Ford emblems to.

I had more aerophagia this morning than yesterday.

Question: It looks to me like I don't need the pressure to stop OA's and H's, and it's not clear to me that the increased pressure is actually doing anything good for me.  I am thinking of dropping back to the 9.8 that I used for the last year and also setting the maximum to 9.8 to block any pressure excursions.  What do you think?  Any other suggestions?

(EERS parts are in the mail so I should have them by the end of the week.)

Thanks!

            

[Gideon]

Set your pressure from 9.4-9.8, The pressure excursions tell us something is happening, otherwise, a single fixed pressure is good.  We need to slowly lower pressure until you either have comfort issues or we see obstructive events coming back into the picture and then I may suggest a small bump back up.

I really think EERS could work out well for you.  The waxing and waning is obvious when you know what to look for, honestly, I'd have never noticed the smallest of the excursions without the bigger ones being there, and likely those are insignificant, but you have plenty going on that hopefully will get addressed.  Please take good notes aimed at extending the EERS Wiki with your experience.

[GuyScharf]

Last night I used pressure range of 9.4 - 9.8.  Got AHI 0.61 consisting of 4 H and 1 CA, all seemingly related to flow rate oscillations as observed before.  Looking at the flow rate graph, I was able to find one 30-minute period of regular breathing (looked like my wife's flow chart).  The rest of the time showed very subtle to strong oscillations.

I looked at the flow graph to see if the magnitude of the oscillations was related to pressure changes or flow limits.  Sometimes it appeared that an increase in the magnitude was related to a pressure increase, but the relationship wasn't clear enough for me to say that is definitely the case.

While I don't feel energized this morning, at least I don't feel totally wiped out like yesterday.

I will try a fixed pressure of 9.4 tonight and see what happens.

EDIT: Here are some sample graphs, captured using the right-click, PopOut Flow Rate Graph option.  Each time I did that, the graph was added to the pop-out window.  Then I had to capture the window to a PNG file using a windows clipping tool.

   

[sheepless]

those flow rate patterns look like my periodic limb movement pattern(s).

[weiss27md]

Maybe Sheepless is on the right track. I have low AHI but have chronic fatigue. After many years I think it may be from my mattress. I ordered a new one. With PAP I was seeing no improvement. When my fatigue first started my in lab sleep study showed 0 AHI.

[GuyScharf]

Well, I don't have PLM, so it's not that. Mattress is good; we've been through that before.

I hadn't considered chronic fatigue syndrome as a possibility; my wife has had that in the past so I should have thought of it.

I am prepared for possibly concluding that my fatigue is not caused by sleep apnea. But I can definitely say that there is a strong correlation between especially bad nights and the weird CA graphs, so this seems like a good avenue to pursue for a while.

[Sleeprider]

The flow oscillations look like classic apneic threshold fluctuations of respiratory drive where PaCO3 fluctuations affect respiratory drive in a feedback loop. I think both you and Fred are totally on top of this with the idea of trying EERS.

[sheepless]

I have no reason to push plm and I hope you're right that you don't have it, but I wonder how you know? if I hadn't inferred it from a few clues, I'd have told you I don't have it either. I'm completely unaware of it. even my wife rarely notices because it's intermittent and because it doesn't wake her. my sleep doc never said a word about it.

the pattern is pretty clear to me but of course I can't say that plm is the only reason for it. it explains lingering fatigue, though, and quite possibly the ca.

while I am curious how you know, I'm really only replying to encourage you to at least keep it in mind if you don't find another explanation.

[GuyScharf]

Original sleep study said I didn't have PLM. What are the symptoms your wife noticed? I can ask mine to check.

[GuyScharf]

Used a fixed 9.4 cmH2O last night.  Felt ok this morning, albeit not great.  Flow graph was similar to preceding days; I've attached a few examples.

I could try changing EPR from 3 to 2, and pressure range from 8.4 to 9.4.  EPR=2 resulted in a lot of aerophagia in my previous tests, but that was at a higher pressure.  (EERS materials won't be here for several more days.)

What do you think?