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Need Help - Constantly Fatigued - Tron28 - 07-11-2023
Hello,
Recently I was diagnosed with mild OSA. My at-home sleep report said I had an AHI of approx. 7. However, my sleep doctor told me it's more likely around 14 when he diagnosed me. I am writing because I have been experiencing severe fatigue, brain fog, blurred vision, light sensitivity, memory recall issues, etc. for about 2 years now. This all came on pretty suddenly after recovering from another illness. However, I've always known I had sleep apnea (I started noticing I would wake up gasping for air around 2017).
Since using my CPAP (ResMed AirSense 11 Autoset) I have been consistently under 5 AHI every night. However, my symptoms are still persisting after nearly 2 months of continued use. Is there anything I can do to improve my outcome? I've attached screenshots of my sleep study and recent night of Oscar data, this attached night being the worse AHI I've had since using the machine. Also, I'm concerned about the CA events, as this seems to be the primary driver of my AHI.
I do have some other medical things I'm ruling out that could be possibly contributing. One being mild anemia (my Ferritin was around 41 when tested a couple weeks ago), and another potentially being some autoimmune related illness. Awaiting results of the latter.
Any feedback would be greatly appreciated. I have been reading a few threads over the past few days, and I really appreciate the sound advice given to all of us sleep apnea sufferers!
RE: Need Help - Constantly Fatigued - Psychotech - 07-12-2023
i would suggest a few change in setting
pressure min-8, max-16
epr at 2
try this setting for 3-5 days post result
your autoimmune illness can be a huge factor for your fatigue
RE: Need Help - Constantly Fatigued - Tron28 - 07-12-2023
Thank you, I will give these new settings a shot starting tonight. Based on this forum, I thought changing/increasing the EPR would increase CA's as well?
And yes, I agree with the potential autoimmune illness. I'm hoping to have that ruled out or heaven forbid confirmed later this month.
RE: Need Help - Constantly Fatigued - Apnea23 - 07-12-2023
Buy an o2ring and start monitoring your daytime and nocturnal spo2 levels.
Any lung or heart history?
Getting your iron stores up should definitely be a priority.
RE: Need Help - Constantly Fatigued - Tron28 - 07-12-2023
Thanks for this suggestion Apnea23. Getting an o2ring to monitor oxygen levels did cross my mind at one point, especially after seeing the sleep report. I will buy one to see if there are any continued problems there. I'm also pretty winded when working out these days.
I do not have any lung issues that I'm aware of. Every time I visit the doc my o2 levels are in the healthy range, 97-98% during the day.
RE: Need Help - Constantly Fatigued - Dormeo - 07-12-2023
I don't myself see any reason to monitor your O2 sats, Tron28. Your sleep study didn't raise any red flags, nor does your Oscar chart.
I would also stay away from EPR for now while your body is still adapting to PAP, given your smattering of CAs. Without EPR, a good minimum would be 6. As time goes by, there's a good chance you'll see fewer CAs; once you get to that point, you can try introducing a little EPR, for the sake of comfort if nothing else.
When I read your report of light sensitivity, blurred vision, and extreme fatigue, I immediately wondered about some form of connective tissue disease, having been down that road myself. Please don't be upset if it turns out you do have an autoimmune disease; once you have a diagnosis and start working with a rheumatologist, a number of treatment options will open up and you can hope to start feeling better.
RE: Need Help - Constantly Fatigued - Tron28 - 07-12-2023
Thank you Dormeo. I plan to raise the min pressure slightly starting tonight and see if I notice any improvement. I ordered the o2 ring as well, but will return if it doesn't provide much value quickly.
Thanks for the kind words. I am a bit nervous about the outcome of having an autoimmune disease, but I understand it's better to know and get treatment versus the alternative. It will undoubtedly be a tough pill to swallow and lifestyle adjustment but I've mentally prepared myself. I'm still a couple of weeks out before meeting/following-up with my rheumatologist regarding next steps.
RE: Need Help - Constantly Fatigued - Tron28 - 07-15-2023
Hello,
So I've increased my min pressure to 6 and reduced max to 18. The first night I felt overwhelmed and full of air, so I used EPR at 2. I seemed to adjust to the pressure rather quickly, however, I've seen an uptick in my CA's which is the problem I'm actually trying to resolve. I've attached new screenshots from last night. I also replaced the EPR with a 20 minute ramp mode.
I will say that a couple of days ago I seemed to have a little more mental clarity, less brain fog, and additional energy. However, I'm not too optimistic just yet as it seemed to be short-lived. Also, the past couple of days I seem to have developed a headache. I'm not sure if it's related to the recent CPAP changes or not. Any feedback/additional suggestions? Thanks everyone!
RE: Need Help - Constantly Fatigued - Sleepy Quixote - 07-15-2023
@Tron28
Hey Tron, fellow Central Apnea person here. None of the three events you show in the zoom are Central Apneas, they are Clear Airway events most likely caused by some sort of sleep disturbance. The one at 03:48ish was most definitely caused by that leak spike. You may have been breath holding while fiddling with the mask in a sleep/wake state trying to get re-situated to get back to regular sleep. There may be no memory of the activity, but there certainly was activity.
The best way to resolve sleep disturbance related CA events is to fix what's causing the disturbance.
Good luck, keep at it, that's the way we get good at it!
RE: Need Help - Constantly Fatigued - Dormeo - 07-15-2023
I agree with SQ that we're looking at CAs following arousals. One way this happens is that the arousal breathing is deeper and washes out some CO2 from the blood. It's a build-up of CO2 that triggers the "breathe now" response. You get a pause before your next breath if the CO2 needs a bit more time to reach the trigger level. This will probably go away as you have fewer arousals, and anyhow, as SQ says, it's the arousals that are the main problem.
Your pressures are going up and down driven mainly by your flow limitations. Some people are bothered by pressure changes. In case you are one of them, you might try setting min = max = 7 and see how that goes. Your obstructive events are well controlled at these lower pressures, so you shouldn't see an uptick in OAs. (Leave the machine in PAP mode and set both min and max at 7. I'm not sure about the AS 11, but some ResMed machines limit what is reported when you're in CPAP mode.)
The other thing is just that it can take time to get used to PAP, and time by itself may help with reducing your arousals. I hope it won't take long for you.