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+--- Thread: New fatigue symptoms emerging? (/Thread-New-fatigue-symptoms-emerging)
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New fatigue symptoms emerging? - nearenough - 12-09-2024
Hi everyone,
It has been almost 2 years since posted here thanks to all of you who helped me dial in my AirCurve when I switched to bi-level therapy. Gideon and SleepRider in particular were life savers - thank you both.
Therapy has been good now for a couple years.
However, in the last couple months, and in particular the last 2 weeks, I feel like something has changed because my daytime (earlier morning) fatigue has gone off the charts.
Up until recently I was using a P10 mask, but I've never been able to control my leak rates well with it (rates often in the 8-10 range 95%). I just picked up 3 new masks to try out, all of which have much better leak rate performance for me. I've been trying F&P Solo (cushions, not pillows), F&P Brevida, and ResMed F40. All 3 are promising and have near no leakage.
All of that said, even with much better leak control, I've been feeling terrible most mornings. I'm wondering if anyone has insights from my charts that point to something obvious. Perhaps dialing up the min EPAP pressure but a couple tenths or something? I don't know if I have UARS, but the discussion linked below hints that even small EPAP changes may help.
https://www.apneaboard.com/wiki/index.php/UARS_Discussion
Thoughts? Recommendations? And thanks for the help.
RE: New fatigue symptoms emerging? - gainerfull - 12-09-2024
Leaks = arousals often times so it could be that over time your therapy has lost efficacy with persistent leaking. Looking at your flow rate graph it looks pretty ratty / disorganized. Have you ever considered trialing a full face mask like an f20? How have you fared w/ higher pressure in the past? Based upon residual flow limitations there could be an opportunity for a epap pressure increase considering your on a PS of 4 and still seeing flow limitations. Would you mind zooming in at about 1hr and about 1hr30mins into sleep so we can see your breathing during REM? Would need to be able to see the indiviual breaths if possible.
RE: New fatigue symptoms emerging? - nearenough - 12-09-2024
Happy to. Most of my flow rate charts look like that, so I'm excited to hear there's room for improvement.
Attached are screenshots from 1 hour in (23:50) and 1.5 hours in (00:20) each for about 3 minutes. Let me know if you need a closer zoom level.
RE: New fatigue symptoms emerging? - gainerfull - 12-12-2024
(12-09-2024, 09:04 PM)nearenough Wrote: Happy to. Most of my flow rate charts look like that, so I'm excited to hear there's room for improvement.
Attached are screenshots from 1 hour in (23:50) and 1.5 hours in (00:20) each for about 3 minutes. Let me know if you need a closer zoom level.
Do you have a night w/ the F40 to compare yet? Your breathing looks good in the zoomed in screenshots - ideally you'd want a thick band of breaths between more unorganized breaths during REM so it kind of looks like alternating smooth and fuzzy caterpillar.
What is your nightly routine for your nasal passages? What are allergies like in your area at the moment? I've been doing a nasal rinse, taking a zyrtec and using a nasal strip so I feel zero resistance when I breathe before I go to sleep with great results recently.
Would you mind zooming in on 2:00-2:20 from the 12/6 screenshot? I'd like to see what's going on in the disorganized area.
RE: New fatigue symptoms emerging? - nearenough - 12-12-2024
Here's my most recent night with the N40 (Subjectively it was the worst morning after I felt overall recently) as well as zoomed 12/6.
I don't have a nighty routine, but I would gladly adopt one. I have seasonal allergies, probably pet allergies too. I don't know if I feel too much nasal resistance, but maybe it would be more obvious if I tried something like your routine.
RE: New fatigue symptoms emerging? - gainerfull - 12-12-2024
From that zoomed in view there are two clusters that look like position changes and at a macro view it looks like you could use more pressure support to help alleviate the hypopneas you're experiencing (the slight abnormalities or spikes you see as compared to the neighboring breaths. If you were wearing an sp02 monitor you'd likely see a drop at each of these and I count at least 10 in that 20 minute window) You may consider trialing a couple nights of PS=4.2+ and work your way up to 5 and see how you feel.
I'd also recommend going into S mode and using your bilevel at a standard pressure - looks like you're 95% pressure is ~ 12/8 so I'd start there and see how you feel. If you wanted to be conservative or are sensitive to pressure you could also start at 11/7. Something new I learned from this board was from another member analyzing his sleep on APAP / Auto mode and he recognized that he had trouble staying in sleep stages with pressure changes so that is why I'd recommend static pressure.
Day to day I don't necessarily "feel" like I have allergies either but when I started using zyrtec or xyzal with a nasal rinse it really opened up my airways and has made my therapy better overall.
RE: New fatigue symptoms emerging? - nearenough - 12-12-2024
Funny you mention both pressure support and pulse ox. When I was first diagnosed, I was prescribed an APAP, and ended up with an AirSense 11. Obviously it has only primitive pressure support features. My issue was I had tons of CAs, and need the bi-level high sensitivity trigger to eliminate them. That said, I did a couple sessions with Jason Sazama before I got the bi-level, and he was encouraging higher pressures. That was okay we got into the higher teens at which point I was in pain every day from the breathing effort.
Now that I have a bi-level, I have no qualms increasing the pressures. I shouldn't have any problem with 12/8.
As for the pulse ox, I started wearing mine again 2 days ago just because things felt so terrible. I'll try to correlate the data after a few days on the increased settings.
I'll try to keep the thread alive - thanks for the help so far!!
RE: New fatigue symptoms emerging? - SarcasticDave94 - 12-12-2024
What level were the Central Apnea on your sleep study? Post the event and count table from that. Not that CA were shown lots here, if that was your original issue, the AutoSet isn't the right answer. Before that's decided, the test results tell you what's right.
RE: New fatigue symptoms emerging? - nearenough - 12-12-2024
Here you go -
Original study post
https://www.apneaboard.com/forums/Thread-Finally-had-a-proper-sleep-study-Please-help-interpret-results
Sleep study results attached in the post
https://www.apneaboard.com/forums/attachment.php?aid=47013
RE: New fatigue symptoms emerging? - SarcasticDave94 - 12-12-2024
If what I see was accurate, your test had 13 Central Apnea only, but wouldn't be enough to indicate an ASV.
OK copy, the history helps. Thank you.
A slight edit to PS or pressure may help, if you want to try it. Of course if it gets worse, just dial it back. Watch your event parameters to see what's changing.