• Site Supporter

On BiPap But Still Tired During The Day

This area is for Sleep Apnea questions and general Sleep Apnea Discussions.


On BiPap But Still Tired During The Day

Postby davidcarey9 » Sat Jun 13, 2009 10:39 am

Hello

I was diagnosed with severe OSA about 3-4 years ago, prescribed CPAP, made little improvement, had another sleep study about 1.5 yr ago prescribed BiPap, I am not sure what the settings are I know they are high 15/11 Doctor said with CPAP my oxygen was dropping to below 80% at night. Switched to BiPap, brought the oxygen up, pressure is high I have issues keeping the mask from leaking, but lately I have been sleeping sometimes 3 - 4 hrs at a time wakeup then able to go back to sleep for maybe 3 more hours. When I get up I have a good stretch that feels as if I slept well, however I can go downstairs sit down in "my chair" and find it difficult to stay awake. My energy levels are still very low. I am 46yo overweight male, up to ten years ago I was very fit and very thin. Once weight started coming on that is when I noticed the sleep problem but it took years to diagnose. I keep gaining weight now, which I now exacerbates the OSA, I have a very full neck (thanks to the weight) and am sure this is where my problem is however it is very difficult for me to get the energy to start exercising. My body used to react well to exercise but not so sure now. Anyway I feel as if I am sleeping better now than I have for many years but yet I am still tired and lack energy. Any Suggestions?

Thanks to all and this forum

David
davidcarey9
 
Posts: 6
Joined: Mon Jun 08, 2009 5:54 pm

Postby CrohnieToo » Sat Jun 13, 2009 11:03 am

Start w/getting a copy of the doctor's dictated results (1-2 pages) and the full scored data summary report w/condensed graphs (5+ pages) from each of your in-lab PSG sleep evaluations AND titrations. Get a copy of your most recent equipment and pressure settings order (script). They are part of your medical records and assuming you are in the USA you have a legal right to these copies under HIPAA. Lets make sure you are aware of ALL that was revealed during your evaluation and titration studies.

You are going to be checking your reports for sleep problems other than "just" OSA. You are going to be looking for whether any other sleep problems discovered during your sleep evaluations were relieved w/BPAP use.

Meanwhile, what brand and model BPAP (bi-level PAP) are you using? Not all bi-levels are fully data capable and we want to know whether yours has full data capability or not. If it is fully data capable you are going to want to be able to access the data available via the LCD screen. Or you are going to want your local DME supplier or your sleep doctor to do a data download and give you a FULL PRINTOUT, not just the statistics page. You are going to want to see for yourself just how effective your current therapy settings are according to the data.

You might consider asking your sleep doctor or your family doctor to script an overnight loan of a recording oximeter to use in conjunction w/your BPAP to see how your 02 saturations are doing if you aren't willing or able to get any of the above.

Just how much overight are you? Are you considered morbidly obese where your weight might be affecting your breathing ability, especially when laying down? Could you be so heavy your weight is affecting your breathing ability even during the day? Are you a smoker or ex-smoker? Do you have asthma or allergies? COPD or other lung condition? Are you short of breath during the day w/just normal activity?
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
User avatar
CrohnieToo
 
Posts: 7943
Joined: Mon Mar 20, 2006 9:18 pm
Location: Mid-Michigan
Machine: Resmed S8 VPAP Auto
Mask: Resmed Quattro FX Small
Humidifier: Resmed H3i
Year Diagnosed: 2006

Postby davidcarey9 » Sat Jun 13, 2009 1:43 pm

Hey thanks for taking the time, here is what I can tell you now: the machine I am using presently is a Puritan Bennett GoodKnight 425 on the side of the machine the DME has a label for the settings BiPap 15/11 cm h20 Ramp 15. The machine does have an "Information Access" button, I pushed it and the first three numbers were the settings and the Ramp setting that slows it down for 15 minutes initially, to aid in going to sleep and then it Ramps up to the necessary settings. The rest of the information is greek to me. My weight is probably considered morbidly obese I am 6'3 and 325lbs big guy. I came from 6'3 170 so I have an extra me I am packing around. Family doctor says "football fit". A little high blood pressure, cholesterol just under 200. Lucky so far. Yes short of breath most cases of regulart daily routine.

I work out on the river with coal/grain barges and am gone 28 days at a time, very physical work, am still able to function, just not as agile as I used to be. I take machine with me on the boat and sleep fairly decent then about 5-6 hours per day.

Thanks
David

p.s. the slinky bit is my new phrase for work. thanks for that also haha
davidcarey9
 
Posts: 6
Joined: Mon Jun 08, 2009 5:54 pm

Postby CrohnieToo » Sat Jun 13, 2009 3:02 pm

Thanks, I fell in love w/that little ditty the first time I saw it and just HAD to purloin it for my own use. Unfortunately, I've never found the source to give credit for it.

Effective BPAP therapy SHOULD help reduce that BP, maybe even improve the cholesterol and help w/weight loss given you have such a good physical job. That puts you way ahead of those office pencil pushers when it comes to losing weight, improving BP, etc. so thank your lucky stars for such a healthy physically demanding job!!

I'm not familiar w/the Puritan Bennett 425. I do know that the PBs are great xPAPs providing excellent therapy but I'm not sure of which models can produce what data.

The first thing I would look for in the data is the Leak rate. If your Leak rate is too high the end result is therapy lost thru the Leaks instead of delivered where needed to keep your airway passages open. Do you still have the literature that came w/your mask? In it somewhere there should be a table or chart that has the allowed vent rate running up the left side and various pressures in 2 cm increments across the bottom w/a curved or slanted line in the box itself. Start at the pressure of 13 (midpoint between 15 and 11) and run up to where the line intersects the allowed vent rate level. IF your reported Leak rate is above that number you are experiencing mask or mouth leaks that can interfere w/the accuracy of your other data AND w/the therapy you are receiving.

Insurances won't pay for the software - but - the software for the PBs are readily available for sale on line. Be sure to price check several online DME suppliers before purchasing to find the best price. The original PBs used the SilverLining software. PB has been bought out by Covidien and the Covidien software is called Sandman I think. Try a websearch on Puritan Bennett 425 and see what info you can find about the appropriate software if you are interested in really following your therapy and progress.

Data from a fully data capable xPAP can provide the answers or at least clues as to why you aren't feeling rested yet. But you really do need to use that BPAP every time you sleep and you need more hours of sleep to get feeling rested again.

Given you are short of breath thru out the day I would suggest that you ask your family doctor to order a full pulmonary function test. I'd want to know WHY I was SOB during the day and what can be done about it.

Personally, I would contact my sleep lab or sleep doctor and request a copy of the doctor's dictated results (1-2 pages each) and the full scored data summary report w/condensed graphs (5+ pages each) from both my in-lab sleep evaluation PSG "and" my in-lab titration PSG and while you are at it you might just as well request a copy of your equipment order (script) too. I'd want to see for myself just what was encountered during both my sleep evaluation and my titration studies. Its not very often that a sleep doctor will script a BPAP or that insurances will pay for a BPAP w/o first having failed CPAP therapy UNLESS there is some other underlying condition in addition to "just" OSA. These are all part of your medical records and assuming you are in the USA you have a legal right to copies under HIPAA.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
User avatar
CrohnieToo
 
Posts: 7943
Joined: Mon Mar 20, 2006 9:18 pm
Location: Mid-Michigan
Machine: Resmed S8 VPAP Auto
Mask: Resmed Quattro FX Small
Humidifier: Resmed H3i
Year Diagnosed: 2006

Postby davidcarey9 » Sat Jun 13, 2009 5:15 pm

Again thanks, I will explore the avenues you have suggested, with the leak rate, concerning the mask, the pressure is high on my machine, using a ResMed Ultra Mirage FF mask, when I first started with the BiPap the mask leak was tremendous. Presented the issue to the sleep lab, we went through 5 or 6 different masks, they were very patient with me but I could not find anything that would fit comfortably or comparable to the ResMed UM FF. I continue to use my old mask and I probably wear it tighter than is recommended, I know the standards say not too tight, but in order for this to work, the way I sleep (side sleeper) I wear it tight, sometimes so tight it feels like a piano wire around the back of my head (I do adjust then) but I have to wear it tight. At any rate, I feel I have the mask leaks down to a minimum but I am not sure what you mean by mouth leak. Is that the same or is that something different?

You are right, the physical requirements of my job have probably saved me from many other medical issues. I am beginning to see my age group start with the cardiac issues. I leave Tuesday for back to work, I have an appointment with my GP when I return, I will request cardio testing, I am thinking if I force myself into exercise while I am home, (provided the heart can handle it) I will benefit from it, in the past my body has always responded well to physical/cardio exercising.

Hey thanks you sure seem to know a lot, I appreciate you taking the time at answer not only mine but I see you are involved with this forum, so thanks for what you are doing.

Before you think of me as a slinky I will let you go.

Peace
David
davidcarey9
 
Posts: 6
Joined: Mon Jun 08, 2009 5:54 pm

Postby CrohnieToo » Sat Jun 13, 2009 7:11 pm

Giggle. I'm just passing on the help, support and advice others have so graciously passed on to me, plus a few personal lessons I learned, many the hard way. Just stay away from the staircases and you should do all right. *wicked grin*
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
User avatar
CrohnieToo
 
Posts: 7943
Joined: Mon Mar 20, 2006 9:18 pm
Location: Mid-Michigan
Machine: Resmed S8 VPAP Auto
Mask: Resmed Quattro FX Small
Humidifier: Resmed H3i
Year Diagnosed: 2006



  • Site Supporter

  • Similar topics
    Replies
    Views
    Author

Return to SLEEP APNEA HELP!

Who is online

Users browsing this forum: Yahoo [Bot] and 3 guests

  • Site Supporter