New to Oscar-recommendations needed

[PuffDr4gon]

Hi guys, thanks for being available to help a noob like me. I was diagnosed with OSA in August 2023. I've used my Resmend Airsense 11 ever since being prescribed. As you can imagine I've had limited support from my care team and found out about Oscar recently. I would like to optimize my treatment best I can because as of late I've been tired in the morning and mid-day. Are there any setting changes you can recommend?

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[Pugsy]

I know you don't want to hear this but there isn't anything showing on your reports that is just standing up screaming "fix me and you will feel better".

Do you take any medications? If so, what?
How is your sleep quality? Sleeping soundly or wake often???
How many hours of sleep do you think you are getting? Real sleep....not laying in bed awake?
Any other physical or mental health issues going on?

[PuffDr4gon]

Do you take any medications? If so, what?
-Synthroid 100mcg daily
-Vilazodone 10 mg taken at lunch

How is your sleep quality? Sleeping soundly or wake often???
-Hit or miss. When I'm home I will have good sleep. When I work overnight and sleep in the call room it feels like sleeping with 1 eye open. This is 3x a month.

How many hours of sleep do you think you are getting? Real sleep....not laying in bed awake?
-6 to 7 hr

Any other physical or mental health issues going on?
-General anxiety and day to day stress. I don't feel like it prevents me from sleeping. If anything, it makes me want to sleep.

[Pugsy]

Vilazodone 10 mg is known as a SSRI type of drug and those are well known for messing with the sleep stages as well as causing some really annoying (and problematic) daytime symptoms.
It may or may not be a factor in your unwanted symptoms but there is a possibility.
Of course the very reason you are taking that medication can also be a factor in your unwanted symptoms.

Google the side effects along with googling "SSRIs and sleep" as well. Pretty much all those type of mood meds are well known to mess with sleep quality and/or sleep stages.

Also...have a chat with your doctor about these new and unwanted symptoms. There are lot of other potential causes for those symptoms besides sleep apnea or sub optimal OSA therapy. It wouldn't be impossible for it to be from some other problem..

[robysue1]

[/quote]

I would like to optimize my treatment best I can because as of late I've been tired in the morning and mid-day. Are there any setting changes you can recommend?

Like Pugsy, I don't see anything in the posted data that screams, "Fix this and you'll feel better."

Do you take any medications? If so, what?
-Synthroid 100mcg daily
-Vilazodone 10 mg taken at lunch

Synthroid is used to treat hypothyroidism. More questions: Are you taking the synthroid exactly as directed every day? And have you talked to the doctor who prescribed the synthroid? Since fatigue is a significant symptom of hypothyroidism, it may be that your dose of synthroid needs to be adjusted.

Vilazodone is used to treat depression (among other things), and sleepiness and fatigue are listed as common side effects. You may want to talk to the doctor who prescribed the Vilazodone to help sort out whether the benefits you are getting from vilazodone (in the form of relief from the depressive symptoms?) outweighs any side effects you may be experiencing. It's also possible that if fatigue was one of your symptoms that led to a diagnosis of depression that led to the vilazodone prescription, that the dosage may need to be adjusted to better manage the depression symptoms.

How is your sleep quality? Sleeping soundly or wake often???
-Hit or miss. When I'm home I will have good sleep. When I work overnight and sleep in the call room it feels like sleeping with 1 eye open. This is 3x a month.

When you work overnight and sleep in the call room, are you sleeping without the CPAP? If so, that could explain the continuing issues with daytime fatigue: Some of us are so sensitive to what happens when our apnea comes roaring back because we don't use the CPAP, that it takes us a couple of days and good nights sleep with the CPAP to recover from one night without it.

If you are using the CPAP on those nights when you work overnight and sleep in the call room, the fact that you feel like you have to sleep "with 1 eye open" could still be the culprit, particularly since this happens about every 10 days on average: While some people are capable of "pulling an all-nighter" and getting little or no meaning quality sleep for a night or two and still feel fine the next day, other people find that if/when they're forced into a situation where they simply can't sleep "normally" leaves them exhausted and that it can take several days to recover each time they do this kind of thing. And as we get older? Most of us find that it gets harder to go even a single night without good sleep.

How many hours of sleep do you think you are getting? Real sleep....not laying in bed awake?
-6 to 7 hr

How many hours do you have to lie in bed to get those 6-7 hours of real sleep?

Any other physical or mental health issues going on?
-General anxiety and day to day stress. I don't feel like it prevents me from sleeping. If anything, it makes me want to sleep.

It sounds like the general anxiety and day-to-day stress may be serious enough to cause the tiredness you are feeling midmorning and in the afternoon. Since you are also taking vilazodone, it is worth talking to the doctor who prescribed the vilazodone about whether your anxiety, stress, and depression are sufficiently well managed or whether a change in dosage of the vilazodone or a potential change in medication might make the generalized anxiety less likely to trigger the daytime fatigue and sleepiness.

[PuffDr4gon]

Synthroid is used to treat hypothyroidism. More questions: Are you taking the synthroid exactly as directed every day? And have you talked to the doctor who prescribed the synthroid? Since fatigue is a significant symptom of hypothyroidism, it may be that your dose of synthroid needs to be adjusted.
-Yes, I take as prescribed. I just had lab levels checked 3 days ago and I'm within the therapeutic levels. I have follow up apt in 2 weeks and I'll ask MD about it.

Vilazodone is used to treat depression (among other things), and sleepiness and fatigue are listed as common side effects. You may want to talk to the doctor who prescribed the Vilazodone to help sort out whether the benefits you are getting from vilazodone (in the form of relief from the depressive symptoms?) outweighs any side effects you may be experiencing. It's also possible that if fatigue was one of your symptoms that led to a diagnosis of depression that led to the vilazodone prescription, that the dosage may need to be adjusted to better manage the depression symptoms.
-I had apt with them 2 days ago and discussed it. I take for anxiety not depression.

If you are using the CPAP on those nights when you work overnight and sleep in the call room, the fact that you feel like you have to sleep "with 1 eye open" could still be the culprit, particularly since this happens about every 10 days on average: While some people are capable of "pulling an all-nighter" and getting little or no meaning quality sleep for a night or two and still feel fine the next day, other people find that if/when they're forced into a situation where they simply can't sleep "normally" leaves them exhausted and that it can take several days to recover each time they do this kind of thing. And as we get older? Most of us find that it gets harder to go even a single night without good sleep.
-I should have clarified. I work 3 overnights in a row. I'm on call so may or may not be woken up. Then 30 days go by before I do another 3 days. The 3 days of data I provided here are from my overnight 3 day shift. As you can see I did not get woken up for work the last 2 days
-Yes, I bring my cpap and use it every time

How many hours do you have to lie in bed to get those 6-7 hours of real sleep?
-8hr