Sleep study proved CPAP is working, so why am I still so tired?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
DankShroud
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Sleep study proved CPAP is working, so why am I still so tired?

Post by DankShroud » Mon Mar 12, 2018 9:25 pm

After being diagnosed with mild OSA (AHI 7.5), I was put on CPAP for two months. I never felt any better and recently underwent a second sleep study where they monitored me using my current pressure settings. The results were good - CPAP took my AHI down to 1.5, I moved through all the sleep stages and had only 8 breathing events the whole night. I was tested for other sleep disorders that night and the next day during a nap test and came out clean. The doctor suggested that I might have idiopathic hypersomnia, but that seems unlikely. He is confident that my OSA is no longer making me tired. I feel exactly the same as I did before even being diagnosed; it doesn't make sense that I feel unchanged whether my AHI is 7.5 or 1. What could be going on here? Is it possible that sleep apnea was never making me tired in the first place? Is an AHI of 1.5 still too high? Any ideas?

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Julie
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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by Julie » Mon Mar 12, 2018 9:33 pm

Remind us of your pressure settings.. And then see your GP if you haven't recently to check routine bloodwork, cardiac status, sugar, thyroid, Vit. D levels, and anything else he suggests.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by jennmary » Mon Mar 12, 2018 9:43 pm

Have you had your thyroid checked? Your b12, iron, D3 levels? Hormone levels?

It is easy to assume that these issues are all due to SA. But I learned the hard way that sometimes SA isn't the only issue. I had Thyroid, B12, and serious iron issues that went unaddressed for a very very long time because I was convinced that all of my symptoms were explained by sleep apnea.

Or....could be that you do have some other sleep disorder. Or your body could still be healing from years of suffocating all night and you just need to give it more time. lol....clearly I am not much help with pinpointing things. But I just want to say that if you have not ruled out other factors.....you should.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by DankShroud » Mon Mar 12, 2018 9:48 pm

Julie wrote:
Mon Mar 12, 2018 9:33 pm
Remind us of your pressure settings.. And then see your GP if you haven't recently to check routine bloodwork, cardiac status, sugar, thyroid, Vit. D levels, and anything else he suggests.
My current pressure is 11-12. I still think something is wrong with my sleep from how terrible I feel upon waking

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by kteague » Mon Mar 12, 2018 10:49 pm

Did your report make any mention of limb movements?

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by Julie » Mon Mar 12, 2018 10:50 pm

Ok, remind me why your settings are 1 cm apart rather than the high one being quite a bit higher, as is more usual.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by DankShroud » Mon Mar 12, 2018 11:01 pm

Julie wrote:
Mon Mar 12, 2018 10:50 pm
Ok, remind me why your settings are 1 cm apart rather than the high one being quite a bit higher, as is more usual.
The sleep study showed good control of my apnea at a constant pressure of 11 cm. I had it on 11-20 before the study and my machine reported an average AHI of 3-4. The doctor said the machine is scoring false events and my real AHI is something like 1.5. I just changed it to 11-12 because I didn't want it ramping up to 16 to treat a false event and causing me some aerophagia. Did I do the wrong thing?

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by DankShroud » Mon Mar 12, 2018 11:03 pm

kteague wrote:
Mon Mar 12, 2018 10:49 pm
Did your report make any mention of limb movements?
Yes, I have no other sleep disorder detectable by a polysomnography. At least according to the polysomnography.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by kteague » Tue Mar 13, 2018 10:37 pm

DankShroud wrote:
Mon Mar 12, 2018 11:03 pm
kteague wrote:
Mon Mar 12, 2018 10:49 pm
Did your report make any mention of limb movements?
Yes, I have no other sleep disorder detectable by a polysomnography. At least according to the polysomnography.
What exactly did your report say about limb movements? Your legs were wired for the study, right? While most do not have periodic limb movements, for those who do, it is not unusual to have them under appreciated in the presence of sleep apnea, and find they become more problematic once CPAP resolves the apneas. More sleep without interruption of apneas means more opportunity for limb movements to manifest. Just trying to be sure this possibility can be put to rest. Chances are you don't have periodic limb movements, just have to wonder when one continues to feel like sleep is not restful even when their CPAP treatment is therapeutic.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by Julie » Tue Mar 13, 2018 10:56 pm

Capping the higher setting so low to avoid machine going higher is defeating the purpose of Apap... it only goes as high as necessary in any case, but not allowing it to do so is counterproductive.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by DankShroud » Tue Mar 13, 2018 11:48 pm

kteague wrote:
Tue Mar 13, 2018 10:37 pm
DankShroud wrote:
Mon Mar 12, 2018 11:03 pm
kteague wrote:
Mon Mar 12, 2018 10:49 pm
Did your report make any mention of limb movements?
Yes, I have no other sleep disorder detectable by a polysomnography. At least according to the polysomnography.
What exactly did your report say about limb movements? Your legs were wired for the study, right? While most do not have periodic limb movements, for those who do, it is not unusual to have them under appreciated in the presence of sleep apnea, and find they become more problematic once CPAP resolves the apneas. More sleep without interruption of apneas means more opportunity for limb movements to manifest. Just trying to be sure this possibility can be put to rest. Chances are you don't have periodic limb movements, just have to wonder when one continues to feel like sleep is not restful even when their CPAP treatment is therapeutic.
The report found that "there were no periodic leg movements". What's unusual to me is that my hypnogram - the "sleep stage" chart - is peppered with dense, periodic awakenings where I move rapidly from a lower sleep stage to full wakefulness. What's weird is that these arousals don't correspond with any apnea/hypopnea events. I could post a picture if that would be helpful. Should I suspect UARS, where I'm reacting to partial obstructions too suble and brief to be detected by the polysomnography? Would it be worthwhile for me to share sleepyhead readouts from my CPAP? Good advice would be appreciated

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by DankShroud » Tue Mar 13, 2018 11:56 pm

Julie wrote:
Tue Mar 13, 2018 10:56 pm
Capping the higher setting so low to avoid machine going higher is defeating the purpose of Apap... it only goes as high as necessary in any case, but not allowing it to do so is counterproductive.
I guess I was trying to recreate the constant 11 cm pressure from my sleep study, where I would know that my apnea is at least technically controlled.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by Mikebear » Wed Mar 14, 2018 6:17 am

Look up the term "sleep debt", and relax a bit more. You need to find out how long your body REALLY needs you to be asleep, and build up to that amount every night.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by Pugsy » Wed Mar 14, 2018 7:32 am

DankShroud wrote:
Tue Mar 13, 2018 11:48 pm
Would it be worthwhile for me to share sleepyhead readouts from my CPAP?
Please post a typical night detailed report.
See here for what and how.
viewtopic/t158560/How-to-post-images-for-review.html
Maybe there's some little something there that might could be improved upon that might help you feel better.
Worth looking.
DankShroud wrote:
Tue Mar 13, 2018 11:48 pm
What's weird is that these arousals don't correspond with any apnea/hypopnea events. I could post a picture if that would be helpful. Should I suspect UARS,
Something worth considering for sure. If that is the case then the detailed software reports may not help much because these machines don't really measure those low level obstructions that seem to go along with UARS all that much and we really don't have much to measure and instead have to rely on how we feel which is much harder to evaluate.
There is a way to change SleepyHead though to see if you are having many low level air flow reductions and have SleepyHead flag stuff it wouldn't normally flag.
More on that if you want to try it.

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Re: Sleep study proved CPAP is working, so why am I still so tired?

Post by ChicagoGranny » Wed Mar 14, 2018 7:39 am

#1
DankShroud wrote:
Tue Mar 13, 2018 11:48 pm
What's unusual to me is that my hypnogram - the "sleep stage" chart - is peppered with dense, periodic awakenings where I move rapidly from a lower sleep stage to full wakefulness.
#2
DankShroud wrote:
Mon Mar 12, 2018 9:25 pm
I was tested for other sleep disorders that night and the next day during a nap test and came out clean.


There is a big contradiction between #1 and #2. #1 can certainly make you feel bad. What did your doctor say about #1?