Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

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vintshave
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Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by vintshave » Fri Mar 15, 2019 11:47 pm

I am a RELIGIOUS APAP user. I've been on the blower for around 10 years. I have 100% compliance (even take it for overnight motel stays) and have an enviably low average AHI of under 2.0. I am currently using nasal pillows but I have been on every type of mask on the market over the last decade in search for greater comfort.

I attached a screen shot of a typical night.
Screenshot mar 12 19.jpg
Screenshot mar 12 19.jpg (443.91 KiB) Viewed 3059 times
Looks pretty good, right? Not exactly. I have nightmares. Really vivid ones that haunt me what (seems to be) all night long. Between these and the dry mouth, I probably wake up an average of 10 times a night or more. Of the two, the nightmares are the larger problem - they make The Exorcist look about as scary as The Lion King). I average between 8 and 14 hours of sleep per night. Why so long? I know that if I am exhausted when I wake up, I will remain so for the rest of the day, so I go back to sleep for another hour and wake up again. If still exhausted, I go back to sleep. That's how the hours can get so long. Because of the length of time asleep, the time I go to sleep and the number of hours I spend before sleeping the next night can change radically. I might go to bed on Monday at 11pm and the next night fall asleep at 5am. Fortunately my line of work accommodates this crazy schedule. Add to this a massive brain fog which makes thinking a real effort and I'm really worried. I took the SAGE memory test (the gold standard for quick cognitive impairment screeners) and had it scored by a professional and scored 21 out of 22, making genuine cognitive impairment unlikely.

I'm feeling really desperate and hoping someone can shed some light on my problem and propose a solution.

J

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by palerider » Sat Mar 16, 2019 12:03 am

Before you post again, please hit f9 to turn off that data hiding calendar.

I'd suggest you raise your minimum pressure by 1cm, and see how things look after a couple days.

Your ahi isn't bad... but it's not great. it's on the upper end of what I'd call 'acceptable.'... but there's room for improvement, I believe.

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vintshave
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by vintshave » Sat Mar 16, 2019 2:56 am

Here is the graph after hitting F9:
Screenshot mar 12 19.jpg
Screenshot mar 12 19.jpg (493.81 KiB) Viewed 3044 times
You are recommending INCREASING the pressure from 12 to 13? I was thinking of lowering it to 11 since my EPAP is spending a lot of time below 13. I was concerned that my pressure was too high. While I'm a CPAP veteran, I'm a SleepyHead statistic newbie. I also thought that an AHI of 1.52 was incredibly low - on par with people who are not considered to have apnea. Is that incorrect? I'm here for an education so please correct me if I am missing something.

J

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Julie
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by Julie » Sat Mar 16, 2019 5:02 am

1.52 is NOT 'incredibly low' for someone WHO IS ON APAP - it's average. And while your min. of 12 is a bit higher than some others, trying it out at 13 is not abnormal by any means. Lowering the min. pressure will make things worse, not better - and leave the max. setting high.

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by palerider » Sat Mar 16, 2019 5:51 am

vintshave wrote:
Sat Mar 16, 2019 2:56 am
You are recommending INCREASING the pressure from 12 to 13?
Yes.
vintshave wrote:
Sat Mar 16, 2019 2:56 am
I was thinking of lowering it to 11 since my EPAP is spending a lot of time below 13. I was concerned that my pressure was too high.
"too high" isn't a thing for the majority of people.
vintshave wrote:
Sat Mar 16, 2019 2:56 am
While I'm a CPAP veteran, I'm a SleepyHead statistic newbie. I also thought that an AHI of 1.52 was incredibly low - on par with people who are not considered to have apnea. Is that incorrect?
1.52 is just on the edge of what I'd call "ok", if my AHI is much above that, I feel worse the next day. Mine's usually under 0.5

You complain of having problems that are indicative of poor sleep, so,the idea to raise the pressure to see if that would reduce breathing disturbances was the first, easiest thing to do.

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katestyles
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by katestyles » Sat Mar 16, 2019 9:14 am

You have an event flag graph that is full of flags. Every flag is an indicator of poor sleep - Either because it is a real event, or because it it is sleep-wake-junk, which means a false result becasue you were already awake.

Raising your pressure will probably help.

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TropicalDiver
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by TropicalDiver » Sat Mar 16, 2019 10:42 am

Not a medical professional -- but a few things for the OP to consider.

First, while AHI is the most used indicator of treatment quality, a great AHI is not a guarantee that the treatment is perfectly dialed in. Others have noted the many other flags in the report. I would also not call your AHI enviable.

Second, I would define "too much" pressure as a pressure setting both higher than needed for optimal treatment AND where that higher pressure is causing some other issues for you mask leaks, swallowing air, lots of centrals, etc.).

Third, look at your pressure graph to understand what others are saying. You start at a pressure of 12. The machine starts ramping up to around 13.5. Then tries to go back down to 12. Then back up.

If the graph was flat (with only the odd spike above 12), then one might think less pressure was in order. But your graph is the opposite.

Is this was my report, I would go up to 13, see how that works (and would consider 13.5 if it doesn't improve at 13).
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by Dog Slobber » Sat Mar 16, 2019 11:03 am

vintshave wrote:
Fri Mar 15, 2019 11:47 pm
I am a RELIGIOUS APAP user.
That's OK, everyone is welcome here. I'm an ATHEIST APAP user. Heck, we even have a guy from Flagstaff.

... have an enviably low average AHI of under 2.0.


Not really all that enviable.



I am currently using nasal pillows but I have been on every type of mask on the market over the last decade in search for greater comfort.
Consider the Bleep/DreamPort, excellent reviews from reputable people.
viewtopic/t174807/BleepDreamPort-nasal- ... hread.html


Here is the graph after hitting F9:
Just get rid of the pie chart and the formatting will be perfect.


You are recommending INCREASING the pressure from 12 to 13? I was thinking of lowering it to 11 since my EPAP is spending a lot of time below 13.
APAPs (typically) will try to get to their minimum. Sometimes at the expense of events, and sometimes will respond too slow to prevent events because they are at their minimum.


I also thought that an AHI of 1.52 was incredibly low - on par with people who are not considered to have apnea. Is that incorrect?
1.52 is not incredibly low. Don't get me wrong, it's pretty good. But I'm pretty sure we can do better.

My AHI was 3.5 while I was being treated by the "professionals". When I followed the advice of the people here it's now about 0.4.

The common sediment (<-that one's for you CG) that an AHI under 5 is normal or treated and maybe that's true, I think it's somewhat arbitrary. But the problem is; Drs and patients see they're are under 5, pat themselves on the back, declare "Cured" and call it a day. There are all kinds of people running around between 1 and 5 who can be improved.

The other advantage of raising the minimum is, you can sometimes prevent the machine from using higher pressure.

When my minimum was 8,9 and 10, it would often approach 13 to 14. When I got to my sweet spot at 11, it peaks at about 12.10ish.

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by zonker » Sat Mar 16, 2019 11:07 am

Dog Slobber wrote:
Sat Mar 16, 2019 11:03 am
vintshave wrote:
Fri Mar 15, 2019 11:47 pm
I am a RELIGIOUS APAP user.
That's OK, everyone is welcome here. I'm an ATHEIST APAP user. Heck, we even have a guy from Flagstaff.
HEY!!!
people say i'm self absorbed.
but that's enough about them.
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vintshave
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by vintshave » Sat Mar 16, 2019 1:10 pm

Thanks for all the input. I really appreciate it.

Is there any benefit to putting the machine into A-trial mode?

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by remstarcpap » Sat Mar 16, 2019 1:25 pm

Hi there,

I actually wonder if your problem is more with sleep hygiene than with CPAP although I agree with the others about changing your therapy in order to improve your AHI. You have a lot of event flags, but these may represent wakefulness as well as CPAP issues.

You say that you sleep from anywhere from 8 to 14 hours and that your bedtime is all over the place. This is a classic marker of bad sleep hygiene. The goal in good sleep is to have high efficiency, which means that most of the time you are in bed you are actually asleep. Good efficiency numbers are 85% or higher. People with sleep problems can train themselves to be worse sleepers by doing what you are doing.

I'd recommend you consider consulting with a professional who offers CBT-I. This is cognitive behavioral therapy for insomnia. General rules of thumb include:

-Try to go to bed and wake up at the same time each day including weekends
-limit time spent in bed to roughly 8 hours regardless of sleep
-if you wake up in the middle of the night and can't get back to sleep in 20 minutes or so, get up, leave the bedroom, and do something uninteresting until you are sleepy again and then go back to sleep.

Also, consider trying sleep restriction therapy.
https://stanfordhealthcare.org/medical- ... ction.html

This is where you only spend the time in bed that is roughly about how much sleep you're actually really getting. This trains you to be a more efficient sleeper.

Good luck and I hope your sleep improves. Nightmares are no fun. Is there something going on in your life that's particularly stressful, other than sleep issues?

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palerider
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by palerider » Sat Mar 16, 2019 2:10 pm

TropicalDiver wrote:
Sat Mar 16, 2019 10:42 am
Third, look at your pressure graph to understand what others are saying. You start at a pressure of 12. The machine starts ramping up to around 13.5. Then tries to go back down to 12. Then back up.

If the graph was flat (with only the odd spike above 12), then one might think less pressure was in order. But your graph is the opposite.
Those spikes are actually *good*.

The respironics auto algorithm is (as far as I'm concerned) somewhat brain dead... besides sitting there and doing *nothing* while the user has events here and there, it also has this perplexing, seemingly backwards routine.

When the user is sleeping very peacefully, nice regular breathing, the machine seems to get bored and starts saying "hey, can I make this better?" and raises the pressure, "nope" and drops it back down. over and over.

But! when the patient is breathing irregularly, the exact time when a little more pressure might help... what does the machine do? diddly squat, it just sits there and drools on itself.

I've heard hand wavy bullshit about "oh, they though that changing the pressures might further disturb sleep" or some such rot, but the fact is "raising the pressures might *IMPROVE* sleep" but... they don't try that.

Stupid, as far as I'm concerned.

Anyway, the point is, the more of those pressure probe spikes, the better. An ideal night would look like a sawblade all the way across.

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by palerider » Sat Mar 16, 2019 2:16 pm

Dog Slobber wrote:
Sat Mar 16, 2019 11:03 am
vintshave wrote:
Fri Mar 15, 2019 11:47 pm
I am a RELIGIOUS APAP user.
That's OK, everyone is welcome here. I'm an ATHEIST APAP user. Heck, we even have a guy from Flagstaff.
We don't talk about the guy from Flagstaff...
Dog Slobber wrote:
Sat Mar 16, 2019 11:03 am
arbitrary. But the problem is; Drs and patients see they're are under 5, pat themselves on the back, declare "Cured" and call it a day.

Actually, I think they yell "NEXT"
Dog Slobber wrote:
Sat Mar 16, 2019 11:03 am
There are all kinds of people running around between 1 and 5 who can be improved.
That "5 is ok" line conveniently neglects the fact that an AHI of 5 means, *on average* your sleep is being interrupted *at least* every 12 minutes, ..(maybe more, since other breathing things bother your sleep but don't count in the AHI) ... that's like nothing but a long series of naps all night long.

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Last edited by palerider on Fri Jan 17, 2020 10:57 am, edited 2 times in total.
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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by palerider » Sat Mar 16, 2019 2:17 pm

vintshave wrote:
Sat Mar 16, 2019 1:10 pm
Thanks for all the input. I really appreciate it.

Is there any benefit to putting the machine into A-trial mode?
Since it's already in auto mode... no.

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Re: Lots of problems with a low AHI - waking, fatigue, nightmares, brain fog

Post by vintshave » Thu May 23, 2019 12:49 am

Still having the same problems: nightmares, frequent waking, brain fog while awake. Generally symptoms of poor sleep quality even though I spend a lot of hours asleep. I've attached a graph of a typical night. This torture is DAILY (well, nightly). I hope that someone can help.

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