Newish User - great AHI, very tired

[tiredinVA]

Hi everyone,
New here, male, 44 and but have started using CPAP (Resmed Airsense 10 Autoset with ramp 5-20 to start with) on July 30 after a home sleep study (WatchPAT) showed moderate sleep apnea (AHI 14 on side and 32 on back).
I am still very tired and feel crappy when waking up. I typically sleep only around 5 hrs a night, although I wear the mask for over 7 hrs (trying to fall back asleep when waking say at 2am, 4am etc.)
I feel better when skipping a night (!?)
I have downloaded the Sleepyhead software and hope I did the screenshot correctly. Any input? Can someone see anything in last night's data?
Thanks!

[Pugsy]

Welcome to the forum.

So why are you only sleeping around 5 hours normally and why lay there for a couple of hours trying to either fall asleep or go back to sleep? Anything special keeping you from sleeping longer.

Do you take any medications of any kind? If so, what?

Do you have any other physical or mental health conditions that could be a factor in not getting more sleep?

5 hours of sleep simply isn't enough sleep no matter how good your software reports look.
What you show does look good on paper.
What we don't see is the flow limitation graph and it might give us a clue.
Can you omit the mask pressure graph and make the flow limitation move up into viewing area?
We don't need 2 pressure graphs and the regular pressure graph is best for your kind of machine.

[Wulfman...]

Hi everyone,
New here, male, 44 and but have started using CPAP (Resmed Airsense 10 Autoset) on July 30 after a home sleep study (WatchPAT) showed moderate sleep apnea (AHI 14 on side and 32 on back).
I am still very tired and feel crappy when waking up. I typically sleep only around 5 hrs a night, although I wear the mask for over 7 hrs (trying to fall back asleep when waking say at 2am, 4am etc.)
I feel better when skipping a night (!??)
I have downloaded the Sleepyhead software and hope I did the screenshot correctly. Any input? Can someone see anything in last night's data?
Thanks!

Good grief! You need to give it more time. AND, you need to get more sleep, as Pugsy said.
You didn't get sleep apnea overnight and you don't get overnight results. It can take MONTHS even when you get your therapy optimized......including enough sleep.
You need to take this therapy "one night at a time". You can't rush it. It's not instantaneous. Find some patience.


Den

.

[tiredinVA]

Thanks, let's try this again:

- I have always been an early riser and have rarely needed more than 6 hrs of sleep.
- sleep in a DARK room
- I always fall asleep easily, like within 10 mins.
- sleep with central AC on
- sleep with earplugs
- no heavy meals at night, no alcohol after 7pm
- no TV/electronics in bedroom
- no medications
- I work at home, low stress
- I weigh 170 lbs (77kg) ; 5"11 (181 cm)
- no mental or physical conditions

For the past 3-4 years, I feel absolutely horrendous, when waking up. My wife has never observed me gasping at night or stopping breathing, but I had the test done anyway. It showed moderate apnea with 14 - 32 AHI.
- I use the Philips Dreamwear nasal pillow with the Airsense 10 Autoset

For the first 4 weeks, I actually noticed a slight improvement in my energy levels, despite still feeling crappy at dawn. I was able to sleep 5-6 hrs solid, with the mask on. The past 3-4 weeks, no such luck. I wake up 3-4 times every night for no apparent reason and since I lie awake for a significant chunk of time, while under CPAP, my AHI is artificially lower (no events while awake). I just find it hard to fall asleep again at say 3 or 4 am, mask or no mask. The Airsense shows around 2-4 events per hour if I look right after a solid 3 hr sleep period.

Below another screenshot with Flow limitation graph.

[Wulfman...]

Since your minimum pressure setting is very low, I would suggest increasing it to see if some extra air might help.
There was some discussion (and recommendations from the manufacturers) that pressures below 6 or 7 may not be enough to clear the CO2.


Den

.

[Pugsy]

The FL graph is really unremarkable.

There's nothing on this report that is screaming out "fix me and you will be a bundle of energy".

5 hours of sleep is simply not enough sleep for most people. Maybe you used to get by just fine with 6 but maybe something has changed now and/or you just need to get one hour more.

I don't have anything to offer in terms of magic tweaks or changes to your machine. On paper you are looking good except for the admitted short hours of sleep.

The WatchPat doesn't do sleep stages if I remember correctly.....maybe you need a real in lab sleep study to see if something odd is going on with your sleep that is unrelated to sleep apnea. Maybe a bunch of spontaneous arousals or something that are causing fragmented sleep somehow.
Maybe need a good thorough work up for other potential causes for fatigue...including the normal labs as well as some hormone levels and vitamin D levels.

If a person wakes up during the night (or frequently) and can't go back to sleep easily or quickly....sleep maintenance insomnia and the list of potential culprits is a mile long. Sleep apnea is but one of many potential culprits.
Sleep onset insomnia....difficulty falling asleep initially but can work itself in during the middle of the night if we are awake for prolonged periods of time in the middle of the night after an arousal from some reason or another.

Fragmented sleep is a killer in the energy level department. We simply need the normal cycles in the normal percentages for the restorative powers of sleep to work their magic. Mess up that cycle and we end up lacking in the sleep and energy department.

You could try more minimum pressure or even fixed pressure (something around your overall mean average probably) and see if it makes any difference or not. Worth trying for sure.

[Wulfman...]

A link to some past discussions of that subject.

search.php?keywords=%22clearing+co2%22

One in particular:

viewtopic/t38408/Nothings-changed-why-s ... o&start=15


Den

.

[creativchops]

Firstly, I’m sorry you’re still feeling tired.

Based on your Pressure Max and 95% results, I don’t think you should be adjusting pressure, in fact I’d reduce your max setting down from 20 to 12. However, Den has an interesting point about clearing the CO2...

I completely agree with Pugsy, and others that you need more sleep! You’re not getting enough time to have decent Stage 4/REM recovery sleep. You are habituated to 5-6 hours, which could be the reason you’re now so tired...the accumulation of lack of sleep is now showing its affects. Ultimately, you need to break this habit and it’s going to take patience and consistency.

You mentioned you feel better when you don’t wear it, which suggests to me you’re not being consistent with your therapy, one step forward two steps back in getting used to wearing it. It will never feel “normal” if you’re not consistent.

If after 30/60 days of everyday use you’re still having issues, I’d suggest you get an over night lab study, coupled with full blood chemistry to see if anything jumps out.

My Husband and I found a huge improvement in quality and length of sleep with clean eating and intermittent fasting. We were quite shocked at the difference, in fact.

Positive thoughts your way!!


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[tiredinVA]

Thanks for that! Doctor changed me to timed ramp and constant 6 cm a week ago and I see no change whatsoever. AHI still around 1 and still tired to death. He also said with nasal pillow there is absolutely no chance of excess CO2. I doubt it's because of lack of sleep because lately I have been sleeping 6 hrs solid and feel even worse.
I am in fact using it consistently and skipped only one night in the 9 weeks of treatment. And that was when I felt so much better. What do you mean by "clean eating"?

Firstly, I’m sorry you’re still feeling tired.

Based on your Pressure Max and 95% results, I don’t think you should be adjusting pressure, in fact I’d reduce your max setting down from 20 to 12. However, Den has an interesting point about clearing the CO2...

I completely agree with Pugsy, and others that you need more sleep! You’re not getting enough time to have decent Stage 4/REM recovery sleep. You are habituated to 5-6 hours, which could be the reason you’re now so tired...the accumulation of lack of sleep is now showing its affects. Ultimately, you need to break this habit and it’s going to take patience and consistency.

You mentioned you feel better when you don’t wear it, which suggests to me you’re not being consistent with your therapy, one step forward two steps back in getting used to wearing it. It will never feel “normal” if you’re not consistent.

If after 30/60 days of everyday use you’re still having issues, I’d suggest you get an over night lab study, coupled with full blood chemistry to see if anything jumps out.

My Husband and I found a huge improvement in quality and length of sleep with clean eating and intermittent fasting. We were quite shocked at the difference, in fact.

Positive thoughts your way!!


Sent from my iPhone using Tapatalk