Minimal AHI ... Still DEAD Tired! - 10 years in.

[deadtiredcanadian]

You mention that your wife reports twitching and occasional shuddering at night.. you might look into that with your doctor if you haven't already; it could be what's waking you up in addition to the OSA, thus preventing optimum sleep. Your machine probably isn't going to respond to twitches and shudders.

From this thread and all of your help it is becoming clear to me that I need to investigate this further.

I has hoping that the answer was going to be rather straightforward when I downloaded all of the data today: I'm still having tons of AHIs... however that's not the case. I will still up the pressure like some suggested and give this a try.

It seems to me from what I've been able to learn since 10:30 AM this morning that the restless leg and related symptoms can be the culprits.

I have very vivid/intense dreams virtually every single night. I toss and turn and change positions countless times. In the dreams I will apparently have pretty bad twitches, jerky and sudden movements and other related bodily reactions. I am curious about the effect that medication would have on this, and will be exploring this avenue.

[GTOJim]

I apologize to everyone, I didn't mean to derail this thread, I wasn't asking for help, sorry if it may have sounded that way. The OP requested additional information from a previous post I made. My response I listed two meds I'm taking, and was asked for information regarding other possible medications which I was attempting to answer.

I was attempting to point out how sleep doctors tend to ignore PLM issues. My previous sleep doctor chose to ignore it until I pointed it out and made a poor example and of how my new sleep doctor chose to ignore the issue in my latest sleep study, since he interpreted my study he omitted any PLM arousal from the results of the study. I"m sorry I ended up venting a bit which I didn't mean to do, it wasn't my original intent.

Sometimes we can get passionate about things, I got carried away, I apologize to everyone especially to the OP.

GTOJim -- Please start your own thread so that deadtiredcanadian's can stay on track -- both of you will get better help that way.

The OP deadtiredcanadian has already said that he doesn't take any medications.

[kaiasgram]

I have very vivid/intense dreams virtually every single night. I toss and turn and change positions countless times. In the dreams I will apparently have pretty bad twitches, jerky and sudden movements and other related bodily reactions.

Also make sure REM sleep behavior disorder is -- or has been -- ruled out. From the Mayo Clinic website:

Rapid eye movement (REM) sleep behavior disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep — sometimes called dream-enacting behavior.

[palerider]

For the past 565 days my average AHI is 1.67

I think the point has been made, but the last 565 days don't matter... what's the last month look like?

[kteague]

I'm a little late to this party Just want to add that even though an autopap may be doing its job preventing apneas, some individuals are sensitive to the pressure fluctuations, and experience sleep stage disruptions with the pressure changes. These people might do better with straight pressure - it's not really about AHI in these situations.

Are you using a ramp feature on your machine? Do you happen to use it when you wake up during the night? Just asking because events that are not calculated into the AHI can be happening if one sleeps while the machine is ramping.

Do consider investigating whether limb movements are an issue or not. If so, please become informed before selecting a treatment. No need to go into a lot of detail if there's not an issue. I do want to say that doing another diagnostic sleep study, one without CPAP, is not going to be your ideal approach to evaluate limb movements. What you need to know is if your limbs are problematic while using your therapeutic CPAP treatment. You could always record yourself to get an idea. That wouldn't show how disruptive they are to your sleep stages, but would at least give you an idea which way to proceed.

[deadtiredcanadian]

I was attempting to point out how sleep doctors tend to ignore PLM issues. My previous sleep doctor chose to ignore it until I pointed it out and made a poor example and of how my new sleep doctor chose to ignore the issue in my latest sleep study, since he interpreted my study he omitted any PLM arousal from the results of the study. I"m sorry I ended up venting a bit which I didn't mean to do, it wasn't my original intent.

Thank you very much for this clarification and reference. This is quite valuable to me as I am going to go on a goose-chase trying to get this PML issue addressed. Your post has helped me.

As stated before, I will increase the pressure on my APAP or make it in to a CPAP to see if that will help at all; nothing to lose there; yet at 1.67 AHI over 550+ days or so, AHIs don't seem to be the issue. I was just hoping it would have been something simple like that.

[deadtiredcanadian]

Also make sure REM sleep behavior disorder is -- or has been -- ruled out. From the Mayo Clinic website:

Rapid eye movement (REM) sleep behavior disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep — sometimes called dream-enacting behavior.

Thank you. Yes, I have researched this as well and my symptoms are way milder than that. I do constant twitching and jerking of my body and that may be a huge cause above and beyond Sleep Apnea.

[deadtiredcanadian]

For the past 565 days my average AHI is 1.67

I think the point has been made, but the last 565 days don't matter... what's the last month look like?

It's very consistent AHI under 5 with minimal leaking over the past 18 months since I have the new mask. Even when I look at it day by day it's very low. The highest I've had has been one day at 4 but otherwise very low including 0.5 or so.

[Guest]

I'm a little late to this party Just want to add that even though an autopap may be doing its job preventing apneas, some individuals are sensitive to the pressure fluctuations, and experience sleep stage disruptions with the pressure changes. These people might do better with straight pressure - it's not really about AHI in these situations.

This is a good point and I will start investigating ramping up the pressure starting tonight to a relatively high bottom. My pressure averages at 7.5 to 8, so I will start at 6 and expect this shall give me even lower AHIs but also would have less fluctuation.

Are you using a ramp feature on your machine? Do you happen to use it when you wake up during the night? Just asking because events that are not calculated into the AHI can be happening if one sleeps while the machine is ramping

Yes I am, only for 15 minutes. So I start at 4 and 15 minutes later it's already quite high. I know this as often it takes me longer to fall asleep and when I take the mask off to accommodate the pressure is very high.

Regarding the times that I wake up, I rarely, if ever, take the mask off. In other words, the ramp up would only be activated the first time that I turn the machine on and from that point forth will keep it at high pressure.

Do consider investigating whether limb movements are an issue or not. If so, please become informed before selecting a treatment. No need to go into a lot of detail if there's not an issue. I do want to say that doing another diagnostic sleep study, one without CPAP, is not going to be your ideal approach to evaluate limb movements. What you need to know is if your limbs are problematic while using your therapeutic CPAP treatment. You could always record yourself to get an idea. That wouldn't show how disruptive they are to your sleep stages, but would at least give you an idea which way to proceed.

This is an excellent point which it had not occurred to me. Like others have suggested, I will investigate that limp movement and will request a CPAP study while they test for the limp movement

[kteague]

I have very vivid/intense dreams virtually every single night. I toss and turn and change positions countless times. In the dreams I will apparently have pretty bad twitches, jerky and sudden movements and other related bodily reactions. I am curious about the effect that medication would have on this, and will be exploring this avenue.

Movements while sleeping can be a 'chicken or the egg' kind of thing. Movements acting out dreams can be one thing. The brain making dreams due to physical sensations such as limb movements would be another. They would not have the same treatment approach. Movements from acting out a dream will likely appear as random in timing and appearance, unless you're dreaming about skating or biking. If the movements happen to take place during a sleep study, the data will show if one is in REM. I'm not a guru on REM Behavior Disorder, but my father acted out his bad dreams. The episodes were so scattered it would have been hard to predict when it would manifest. Movements from PLMD (Periodic Limb Movement Disorder) will be rhythmic in timing and stereotypical in appearance. A home video could give you a good idea. PLMD is pretty distinctive. Once you know what you're dealing with you can decide the next step. Some people have PLMD but their movements aren't strong and don't disrupt their sleep. A sleep study would tell you how disruptive your movements are to your sleep.

[zoocrewphoto]

I'm a little late to this party Just want to add that even though an autopap may be doing its job preventing apneas, some individuals are sensitive to the pressure fluctuations, and experience sleep stage disruptions with the pressure changes. These people might do better with straight pressure - it's not really about AHI in these situations.

This is a good point and I will start investigating ramping up the pressure starting tonight to a relatively high bottom. My pressure averages at 7.5 to 8, so I will start at 6 and expect this shall give me even lower AHIs but also would have less fluctuation.

Are you using a ramp feature on your machine? Do you happen to use it when you wake up during the night? Just asking because events that are not calculated into the AHI can be happening if one sleeps while the machine is ramping

Yes I am, only for 15 minutes. So I start at 4 and 15 minutes later it's already quite high. I know this as often it takes me longer to fall asleep and when I take the mask off to accommodate the pressure is very high.

Regarding the times that I wake up, I rarely, if ever, take the mask off. In other words, the ramp up would only be activated the first time that I turn the machine on and from that point forth will keep it at high pressure.

Do consider investigating whether limb movements are an issue or not. If so, please become informed before selecting a treatment. No need to go into a lot of detail if there's not an issue. I do want to say that doing another diagnostic sleep study, one without CPAP, is not going to be your ideal approach to evaluate limb movements. What you need to know is if your limbs are problematic while using your therapeutic CPAP treatment. You could always record yourself to get an idea. That wouldn't show how disruptive they are to your sleep stages, but would at least give you an idea which way to proceed.

This is an excellent point which it had not occurred to me. Like others have suggested, I will investigate that limp movement and will request a CPAP study while they test for the limp movement

Can you post a screen shot of the graphs showing the events and pressure? Some of what you say seems a bit confusing. You mentioned that your machine is set 4-20, but you also mention ramp. You can't ramp from 4 to 4, so if you have ramp turned on, you are basically telling it to do nothing for 15 minutes. It also seems odd that after 10 years, you are not uncomfortable at 4? Most people are not comfortable at such a low pressure.

In this post, you mentioned that the pressure ramps up to high, but before you said it was staying around 7 1/2 to 8. Do you consider 8 to be high, or is it really going higher than that. If so, you really do need to look at the graphs and set a better range. For example, If you need a minimum of 7 and have occasional spikes to 13, you have a ton of pressure changes as it starts at 4 and goes up and down to meet your needs. My machine is set for 11-17. It spends most of the night between 11 and 13, but it will usually have 3-5 spikes up to 15, sometimes a few to 17. Probably spends less than 5 minutes a night that high, but there are times when I need it.

Many people are sensitive to pressure changes, so that could keep you in a light sleep with lots of arousals that you can't remember. Also, Many people don't feel really good unless they have an ahi under 2 or even under 1. Keep in mind that an ahi of 2 still means being disturbed twice every hour. And those events could be the bare minimum of 10 seconds, or they could be over a minute long. You may feel a lot better with a narrow pressure range a consistent ahi less than 1. You also need to know if your events are short or long, and whether they are spread out during the night, or all clustered together in one big destructive package.

[palerider]

For the past 565 days my average AHI is 1.67

I think the point has been made, but the last 565 days don't matter... what's the last month look like?

It's very consistent AHI under 5 with minimal leaking over the past 18 months since I have the new mask. Even when I look at it day by day it's very low. The highest I've had has been one day at 4 but otherwise very low including 0.5 or so.

5 is pretty crap. that's what I feel like if mine's that high.

[Pugsy]

Apnea events, aka AHI are just one of many things that impact sleep quality and anything that impacts sleep quality negatively has the potential to make us feel like crap during the day.
Also...sometimes we just feel like crap because of something totally unrelated to sleep at all but if we know that our sleep quality could be improved upon then it just makes sense to at least try to improve sleep quality in an effort to rid ourselves of the daytime feeling like crap.

Fatigue has many, many causes and sleep apnea is just one of those many causes. The cpap machine can't fix a problem if the problem isn't related to sleep apnea...no matter how good that AHI is or how much we want it to.
Been down that road myself. My AHI is almost always really good and leaks never wake me and I don't spend much time in large leak territory but for me I have discovered that sleep quality (both hours of sleep and awakenings during the night) makes a huge impact on how I might feel the next day. My main culprit for messing with my sleep quality is pain....hurts to move and hurts not to move and if I didn't take some meds to help me sleep a little deeper and help with the pain I would be waking up 30 to 50 times a night with every time I needed to move in bed.
The best cpap therapy in the world can't fix my old broken back and pelvis and the good old arthritis that has moved in to stay.

Good restful, restorative and quality sleep depend on so much more than the AHI number.
If you know that your sleep quality in general needs improvement....like you know you wake up often....start there and try to figure out why and what can be done about it. It's a starting point and we all have to start somewhere.

[deadtiredcanadian]

Good restful, restorative and quality sleep depend on so much more than the AHI number.
If you know that your sleep quality in general needs improvement....like you know you wake up often....start there and try to figure out why and what can be done about it. It's a starting point and we all have to start somewhere.

I agree with you in concept. The problem is that how to improve sleep quality is anyone's guess. I understand and this really is the kicker: if my AHI is low already then it's not Sleep Apnea the problem. Then Sleep Quality is the next suspect. But how in the world does one truly improve sleep quality beyond the common advice? I mean, I am not the greatest and all the common advice for sleep but I'm quite there --- and yet my sleep quality is still crap.

How to improve the crap IS the question

[zoocrewphoto]

Good restful, restorative and quality sleep depend on so much more than the AHI number.
If you know that your sleep quality in general needs improvement....like you know you wake up often....start there and try to figure out why and what can be done about it. It's a starting point and we all have to start somewhere.

I agree with you in concept. The problem is that how to improve sleep quality is anyone's guess. I understand and this really is the kicker: if my AHI is low already then it's not Sleep Apnea the problem. Then Sleep Quality is the next suspect. But how in the world does one truly improve sleep quality beyond the common advice? I mean, I am not the greatest and all the common advice for sleep but I'm quite there --- and yet my sleep quality is still crap.

How to improve the crap IS the question

Have you ruled out pressure changes disturbing you (by using a more narrow range or straight pressure). Have you confirmed from your graphs that you events are not clustered or long? My mom used to have a low ahi of 3.4 with her pressure of 10. I let her use my machine with full data for 4 hours and then printed the graphs. She had a cluster of events, all over 30 seconds each, one over a minute long. She went to a new doctor with the data, and she now has a full data machine with a pressure of 10-15 and much better sleep quality.

You have the data, but you haven't shown us any. There is more to sleep apnea than just ahi. There are also events under 10 seconds that don't officially count as events, but a lot of them clustered can really cause a problem. It would be helpful to rule these things out.