So what now?

[DankShroud]

After a long and frustrating four months on CPAP with no relief from my mild (7.5 AHI) OSA, I've set my minimum pressure to the highest 20cm. I don't have any issues with the pressure and sleep through the night without any discomfort. I don't have aerophagia, I don't remove my mask, I fall asleep quickly and have an insignificant leak rate. I have no compliance problems and sleep 8-11 hours every night. Sleep studies have confirmed that I don't have ANY other sleep disorder. I have no centrals and my AHI is a low 1.5. I've tried every mask type, every pressure setting, cervical collars, tongue restraining devices, chinstraps and sleeping positions. No matter what, I wake up exhausted. Doctors have confirmed that my mild apnea is caused by a large tongue and small throat, I'm an ideal candidate for CPAP. Bloodwork has come back normal on all measures. This disorder has cost me scholarships, relationships, my self confidence and anything else I ever valued in life. I'm not depressed, CPAP just doesn't work. My mind and personality is erased, all I know is this tiredness. I feel cursed, like I'm shut out from everything good. I hope that somebody reads this and points out some major flaw in my treatment or has some great insight. My symptoms are textbook untreated sleep apnea - cognitive dysfunctions, failing memory, outbursts, poor impulse control, and every other devastating result of sleep deprivation. I'm on a ResMed Airsense 10. Pressure is 20cm-20cm. Please help.

[Bertha deBlues]

I'm so sorry you're having problems. I'm still a relative newbie, and wish I could offer suggestions. Please hang in there, as there are many knowledgeable users here that will have useful advice.

[TASmart]

If your sleep apnea is treated sufficiently, and you still are feeling tired, worn, exhausted then it's more than a little likely that sleep apnea is not the cause of your poor rest. You need to find a physician that will treat you, not a suspected condition. You could have any of a number of sleep disorders, metabolic issues, or mental health issues that cause either daytime sleepiness or physical exhaustion. But is PAP is not the solution, then you need to look at other potential problems, starting with chronic fatigue and going on an elimination basis. Not what you wanted to hear, but that's the basic facts.

[Pugsy]

You start looking elsewhere.
Your symptoms can be caused by any number of things and sleep apnea is only one of the items on a very long suspect list.

Medications....side effects primarily
Insomnia...
Other physical and mental health issues....
Hours of sleep...
Stress....
External factors....bed comfort...dog barking...whatever...

The cpap machine can only fix problems caused by sleep apnea or sleep disordered breathing and does a terrible job fixing problems caused by something else.

[D.H.]

To the OP,

Please don't interpret the prior poster as suggesting that you should discontinue CPAP. Sleep Apnea is a dangerous disease, and you need to treat it even if you're not experiencing relief.

Also, please fill in your profile. It would be useful to know what equipment you're using.

[Pugsy]

Please don't interpret the prior poster as suggesting that you should discontinue CPAP.

Please don't go putting words in my mouth that I never said.

To the OP...just in case your mind went there...
Often people have more than one problem that needs being dealt with...just because you have one problem doesn't mean you can't have another problem or problems.
Fix what you can with what you know needs to be done and if that doesn't solve the problem then start looking for other culprits.
Doesn't mean you stop taking care of the known problem while looking elsewhere.
You just have to do both...treat the SDB as best you can and while doing that look for other culprits for why you don't feel so great.

[TedVPAP]

If your AHI is low when using PAP
AND
you are sleeping soundly when using PAP,
then your issue is no longer due to OSA.

Simple.

Your treated AHI is relatively low.
Previously you questioned whether spontaneous arousals was your problem. Did you reach a conclusion?

[DankShroud]

If your AHI is low when using PAP
AND
you are sleeping soundly when using PAP,
then your issue is no longer due to OSA.

Simple.

Your treated AHI is relatively low.
Previously you questioned whether spontaneous arousals was your problem. Did you reach a conclusion?

The only thing that begins to make sense is that I'm still reacting to the machine somehow, or having subtle obstructive arousals. An oral device might help, I don't know.

[TedVPAP]

Since your AHI is fine, you are postulating that maybe there are arousals that are not being flagged. I don't know but since you are searching, you should look carefully. Sleepyhead shows every breath.
If you have UARS then the treatment is pressure. Have you tried CPAP at higher pressure? And I do mean CPAP not APAP.

[DankShroud]

Since your AHI is fine, you are postulating that maybe there are arousals that are not being flagged. I don't know but since you are searching, you should look carefully. Sleepyhead shows every breath.
If you have UARS then the treatment is pressure. Have you tried CPAP at higher pressure? And I do mean CPAP not APAP.

I'm currently using the highest pressure of CPAP

[Lucyhere]

After a long and frustrating four months on CPAP with no relief from my mild (7.5 AHI) OSA, I've set my minimum pressure to the highest 20cm. I don't have any issues with the pressure and sleep through the night without any discomfort. I don't have aerophagia, I don't remove my mask, I fall asleep quickly and have an insignificant leak rate. I have no compliance problems and sleep 8-11 hours every night. Sleep studies have confirmed that I don't have ANY other sleep disorder. I have no centrals and my AHI is a low 1.5. I've tried every mask type, every pressure setting, cervical collars, tongue restraining devices, chinstraps and sleeping positions. No matter what, I wake up exhausted. Doctors have confirmed that my mild apnea is caused by a large tongue and small throat, I'm an ideal candidate for CPAP. Bloodwork has come back normal on all measures. This disorder has cost me scholarships, relationships, my self confidence and anything else I ever valued in life. I'm not depressed, CPAP just doesn't work. My mind and personality is erased, all I know is this tiredness. I feel cursed, like I'm shut out from everything good. I hope that somebody reads this and points out some major flaw in my treatment or has some great insight. My symptoms are textbook untreated sleep apnea - cognitive dysfunctions, failing memory, outbursts, poor impulse control, and every other devastating result of sleep deprivation. I'm on a ResMed Airsense 10. Pressure is 20cm-20cm. Please help.

Cognitive dysfunctions, failing memory, etc. can certainly be the result of sleep deprivation. However, as already mentioned, your symptoms can be the result of other issues. I believe you aren't depressed. You would know it if you were. I may be reading into this but I sense you are an anxious person. Have you considered therapy? Maybe talk therapy or CBT? If you are open to it, it may be another avenue to pursue. I wish you all the best.

[Bill44133]

After a long and frustrating four months on CPAP with no relief from my mild (7.5 AHI) OSA, I've set my minimum pressure to the highest 20cm. I don't have any issues with the pressure and sleep through the night without any discomfort. I don't have aerophagia, I don't remove my mask, I fall asleep quickly and have an insignificant leak rate. I have no compliance problems and sleep 8-11 hours every night. Sleep studies have confirmed that I don't have ANY other sleep disorder. I have no centrals and my AHI is a low 1.5. I've tried every mask type, every pressure setting, cervical collars, tongue restraining devices, chinstraps and sleeping positions. No matter what, I wake up exhausted. Doctors have confirmed that my mild apnea is caused by a large tongue and small throat, I'm an ideal candidate for CPAP. Bloodwork has come back normal on all measures. This disorder has cost me scholarships, relationships, my self confidence and anything else I ever valued in life. I'm not depressed, CPAP just doesn't work. My mind and personality is erased, all I know is this tiredness. I feel cursed, like I'm shut out from everything good. I hope that somebody reads this and points out some major flaw in my treatment or has some great insight. My symptoms are textbook untreated sleep apnea - cognitive dysfunctions, failing memory, outbursts, poor impulse control, and every other devastating result of sleep deprivation. I'm on a ResMed Airsense 10. Pressure is 20cm-20cm. Please help.

what does your sleep data look like? How is your leak rate? what kind of events are you having? Are you mouth breathing and your therapy is going out your mouth? Please provide more information/data on how your therapy is going.
other than you have your pressure set to max we don't have any information.

[DankShroud]

After a long and frustrating four months on CPAP with no relief from my mild (7.5 AHI) OSA, I've set my minimum pressure to the highest 20cm. I don't have any issues with the pressure and sleep through the night without any discomfort. I don't have aerophagia, I don't remove my mask, I fall asleep quickly and have an insignificant leak rate. I have no compliance problems and sleep 8-11 hours every night. Sleep studies have confirmed that I don't have ANY other sleep disorder. I have no centrals and my AHI is a low 1.5. I've tried every mask type, every pressure setting, cervical collars, tongue restraining devices, chinstraps and sleeping positions. No matter what, I wake up exhausted. Doctors have confirmed that my mild apnea is caused by a large tongue and small throat, I'm an ideal candidate for CPAP. Bloodwork has come back normal on all measures. This disorder has cost me scholarships, relationships, my self confidence and anything else I ever valued in life. I'm not depressed, CPAP just doesn't work. My mind and personality is erased, all I know is this tiredness. I feel cursed, like I'm shut out from everything good. I hope that somebody reads this and points out some major flaw in my treatment or has some great insight. My symptoms are textbook untreated sleep apnea - cognitive dysfunctions, failing memory, outbursts, poor impulse control, and every other devastating result of sleep deprivation. I'm on a ResMed Airsense 10. Pressure is 20cm-20cm. Please help.

what does your sleep data look like? How is your leak rate? what kind of events are you having? Are you mouth breathing and your therapy is going out your mouth? Please provide more information/data on how your therapy is going.
other than you have your pressure set to max we don't have any information.

I'm using a nasal mask with a chinstrap. Most nights I duc take my mouth shut, leak rate is around 2L/m. I'm having mostly obstructive events.

[ChicagoGranny]

DankShroud

See this checklist -

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

[Mogy]

Mild OSA is not responsible for the symptoms you describe in the majority of cases. Treating mild OSA with xPAP was a long shot at best.
A study about mild OSA and it's impact concluded the following:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163952/

Conclusion.
Individuals with mild OSA in this cohort do not have worse sleepiness, mood or quality of life in comparison to those without OSA.