Here are the questions I’m looking to have answered. I’ll go into more detail about these at the end of the post:
- Do you think that sleep apnea is actually the most major factor in my sleep problems?
- Do you have any advice on how to reduce sleep fragmentation?
- Is there any way of inducing more REM sleep? Is it a problem that I have so little?
- Assuming that I do need to continue using the CPAP machine, how do I make sure that it stays on throughout the night if I have the tendency to wake up constantly and take it off?
I’ve been having really bad sleep problems for 2 years. I quit my full-time job around then partly because I was feeling so tired and found it hard to work. One time, shortly after quitting, I was driving on the freeway around noon when I thought “hmm, I feel slightly more tired today than usual. I’m going to have a nap when I get home”. I remember nothing after that point, and woke up after crashing full speed into a car stopped in front of me.
Nowadays I am working part-time with very flexible hours, but I am finding it very difficult to complete tasks since I’m sleeping so much, can hardly focus because I’m so physically exhausted, and I have been completely unable to wake up early enough in the morning for anything earlier than 11. I am deeply worried that, at this rate, I will never be ready to start a full-time 9-5 job. Beyond that, my social life has become practically non-existent because I’m so tired at night that I find it very hard to do anything (and beyond that, staying out any later than 11pm deeply impacts my sleep schedule), and my sex drive has become effectively zero. I’m 24 and in the prime of my life, but I feel like I’m 80. Also as an aside, due to the incident, my license was suspended, and I can't get it back until I prove I'm "better".
Generally I need to sleep a long number of hours to feel even close to rested. Nowadays, my body wants to sleep around 11-12 hours, but even after that long of a sleep I feel like I’ve barely slept at all. It’s been months, maybe years since the last time I felt well rested. I have tried sleeping more, I have tried sleeping less, I have tried regimenting my sleep, but nothing seems to help.
I have had my CPAP machine for 5 months now. I have had compliance issues every once in a while, but there was a good chunk of time that I was very compliant. My AHI (untreated) is 8.50, and when using CPAP I regularly get an AHI of under 5. Even after a fairly long period of compliance, I felt no difference physically. I have been tested for other sleep disorders, but they found nothing out of the ordinary. One recent test shows that I have “Severely decreased mean sleep latency indicating severe daytime sleepiness” despite the fact that I was on CPAP for months, which is pretty obvious given how I feel.
Results from Various Sleep Studies
I have had two MSLT’s performed: the first was taken in October 2016 without a CPAP machine used, the second was taken in January 2018 with a CPAP machine. Here is a quick tabulation of the results:
Tabulation of MSLT Results - Imgur
Comments:
- I have “severe” daytime sleepiness based on MSLT: 0-5 minutes is considered “severe daytime sleepiness”.
- My REM cycle %SPT is less than half that normal (normally it should be 20-25%).
- CPAP Machines do help to lower my AHI, but actually fails to reduce the overall arousals. When I was not on the CPAP machine (Oct 2016), I had 25.1/hr arousals, including 7.0/hr apnea arousals. When I on the CPAP machine (Jan 2018), I had effectively 0/hr apnea arousals, but my spontaneous arousals were high enough that they still had roughly the same total arousal rate. I think someone mentioned that the normal arousal rate should be around 5/hr, in which case my ~25/hr is much higher.
- It sounds like a large number of intervening wakefulness, but I can’t seem to find any information on what it should be.
CPAP Results – SleepyHead
I have been using my CPAP machine for nearing 5 months, but I have found no difference in my quality of sleep. I still feel exhausted every day, and at no point throughout these months have I noticed any significant differences. See below graphs from SleepyHead.
Sleepyhead Graphs - Imgur
I had a fairly decent compliance, mostly so during November through January, less so during February, and significantly less in March. The AHI is also regularly below 5, which is good. The biggest issue is, as I made clear earlier, that I have a ton of sleep fragmentation. Most (if not all) of my sleeps have been fragmented with the CPAP machine. I will put it on at bed-time, wake up an hour or so later, take it off, wake up a couple hours later, put it back on, wake up again and take it off, ad nauseam (see the session time graph). I don’t do any of this consciously, it happens entirely in a state of semi-consciousness.
Questions
So basically, my questions are:
- Do you think that sleep apnea is actually the most major factor in my sleep problems? My non-supine sleep apnea AHI is 5.5, whereas my supine is 11. The 5.5 isn’t even bad (maybe I could get away with no CPAP machine and sleeping on my side). It almost appears that, although the sleep apnea obviously exists, a larger issue seems to be the fact that I have such fragmented sleep and so little REM. Specifically I am wondering whether or not my lack of success with the machine could be largely due to fragmentation and low REM time, given the fact that the CPAP seems to be controlling my AHI without result
- Do you guys have any advice on how to reduce sleep fragmentation? The current sleeping pill I’m taking is clearly not doing it. What other strategies could I try?
- Is there any way of inducing more REM sleep? Is it a problem that I have so little?
- Assuming that I do need to continue using the CPAP machine, how do I make sure that it stays on throughout the night if I have the tendency to wake up constantly and take it off? Also, is it possible that the mask being on my face is causing the increase in spontaneous arousals in the Jan 2018 test? I do feel like I wake up more often when I'm using CPAP (which is obviously a problem)
Cory