Still sleepy with good AHI

[Notsorandom]

Hello, I've read this board for a long time and have found the posters here so helpful in getting started with my CPAP treatment and adjusting to it. The post on this board have helped me with a number of issues from mask fit to humidifier settings and getting sleepy head set up. So I wanted to say thanks to everyone here for that!

I'm also posting because I am a bit stumped. I started on CPAP but was not getting restful sleep no matter how long I slept or what pressure setting was used. My doctor prescribed a Resmed A10 ASV because I wasn't feeling rested and that I also woke up in the middle of the night severely out of breath. I have been using the ASV for a while now and am pretty well adjusted to it but still do not feel rested with it either. My AHI numbers always look great at well below 1 pretty much every night.

Neither one of the two sleep doctors I've had are interested in looking at the detailed data my machine is recording beyond the AHI number. I spoke with a few of their techs and they said they didn't even have the software able to read it. I've ready through the excellent tutorials and resources on recognizing sleep discorded breathing from here but don't know what I am seeing on my graphs is normal or not. I was hoping that someone here might be willing to take a look and see if there is anything going on with my breathing and if so offer recommendations on how I might adjust my machine.

I have attached a screenshot from Sleepy Head. I woke up that morning feeling out of breath when the alarm went off and this screenshot is from about 30 min before I woke up. That night my mean tidal volume was 380ml, respiration rate was 16.2, Epap 10 and Ipap mean 13.52 and 95% at 17.86. My leak rate for the night was 4l/min. I am not sure if those are good figures or not. I'm happy to post any other part of that night or any other night along with anything else you'd like to see from Sleepy Head. Thank you so much for your help!

[zonker]

Hello, I've read this board for a long time and have found the posters here so helpful in getting started with my CPAP treatment and adjusting to it.

welcome to the zoo!

please see here for formatting of your charts-

wiki/index.php/Sleepyhead:Organize

[Notsorandom]

Thanks for the link. Here is a correctly formatted screen shot. I had a zero AHI but still was tired the next day.

[ClayL]

Lots of people that do not have sleep apnea don't sleep well at night. CPAP is not a cure all for poor sleep.Since your sleep apnea seems to be under control maybe you can get your doctor to work on your poor sleep issues.

[zonker]

Thanks for the link. Here is a correctly formatted screen shot. I had a zero AHI but still was tired the next day.

well, dang! as clayl says, it's not all down to apnea. there may be other issues to consider.

how long have you been on cpap?

[palerider]

You might try bumping up your minepap a little. You're still having flow limitations, and that can disturb your sleep.

[Pugsy]

Do you take any medications? If so, what?
Are you waking up very many times during the night?
Do you have any other mental or physical health conditions going on?

[katestyles]

Thanks for the link. Here is a correctly formatted screen shot. I had a zero AHI but still was tired the next day.

well, dang! as clayl says, it's not all down to apnea. there may be other issues to consider.

tru dat- my AHI last night was one of my best, but my sleep was pretty disturbed by leaks waking me, being poked by my bed partner when my leaks woke him - is it nap time yet?

[Notsorandom]

Thanks for the responses folks!

well, dang! as clayl says, it's not all down to apnea. there may be other issues to consider.
how long have you been on cpap?

I have been using CPAP for a number of years now. I've had the ASV machine for a bit over a year. My sleep study showed an AHI of 8 but that was several years ago. I'm not sure where it would be now without the CPAP.

Do you take any medications? If so, what?
Are you waking up very many times during the night?
Do you have any other mental or physical health conditions going on?

I take 5mg of Sonata and 0.3 mg meletonin right now which dose a good job of getting me to sleep. So no complaints there. In the past I've tried Trazadone, Seruqle, Gapapentin, and Lunesta. None of them seemed to make things better. I usually get up once in the night to use the rest room. Most of the time it isn't a problem getting back to sleep. I'm healthy otherwise, 35 years old skinny guy. After a very extencive blood panel my doctor rulled out auto-imune, amemia, and low hormone levels.

You might try bumping up your minepap a little. You're still having flow limitations, and that can disturb your sleep.

That was a thought I had too. I have gotten my min pressure up to about 12 before but I get really bad aerophagia. I'm not sure if there is a good way to deal whith that issue or not. I will bump up my pressure a bit over the next few nights and see if that makes a difference in the flow limitations.
Thanks all!

[Pugsy]

So tell me your main complaint that you wished you weren't having...is it just that you are still sleepy and want to take a nap during the day or is it anything else?
How long have you been on the machine?
How come this particular machine? Any history of centrals during your sleep studies???

So you have one wake up during the night to go pee....but you go back to sleep easily enough.
Do you have very many other wake ups during the night that you also go back to sleep easily enough?

No other medications at all except the Sonata and melatonin???? I am wondering how much of your excessive sleepiness is related to one or both of those drugs. When I take an Ambien (it's rare but it's there for unusual situations where I need to sleep deeper) I am groggy and sleepy all the next day. One of the reasons I don't take it unless I just have to. I feel much worse the next day from the hang over effect.

Melatonin I can't take...one of the side effects to it besides making a person sleepy is vertigo...and in my case it was really bad vertigo so I have no idea if it would also give me a hangover effect the next day....but any of the regular sleeping pills can.

[Notsorandom]

So tell me your main complaint that you wished you weren't having...is it just that you are still sleepy and want to take a nap during the day or is it anything else?
How long have you been on the machine?
How come this particular machine? Any history of centrals during your sleep studies???

I've been using it for about 18 months now. There were a few central in the sleep study but the doctor wasn't concerned with them. I was put on a normal CPAP. When I was still not sleeping well and reported waking up out of breath he prescribed this machine. The times when I would wake up out of breath feeling like a truck hit me ended with this machine but I still feel pretty sleepy the next day.

So you have one wake up during the night to go pee....but you go back to sleep easily enough.
Do you have very many other wake ups during the night that you also go back to sleep easily enough?

I might wake up if my wife does but still manage to get back to sleep okay.

No other medications at all except the Sonata and melatonin???? I am wondering how much of your excessive sleepiness is related to one or both of those drugs. When I take an Ambien (it's rare but it's there for unusual situations where I need to sleep deeper) I am groggy and sleepy all the next day. One of the reasons I don't take it unless I just have to. I feel much worse the next day from the hang over effect.
Melatonin I can't take...one of the side effects to it besides making a person sleepy is vertigo...and in my case it was really bad vertigo so I have no idea if it would also give me a hangover effect the next day....but any of the regular sleeping pills can.

Both medications I take are supposed to be short acting. The melatonin is a low dose as well at 0.3mg. The Sonata has a half life of only a couple of hours so should mostly be gone the next morning. I've taken longer acting drugs that definitely do stick around too long!

Basically what I am wondering is that could there still be some sort of sleep disorder breathing going on like UARS, flow limitations, or periodic breathing. If my sleepiness might be due to something else like periodic limb movements, or if there is just no treatable reason.

[Pugsy]

How old are you?

Basically what I am wondering is that could there still be some sort of sleep disorder breathing going on like UARS, flow limitations, or periodic breathing. If my sleepiness might be due to something else like periodic limb movements, or if there is just no treatable reason.

It wouldn't be impossible of course for there to be something else going on impacting how you feel during the day.

[Notsorandom]

Here are three screenshots from last night. The first is from a relatively boring part of the graph, the machine isn't calling for a high pressure here. I am pretty sure I am not in REM sleep here. I know from my sleep study that REM is when I have apneas and they are periodic enough for me to pick out in Sleepy Head.

non rem.png (101.79 KiB) Viewed 609 times

The second image here is when I think I am in REM. My machine is playing with the pressure much more here. My wave forms look a lot more jagged and irregularly space. Toward the end of the picture the machine ramps the pressure support up to around 8 and keeps it there for a while. It looks like the wave forms get back under control for a little bit there but then the machine dropped the pressure support and they got all jumbled again. What I am wondering is if this breathing is pretty normal or is there something her that I should be pointing out to my doctor?

jaggedRem.png (134.9 KiB) Viewed 609 times

This last image is the overview for the whole night.

whole night.png (153.77 KiB) Viewed 609 times

[Notsorandom]

How old are you?

Basically what I am wondering is that could there still be some sort of sleep disorder breathing going on like UARS, flow limitations, or periodic breathing. If my sleepiness might be due to something else like periodic limb movements, or if there is just no treatable reason.

It wouldn't be impossible of course for there to be something else going on impacting how you feel during the day.

I'm 35 male 5'8 and 150 lb.

[Pugsy]

Okay...not old enough for metabolism to change the half life much.
Older people (like me) will have it take longer to get out of the system. Ambien is supposed to be relatively short lived but I can take 5 mg and still be drowsy at 5 PM the next day. I hate it. I can't even take melatonin at all...causes major vertigo for me.

There are people who continue to complain of residual excessive sleepiness and fatigue, etc despite what appears to be effective OSA treatment...and they don't know why. It's not always easy to figure out why.