Daytime tiredness - Sleep apnia or other issue?

[tsduke]

How does one make the determination whether daytime tiredness/fatique is related to sleep apnia? The reason I ask my sleep doctor is basically saying that since treatment has my AHI under 5 that means my sleep apnia treatment is effective. He says he can give medication to help prevent falling asleep during the day, but I don't fall asleep during the day unless I lay down watching tv or something. Other than that I've never fallen asleep when I didn't want to. I have times where I'm pretty sleep but I can fight it off. Anyway, he's basically saying I probably need to go back to my primary doctor to pursue other root causes.

Not sure what to think of his response. This all came from me asking him after 9 weeks of treatment how long before I can expect to feel the benefits during the day. Many days I feel worse than I did before treatment.

[ChicagoGranny]

Have a look at this checklist -

Good Sleep for CPAPers

- 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
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep. (Some people, including me, actually find listening to their breathing and the sound of the machine to be relaxing.)
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free OSCAR (or the free SleepyHead), to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

CG

BTW, 5.0 AHI is not healthy. Many people say they don't feel well unless their AHI is less than 2.0 or 1.0.

[palerider]

The reason I ask my sleep doctor is basically saying that since treatment has my AHI under 5 that means my sleep apnia treatment is effective.

Well, your doctor is quoting the party line, but the party line is bullshit.

An ahi of 5 is like someone poking you with a stick every 12 minutes... There's no way you're going to feel rested with that much sleep disturbance... Try to get your ahi under 2.

Not sure what to think of his response.

You're right to be skeptical.

Get Oscar, post some charts.

[gmsmith]

So as with almost anything, context is key, an AHI of 5, if the OP had an AHI of over 150 in their sleep study would cause a doctor to do cartwheels to get the AHI down to 5.

That said, having a holistic view of the treatment is important. As palerider said, download Oscar and import your sleep data and please post some charts. Also might help to share some additional context of your treatment and original study. Potentially of interest is your O2 levels during your sleep study.

The idea that you will feel like leaping tall buildings with a single bound doesn't really happen, it is a cumulative effect (generally) and while you are 60 days into your treatment, maybe there are tweaks that can be made. You can do this. There are some pretty knowledgable and supportive people on the forum.

[tsduke]

You lost me at ....- Practice total abstinence of caffeine including sources like chocolate (sigh). I'd would be napping daily if I did that, plus headaches. lol

That <5 AHI thing is what bothers me most about my sleep doctor. He seems stuck on stupid there. I even asked him today why he thinks that is good why he isn't pushing for zero. He just says some can acheive close to it some can't. Seems screws up to me. I would have walked from sleep doctor earlier but I don't feel better during the day and want to figure that out first. He doesn't seem to feel that falls under his care so I guess that doesn't matter.

I have almost 2 weeks of the treatment using an ASV I bought off a member on this site and using it I'm always less than 1, but most days are .2 or less. Problem is I don't sleep as well on it and wake up more plus days are no better if not worse. Whether there is a correlation or coincidence I have no idea. With my ST I was low of 1.7, but usually 4-8, so obviously the ASV has been better for lowering events.

I'm tyring but struggling to be paitent it getting relief, but it's a real struggle when I'm going backwards in how I feel during the day. Double struggle when i'm not a patient person to begin with.

[jnk...]

Getting the best sleep possible isn't always the complete solution for feeling better, but getting the best sleep possible always increases the odds that whatever else you do is more likely to help you feel better sooner and more completely.

[Pugsy]

I have almost 2 weeks of the treatment using an ASV I bought off a member on this site and using it I'm always less than 1, but most days are .2 or less. Problem is I don't sleep as well on it and wake up more plus days are no better if not worse.

So what is the "don't sleep well" consisting of?
Short hours of sleep? How many hours of real sleep are you getting?
Frequent wake ups? If so, any idea why?

If you aren't sleeping well it's going to be extremely difficult to feel great during the day no matter what the AHI happens to be.
AHI of 0.0 means nothing if the sleep quality is crap.
There's so much more to feeling the good numbers than just getting them.

[jnk...]

You lost me at ....- Practice total abstinence of caffeine including sources like chocolate (sigh). I'd would be napping daily if I did that, plus headaches. lol

What you state is proof positive that you need to try what the Granny suggests. Don't knock it until you try it. Some people develop a sort of allergy to caffeine that can wreck sleep even when taken in small amounts early in the day. So please don't shrug off the suggestion just because it sounds hard. If it works, it works. Isn't it worth it to you to find out?

Often the things humans do in an attempt to feel better actually make the root problem worse. Don't get caught in that self-defeating trap.

If the rules of sleep-hygiene don't help you after giving them the full college try for a few weeks, THEN dismiss them offhand. Not before. Otherwise your position could be stated as "I'd sure like to feel better, but not if it means actually doing something about it."

[palerider]

So as with almost anything, context is key, an AHI of 5, if the OP had an AHI of over 150 in their sleep study would cause a doctor to do cartwheels to get the AHI down to 5.

It DOES NOT MATTER what the original ahi was, 5 is simply not good enough.

It's like saying "oh, you've got ONE leg, that's 'good enough' you can hop everywhere"

The 'standard of care' isn't really "good enough", sadly.

[ChicagoGranny]

plus headaches

If you do decide to drop the caffeine habit, remember to taper off slowly. Tapering too quickly can cause bad withdrawal headaches.

If you are consuming a lot of caffeine, it may take three weeks or so.

[palerider]

That <5 AHI thing is what bothers me most about my sleep doctor. He seems stuck on stupid there. I even asked him today why he thinks that is good why he isn't pushing for zero. He just says some can acheive close to it some can't.

Well, zero is possible, but it's a waste of time to pursue it, under 1m5 or so, and I (and most people I've heard from) can't tell any difference... So chasing zero is a case of diminishing returns, the lower you go, the harder it is, and the less improvement you get...

[tsduke]

I have almost 2 weeks of the treatment using an ASV I bought off a member on this site and using it I'm always less than 1, but most days are .2 or less. Problem is I don't sleep as well on it and wake up more plus days are no better if not worse.

So what is the "don't sleep well" consisting of?
Short hours of sleep? How many hours of real sleep are you getting?
Frequent wake ups? If so, any idea why?

If you aren't sleeping well it's going to be extremely difficult to feel great during the day no matter what the AHI happens to be.
AHI of 0.0 means nothing if the sleep quality is crap.
There's so much more to feeling the good numbers than just getting them.

For sure, wake ups. It's hard to tell why but I wake up feeling like I was startled awake if that makes sense. With the ASV maybe it's pressure spikes, but I had the same feeling on the ST which obviously was static pressures. I know one thing I keep experiencing is what feels like muscle tightness in upper chest into the shoulders. When I feel the worst it's usually present. I've already been through tons of tests for my heart and it checks out healthy. Heart testing is what started the whole journey to where I'm at today.

I really don't know how much real sleep I'm getting, but I wake up feeling like junk in the mornings which is why it seems easy to tie my sleep quality to crappy days.

I get your last comments. Just had my hopes up that I would be lucky enough to have low AHI = improvement elsewhere.

[tsduke]

That <5 AHI thing is what bothers me most about my sleep doctor. He seems stuck on stupid there. I even asked him today why he thinks that is good why he isn't pushing for zero. He just says some can acheive close to it some can't.

Well, zero is possible, but it's a waste of time to pursue it, under 1m5 or so, and I (and most people I've heard from) can't tell any difference... So chasing zero is a case of diminishing returns, the lower you go, the harder it is, and the less improvement you get...

I get that zero is chasing perfection and isn't my goal. I just don't get why a sleep doc is like hey you are near 5 you are good to go and has no drive to bring it down more.

[tsduke]

Another question...can one have good AHI numbers but still experience oxygen issues during sleep?

[gmsmith]

Another question...can one have good AHI numbers but still experience oxygen issues during sleep?

Yes