Low AHI, mostly CA events, still feeling extremely tired

[night_rainbow1]

Hi everyone,

I'm new to this message board, looking for any help or advice on my charts.
I have been on APAP treatment since August, but only been using it consistently for the last 2 months. I somehow feel like I'm more tired, foggy headed and waking up with headaches than before I started.

For the first week of treatment I thought I noticed a slight improvement but nothing significant. Its starting to worry me that I feel like I've started getting much worse over a short span of time.

I am 27 years old and consider myself in good shape so not a typical profile, but I have always suffered from sinus issues so that may be driving it. I do notice I end up mouth breathing a lot overnight which I think makes it worse. In that case I am going to see an ENT to see whether he can find any abnormalities in my sinus cavities/structure. I will likely try ask to get a cortical steroid nasal spray, and also to check my thyroid.

In my charts my AHI seems low, but I still feel bad so was hoping someone might notice if there is anything in my charts. I am also curious about the CA (central apnea/clear airway) events since they are the majority of what I am seeing. Does this mean I have central apnea as well or as a result of the pap? It did not indicate this on my sleep report.

Edit: I use a resmed airsense10 for her with a hybrid? mask (it covers the mouth and sits at the base of the nose).

I really appreciate any help or suggestions you may have.

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[Pugsy]

Do you take any medications? If so, what? Even OTC??

Do you wake up very often during the night or do you sleep soundly for the most part?

You don't have central apnea. You aren't having nearly enough central apneas to worry about that.
It's normal to have a few central apneas flagged....anyone and everyone can have them.
It's normal to have a few sleep onset or sleep stage transition centrals ...along with an occasional false positive central flag from simply pausing our breathing briefly while awake.

[night_rainbow1]

Do you take any medications? If so, what? Even OTC??

I take a very low dose (10mg/day) escitalopram, SSRI.

Do you wake up very often during the night or do you sleep soundly for the most part?

For the most part I sleep soundly. Occasionally I'll wake up maybe two/three times in the very early morning, but not on most nights.

[Pugsy]

SSRI medications are well known to mess with sleep architecture...you don't get the needed sleep cycles in the needed percentages for the restorative powers of sleep to work their magic. They especially mess with REM and deep sleep...you just don't get as much as you might need. You can google "sleep and SSRI meds" and get an idea what I am talking about.

Not to mention the side effects of the medication.
Well known to cause extreme fatigue, excessive sleepiness during the day, strong need to nap, etc.

Damned if you do and damned if you don't kind of thing because obviously there is a reason for taking that kind of medication.
Something to have a chat with your doctor about. I know of forum members here who did just that and got off the SSRI or SNRI meds and found out that they had a lot more energy and felt better. All along they thought it was something wrong with their cpap therapy and it was instead a medication side effect.

Half life is fairly long (27 - 32 hours) so the longer you are on it the more of it you have built up in your system even at a relatively low dose. So the side effects can multiply.
https://en.wikipedia.org/wiki/List_of_a ... citalopram

There's nothing of great excitement on your detailed cpap report. A few centrals that may or may not be real asleep centrals but even if every one of them was the real deal not enough to worry about.
Your flow limitations are a bit active (do you have much nasal congestion as that can cause them) and it's possible that they are a factor in sleep disturbances but you say you think you are sleeping fairly soundly so it's unlikely they are to blame.
So I don't know that they are part of the fatigue issue or not. You could try a slightly higher minimum pressure if you just want to try something and see if it helps or not. Won't hurt to try it.

In all honesty...there's a reason I ask the medication question so often and that's because often medication side effects play a significant part in unwanted daytime symptoms. I am betting the meds aren't doing you in favors in that regard but that's to talk to you doctor about.

You could try a little more minimum pressure just to see how you feel. Won't hurt you to try it...like 6 cm instead of 5.
If you never hit the 10 cm max there is no real reason to change it.

[night_rainbow1]

SSRI medications are well known to mess with sleep architecture...you don't get the needed sleep cycles in the needed percentages for the restorative powers of sleep to work their magic. They especially mess with REM and deep sleep...you just don't get as much as you might need. You can google "sleep and SSRI meds" and get an idea what I am talking about.

I had heard a little bit about this before (my sleep doctor mentioned in passing that my REM was delayed and is a common side effect of the medication I'm on), and am actually going to stop taking it. Will take a few months however as I plan on weening off of it.

Your flow limitations are a bit active (do you have much nasal congestion as that can cause them) and it's possible that they are a factor in sleep disturbances but you say you think you are sleeping fairly soundly so it's unlikely they are to blame.

What is happening with/during flow limitations?

I have nasal congestion pretty often and get a lot of allergic reactions. I am going to see an ENT to hopefully get something that could help with this.

[palerider]

What is happening with/during flow limitations?

I have nasal congestion pretty often and get a lot of allergic reactions. I am going to see an ENT to hopefully get something that could help with this.

Think of a flow limitation like breathing through a straw... you *can* get a full breath (so it's not like a hypopnea, which is a reduced volume breath), but it's more work to get that full breath, it takes more time, and effort.

[KandyX]

Maybe you're sensitive to flow limitation?

[palerider]

Maybe you're sensitive to flow limitation?

What does that even mean?

[night_rainbow1]

Think of a flow limitation like breathing through a straw... you *can* get a full breath (so it's not like a hypopnea, which is a reduced volume breath), but it's more work to get that full breath, it takes more time, and effort.

Wow that makes sense now! I've noticed a few times that I've woken in the middle of the night and when trying to fall back asleep it feels tough to get a full deep breath through my nose and have to resort to breathing through my mouth, so this is very likely the cause of my flow limitations. It only makes me even more eager to try using a long term nasal spray or other such solution.

Thanks for all of the insight!

[palerider]

Think of a flow limitation like breathing through a straw... you *can* get a full breath (so it's not like a hypopnea, which is a reduced volume breath), but it's more work to get that full breath, it takes more time, and effort.

Wow that makes sense now! I've noticed a few times that I've woken in the middle of the night and when trying to fall back asleep it feels tough to get a full deep breath through my nose and have to resort to breathing through my mouth, so this is very likely the cause of my flow limitations. It only makes me even more eager to try using a long term nasal spray or other such solution.

Thanks for all of the insight!

Stuffed noses can do that... Most times it probably happens in the throat, but it certainly can be nasal in nature too.