New CPAP user looking for feedback

[DrMuffy]

Hey everyone! I'm pretty new to the CPAP world and I'm looking for any suggestions on things to adjust with my Resmed Airsense 11. I am a 33 year old male in decent health and shape. I was diagnosed with mild/moderate sleep apnea at AHI 3% = 15.8/hour and AHI 4% = 7.5/hour. I began using a ResMed Airsense 11 about four months ago with a full facemask. I didn't mess with the factory settings at all for a couple weeks and only noticed a slight improvement in my sleepiness during the day despite using the CPAP every night. I adjusted the minimum air pressure to 7 for two weeks but then went back down to the factor setting after waking up a lot with high leaks. After a couple of months, I recently adjusted the minimum pressure back up to 7 to see if it would help. I still feel fairly sleepy during the day and so I was hoping you all could take a quick look at my Oscar data and let me know if you think I should adjust the pressure or any other settings.

Thanks in advance!

[Jimmydon2025]

wow, not sure. Who can read and understand charts? My machine doesn’t allow for air pressure adjustments, except by doctor. I believe that would solve my problem if I could turn my down.

[Pugsy]

How many hours of actual sleep are you getting?

Do you wake frequently during the night?

Do you take any medications of any kind? If so, what? even OTC.

[DrMuffy]

How many hours of actual sleep are you getting?

Do you wake frequently during the night?

Do you take any medications of any kind? If so, what? even OTC.

I probably get 7 hours of sleep each night and I tend to maybe wake up briefly once or twice for a few minutes. Sometimes I’ll wake up with the mask blasting air in my face around 4 or 5 and rip it off.

As far as medication, I don’t take any sleeping meds. I take lexapro 10 mg for depression, along with zertec, magnesium, and fish oil with dinner. I also take some DHEA, probiotics, and low dose naltrexone (for potential long COVID complications) in the morning.

[Pugsy]

Have you looked at the side effects for Lexapro?

[DrMuffy]

Have you looked at the side effects for Lexapro?

Yeah, I know it can cause drowsiness or excitability for some people but I’ve been taking it for about 10 years now and I’ve found that it doesn’t really impact me.

So, judging from the lack of feedback on the CPAP stuff, I’m guessing that you all don’t see anything obviously wrong that I’m doing or something worth changing?

Thanks!

[Pugsy]

So, judging from the lack of feedback on the CPAP stuff, I’m guessing that you all don’t see anything obviously wrong that I’m doing or something worth changing?

I really prefer to get a bit of history and feel for what is going on and not rely on one single night's report all that much.
I don't know if that one night is a typical night or a one off "bad" night or conversely a "good" night.

I do wonder if those central apneas/CAs are real asleep centrals or SWJ Sleep/Wake/Junk centrals or simply sleep onset centrals (which is normal) because to have a sleep onset central we have to have a transition to sleep from wake and if that's the case you are having a lot more awakenings than you remember...which is entirely possible...and that means sleep quality itself is less than optimal and might explain excessive sleepiness during the day.

How about using SleepHQ (the free version) so we can zoom in on those flagged centrals and see what they look like?

Lexapro is a SSRI type of medication and all SSRIs are well known to mess with sleep quality and sleep stages.
So it makes me wonder if you are simply having crappy sleep quality because of SSRI messing with sleep stages and when sleep stages are messed with we feel like crap the next day. Did you know that SSRI meds can cause reduced REM sleep stages?

Are those leaks waking you up? They aren't really bad enough to be all that much of of a negative impact on your therapy but they sure could be messing with sleep quality.

And no....I don't see anything in your current settings that really need adjustments at this time that if you changed them you would have the miracle and feel like superman. Your complaint is fairly common....start cpap and despite very decent numbers you don't feel them. Happens all the time and people want some sort of miracle setting changes that will bring about feeling the good numbers. At least I don't see anything that just stands out screaming "fix me and you will feel so much better". I wish I did. Teasing out why we don't feel the good numbers is extremely difficult.....that's why I asked so many nosy questions.

[GrandmaA]

Poor sleep and low energy/sleepiness during the day can be caused by a lot of things in addition to OSA and many contributing things can stack, whereas one alone might not be the problem but several put together have an effect. By treating the OSA you've removed only one of them (if my theory is right but I'm going on personal experience.)

I'm not a doctor so I'm only saying what I would do in your situation - well did. Your mileage may vary and some of this might not apply.

Get deep dive bloodwork. You are in "decent health and shape" but a lot of fatigue-causing problems are not visible on the surface (or picked up on in standard bloodwork) and have nothing to do with physical shape (although there is an association with obesity for several of them). Some things to check for are B12, folate, D, iron, thyroid, testosterone, adrenal function, CBC, A1C, kidney and liver function, but this list is not exhaustive and it should be deep dive not surface, for example, not just TSH for thyroid, but free T3 etc., same with testosterone, etc.

Wean off the Lexapro and naltrexone. They might be giving you only a dubious benefit. (UNLESS you are taking the Lexapro for a major depressive disorder or bipolar with risk of suicidal ideation or the like. Not trying to be nosy, you don't have to tell us.) You've been on the Lexapro for 10 years meaning you started it at age 23, when you're finishing up the tumultuous adolescent/early adult years. You're more mature now and maybe don't need it anymore, but SSRIs mess with your neurotransmitters and with long term use you cannot suddenly quit, you must wean gradually.

Low dose naltrexone for long COVID? Where's the research on that? It hits the opioid receptors though not in a big way but still not something you really want to do indefinitely. It messes up your own natural endorphin production.

Both of them together can be messing with your sleep or daytime energy even if one alone wouldn't. Wean gradually and expect to feel worse before you feel better.

Address what you find in the bloodwork. If levels are "normal" but very near the low range, consider treating to get them up in mid range. Vitamin D is notorious for this issue since "normal" was taken from "average" in a population that no longer spends time out in the sun. Some labs have realized this and adjusted upward. Get the B12 and thyroid up into mid range.

If your diet includes huge amounts of carbs, consider drastically cutting back. Even if your blood sugar is very good and you have no signs of type 2 diabetes. That only means big loads of blood glucose are countered by big dumps of insulin. Without getting into the whole pituitary-adrenal axis and how leptin regulates how energy is used, to summarize, big carb meals and snacks result in an energy/crash cycle.

And of course, get outside in the sun, and get some exercise. The actual sun is important, something to do with light on your retina setting your sleep cycles properly or something. I think we evolved to be outside in the sun looking over a distance to the horizon, not sitting indoors in front of a close screen all day. I admit that's easier said than done with all the indoor desk jobs these days.

This is all directly from my own history only I did it in reverse from treating the OSA. I had bad fatigue problems and in fact was tested decades ago for SA and had none. So I did all of the above; got off all the pharmaceuticals, (took a couple years to do that), bloodwork showed normal but bottom of the range thyroid, B12, folate, and D so I started supplements for all of those, and I cut out a lot of the high carb foods. All of that resulted in great improvement, and then several years after menopause I started hormone replacement. All of that made me much better but in the meantime at some point I developed mild SA and just recently got diagnosed and got on CPAP and that improved me a great deal more even.