Please help! Almost a year on CPAP, still not feeling amazing

[gssp]

Last summer I was diagnosed with mild sleep apnea (AHI = 6). Despite being mild, I had a lot of RERAs - overall RDI of 9.5/hour but 30/hour RDI during REM. My research seemed to suggest I fit UARS better than OSA. My doctor said I do not fit the "normal" sleep apnea profile. My main symptoms before diagnosis were waking up 10+ times while dreaming and in the few hours before waking, extreme daytime fatigue, and morning headaches.

I started on CPAP last July, had some difficulty getting started, but after a few months I was feeling consistently 60-70% better. I still had quite a few of nights where I would wake up a good amount while dreaming and in the early morning hours, but my CPAP AHI and usage were "amazing" (7+ hours each night, AHI consistently around 0.5-0.7) and overall I felt a bit better. However, in the last few months, it seems to have gone downhill more, some days feeling as bad as pre-CPAP, and even my CPAP is now showing an AHI over 1. I mouth tape consistently and my leak rate is always very low. Early on I set my pressure to 6.6 - 9 with full-time EPR of 2, and it usually stayed around 6.6 - 7. I tried an increase to 7 - 10, but I saw no difference both in my numbers and in how I felt. I have lost weight if anything in the last few months and been pretty active, so I do not think it could be a factor. I recently had a lot of bloodwork done, and there was nothing concerning there as well. It definitely feels it is CPAP related since I am having more of my pre-CPAP symptoms (waking up a lot while dreaming and in early morning hours, extreme daytime fatigue, etc).

I could be better about not using electronics near bed, and I am a bit of a night owl, but overall my sleep hygiene is very good with consistent bedtime/waketimes. In terms of meds, I take a multi-vitamin and thyroid replacement meds, with the occasional Zyrtec. At the time of my diagnosis, I had an ENT consult and he did not see anything anatomically abnormal.

I've tried digging into my data, but I feel a bit lost. My doctor seemed to think I did not need a pressure above 7 since I had mild apnea, but I want to see if my data says otherwise. Any advice or help would be so appreciated!

Here is SleepHQ data for days I felt quite bad:
https://sleephq.com/public/e2df119d-be7 ... 135fc7cfae
https://sleephq.com/public/0dbf2ef3-b2e ... 3dd2b93dd3

Here is a day that was good numbers-wise:
https://sleephq.com/public/47cfa787-e74 ... 52cc98c482

Thank you in advance!

[Mijjil]

What I can't see from your SleepHQ links is your oxygen desaturations: you could have a very low AHI but still be having significant SpO₂ drops.

SleepHQ and OSCAR both support uploading Pulse Oximetry aligned with your CPAP data: it's worth the investment in a compatible O2Ring if it helps you feel better!

I have the Wellue O2Ring S: I upload it to SleepHQ and import it into OSCAR daily. If I had found SleepHQ before I found Wellue I would have bought their O2Ring Pro to have compatibility with the SleepHQ app and Magic Uploader Pro.

[Pugsy]

waking up a lot while dreaming and in early morning hours, extreme daytime fatigue, etc).

The one thing that stands out to me is potential sleep quality issues from something.
Your "bad" nights show a lot of arousal or awake breathing times and the increase in CA/Centrals seems to reflect those wake ups.
Your "good" night still shows some arousal breathing but to a lesser extent.
It's not surprising that you feel like crap when you don't sleep well.

The bulk of your AHI is from SWJ (sleep/wake/junk) and that doesn't point to anything as to why the poor sleep (heck the machine can't even tell if you are asleep or awake) so we don't know what has changed. Something changed though....now what it might have been is the million dollar question. Kinda hard to fix a problem when you don't know what caused the problem.

Headaches can be from any number of causes one of wish is significant oxygen level drops.
Also simply having crappy sleep quality can cause us to wake up with a headache.
The list of headache causing culprits is quite long.

You probably should at least rule out low oxygen from some reason or other as a potential cause. I doubt that is your problem but probably a good idea to rule it out.
Your doctor can order an overnight oxygen level test if you don't want to buy an overnight recording pulse oximeter and your equipment supply can supply one for you.

When you had your blood tests....did they check your Vitamin D levels (it's not one of the usual routine blood tests) or Testosterone levels (if you are male)?

BTW we dream in all sleep stages but we don't remember them unless we wake up during or right at the end of REM sleep stage.
The fact that someone is remembering a lot of dreams is another indication of crappy sleep.

[Nocibur]

...you could have a very low AHI but still be having significant SpO₂ drops.

Could you explain the mechanism by which that would occur?

TIA.

[Mijjil]

There are plenty of reasons: I have Asthma and before CPAP Therapy my normal daytime average SpO₂ was only 95%.

Others that come to mind are COPD, Emphysema, or even Hypoventilation, where you just don't breathe effectively even though there aren't any Flow Restrictions.

Enough people need Supplemental Oxygen in addition to their CPAP Therapy that Resmed makes a variation of the ClimateLineAir heated hose called the ClimateLineAir Oxy which includes a built-in port to connect the tubing from your Oxygen Concentrator.

Edit: Remember that Apnea-Hypopnea Index (AHI) doesn't include Flow Limitation and Respiratory Effort-Related Arousal (RERA): you could have significant amounts of both and still have a very low, or even zero, AHI. That's why you can configure OSCAR to show you Respiratory Disturbance Index (RDI), which does include FL and RERA, instead.

Screenshot 2026-06-11 184812.png (10.69 KiB) Viewed 860 times

[Nocibur]

There are plenty of reasons: I have Asthma and before CPAP Therapy my normal daytime average SpO₂ was only 95%.

Others that come to mind are COPD, Emphysema, or even Hypoventilation, where you just don't breathe effectively even though there aren't any Flow Restrictions.

Interesting thoughts.

What indication is there that the OP has or could have any of those things?

[Mijjil]

If you have any of those things hopefully you were diagnosed by a doctor and are being treated!

I sleep wearing an O2Ring and find the data it records even more useful the lower my AHI gets: consistently under 1 now.

[Nocibur]

If you have any of those things hopefully you were diagnosed by a doctor and are being treated!

So IOWs, we shouldn't be generating needless anxiety in the OP by suggesting diseases that there's NFC they have.

[Mijjil]

If my AHI was under 1 but I still felt like crap (I don't!) I'd want to know why! I'd be all over my pulmonologist with questions.

I didn't intend to cause any undo stress, but if OP has been at this for almost a year and still not feeling better they'd best talk to their doctor. Their answers are unlikely to be here.

[Nocibur]

If my AHI was under 1 but I still felt like crap (I don't!) I'd want to know why! I'd be all over my pulmonologist with questions.

What evidence do you have that the underlying issue is something a pulmonologist could help with?

[Nocibur]

Their answers are unlikely to be here.

So if you don't know what the underlying issue(s) are how can you conclude that the answer(s) aren't here?

[Mijjil]

If I still felt like crap despite CPAP Therapy why wouldn't I go back to the doctor who diagnosed my Obstructive Sleep Apnea and prescribed my CPAP Therapy?

[Nocibur]

If I still felt like crap despite CPAP Therapy why wouldn't I go back to the doctor who diagnosed my Obstructive Sleep Apnea and prescribed my CPAP Therapy?

You did not say

doctor

You said

pulmonologist

And OP did not say

Obstructive Sleep Apnea

they said

...mild sleep apnea (AHI = 6)

[Mijjil]

A pulmonologist diagnosed my OSA. OP said they're on CPAP, which is prescribed for OSA. If they had CA, they'd be on BiPAP or ASV.

You're being argumentative for the sake of being argumentative and I'm done responding to your nonsense.

[Nocibur]

A pulmonologist diagnosed my OSA.

Irrelevant.

OP said they're on CPAP, which is prescribed for OSA. If they had CA, they'd be on BiPAP or ASV.

An unproven syllogism at best, anyway it's also irrelevant. Reread subject line.