Impaired cognition and memory despite AHI range from 2.5-4.5

[Somnolence]

Hello,

I've been on CPAP treatment since September. My original AHI was around 45 with mostly obstructive events. Treatment with a Resmed S9 Auto has reduced this figure to between 2.5 and 4.5 nightly, but comprised mostly of clear airway events.

I'm frustrated because I'm still dealing with nightly awakenings, daytime fatigue, and impaired cognition. My doctor does not seem concerned by these clear airway events or by the erratic waveform patterns I'm pulling from the machine. These patterns look an awful lot like CSR, but I surely can't qualify for a diagnosis with this AHI. Thus, an ASV machine trial is also off-limits. My sleep studies have noted high awakening/arousal numbers.

What are your suggestions for this situation? I understand the literature notes impairments begin at 5.0, but that doesn't affect my suffering in the least. I've defied the odds on having OSA. My BMI is 19, my tonsils are gone, and I'm in my early twenties.

Help?

[BlackSpinner]

Time to hunt for a new doctor! You want a neurologist sleep specialist, not a pulmomologists.

If you symptoms are not gone, you are not being treated properly, regardless of your AHI. That is only one measure.

[Somnolence]

I've seen 3 sleep specialists, two of which are neurologists. It boggles my mind how these concerns are not taken seriously.

How does this process normally work? Keep searching? It's hard for me to be content with the status quo when that equates to misery.

[archangle]

Welcome. Please enter your equipment in your profile. There's a link in my signature line to help you do this.

Some points.

1) AHI isn't everything.

2) Sometimes, it takes a while to heal, even after you fix your breathing.

3) Sometimes, you don't always heal the damage.

4) Be careful that you don't blame everything on apnea/CPAP. You can still have the same problems anyone else has.

[DoriC]

How's your leak data? Is your mask fit properly?

[Wulfman...]

Hello,

I've been on CPAP treatment since September. My original AHI was around 45 with mostly obstructive events. Treatment with a Resmed S9 Auto has reduced this figure to between 2.5 and 4.5 nightly, but comprised mostly of clear airway events.

I'm frustrated because I'm still dealing with nightly awakenings, daytime fatigue, and impaired cognition. My doctor does not seem concerned by these clear airway events or by the erratic waveform patterns I'm pulling from the machine. These patterns look an awful lot like CSR, but I surely can't qualify for a diagnosis with this AHI. Thus, an ASV machine trial is also off-limits. My sleep studies have noted high awakening/arousal numbers.

What are your suggestions for this situation? I understand the literature notes impairments begin at 5.0, but that doesn't affect my suffering in the least. I've defied the odds on having OSA. My BMI is 19, my tonsils are gone, and I'm in my early twenties.

Help?

Are you using a range of pressures with the APAP? (it sounds like it from the issues you listed)
If you are, I'd suggest switching to straight pressure in CPAP mode and see if that helps. (somewhere around your 95% pressure)

Den

.

[lostsheep]

You might try to find a doctor who is experienced in treating UARS. Such a doctor would notice the funky airflow waveforms and frequent arousals, and take that situation seriously. I had trouble locating that type of expert, though. It doesn't seem to be mainstream(?)

I had AHI scores similar to yours with my CPAP an BiPAP, and mostly felt like crap. And like you, I am atypical for classic OSA - low BMI, no snoring, and no tonsils. I wasn't sleepy until starting PAP therapy!

My original titration pressure was set quite low because of the pressure induced centrals, leaving me with both marginally acceptable centrals as well as marginal airflow. The compromise on pressure level prevented most hypopneas, but (unbeknownst to me) left me with breathing issues. Like you, I also had a high arousal index. I later noticed periodic breathing in the Sleepyhead data at higher pressures, although I don't think that was ever mentioned in the lab's sleep report. The periodic breathing seems to be part of a dysfunctional therapy causing centrals.

The disruption of the PAP machine itself caused yet another obstacle to getting a good night's sleep. I felt worse with treatment, and wasted way too much of my life in 2012 trying to understand and deal with the whole thing. I'm a little angry that one sleep doctor told me to "give CPAP 3-6 months" to see how it is going to work. It seems that the difficulties should have been obvious from the first titration study, when the tech had to back off from therapeutic pressures due to centrals. Through all of my own investigation, I eventually came to understand some of these problems myself. In particular, I learned some key info from Dr. Park's two interviews with Dr. Krakow. http://doctorstevenpark.com/free-telese ... ding-sleep


In my case the justification for ASV could be presented to insurance as "complex apnea" - the appearance of pressure-induced centrals. I can say that the ASV is a big improvement over the previous therapies.

[Pugsy]

Nightly awakenings....fragmented sleep will sure mess with the normal sleep cycles that we need for the restorative powers of sleep to work.
Some things to think about...sleep maintenance insomnia (trouble staying asleep or going back to sleep)?
Meds...take any meds RX or OTC that might impact sleep architecture?
Any idea what is causing the nightly awakenings? Need to try to figure out what is causing it so you can try to fix it.
How many do you think you are experiencing?
Are you seeing clusters of centrals showing up during periods of time that you might be awake or semi awake or are the centrals spread out randomly throughout the night?

If you are using the S9 Autoset in APAP mode consider doing what Wulfman said...try cpap mode. Some people are sensitive to even minor pressure variations as they can cause sleep disruptions. While some people can sleep through wide pressure changes...some people find that even a small pressure change can disrupt their sleep. Worth trying to see if it makes any difference in the quality of your sleep and/or how you might feel the next day.