Newbie looking for help and advice

[schmatt]

I'm hoping some of you may be able to help me figure out what may be going on.

I went to a neurologist/sleep specialist because of excessive daytime sleepiness and not feeling refreshed after getting a full nights sleep. My score typically ranged between 9 & 15 on the epworth scale. Due to this, we did the standard sleep study. The results showed I barely had mild sleep apnea at an AHI of 5. He suggested working on sleep hygiene, and if that fails follow up with CPAP. Since I already had the sleep hygiene down pretty good and already had a machine from my son, I went forward with a CPAP titration. The titration went well and ranged from 4 to 12cm. After this, I started CPAP at a fixed pressure of 7cm. I've been on it for about 1 wk.

I've seen some mild improvement in symptoms, but am unsure that the apnea is the cause of my issues. Based on looking at my CPAP data, my AHI is ranging from 1.86 to 3.82. The majority of the events are central apneas. Looking back at my sleep study, I had 1 OA, 5 CA, 2 Mix & 26 H. During the CPAP titration, I had 0 OA, 6 CA, 0 Mix & 5 H.

I'm not exactly sure that the apneas are necessarily the cause of my problem. Unfortunately, I did not have my report in front of me when meeting with the doctor, so he only mentioned the AHI. However, looking at my original sleep study, I had an arousal index of 22.2, a leg movement index of 20.1 and a leg movement arousal index of 4.86. These numbers went to 19.9, 14.6 & 3.4 for the CPAP titration. This had me suspecting PLMD, due to the very high leg movements. But, from what I have read the leg movements should be during NREM. Looking at the graphs, most of mine are during REM. Also, the arousal index is very high. I'm not sure what could cause something like that. I'm able to fall asleep very fast, <2min, and stay asleep most of the night. Sometimes I remember waking up, but fall right back asleep. The only problem I seem to have is early morning awakenings.

Would you expect it to take some time to see complete improvement in symptoms, especially given the very mild nature of this? Or would you see improvement pretty quickly? Do any of you have opinions whether SA is the real cause of my poor sleep or maybe something else?

If you have any references for further reading, that would be appreciated. I can't seem to find anything except some very high level information. I'm interested in more detailed technical information. I have read the point-counterpoint papers on whether PLMD is real or not in the Journal of Sleep Medicine. Same with complexSA. Very interesting information.

[Julie]

What position do you sleep in - back sleeping will provoke apneas (and snoring), but side sleeping doesn't.

Couldn't begin to comment on what else might be going on without knowing lots more, but do you think it's possible you are mouth breathing and having large mask leaks?

[schmatt]

I am a back sleeper predominantly. I do end up on my side sometimes. But sleeping on anything but my back is very uncomfortable for me.

I tried a nasal mask with a chinstrap. This worked OK, but wasn't the most comfortable. I switched to a full face mask after a couple of nights, because I do tend to drop my mouth open when sleeping. Large leak rate from sleepyhead seemed good. Most leaks were pretty short. I don't remember waking up at all either.

[Julie]

I think if you could find a way to not back sleep (new mattress?) you'd be ok.

[schmatt]

I appreciate your response, but I am looking for a little more information. I was hoping that people might have more info regarding some of the other points of my OP. Primarily from the 4th paragraph. It probably isn't obvious from my original post. So I'll list a few explicit questions.

Is it normal to have a bunch of central apneas when on CPAP?

Does it matter whether these apneas are sporadic or clustered during a certain period?

Are the number of leg movements considered normal, even though from what I've read are quite a bit above average?

What would cause such a high arousal index, since this is above average from what I've read also?

I'm hoping that the members on this board might have some experience with some sleep issues beyond just CPAP.