small AHI increase, big symptoms

[rdavis]

Hi friends! I'm having increasing issues with fatigue and trying to narrow down if it could be apnea related.

I've been on my APAP since 2014. For most of that time I've felt good, and my average AHI was below 1, usually around .7 or so.

In the last year or so, I've dealt with increasing fatigue--dragging out of bed in the morning, needing more naps, not always feeling up to exercise. In the last 2 years, my average AHI has crept up above 1...it's now around 1.2 or 1.5 (again, on average....some nights it's in the 2 range). And about half of my nightly events are now flagged as central events, which was not the case before (previously, most flagged events were hypopnea).

I went to see my pulmonologist yesterday. He's a good doctor and we respect each other. He told me that based on decades of treating CPAP patients, he doesn't think such a small increase in AHI should be causing noticeable symptoms, especially since my average AHI is still on the low end of the normal range. He suggested I address some leak issues with my mask, and wait out a medication change for another health issue that I have going on (that might contribute), and then get back to him for further investigation of my symptoms. So he didn't exactly blow me off, but neither was I completely satisfied when I left the appointment.

What do you guys think? Is it possible that a small AHI increase, which is still in the range of "normal," could cause a noticeable increase in symptoms? If so, how would YOU address this? Push to have your minimum APAP pressure increased? Investigate why there are more central events now?

Thank you!

[LSAT]

Why do you have to "push" to have your pressure increased. After 7 years on the machine, you should learn to do it yourself. It takes about 30 seconds. I personally think a small increase in AHI would have nothing to do with your symptoms. My personal AHI averages about 2.0 and can vary from .5 to 4.0 on any night. That's after 13 years. I do not feel any different regardless of the AHI reading.

[ChicagoGranny]

He told me that based on decades of treating CPAP patients, he doesn't think such a small increase in AHI should be causing noticeable symptoms, especially since my average AHI is still on the low end of the normal range.

He's right.

He suggested I address some leak issues with my mask

What does your leak line look like?

wait out a medication change for another health issue that I have going on (that might contribute)

He's right again.

Push to have your minimum APAP pressure increased? Investigate why there are more central events now?

Why don't you take control of your own therapy? See - OSCAR.

[Julie]

Just about all of us experiment with pressure changes all the time, you don't need your MD to do that for you, but if you don't know how, or don't have the clinician manual, let us know.

[Miss Emerita]

Just so you know, increasing your pressure won't help with central apneas.

Certainly looking at possible side-effects of your medications makes sense. I hope the fix will be as simple as making some changes in the meds.

If that doesn't help, though, I would suggest follow-up with your primary care physician. Tiredness, sleepiness, and fatigue are symptoms that will call for some screening to get a sense of where to focus in trying to arrive at a diagnosis and plan for treatment. Culprits could be a whole lot of things, e.g., thyroid problems or autoimmune disease.

If you see your PCP, think ahead of time about a few things so you can give a really clear account of what you're experiencing. Are naps restorative? When you're too tired to exercise, is the feeling one of muscle weakness or general fatigue? Do you experience these symptoms starting from the time you get up in the morning? Are there times of day that are especially bad? Do you sometimes have periods when the symptoms abate? Does exercise leave you feeling worse or about the same? When this all started, can you recall anything else that happened around the same time, e.g., an infection?

Good luck with this. When you feel wiped, pushing for diagnosis and treatment can be especially hard, but it's the way forward.