Good data after 1 year, but still extremely tired

[sleepfatigued]

Hi all,

I've been using my CPAP consistently for about 10 months now (every night, for the entire night, after a long period of testing equipment and adjusting to the machine). I feel much better than I did a year ago, but I'm still a long way from feeling like my "normal" self. Most days, I still have brain fog and low energy, and I regularly have days where I'm effectively catatonic for the full day and don't have the energy to move.

As an example, I had one of those bad days recently - I'm including the data from the night before. Anecdotally, I slept solidly for the full night, with one bathroom break and a quick return to sleep. To my novice eyes, the data seems to suggest that the CPAP is mostly resolving my apnea (the one thing that jumped out to me was the 6 minutes total time in apnea, which seems high). At this point, I'm wondering whether a) I'm misreading the data and my apnea is not being fully resolved by the CPAP, or b) there's some other underlying condition that's causing this fatigue (though all my doctors insist my bloodwork is normal and I'm perfectly healthy).

Screen Shot 2022-07-27 at 7.24.59 AM.png (558.39 KiB) Viewed 1171 times

My in-lab sleep study was done early last year. I was diagnosed with mild obstructive sleep apnea: AHI: 6.5/hr, RDI: 10.6/hr, no centrals. I didn't do a titration study at the time. I have an appointment with a new sleep clinic in 3 months (the earliest available in my area, NY).

Thanks, much appreciated.

[lynninnj]

hi, sorry I can’t answer your question. I am still pretty new here.

Perhaps the thing to do might be, for me, is to ask if there is some sort of tutorial on reading these things? Has this been done?

I hope that you find answers with your next visit to the doctor.

[Pugsy]

Do you take any medications of any kind? Even OTC stuff? If so, what?

You get 8 to 9 hours of sleep regularly??? Do you remember a lot of wake ups during those hours?

Are you male or female?

What is your age?

What blood tests have you had done that the doctors say are all fine?
The routine yearly stuff like Thyroid, CBC, common panels for heart risk and organ function?

Ever have hormone tests like testosterone if you or a guy or if female those hormones?

Ever have a Vitamin D level test?
Vitamin D tests and hormone tests are not routinely done as part of a basic work up.

Your AHI is not horrible by any means but maybe if you could reduce the number of OAs/hyponeas just a little you might feel better. Worth trying...maybe increase the minimum pressure from 7 to 8...you spend a sizable chunk of time at 8 anyway.

[Julie]

And consider whether or not your issues are strictly 'medical' or otherwise - any chance you're feeling down because of 'life'?

[ozij]

Some people are bothered by the pressure changes, and that keeps them from restful sleep.

It seems to me that some central apneas, and some "arousal like" indications in your flow rate (those spikes) happen just as the pressure changes -- usually when its dropping.

You may want to check this on other nights.

What is your median pressure on other nights? On this night, you spent half your time (the "Med"ian) at or above 8.64 -- that's quite a bit above your minimum of 7.

Have you tried a higher minimum, or fixed pressure therapy? You may simply sleep better.

[zonker]

as others have said, try raising your minimum. this will allow your machine to work a bit easier in responding to your events.

good luck!

[zonker]

Perhaps the thing to do might be, for me, is to ask if there is some sort of tutorial on reading these things? Has this been done?

there isn't. the best way to learn is through experience. posting a chart here is THE thing to do. one can benefit from the experience of others.

[sleepfatigued]

Thanks for the replies.

Pugsy, in answer to your questions:
- I take daily supplements in the morning: Vitamins B + D, probiotics, omega 3. At night, I sometimes use CBD oil about an hour before bed. No prescription medication
- Yes, 8-9 hrs regularly. I will wake up 0-3x/night - typically, once to use the bathroom, and once because I have an issue with my mouth tape coming loose (after much experimentation, I found Somnifix to be the best for me, with a headband over it to minimize the effects of drool...)
- I'm 35M, generally active and in good shape (bicycling, weight-lifting)
- Tests: I've done several fairly comprehensive blood panels (maybe 50 or 60 indicators), including testosterone and other hormones, thyroid, glucose, Vitamin D - all "normal"

Julie, to your question: yes, I do sometimes feel down. This is an interesting chicken or egg question. On the infrequent occasions when I sleep quite well, my mood is much better the following day. But it's possible that depression (even sleep-induced) is dragging me down at other times, too and causing a self-reenforcing cycle.

ozij: It looks the median of my median pressure over the last month is ~8, with a typical range of 7.5-8.5.


I'll try raising my minimum to 8, to start. Thank you again all, it's been a long process to get to where I'm at now, and it always feels good to move from stuck/flummoxed to having another set of experiments to try.

[sleepfatigued]

2 other things that may or not be interesting or relevant:

1. I'm currently experimenting with diet changes - I'm 3 weeks into an experiment of gluten- + dairy-free, and no eating 3 hrs before bed. It seems to be much easier to fall asleep on this routine, and I wake up less throughout the night. But there hasn't yet been much change in how I feel during the day.

2. I spent the winter living in a place at high elevation (~7500'). I felt like a zombie for most of that period (substantially worse than I had felt at sea level immediately prior), and through a series of doctors there eventually pinned it down to low overnight spO2 levels - essentially, my body had never fully adjusted to the elevation, even after 3 months. My doc prescribed supplemental oxygen for my last week, but unfortunately I had some issues with the rental machine, and so the results of that experiment were inconclusive.

My quality of sleep in the 3 months since returning to sea level is the same as it was before I left (which is to say: pretty good, I'm (generally) not a zombie, but not yet *great*)

[lynninnj]

Perhaps the thing to do might be, for me, is to ask if there is some sort of tutorial on reading these things? Has this been done?

there isn't. the best way to learn is through experience. posting a chart here is THE thing to do. one can benefit from the experience of others.

Thanks Zonker.

After reading some other people discussing how they didn’t put the SD card back in properly and it didn’t have the data on it, I’m going to continue to wait until after my first month is up before I pull the card and start looking at it.

I just don’t want to risk it. I did find a description link out from somewhere on the sport. I think it was a Wikipedia page. Maybe something sleepyhead.

Thanks to everyone so far.

As far as the other poster I was looking at the supplements that you’re taking. There is a tiny bit of THC in CBD. It is possible that that could interfere with your sleep patterns. I will take my CBD in the morning. If I feel a little bit inflamed at the end of the day I take a turmeric as well. Maybe that will help.

I definitely find a gluten create an inflammatory response in me. That’s usually the only reason I have to take a turmeric in the evening.

[zonker]

Thanks Zonker.

After reading some other people discussing how they didn’t put the SD card back in properly and it didn’t have the data on it, I’m going to continue to wait until after my first month is up before I pull the card and start looking at it.

I just don’t want to risk it. I did find a description link out from somewhere on the sport. I think it was a Wikipedia page. Maybe something sleepyhead.

you have far more patience than i!!

that sleepyhead software is abandoned and replaced by oscar.

[lynninnj]

I know I got it from this board.

This is the link to what I was just reading. Discuss is Oscar.

http://www.apneaboard.com/wiki/index.ph ... rpretation

[Pugsy]

http://freecpapadvice.com/sleepyhead-free-software

Watch the videos above and see if you can get a handle on how to zoom in and distinguish asleep breathing flagged events from arousal/awakening flagged events. While the videos mainly are talking about central/CA events...in real life false positive flagged arousal breathing events can happen in any category.
Just because you maybe don't remember an arousal/awakening doesn't mean it didn't happen.

Couple things to maybe try
1...increase the minimum a bit which has already been mentioned.
2...reduce EPR a bit and see if the CAs/centrals maybe reduce in numbers.

My gut wants to tell me that perhaps you have a sleep quality problem that is likely unrelated to the airway.
We can't blame it on meds or the other usual suspects so have to dig deeper.

[lynninnj]

http://freecpapadvice.com/sleepyhead-free-software

Watch the videos above and see if you can get a handle on how to zoom in and distinguish asleep breathing flagged events from arousal/awakening flagged events. While the videos mainly are talking about central/CA events...in real life false positive flagged arousal breathing events can happen in any category.
Just because you maybe don't remember an arousal/awakening doesn't mean it didn't happen.

Couple things to maybe try
1...increase the minimum a bit which has already been mentioned.
2...reduce EPR a bit and see if the CAs/centrals maybe reduce in numbers.

My gut wants to tell me that perhaps you have a sleep quality problem that is likely unrelated to the airway.
We can't blame it on meds or the other usual suspects so have to dig deeper.

The THC in CBD, while small, may be having an effect like alcohol would in interfering with sleep patterns.

Worth a try to switch up timing imo.

And just for the record I defer to your knowledge and understanding, but these little things I know a little bit about separate from CPAP. It’s good to integrate these ideas.

[Pugsy]

The THC in CBD, while small, may be having an effect like alcohol would in interfering with sleep patterns.

Worth a try to switch up timing imo.

You know you might be on to something there. I forgot about the CBD stuff. It could very well be acting like alcohol on the nervous system and messing with sleep quality.

This document does a good job explaining how and why alcohol messes with sleep and I often tell people to read it and just substitute the word "anything" when they see alcohol.
Counting arousal breathing segment episodes seen in the flow rate is one way to get an idea as to just how solidly we sleep and we don't always have an apnea caused arousal or flagged event during the arousal breathing.
We always have a lot more arousals than we remember.

https://www.sleepfoundation.org/nutriti ... -and-sleep