Newbie asks: If my AHI has dropped, why is head still foggy?

[sleepyjames]

While I have probably had SA for years, I finally got a sleep study only last August, and on CPAP since September. I have tried a couple different masks, and have settled on the Mirage Activa LT for now. I started out with pressure of 11 (derived from my sleep study) but still had an AHI around 7 or 8. After going through a couple masks, the Activa LT seemed bearable, and then I started (with my neurologist's encouragement) to play with my pressure settings. I was up to 15 with the A-flex at 1, and noticed that toward the middle of the night, the A-flex seemed to lower the pressure so much that I was registering a bunch of Apnea's and hypoapnea's as a result. I turned off the A-flex, and then of course the pressure was too high and I was waking up constantly. I finally ramped the pressure down to 13 (again, with the A-flex off) and for the last 2 weeks, my AHI index has dropped to an average of about 0.5--which I understand to be pretty darned good. My vibratory snore index has gone from way high to almost nothing, and my average mask leak is about 35%. Here''s the problem, though--while some mornings I wake up feeling OK, more often than not I am waking up with my head cloudy, and feel "out of it"--feel like there is a band around my head, ear's slightly ringing, but mostly just slowed cognitively and just a little like in a daze. I guess I'm just confused about 2 things primarily--first, why if the numbers look so good, do I feel so lousy, and secondly, why some days I wake up and feel pretty good and yet other days I feel like the above. I've wracked my brain trying to come up with something I'm doing differently that is leading to a bad outcome on these days as I've described them, but am at a loss so far.
I know there is a wealth of collective wisdom on these boards, and 2+ heads are always better than 1, so I'm hoping those of you who have been at this considerably longer than I might be able to steer me in the right direction.....

Many thanks for listening to my minor tale of woe! Any help you might be able to provide will be greatly appreciated...


Sleepy James

[Julie]

Hi, have you considered the possibility, very common to a lot of us once we begin having air pumped in at sometimes high-ish pressures, that you may be sleeping with your mouth open (unknowingly) and losing the Cpap air that way? If that's the case, you need to investigate full face masks (just extensions of nasal ones that also just cover your mouth) so you can sleep however you want (especially if you have a cold and are congested) without wasting therapy air. Raising your pressure made it worse, of course, because an even stronger one was being used inadvertently opening your mouth. People try chin straps to keep their jaws closed,but while it may accomplish that, it doesn't keep your lips closed, and so is often ineffective.

[sleepyjames]

Thanks, Julie--I hadn't considered that. It does seem somewhat daunting though--I had more than a bit of anxiety just using the nasal mask at first, and still occasionally have a return bout now and again.... i guess one question I would have is: if my AHI numbers are way down, even if I was "mouth breathing" what difference would that make if the apneas and hypoanpneas are being addressed as reflected by the data? Not trying to be a wiseguy here--just trying to make sense of it all...
Thanks,
Sleepyjames

[pmcall57]

As I understand it, the machine cannot detect any apnea you have while your mouth is open and the therapy air is escaping. So your AHI can be low, but you're still having apneas. That's where the leak rate comes in -- if it's high you may well be opening your mouth. Your leak rate of 35% seems high, depending on what mask, I guess. Is it in the allowed range for your mask? If so, then I'm stumped and someone more experienced will have to weigh in. Pam

[sleepyjames]

Thanks Pam--that makes some sense. If anyone else has a different view, I'd love to hear it though......(I guess that reflects my ambivelance about a FF mask.....)
Thanks,
SleepyJames

[billbolton]

first, why if the numbers look so good, do I feel so lousy, and secondly, why some days I wake up and feel pretty good and yet other days I feel like the above

The most straightforward answer to both questions is that there are other things which are not "right" with your sleep.

xPAP isn't a silver bullet that will eliminate all sleep problems (or even all Sleep Disordered Breathing problems).

As suggested above, in any case, you should probably need to look at your leak rate and see if you can bring that down.

Cheers,

Bill