medication in addition to CPAP

Hi,

I have spent the last 10 months going through a series of tests, to understand why I had poor sleep quality and feeling tired during the day.

The initial home sleep study confirmed some mild OSA, so I have been on CPAP for 8 months now. I have been pretty much compliant during that time, and AHI is typically below 1 now, so OSA can be considered treated

However, CPAP does not seem to have made a drastic effect on how I feel in the morning and during the day, so it's probably not the only cause for poor quality sleep.

We had a full PSG sleep study done a month ago, and this only apparently highlighted that sleep latency is very short (so yes, I am tired and falling asleep very fast), and that the OSA was more severe than original expected (measured without CPAP).

Doctor's conclusion currently is that, while there isn't much we can do to improve sleep further, we can make me feel more awake during the day, so he prescribed me Modafinil, on a small dose to start with. It's an awakeness promoting drug, basically the legal equivalent to amphetamines, in term of effects.

I don't know if such drug is also supposed to promote better sleeping, by consuming more energy during the day/be more active, or if it is just degrading sleep quality further.
So far, I am staying up later in the evenings, and I have lost 2-3 hours of sleep per night.

I still wake up tired, but surely feel much better an hour after taking the drug, and don't need a nap anymore during the day.

Thanks,
T.

It appears that your doctor has stopped short of exploring every possible option to address your sustained problems - unless there's a piece of the story we don't know. If one is therapeutically treating their sleep apnea but still has symptoms possibly indicative of poor sleep, it seems only logical to me to do another sleep study while using CPAP the entire night at the known effective pressure to see if another sleep issue might be identified. Losing 2-3 hours of sleep each night due to a med meant to conteract the daytime effects of sleep issues seems counter-intuitive to me. Sometimes meds are needed to function enough to meet responsibilities, but they should not be a substitute for efforts to resolve residual sleep issues. The earlier in the day you can take the med the better, but if delayed sleep cannot be prevented, you might have a tough decision to make. There are some people who have stubborn idiopathic hypersomnia regardless of all efforts, but I wouldn't accept that until everything has been thoroughly assessed. Here's some questions that cross my mind. You don't have to answer them for me, but maybe they'll trigger a thought for you that helps with a "what's next?" plan.

Are you on any other meds that could contribute to your daytime symptoms?
Is there anything about your story that would make you concerned about possible narcolepsy?
Did your sleep study make any mention of the presence of limb movements?
Have you had your Vitamin D level checked, or Vitamin B levels?

BTW, I took that med for a while. A lower dose wasn't very effective, but a dose high enough to make me alert caused palpitations and messed with my RLS. At the dose I was on, I could take it then lay down and take a long nap, so I just gave up on it.

It seems far more likely that your treatment has not been optimized and that you may need to change e.g. the pressure settings - so often not done properly by the doctors who think that setting an Apap at the lowest number possible (4) or close to it will allow it to address even high level apneas in time to prevent them, and that isn't the case at all, so many of us have had to adjust the machine to address this. Could you let us know the basics of your study results and what your pressure settings (not ramp settings) are now?

It doesn't seem to be an OSA issue anymore, as it seems to have been treated by CPAP/APAP. I consistently have an AHI of 1.5 or below, even sometimes 0, so settings don't seem to be an issue (pressure is set between 8.5 and 12.5, and average pressure through the night is usually 9.5/10).

Last full sleep study was done without CPAP for the first half, and then with CPAP. This confirmed that OSA was actually more pronounced than original thought, when CPAP is not used, compared to the home sleep study done 10 months ago. So the untreated AHI is higher than thought, but CPAP is therefore even more effective.

There was no indication of limb movement during the full sleep study.

We have done some blood tests several times, and nothing of significance was found.

Anyway, he seems to be out of ideas now.

I am not on other meds, and I don't have narcolepsy. However, without medication, I would fall asleep quickly when lying in bed, having a nap, sitting on a chair etc.

With the drug I have been given, daytime issues are mainly resolved, and I don't need to take naps during the day anymore. However, sleep is worse, and waking up in the morning worse than before.

Was the second half of your study a titration? Was the pressure they came up with different from what you'd been using the prior months? If there was a change and the pressure before was not fully effective, maybe it just hasn't been long enough on therapeutic treatment to have recovered. If there hasn't been a significant change in settings or in your AHI, I still think the final frontier would be a study of an entire night at your proven effective settings to see what your sleep looks like as you currently experience it. Another study without a machine or on the machine at increasing pressures as in a titration is not a representation of your normal nights. Even if your OSA is resolved, there are other things that could be wrong with your sleep. I know these tests can not be done willy-nilly. Took a long time before my 3rd sleep doctor did this type of study on me. I would suggest you post your machine data on here to see if any of the data gurus can spot anything obvious. There's a lot more to data than the AHI. I don't know what else to suggest, but I wish you well in figuring things out.

First part of the night was without a CPAP machine.

Second part of the night was using my own CPAP machine (which is actually a Resmed Autoset), with my normal settings/range, so it was not a titration exercise. However, they connected a tube between the mask and the CPAP machine, to connect to their own sensor.

Anyway, the sleep doctor believes that OSA is treated, and therefore there are remaining issues elsewhere.

I would think the med is the last resort and not the first. you need to go through your sleep hygiene, possibly with a doctor in that field