CPAP for 9 months, still not under 1 AHI

Hello all,

It's been a minute since I last checked in. I have been using the CPAP religiously since I got mine, and it has helped a LOT compared to my untreated sleep. My AHI was 22 (mostly hypopneas) and it was wrecking my life... Now my avaerage is in the 2-5 AHI range, so a big improvement. But, I am still waking with fatigue, brain fog, anxiety from not ideal sleep. I would really like to improve these numbers but if this is as good as it gets then I am also looking into surgical options (I do not need advice or opinions on that right now, thanks). For more info I wear a nasal pillow mask and have found it quite comfortable so far - I don't have trouble breathing through my nose as long as I use the flonase to keep any congestion clear.

Here's what I do already:
Mostly consistent bedtime, refrain from drinking too many liquids before bed so I don't have to pee int he middle of the night
Flonase spray to reduce mild allergy from my cat
Stress reduction techniques as needed
Earplug/s in case my partner is home late and cooking (he works in the evenings) so I'm not disturbed
Pillows, pillows, pillows - I've tried so many different combinations to see what works best - I'm still figuring that out (I'm a side sleeper)
Cleaning the machine regularly, rinsing the mask with soap/water every day
No food 2-3 hours before bed

Here are some nightly readouts from SleepHQ:
https://sleephq.com/public/f54e7fd6-9e3 ... 7b94c71177
https://sleephq.com/public/a3a0120c-379 ... 6ab803d499
https://sleephq.com/public/8295964a-53c ... a9095bae91
https://sleephq.com/public/8295964a-53c ... a9095bae91
https://sleephq.com/public/4688592d-95e ... ae42d926cb

Here's more info from my sleep study taken in May of 2024:

A breakdown of sleep staging reveals the following: Stage N1 29.5 minutes (9.0% of total sleep time), Stage N2 159.0 minutes (48.5% of total sleep time), Stage N3 95.0 minutes (29.0% of total sleep time) and last, REM 44.0 minutes (13.4% total sleep time).

Arousal Statistics:
A total of 122 arousals (22.4/hour) were observed during the analysis period as follows, 106 respiratory arousals, 2 Leg Movement arousals, 14 spontaneous arousals

The patient demonstrated Moderate Obstructive Sleep Apnea.
The patient had a baseline AHI of 22.2/hour with a nadir oxygen saturation of 91%.
The patient's oxygen saturations remained at less than 88% for 0.0 minutes.
The patient's sleep was fragmented.
The patient had reduced sleep efficiency during this Polysomnogram.
The patient had a normal number of Periodic Limb Movements of Sleep during this Polysomnogram.
The patient's EKG demonstrated normal sinus rhythm.

If anyone has the time and inclination to look this over and offer help, I'd really appreciate it. Thanks for reading! ~Jess

How many times do you remember waking?

Do you take any meds? If so, what?

I'm not on any medication currently.

Pugsy wrote: ↑

Thu Mar 06, 2025 11:40 am

How many times do you remember waking?

...was the other question.

It really depends. I quite often sleep through the night, but I usually wake up at least once, usually late into the night/early morning. I will go to sleep on my side and wake up on my back. I've noticed that the central apneas increase when I'm on my back, which makes sense (looking at the early morning data). I don't seem to have a remedy for this, other than limiting my intake of liquids before bed. Thoughts?

Pugsy wrote: ↑

Thu Mar 06, 2025 11:40 am

How many times do you remember waking?

Do you take any meds? If so, what?

Answered this above if you have any thoughts

ladypreneur1 wrote: ↑

Thu Mar 06, 2025 11:30 am

It's been a minute since I last checked in. I have been using the CPAP religiously since I got mine, and it has helped a LOT compared to my untreated sleep. My AHI was 22 (mostly hypopneas) and it was wrecking my life... Now my avaerage is in the 2-5 AHI range, so a big improvement. But, I am still waking with fatigue, brain fog, anxiety from not ideal sleep. I would really like to improve these numbers but if this is as good as it gets then I am also looking into surgical options (I do not need advice or opinions on that right now, thanks).

The largest part of your treated AHI is made up of central apneas, and surgery is not going to help eliminate them. Centrals are not caused by tissue relaxing and blocking the airway. And surgery is designed to remove the excess tissue that relaxes and falls into the airway.

I've zoomed in and scrolled through all of the SleepHQ data that you posted. And what I'm seeing is a whole lot of post arousal events, mainly post arousals CAs. As post arousal events, these would most likely not be scored on an in-lab sleep test with EEG data available to the tech monitoring the test. They wouldn't be scored because they don't represent sleep disordered breathing problems since they occur when you are awake or when you are transitioning to sleep.

Here are screenshots from your data that show post arousal centrals:








I know these are all post arousal centrals because they follow larger than usual inhalations, and those larger than usual inhalations are the indication that you aroused/woke up (briefly) before the central was scored. And so those CAs are just sleep transitional centrals as you go back to sleep---i.e. they're the result of your body handing over control of your respiration to the autonomic nervous system and resetting the CO2 trigger for inhalation a bit higher. These are not "real" in the sense of being part of sleep disordered breathing.

All or almost all of your CAs have this same kind of pattern of following a few big inhalations. And many of your other events do as well. So it is quite likely that your real treated AHI actually is under one if you discount all of the post-arousal "events".

It's also clear that your machine reported AHI is being significantly increased by false events that are scored when you are in bed and awake or very lightly "dozing" (i.e. bouncing back and forth between light sleep and wake) in the 15-40 minutes before you get up in the morning. Here is a screen shot that show that "sleep-wake-junk" pattern from dozing at the very end of the night before you decide to just get up for the morning:

None of these events are "real", but they represent a rather large number of the events recorded for the whole night.


Now you've said this about what you remember about wakes during the night:

ladypreneur1 wrote: ↑

Thu Mar 06, 2025 6:22 pm

It really depends. I quite often sleep through the night, but I usually wake up at least once, usually late into the night/early morning. I will go to sleep on my side and wake up on my back. I've noticed that the central apneas increase when I'm on my back, which makes sense (looking at the early morning data). I don't seem to have a remedy for this, other than limiting my intake of liquids before bed. Thoughts?

And you've said this about your sleep hygiene:

Here's what I do already:
Mostly consistent bedtime, refrain from drinking too many liquids before bed so I don't have to pee int he middle of the night
Flonase spray to reduce mild allergy from my cat
Stress reduction techniques as needed
Earplug/s in case my partner is home late and cooking (he works in the evenings) so I'm not disturbed
Pillows, pillows, pillows - I've tried so many different combinations to see what works best - I'm still figuring that out (I'm a side sleeper)
Cleaning the machine regularly, rinsing the mask with soap/water every day
No food 2-3 hours before bed

You also stated in your first post:

But, I am still waking with fatigue, brain fog, anxiety from not ideal sleep. I would really like to improve these numbers

My take on your data: The easiest way to get your AHI down is to simply get up out of bed a bit earlier. As in: Don't doze on your back when you wake up and it is after 8:00. All those CAs scored right before you wake up when you are on your back at the end of the night? They're not real sleep disordered breathing---they're indications that your body simply doesn't want to sleep anymore: It's having trouble getting back to real sleep because it's done with sleeping. Simply getting up when you wake up and it's after 8:00 will cut your treated AHI by 40% or more on many nights.

I also suspect that some of your "fatigue, brain fog, and anxiety from not ideal sleep" is actually from trying too hard to get just a bit more sleep after you wake up in the morning sometime between 7:30 and 8:00. Getting up when you first wake up when it is light outside just might make your brain not feel so tired---the effort to get that last bit of "extra sleep" when your body is just refusing to go back into a real, continuous sleep is likely wearing you out more than you realize.

Now, if you enjoy that time when you're lying in bed not really sleeping, but not yet awake, then there would be no reason for forcing yourself out of bed. But you then would need to take that into account when you're looking at the data and you see an AHI > 3.5 that is made up of a lot of CAs. Chances are all that's "wrong" is that you spent a lot of time in bed not really sleeping at the end of the night simply because you were enjoying lying in bed in the morning before getting up. In other words, you also need to consider the possibility that if you are looking at your data right after you get out of bed, seeing that AHI that's higher than you think it should be might also be responsible for your body's reaction of "fatigue, brain fog, and anxiety from not ideal sleep": Your brain sees the "bad data" and decides the sleep was not ideal and so things no longer seem as bright and clear as they should seem.

I know these are all post arousal centrals because they follow larger than usual inhalations, and those larger than usual inhalations are the indication that you aroused/woke up (briefly) before the central was scored. And so those CAs are just sleep transitional centrals as you go back to sleep---i.e. they're the result of your body handing over control of your respiration to the autonomic nervous system and resetting the CO2 trigger for inhalation a bit higher. These are not "real" in the sense of being part of sleep disordered breathing.

All or almost all of your CAs have this same kind of pattern of following a few big inhalations. And many of your other events do as well. So it is quite likely that your real treated AHI actually is under one if you discount all of the post-arousal "events".

It's also clear that your machine reported AHI is being significantly increased by false events that are scored when you are in bed and awake or very lightly "dozing" (i.e. bouncing back and forth between light sleep and wake) in the 15-40 minutes before you get up in the morning. Here is a screen shot that show that "sleep-wake-junk" pattern from dozing at the very end of the night before you decide to just get up for the morning:

None of these events are "real", but they represent a rather large number of the events recorded for the whole night.

Wow, thank you very much for the detailed breakdown. I will try getting up when I first awake and see if that helps. I do notice a difference on days where I have fewer obstructive apneas vs. central apneas. I still get some of the former but I do see how my overall score is bumped up significantly by the latter. Adding more exercise to my routine helps my sleep immensely, I think I am easily dysregulated by stress too. The fatigue/brain fog is still prevalent, especially if I have days where my OA score is higher. But it's not always correlated to the numbers on the machine, and it feels like the sleep debt I incurred while having untreated sleep apnea will take a while to "repay".