Still tired despite low AHI. Looking for suggestions.

Hi all,

I have been on CPAP several years. Despite AHI < 1, I still often wake up sweating during the night (sometimes the sheets are so wet I have to move to a different spot on the bed). Other times I wake up gagging. I often start the day feeling tired.

I would really love any suggestions on how to improve my sleep.

I use the ResMed AirFit P30i nasal pillow, and mouth tape. I also wear a sleep position sensor to keep me on my side. And a neck brace to stop my chin tucking.

The gaps in the flow rate below are when I wake up sweating and take off my mask.


Using OSCAR, I've identified that my breathing goes erratic before an awakening. As a lay person I don't know if this is normal REM breathing, or disordered breathing. Screenshot below, with a regular breathing screenshot for reference.


I have been trying to increase my floor pressure to see if that helps, and it doesn't seem to yet. Also, some days I wake up in pain from air in my stomach so I'm hesitant to go too high.

Any help much appreciated.

-Chris

There are many causes for fatigue besides sleep apnea. I'm fighting this myself despite low AHI. I think mine is gut related.

Hi Chris, you have a somewhat active flow limitation graph, and I recommend that you increase your EPR from 1 to 3. Ordinarily you'd also want to raise your minimum, but your AHI is so low I don't think that's a problem.

This change might help to reduce the FLs, which could be contributing to your poor sleep, and it might also help reduce the aerophagia you're experiencing.

Flow limitations generally occur when the tissues lining the airway relax, constricting it slightly. They can cause you to labor harder to inhale, and they can disrupt the normal cycles of sleep. You can see them in zoomed-in views of your flow rate. The ideal inhalation will show a smooth curve above the zero line; flow-limited inhalation exhibits points, plateaus, or dents in the inhalation trace. You will probably see some of this even where there aren't any FL flags.

Keep us posted, would you?

It sounds like you are having night sweats. They can be quite disturbing to a person's sleep. That could easily explain your tiredness.

Miss Emerita wrote: ↑

Sat Jan 09, 2021 2:13 pm

Hi Chris, you have a somewhat active flow limitation graph, and I recommend that you increase your EPR from 1 to 3. Ordinarily you'd also want to raise your minimum, but your AHI is so low I don't think that's a problem.

Keep us posted, would you?

Thank you for the suggestion. I increased my EPR to 3 last night and it seemed to help. I didn't have any sweaty awakenings. I woke a early but I'll see how I go in the next few days.

I am surprised though, because I thought a low or zero EPR would keep more consistent pressure and help keep the airways open?

weiss27md wrote: ↑

Sat Jan 09, 2021 2:03 pm

There are many causes for fatigue besides sleep apnea. I'm fighting this myself despite low AHI. I think mine is gut related.

I think my issues are still sleep related because my fatigue is worse on the nights I have more awakenings.

Deborah K. wrote: ↑

Sat Jan 09, 2021 4:19 pm

It sounds like you are having night sweats. They can be quite disturbing to a person's sleep. That could easily explain your tiredness.

I was thinking of the night sweats as a symptom rather than a cause. You think the sweating itself might be a cause of the fatigue?

Our sleep can be disturbed by any number of things and they aren't always related to airway issues.
When we don't sleep well because we wake often (no matter what the cause) we are going to feel like crap.
CPAP fixes airway issues but if something else is causing the wake ups the cpap probably isn't going to be able to help much with any other issues that might be causing the wake ups.

The sweating could be a symptom of a problem with the airway or it could also be a symptom of something else.
Symptoms themselves can cause wake ups but the underlying cause of the symptom is your primary culprit.
So the sweating itself could cause the wake up but the cause of the sweating is the primary culprit.

Example...before cpap therapy I would wake up with a painfully full bladder and have to go pee...so the full bladder was a symptom that caused the wake up but the primary cause of the full bladder in the first place was the real culprit and that was over active kidneys which was caused by the stress hormone put out by the heart as a result of being under stress from apnea events.

It's sort of a which came first kind of thing sometimes.

One thing that's helped me get a better nights sleep is being careful about what I eat for evening meals and any snacks later on at night. A heavy meal or one that has difficult to digest foods (I like broccoli, but it doesn't like me) for supper may take a while to digest and may not let you get the full rest your body needs. Sugary foods and/or drinks can push your heart rate up and the effect may linger on for while after your asleep which doesn't help for a good nights rest. I still snack at night while watching a NetFlix movie or similar, but it's on the light side and with a cup of chamomile tea. While CPAP is supposed to help reduce acid reflux occurances, is it possible the gagging may be something of a problem like that?
When I was in my 40's some 30 years ago I was having occasional drenching night sweats for a few years. My doctor never did find a reason and it eventually went away, but probably worth mentioning to your doc if you haven't already.

chriscpap wrote: ↑

Sun Jan 10, 2021 4:30 pm

Deborah K. wrote: ↑

Sat Jan 09, 2021 4:19 pm

It sounds like you are having night sweats. They can be quite disturbing to a person's sleep. That could easily explain your tiredness.

I was thinking of the night sweats as a symptom rather than a cause. You think the sweating itself might be a cause of the fatigue?

Chris, are you a bit older female? If so night sweats are common, and can be relieved.

Deborah K. wrote: ↑

Sun Jan 10, 2021 9:07 pm

Chris, are you a bit older female? If so night sweats are common, and can be relieved.

Nope, 40yo male

chriscpap wrote: ↑

Sun Jan 10, 2021 9:18 pm

Deborah K. wrote: ↑

Sun Jan 10, 2021 9:07 pm

Chris, are you a bit older female? If so night sweats are common, and can be relieved.

Nope, 40yo male

Can't help you with the night sweats then.

https://www.mayoclinic.org/symptoms/nig ... m-20050768

https://www.webmd.com/menopause/guide/8 ... ght-sweats
read it...menopause is the only thing that is female oriented...other causes are unisex.

About EPR: the change in pressure is breath by breath, and the difference between inhale and exhale is constrant. Plus the ResMed algorithm allows the machine to turn on a dime from inhale (higher) to exhale (lower). The feel for the user is just that it is easier to exhale.

When the autoadjusting pressure changes occur, they change the minimum, sometimes raising or lowering it a fair amount over a relatively short period of time. Some people find that disruptive; others aren't bothered at all.

Pugsy wrote: ↑

Sun Jan 10, 2021 9:56 pm

https://www.mayoclinic.org/symptoms/nig ... m-20050768

https://www.webmd.com/menopause/guide/8 ... ght-sweats
read it...menopause is the only thing that is female oriented...other causes are unisex.

I knew that. I just meant that that is the only type of night sweats I might be able to help with.