Lower than 5 AHI - still very tired - all of my events are clear airways - where to go from here?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
bjjkaril1
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Joined: Fri Jun 24, 2022 9:39 am

Lower than 5 AHI - still very tired - all of my events are clear airways - where to go from here?

Post by bjjkaril1 » Fri Jun 24, 2022 9:51 am

Medical info:
Age: 24
Gender: Male
Weight: 170 lbs
Height: 5'11
Build: Athletic
Smoke/drink: Don't smoke at all and don't regularly drink. At most one alcoholic beverage/week
Possible problems: deviated septum, family history of anxiety/depression/ADD

So last year I was diagnosed with sleep apnea with an AHI of 8-10. I was told to jump on a CPAP, so I bought myself a Resmed 10 and started using a F20 facemask. Went from 8-10 AHI night to about 1.5-4. Problem is my AHI still bounces and a couple nights ago I had about a 4.15 AHI and was extremely exhausted during the daytime. Delved into my data on OSCAR a bit and noticed that literally the bulk majority (90%) of my events are clear airway events:
https://i.postimg.cc/g2TRkgXY/ahi-4-15-night.png (4.15 night I was talking about) - AHI that night jumped up around 10-11 AHI around 5-5:30 AM
https://postimg.cc/gallery/kBPpyH6 - here's two other nights showing the same thing (this is essentially how it is every night, the clear airway events make up the 90% of events)

So at this point I don't know if I should concentrate or point the finger at sleep apnea. If my apneas/night are always under 5, should I feel energized and OK? It could be a multitude of things. The way I see it is if it's not a high chance of sleep being the problem, then I have to be depressed and have a chemical imbalance. Really just not sure what to do here - I don't really have a doctor thats knowledgable about this stuff, they just handed me a CPAP prescription and I went on my own way.

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Pugsy
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Location: Missouri, USA

Re: Lower than 5 AHI - still very tired - all of my events are clear airways - where to go from here?

Post by Pugsy » Fri Jun 24, 2022 12:39 pm

Please review this thread for examples of the format for sharing your detailed reports.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

How is your overall sleep quality? Waking frequently during the night or sleeping soundly for the most part?

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

Take a crash course in figuring out if those centrals you see flagged are real asleep centrals or related to an arousal or awakening. Watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software

If the centrals seem to be primarily asleep centrals...you might try reducing or turning off EPR exhale pressure relief and see if it changes the number of centrals. No guarantee it will help but it might if you happen to be one of the very small minority that using EPR can cause centrals. It is about the only thing that you can try and easy to do so probably worthwhile. Most people can use EPR and it doesn't cause centrals.

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bjjkaril1
Posts: 2
Joined: Fri Jun 24, 2022 9:39 am

Re: Lower than 5 AHI - still very tired - all of my events are clear airways - where to go from here?

Post by bjjkaril1 » Mon Jun 27, 2022 8:35 am

Pugsy wrote:
Fri Jun 24, 2022 12:39 pm
Please review this thread for examples of the format for sharing your detailed reports.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

How is your overall sleep quality? Waking frequently during the night or sleeping soundly for the most part?

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

Take a crash course in figuring out if those centrals you see flagged are real asleep centrals or related to an arousal or awakening. Watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software

If the centrals seem to be primarily asleep centrals...you might try reducing or turning off EPR exhale pressure relief and see if it changes the number of centrals. No guarantee it will help but it might if you happen to be one of the very small minority that using EPR can cause centrals. It is about the only thing that you can try and easy to do so probably worthwhile. Most people can use EPR and it doesn't cause centrals.
Hi Pugsy,
Thanks for the reply. So far my overall sleep quality seems to be good - I only wake up at most once a night to use the bathroom (before starting CPAP I was waking up 2-4 times a night to use the bathroom).

I currently take accutane but have dropped the dosage from 60 mg to 30 mg/day. I've discussed with my dermatologist and we think this may be a contributor to excessive fatigue/tiredness since accutane is hard on the CNS. I'll be done with accutane within 2 months - so for now I'm just toughening it out since I've suffered from acne my whole life and my self esteem is already improving.

I actually turned off EPR exhale pressure relief on my Resmed 10 - 2 nights ago based off your recommendation. The first night I had an AHI of 1.6, the second night an AHI of 1.2 - could just be a coincidence but we'll see if that helps long term - that's the lowest my AHI has been in a long while though so potentially some improvement if it sticks!

Overall I'm still really confused on what's going on - if I still don't feel right a few weeks/months after accutane, then would it be worth visiting a neurologist to see what these clear airway events are (if it's consistently above, say 3 or 4?) - since I've had those clear airway events for 10 months and almost no obstructive events? And does that essentially mean the CPAP (resmed 10) I have is useless in treating those clear airway events? My main goals right now are to finish this course of accutane, then see how I feel after accutane and go from there. Thank you very much for reaching out, I appreciate it!

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Pugsy
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Re: Lower than 5 AHI - still very tired - all of my events are clear airways - where to go from here?

Post by Pugsy » Mon Jun 27, 2022 8:55 am

You are asking me questions about the future that I can't answer because I don't have a very good crystal ball.
Cross the future bridge when you get to it.

Not all fatigue is caused by sleep apnea....and that includes central apneas.
Not all fatigue is caused by medication side effects. Google "causes of fatigue" and start reading.
Having a few centrals is normal anyway...start reading the recent threads about central apnea. Lots of good information there.

Most doctors here in the US won't even bother looking at reports with centrals until someone consistently sees at LEAST 5 per hour average in centrals every hour every night kind of thing. I have no idea what your doctors might do.

Generally what I tell people is if they have a concern about anything then they should talk to their doctor(s) about that concern. While I seriously doubt the centrals you are seeing are the cause of your fatigue UNLESS those centrals aren't real asleep centrals but instead awake/arousal centrals which points to maybe less than optimal sleep in general and it's the less than optimal sleep which can cause the fatigue.
If that's the case then the cause of the fatigue might be poor sleep quality but the centrals would be a symptom of the poor sleep quality and NOT the cause of the poor sleep quality.

You probably should take a crash course on evaluating flow rate breathing to see if those centrals are even real asleep centrals along with just in general scroll through your flow rate and look for evidence of arousal/awake breathing.
http://freecpapadvice.com/sleepyhead-free-software

To fix any problem you first have to identify the cause of the problem and unfortunately even identifying the cause can be difficult and then the fixing thing isn't so easy either sometimes.

I would look closely for sleep quality issues in general because often people have more than one issue for a potential culprit in your fatigue complaints. Doesn't hurt to do that detective work while also giving cpap some time to help.
Get a good in depth physical with extra blood work to check for hormone levels along with thyroid function and all that routine stuff to rule out metabolic issues.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.