Assistance Requested: AHI <1 But Very Tired

Hello everyone,

First post for me and hope I've followed all the guidelines around OSCAR imgur posting. For many months if not years I've felt like CPAP has helped but I wake up feeling like I've had 4 hours of sleep even with 8+ hours and AHI values <1. Recently I've had very good AHI/RDI figures as I tried to dial things in as much as possible, but the problem is that I still wake up with owl eyes and feel sleepy all the time. I've scheduled a new sleep doctor and an ENT to try and get more help, since my existing sleep doc didn't care about anything except the AHI number and pretty much ushered me out the door as I was explaining how tired I was. Looking for any input or suggestions as to what might be causing me to look and feel tired even with CPAP therapy. After reading the forums briefly I'm wondering if maybe it's a UARS issue and I need a Bipap or ASV machine, or maybe an oxygen concentrator, but I just don't understand enough yet to make a semi-educated guess to take to my potential new doctors. Any help would be most appreciated!

Main details about my therapy:

• Been on CPAP for several years with a prescribed pressure of 8.4

• Using an Airsense 10 Auto and Wisp nasal mask

• Experimented with auto mode as well as several different combinations of pressure and EPR

• Recently turned off the ramp feature after reading through the forums

• Have started mouth taping/chin-strap/breathe-right strips off and on with a small amount of improvement but nothing material

• Went to my PCP for bloodwork and nothing popped out as a separate issue (I was mainly looking for testosterone or thyroid issues)

My OSCAR data:

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

How many hours of actual sleep are you averaging?
Are those hours fragmented with a lot of wake ups?

Hello Pugsy,

Currently on 3 medications for high blood pressure. The meds are Hydrochlorathiazide, Losartan and Nebivolol (Bystolic). The one medication that I actually asked the doc about today was Bystolic, which is a beta blocker and evidently can mess with melatonin production. The doc didn't have any input on that for the moment and I'll be getting another sleep study once approved. It does make me wonder if I should supplement with melatonin or consider talking to my PCP about reducing or eliminating Bystolic.

Most of the BP meds or beta blockers can cause fatigue/tiredness. Some maybe more than others and affect different people differently. They can mess with sleep quality which can cause fatigue and even cause fatigue without messing with sleep itself.

The Nebivolol is of course known to cause fatigue.

I take Losarten and HCTZ myself and it is also known to cause fatigue but I don't know how much of my fatigue is from crappy sleep quality (other health issues that mess with sleep) or might be from the medications.

It's something to consider when we don't feel as good as those nice low numbers give us the impression we should be feeling.

Not all our problems or unwanted symptoms are caused by airway issues. Sometimes it's just other stuff getting in the way.

I appreciate the info and you sharing your experience with the meds. Given how poorly I feel I suspect some adjustments to dosage may be needed, but time will tell.

Given the low O2 levels that I'm recording with my Wellue O2 ring it seems like something is causing arousals/struggles to get enough oxygen. It seems to be common for my O2 levels to be in the mid to high 80s for about 15 minutes each night, which seems too low. Realizing now that I should have shared this in the original post but the ring is still fairly new to me as well.