Insight to constant fatigue

Greetings fellow cpap users,
I have been on cpap many years with obstructive apnea - but I'm new to the details of these charts and what they mean. I feel like the answer is here but I don't know what to change. sooooo close!

Can others look at my SleepHQ night last night and provide any insights. I wake up tired all the time. Don't feel that I'm getting much quality sleep. the "MY AIR" app says I'm doing great! The cpap machine says seal is good.

my AHI is 5.42 last night. I have developed a bit of a leak also I can't figure out. Also many flow limits that I don't fully understand. All insights or suggestions are welcome. thank you so much!
https://sleephq.com/public/55b7ae23-516 ... 5d8f08a167

Here is another night recently with all the details. AHI was 7.44. It seems I'm not getting mostly central events and Hypopneas rather than obstructive events https://sleephq.com/public/cecd125d-850 ... 3b5a2e26e1

let me know if there is other data I should provide. I do wear a Wellvue SO2 ring at night most of the time so there is a lot of charts and detail.

The variable pressure max was recently increased by the pulmonologist since I was spending much time at the prior peak. so the leak might be caused by that new pressure causing my mouth to open.
many thanks!!!

AirSense 11 Autopap
mask N30i

How's your overall sleep quality? Do you remember waking very often?

Are you experiencing any nasal congestion?

Do you take any meds of any kind? If so, what are they? Full name please and not say "blood pressure med" or whatever.

I do take losartin, atorvistatin, metroprolol and levothyroxin. I do awaken a few times in the night and feel like I'm just resting for long periods. I do not have any nasal congestion. I sleep on my back for most of the night and don't move around much. My husband says I'm mostly quiet. without cpap I am not quiet.
My sleep doc said that meds can increase the central apneas.
thank you!

Your flow limitation graph is pretty ugly. Flow limitations can mean that the airway is trying to collapse and/or disrupt sleep.

To give you an idea how your Flow Limitation graph compares to someone's FL graph that doesn't have much in the way of FLs...
take a look at this one


The reason I asked about nasal congestion was because nasal congestion can show up on the FL graph as increased activity.
So if you aren't having much nasal congestion we can't blame the FL graph ugliness on nasal congestion.

Some of your meds may or may not impact fatigue and/or sleep quality.
When I look at your flow rate up close I see evidence of a lot of arousal/awake breathing which points to not sleeping so great which in turn can lead to feeling not so great during the day.

Pay extra attention to beta blockers
https://www.goodrx.com/conditions/insom ... g-insomnia
Also research each of your meds for side effects like fatigue. I take Losartan as well...and I already checked it and yep....fatigue is a listed known side effect. Not saying that medication side effects is the only problem...just saying it might be impacting or adding to the problem.

How old are you? Female I assume?? Any chance that menopause is now a factor?? And don't laugh...I am female and age 72 and thought I was done with menopause but Mother Nature had other ideas and she now is blessing me with hot flashes in the middle of the night again.

BTW....I don't think you have a central apnea problem. I think those CA/Central flags are primarily a symptom of not sleeping well.
Pauses in breathing while awake or semi awake. Remember the machine can only measure air flow....it has zero idea if you are asleep or not.

Now why you aren't sleeping so great??? That's the million dollar question.
My first thought was maybe the FLs are a factor and they might be. Normally we would suggest adding EPR to see if it impacted the FLs or not but you are already using max EPR at 3 so that option is used up. Only other option then to try to reduce FLs is more baseline pressure....more minimum....maybe you might get lucky with just a little more minimum that would better prevent the FLs from materializing.

No guarantees or promises though. It's an educated guess knowing what FLs can do but just because they can cause a problem doesn't mean it will always cause a problem.

yes, I'm a 74 yo female and have been on cpap for 20 years. I come from a long line of snorers... although none of the prior generations used cpap but all my siblings do. Our parents and grandparents lived into their late 90's without cpap. I'll try to read up on the flow limit and what it means.

A couple of weeks ago, I lowered the EPR to 2 for two nights, then to 1. Leaks got worse... I put it back to 3 and hope my doctor doesn't notice that I'm monkeying with the settings.

Does the O2 graph add anything to the equation?