Looking for advice - Tired, Morning Headaches, etc.

I've been on CPAP Therapy for over a little over four years now. While I've certainly had some positives from it - I wouldn't say it's ever had the results I was hoping for. Leading up to me being diagnosed with Sleep Apnea I had fatigue and headaches pretty consistently every morning when waking up. I did a sleep study, and I believe my AHI was somewhere between 15-20 AHI, so I was likely more in the mild to moderate category technically.

For a while, the CPAP therapy dramatically cut down the headaches I had waking up. However, I would still get them occasionally. Excedrin extra strength would almost always knock them out though. Recently I've noticed that my fatigue has been amplified considerably and I am now suffering from headaches waking up almost every morning. Sometimes they go away relatively quickly and others linger on for much of the day. I am still wearing my CPAP religiously every night.

My doctor has been pretty unhelpful, and their answer seems to be putting me on some sort of stimulant rather than addressing the likely root of the problem which I have to assume is poor sleep quality. This has led me to experimenting with my setting on my CPAP starting this week to see if anything helps. I have an AirSense 10 device. Everything I believe is default besides in the last few days I've been playing with the minimum pressure (last night I set it from 6 to 8.)

Just received my SD Card reader today, and hoping that someone on here may be able to interpret the results and give some suggestions.

I use a full mask, but am open to experimenting with different supplies. I've noticed that I pretty much have dry mouth consistently whether it be waking up in the middle of the night or in the morning. Use a heated tube and always fill the dehumidifier every night though.

I've downloaded and started playing around with OSCAR, but this is all new to me so please let me know if I should be sharing anything more than might be helpful.

Attached a few screenshots, and I'm also including a link that I created on SleepHQ with my data if that's helpful:

https://sleephq.com/public/teams/share_ ... bd4e202ea5

Appreciate any insight! Thanks in advance.

Do you remember waking up very many times during the night? How many?

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

Do you have any other physical or mental health issues?

Sabres1985 wrote: ↑

Fri Aug 23, 2024 4:05 pm

I've been on CPAP Therapy for over a little over four years now.

welcome to the zoo! sorry you've gone through so much aggravation so far in your journey.

something that strikes me right away is your pressure settings. it looks like you have ramp on. you may want to get rid of that and just start with the real pressure setting to start right away. now, notice how on your pressure chart that the pressure start down at that 4 then goes past that all the way up to at least 13 or so? then falls back to around 8, if my elderly eyes don't deceive me.

my advice would be to turn off ramp and start pressure around 8. see if that's comfortable for you. in the end, you'll probably want your minimum pressure even higher. but give it a go and see how it goes tonight.

good luck!

Pugsy wrote: ↑

Fri Aug 23, 2024 4:20 pm

Do you remember waking up very many times during the night? How many?

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

Do you have any other physical or mental health issues?

I take Xanax as needed but only to help me sleep when my mind is racing. Rarely any other time besides that. On average maybe once a week and a small dose of .25 mg.

Take Flonase seasonally as well.

No real physical issues besides high cholesterol and being a little overweight. Been working out and trying to watch my diet more since the end of last year.

Mental issues slight depression and occasional anxiety, both manageably.

I do wake up quite a bit. Probably 3 times on average per night that I remember.

zonker wrote: ↑

Fri Aug 23, 2024 4:27 pm

Sabres1985 wrote: ↑

Fri Aug 23, 2024 4:05 pm

I've been on CPAP Therapy for over a little over four years now.

welcome to the zoo! sorry you've gone through so much aggravation so far in your journey.

something that strikes me right away is your pressure settings. it looks like you have ramp on. you may want to get rid of that and just start with the real pressure setting to start right away. now, notice how on your pressure chart that the pressure start down at that 4 then goes past that all the way up to at least 13 or so? then falls back to around 8, if my elderly eyes don't deceive me.

my advice would be to turn off ramp and start pressure around 8. see if that's comfortable for you. in the end, you'll probably want your minimum pressure even higher. but give it a go and see how it goes tonight.

good luck!

I'll give that a shot tonight. Thanks for the suggestion.

Sabres1985 wrote: ↑

Fri Aug 23, 2024 7:34 pm

I do wake up quite a bit. Probably 3 times on average per night that I remember.

I looked at the SleepHQ report because I could zoom in on the flow rate (breaths) and there is evidence of a LOT more arousals/awakenings than just 3. We don't remember all arousals especially when the time awake is very brief.

Your sleep quality is far from optimal. Is it the cause of your unwanted symptoms?? That I don't know for sure but it is entirely possible that if it isn't solely to blame it is most likely playing a factor in it all.

Do you happen to have on hand one of those overnight recording pulse oximeters to check your oxygen levels during the night?

Lots of things can cause headaches and one of those things is low oxygen levels.

Take a look at this thread. I have some examples of arousal breathing in it.
viewtopic.php?f=1&t=187767&p=1451526#p1451526

Pugsy wrote: ↑

Fri Aug 23, 2024 7:44 pm

Sabres1985 wrote: ↑

Fri Aug 23, 2024 7:34 pm

I do wake up quite a bit. Probably 3 times on average per night that I remember.

I looked at the SleepHQ report because I could zoom in on the flow rate (breaths) and there is evidence of a LOT more arousals/awakenings than just 3. We don't remember all arousals especially when the time awake is very brief.

Your sleep quality is far from optimal. Is it the cause of your unwanted symptoms?? That I don't know for sure but it is entirely possible that if it isn't solely to blame it is most likely playing a factor in it all.

Do you happen to have on hand one of those overnight recording pulse oximeters to check your oxygen levels during the night?

Lots of things can cause headaches and one of those things is low oxygen levels.

Take a look at this thread. I have some examples of arousal breathing in it.
viewtopic.php?f=1&t=187767&p=1451526#p1451526

I don't but I'll buy one on Amazon and report back

Turned off the ramp, and it doesn't bother me from a comfort standpoint but I'm not sure it's really making a difference in sleep quality at all. I've been aware of waking up at least 3-4 times a night, and my AHI has been between 3-6 the past few nights. I raised my minimum pressure from 8 to 9 last night, but that didn't really seem to have an impact. I'm not too sure what changes to consider from here.

I wore an Oximeter for the first time last night. I can't seem to get this to import into SleepHQ, so I'll include a link to the PDF of my report. It looks like my O2 maybe dipped for very short periods of time, but I have no idea how to interpret this or if this may be related to my headaches at all.

My SleepHQ link is updated with my most recent nights:

https://sleephq.com/public/teams/share_ ... bd4e202ea5

Any suggestions on what I should be considering from here?

More pressure is never going to reduce those CAs/centrals. More pressure will help reduce OAs and hyponeas that are obstructive in nature when a person is actually asleep.
The bulk of your AHI is central but the bulk of those centrals are post awake/arousal flagged events.
You weren't sound asleep when they got flagged.

The poor sleep quality is causing the centrals to pop up because of the arousals.
The central apneas are a symptom of poor sleep quality and not the cause of the poor sleep quality.
Now what might be causing the arousals/awakenings.....million dollar question.

BTW did you know that it is normal to wake up after a REM stage sleep cycle completion?
Google "sleep stages" and look at the normal hypnograms and you will see what I mean.
So depending on how many REM cycles a person might have, there could be several "normal" awakenings.
Most of the time we just roll over and aren't awake very long so we don't form a memory of those post REM arousals.

Pugsy wrote: ↑

Wed Aug 28, 2024 9:13 am

More pressure is never going to reduce those CAs/centrals. More pressure will help reduce OAs and hyponeas that are obstructive in nature when a person is actually asleep.
The bulk of your AHI is central but the bulk of those centrals are post awake/arousal flagged events.
You weren't sound asleep when they got flagged.

The poor sleep quality is causing the centrals to pop up because of the arousals.
The central apneas are a symptom of poor sleep quality and not the cause of the poor sleep quality.
Now what might be causing the arousals/awakenings.....million dollar question.

BTW did you know that it is normal to wake up after a REM stage sleep cycle completion?
Google "sleep stages" and look at the normal hypnograms and you will see what I mean.
So depending on how many REM cycles a person might have, there could be several "normal" awakenings.
Most of the time we just roll over and aren't awake very long so we don't form a memory of those post REM arousals.

Just realized I can attached my oximeter report as an image and attached that here.

Should I have any concerns with my levels or do you think this is not a factor then?

Noted on what you mentioned. How do I get to the bottom of this? Do I need to find a better specialist? My specialist did not seem interested in digging into my poor sleep quality and instead wanted to prescribe me a stimulant which I don't think is a good solution here.

Welcome to the forum Sabres1985. I have to ask: Are you a fellow Buffalonian?

I agree with Pugsy when she says it looks like you are having a lot of micro-arousals that you don't remember during the night. My guess is that the wakes that you do remember are probably normal post-REM wakes. The problem is not those few wakes that you do remember; its that you are having problems with something other than obstructive sleep apnea causing mini- and micro-arousals. On an in-lab sleep test, most of them would likely be called "spontaneous arousals" meaning there was no obvious cause for them to happen. And trying to eliminate spontaneous arousals is difficult: Additional CPAP pressure doesn't fix them because they're not caused by sleep disordered breathing.

One clue to some of your arousals can be seen in this zoomed in shot of your SleepHQ data:


The large inhalation just after 1:14 indicates that you probably aroused around that time. There's also a small leak scored at the same time. Whether the leak caused the arousal or the arousal caused the leak is anybody's guess. But you fixed the leak since the leak rate drops to 0, but you had trouble getting back to sleep. My guess is that both those OAs are actually mis-scored sleep-transition centrals that would not be scored on an in-lab sleep test. You're trying to get back to sleep, but you don't succeed in getting back to sleep, probably because the leak comes back and is even bigger this time. The second pair of OAs also looks like mis-scored sleep-transition centrals OR possibly conscious breath holding while trying to re-seal the mask since they occur when you've managed to get the leak rate to drop to 0 again. But after that, you have another good-sized leak, followed by doing something to mostly fix the leak and at that point you manage to get back to sleep.

Now it's worth mentioning: Most people are not particularly sensitive to a relatively rapid 2cm increase in pressure. But a few people are. And it's possible that the increase in pressure in response to those OAs that are most likely mis-scored sleep transition centrals added to the the "fight the leak" problem after the initial arousal and the combination kept you from getting back to sleep quickly. This whole arousal-related episode lasts at least 45 minutes with maybe 15-20 minutes of decent quality sleep in the middle, as this slightly zoomed out shot of this same data shows:


So if I were you, I think I'd start trying to tease out small pesky leaks are part of what is leading to arousals.