Low AHI but still tired

I've been on CPAP for almost a year now, using it every night. According to the data on the machine, I'm doing well as almost every night is below 1 AHI for the night, however I still feel tired every day. I have an appointment to see the DME on Thursday of this week, to see what kind of insight they can offer.
I don't take any medications, so there isn't anything there that could be affecting my results, so basically I'm at a loss as to why I don't feel better after all of this time.
I'll try and post images of recent sleepyhead data from a night last week, which is failry typical of the numbers I see each day.
Thanks in advance for any suggestions!

Wish I had a dollar for every time I see a question like yours.
Lots of things can affected how we feel during the day besides AHI numbers. Wish it were that simple

Could you please post an image of the Flow limitation graph? That's the only thing absent from the report you posted that might show us something that might be a factor.

AHI graph and pressure graph is not needed..you are using fixed pressure so it isn't going to vary and the AHI graph is redundant information that is rather useless. The AHI breakdown on the left side of a detailed daily report is a better choice to include.
Do you know how to just do a screen shot of the daily detailed report instead of having to print off the report and then do a picture?
Explained here with examples of what we like to see.
viewtopic.php?f=1&t=81072&p=737779#p737779

In terms of your complaint...being tired
Is this fatigue or being sleepy and wanting to nap? There is a difference so just wanted to clarify it as people often say one thing and mean another.

How many hours of sleep do you normally get? Are all these hours with using the machine or do you ever get 6 hours (like this report shows) and take it off and get another 2 hours without machine?
Do you wake often during the night? If so, any idea why?

If you normally only average 6 hours or so of sleep...maybe you just need more hours of sleep. I need about 8 hours or my butt is dragging for sure.
Less than 7 hours and I will usually want and need a nap.
So how is your sleep hygiene in general?

And of course the other medical reasons for feeling like crap during the day....thyroid, hormone, other health problems and this is where you need an in depth work up and discussion with your doctor. The machine can't fix stuff that is unrelated to the apnea events itself.
It can't fix short hours of sleep fatigue or insomnia unless sleep apnea is the only cause...and there are lots of other things that affect sleep quality and thus how we feel during the day.
Getting a nice low AHI is the easy part. Finding and fixing other possible causes is the hard part.

Thanks for taking the time Pugsy to respond, I appreciate it. I'm struggling with the screenshot though. I'm not sure why the flow limitation is not showing up, it is enabled in the selected graphs.

The being tired, is just that, being tired. Sometimes when I leave the house in the morning, I feel so tired I'm looking forward to being able to go back to sleep that night, and often in the afternoon, will struggle not to fall asleep on the train ride home.

Normal sleep is 6.5 to 7 hours, all with the machine in use. I do wake up during the course of the night, often three, four or even five times, usually rolling over and falling right back to sleep. I can fall asleep quite easily at night, often within a minute or two. Rarely, do I ever get more than seven or so hours of sleep. I envy people who can sleep for ten hours! On weekends, I typically sleep the same amount, and waking up at 4 AM on a weekend is not fun.

I just had my yearly physical, and all the blood work etc. came back within the normal ranges, so hopefully there isn't any thyroid, hormonal or other health issues.

Pugsy,
Here is a screen capture that shows the events for that particular day:



The graph for flow limitations is still not showing up for me. It is checked in "Preferences", so I'm baffled by that.

Thanks!

Never mind about the Flow Limitation graph. For some reason I read the wrong machine being in use. My error.
You won't have a Flow limitation graph because the Respironics machine doesn't do flow limitation graphs.
Since you are using fixed cpap mode your machine doesn't flag flow limitations either. It only flags them in auto (apap) mode.
You can use your machine in auto mode (assuming you have the correct machine chosen in your profile) with minimum pressure to equal maximum pressure essentially making it function like cpap mode but will turn on the Flow limitation flags.
Though I suspect it won't show us much but if it did the Flow limitations would be flagged on the top events graph on the right. Near RERAs.

The detailed report is extremely faint and I cant see the top events graph very well at all but it doesn't look like there is a horrible amount of activity on it anyway.

I suspect that your fatigue issues are not related to the effectiveness of your OSA therapy but instead related to something else.
Now it might be hours of sleep...

ktmtrailrider wrote:The being tired, is just that, being tired. Sometimes when I leave the house in the morning, I feel so tired I'm looking forward to being able to go back to sleep that night, and often in the afternoon, will struggle not to fall asleep on the train ride home.

This really means two things...tired as in fatigue but if you have a struggle to stay awake on the ride home...that's sleepiness...
I can be physically exhausted but not sleepy...everyone can. So 2 distinct symptoms that may or may not be related. Fatigue doesn't always equal the need to nap.

The waking during the night might be a factor as each awakening messes with the normal sleep architecture...so you don't get optimal percent of time in each sleep stage and the natural progression of sleep stages are disrupted.
The 6 to 7 hours..may also be a factor in combination with fractured sleep.
Probably not any one sole factor but likely a combination of factors which may include sleep quality but might also include things unrelated to sleep quality.

When you talk to your doctor about things...ask about Vitamin D level testing...it isn't something that is normally done as part of yearly exam.
You may need more hours of sleep with less awakenings..and of course that is much easier said than done if the body doesn't want to cooperate.
Again something to talk to the doctor about. It doesn't sound like there is much of an insomnia issue since you fall asleep easily and when you do wake during the night you go back to sleep easily.

Other than the possibility of the short hours of sleep and maybe the fragmented sleep being a factor with your fatigue and daytime sleepiness...I don't think you are going to find an answer to your problem in your reports. Nothing screams out "fix me and you will feel better" except maybe the hours of sleep and I know that's a stretch. I do mention it because I know first hand how I feel with 7 hours vs 8 hours of sleep..it's something I have personal experience with and I am sure I am not the only one in the world that an hour more of sleep makes a big difference.
Now I know there are people who do very well with less hours of sleep...but since you are here with problems...you aren't one of them.
How much does it impact how you are feeling during the day? In all honesty I don't have a clue because everyone is different.
It might not matter at all...but again it might.

I wish it were so easy to look at the report and tell you that so and so points to sub optimal therapy and if you fix it then you for sure will feel better but it just doesn't work that way.

It's going to be hard work trying to figure out what might be the cause and probably a lot of detective work to be done to try to figure out what it might be. Talk to your doctor about looking outside the box for possible causes...talk about the need to nap in the afternoon..that's significant and might be related to the shorter hours of sleep.
Check vitamin D levels
check specific hormone levels and not just thyroid
Don't forget to look at OTC meds and not just RX meds if you take anything at all.
Body aches and pains, bed comfort, etc... look at everything you can possibly think of that might impact sleep quality and quantity.

Pugsy,
Thanks very much for taking your time to review my results. I was really hoping that there would be a simple tweak to the settings on my machine, and I would be all set. Unfortunately, I guess it won't be that easy. I don't take any OTC medications either, but I do have the normal body aches etc as part of the aging process.

When I see the DME on Thursday, I will go over with them the issues you have brought up, as I would really like to be able to wake up feeling refreshed.

Before I started CPAP, I would sleep the whole night thru, without waking up during the night. During that time, I wasn't fighting the daytime sleepiness issue either.

Thanks very much for your insight, this has actually served as a very good "prep" session for me before going to see the DME this week.

I don't see anything on the report itself that leads to any need of any pressure tweaking but that's not to say that something might be done that might make your sleep quality better.

Maybe try a different exhale relief setting...maybe try switching to apap mode with minimum and maximum to equal what you are using now just so you can at least verify that Flow limitations aren't present in large numbers.
Some people find that they sleep and feel better by using 1 or 2 cm more pressure than the reports indicate that they need.
Maybe the few snores we see here are enough to mess with sleep quality...they don't scream out "fix me" but that doesn't mean that they totally can be ruled out as a possible culprit.

I think most likely there is a combination of factors that won't be easy to figure out.

I was in your shoes for about 2 years...good numbers on the reports..sleeping about 7 hours most of the time...still needing to nap every day.
Figured it was about as good as it was going to get (I have wake ups from arthritis issues that I have to treat with meds) and stumbled across a different machine and low and behold I started sleeping longer and the need to nap every day went away. I hesitated to mention it because on paper it should not have made any difference and I didn't want people to start thinking "I need Pugsy's machine so that I feel better" because I don't know that it would fix the problem. I tried a Bilevel machine on a lark..and immediately felt better...and long term I saw that I was sleeping on average 45 minutes longer...need to nap is gone as long as I get close to 8 hours of sleep. I wish my crystal ball wasn't broken so I could tell you with certainty if you got more sleep with less wake ups that you would see the improvement you want...unfortunately all I can say is "maybe".

I don't see anything wrong in any of your graphs. Vice versa, it shows excellent results. As to your posting "however I still feel tired every day", you need to explain if you're sleepy during daytimes or just feel fatigue. It could be an underlying medical condition other than OSA. If it is Residual Excessive Sleepiness during daytimes, then if you would enter your age and gender I could comment on possibilities.

Fair warning - Avil is not a doctor though likes to think of himself as one.

Regardless of age or sex, stress (real or imagined) can have a huge impact on how we sleep. Also, it might be helpful if you could record your sleeping to see if there is any external noise that could be causing you to wake up. I would think about cars, planes, and air conditioners to start with.

However, keep in mind that for some of us it may take a long time to reach Nirvana. In addition to the other things discussed, are you too hot or too cold at night?

All things to discuss with your docs.

I don't enjoy being the bringer of bad news, but there is mounting scientific evidence that severe sleep apnea causes damage to certain regions of the brain that are responsible for wakefulness. There is currently no treatment for this damage, and the tiredness might not ever go away. Hopefully some day there will be a treatment.

You might wish to try the following medicines: ritalin, provigil (modafinil), amphetamines (like Vyvanse). These medicines might help some people.

I suffer from this problem too...excessive daytime sleepiness that is not cured or treated even after CPAP. You are not alone.

And of course I am not saying that brain damage is your problem, there are many possible causes but unfortunately that is a very possible one.

SleepyToo2 wrote:Regardless of age or sex, stress (real or imagined) can have a huge impact on how we sleep. Also, it might be helpful if you could record your sleeping to see if there is any external noise that could be causing you to wake up. I would think about cars, planes, and air conditioners to start with.

However, keep in mind that for some of us it may take a long time to reach Nirvana. In addition to the other things discussed, are you too hot or too cold at night?

All things to discuss with your docs.

Thanks, I'm still looking for the magic bullet!

No noise issues where we live, small quiet town of 6,000 people, where you ca hear a pin drop at night!

We sleep in a cool room, as we both sleep better as opposed to a warm room.

Stress isn't at a high level either.