Any ideas about getting a better sleep? Update ...

After I was convinced my mask, presssures, etc. were as good as I could expect, I resorted to taking melatonin to help me remain asleep. It also helps with resuming sleep after the inevitable bathroom break around 2 am. I started with 1 mg and over a month or so, increased to 3 mg. I take the time-release version to make the effect last through the night. It helps a lot and I have notice no side effects.

Having MORE daytime fatigue than ever and nocturnal POLYuria has come back. I switched back to ferrous fumarate to try and get my ferritin levels up but that won't happen quickly. I seem to have a malabsorption issue with the iron so it will take a lot longer to get the levels up to the recommended 'at least 50' ... to help my PLMD.
I have noticed more flow rate limitations than usual ... but not sure if they are a factor in how I am feeling during the daytime or if they are even a concern.
On a positive note, my mouth seems less dry during the night. Average leak rate for the past week is 3.04 and 95% rate is 13.20

CoastalSun wrote:I have been on CPAP for just over a year now and I am STILL not getting a good sleep. But at least I don't wake up every morning with a headache, sore throat, feeling like I was 'hit by a truck' and daylong extreme fatigue. Even my heart palpitations have decreased. I haven't woken up during the night since starting CPAP with choking/gasping for air. However, I am still waking up 5 to 7 times during the night because I need to go to the washroom with VERY full bladder, my mouth is extremely dry, or I just wake up.

CPAP can help with “critical closing pressure” by making the pressure inside the airway always above that pressure. However closing pressure is only one of the factors that make sleep apnea.

The fact that you wake up with a full bladder does make me thing you are having events (raises sugar levels which end up flushed through the bladder). The fact that your mouth is still often dry, in my opinion, points toward high respiratory control loop gain as being one of your issues. It tends to make you want to breath more and at the same time frustrates metabolism in the airway passage so things tend to dry faster and not be wet as much.

CoastalSun wrote: Most of the time, I am able to fall back to sleep quite quickly but I don't sleep more than 6 hours and that is not a solid sleep. So actual sleeping time is between 5 and 6 hours. I still feel fatigued and this morning, I have a nasty headache.
I am waking up way too many times, tired during the daytime, difficulty staying awake in the evening until bedtime - the past few evenings, I have almost fallen asleep sitting up and it was barely going on 9 pm

Another issue may be low arousal threshold.

CoastalSun wrote:In January, I increased the pressure (as prescribed) by 1.0 to see if that would help with the flow limitations during REM. It backfired with severe aerophagia. I dropped the pressure back to 7.6 and it seems to be OK.

This would tend to confirm my guess that high respiratory control loop gain is an issue. The small increase brought another symptom I consider associated with high respiratory control loop gain. Any increase in pressure also increases the control loop gain.

CoastalSun wrote:I have done all the lifestyle things as far as preparing for a good sleep: no eating after 6pm, no alcohol, don't smoke, am normal weight, don't have GERD (gastroscopy done), don't nap during the daytime, dark/cool room, drink one coffee in the morning and not every morning, and have black tea but not after 3pm. Don't even eat chocolate LOL! Don't eat spicy foods anymore. Exercise every day, either at the gym or go for a long walk. So why am I STILL waking up 5 to 6 times a night?
I did have mild PLM on my initial sleep study and I have been taking iron supplements to try and get my ferritin levels up to a decent level. Will get it checked tomorrow.
Although my AHI looks good, I am definitely not feeling like I am getting optimum sleep.
Thoughts? Ideas? Maybe it's time for another sleep study.
I know I can't go without the CPAP and I haven't missed a single night since starting. I need that air

For most of the years that I have used CPAP I have tried to make CPAP work better for me by making changes in lifestyle. You have made a good start at that.

Find a good dietitian. For me medicade/medicare paid for three years working with one. With this help I have maintained a weight loss of about 10% for over five years an am now at a weight loss of 19% still going down. It is by no means just the weight loss. Learning to eat well has helped my whole body heal with the good well chosen whole foods.

I have also used a personal trainer and am running about 83% of my 10,000 steps a day for the past two months. I have gotten closer to the goal every year. I also do resistance training, cycling, and some hiking and am looking toward other sports.

So now I run with about half of the CPAP pressure I used to use. If you are able to use less CPAP pressure I believe you will do much better.

I have noticed that when I go well over 10,000 steps a day (say for me about 15,000 steps a day – note that I am running at about 8200 steps a day average and have been doing this for years) that I do much better with not waking during the middle of the night. I then to sleep better longer.

What I am recommending is that you commit to learning to eat well and move well. My family of origin never taught me these skills. I had to find and use other resources.