Still feeling tired with CPAP. Please help.

Hi,

I used to have loud snoring and did not take it seriously. But over some months I started feeling very tired. I then read in internet about sleep apnea. I immediately did a sleep study in 2009. I was diagonised with OSA with my AHI as 42. My doctor told me that my Airway was collapsing due to to some structural issue. I was given 2 options. One was to do a surgery and other option was to use CPAP. I choose CPAP option. I was given a F&P sleep style 200 AUTO SERIES. I used it for 6 months and had good compliance. But I was feeling more tired and stopped using it. For the past 4 years, I did not use the machine but still had fatigue and sleepiness. I then started reading the post in this forum. I then decided that I will try CPAP again. I rented a Resprionics Aflex machine for a week and felt really good. I had more energy and was waking up refreshed. I then brought S9 autoset. Initially I felt better but for the past 3 months I am not feeling refreshed. I feel tired and when I travel by Bus to office I sleep as if I did not sleep in the night. My AHI number is below 5 and there are no leak issues or compliance issue. I like to know from the experienced people on what should I do. I am in a job which requires me to have maximum attention and energy. I did my blood test and found out that my TSH is in borderline and also deficiency in Vitamin D. I am taking medicine for both. I still feel my OSA in contributing for my fatigue as I dont feel refreshed after a nights sleep. It is really frustrating.

Thx

Hi, too bad you're not doing better, but things can usually be fixed. Are you using any software to track overnight events (Sleepyhead is free on this forum)? It might tell you whether, e.g. you're mouth breathing when sleeping and losing therapy air that way, in which case a trial of a full face mask might be in order. Is your MD measuring your results on Vit. D and thyroid meds? What about low T testing?

Not everything wrong with us is related to sleep apnea and the machine can't fix stuff that isn't related to sleep apnea.
Let's use the software available (see the links in my signature) to make sure that at least the therapy itself is optimal. It's not all about the AHI number. SleepyHead will work fine with your machine.
Please post an image of a typical night explained here with some examples of the software reports Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

Also....how many hours of sleep are you averaging? Do you wake often during the night for any reason? If so, why?
What meds do you take?
Is it fatigue or excessive daytime sleepiness (they aren't the same thing) or maybe both that you wish to improve upon?
How is your sleep hygiene? Good or bad? Any issues going to sleep or staying asleep?

Hi,

I have attached my last night reports. Let me know if there is anything wrong here. Regarding the medication. I have hypothyroidism. The number reported was 5.3 in my blood work and vitamin D was at 13. I am taking 50mcg of thyroid tablets and 60000 IU per week.

I have hypothyroidism. The number reported was 5.3 in my blood work and vitamin D was at 13. I am taking 50mcg of thyroid tablets and 60000 IU per week.

Are you taking your meds correctly? Thyroid meds MUST be taken on an empty stomach an hour before eating and avoid calcium for a few hours. Also a reading doesn't mean all that much, it is a guide. My daughter reads low normal when she is having symptoms.

Try to set your machine in straight cpap mode, the pressure changes can disturb your sleep.

Hi Tmr,

Thanks for your suggestion. I do not wake up often in the middle night or atleast I dont remember waking up. Can there be a situation where our sleep is disturbed but we still do not know remember it.

Hi Black Spinner,

Yes I do take it in the morning well before my break fast

If we wake up for a min or two we usually don't remember it. A good example is sleep apnea, it wakes us up but for most we don't remember.

Yes, definitely. You may well have disturbed sleep without coming awake enough to ever be aware of it, or at least wouldn't remember the arousals. Your charts are rather all over the place, but whether it's all due to Cpap, OSA or hypothyroidism is hard to say yet. Are you sure you're not losing air either out of your mouth when asleep (for which I'd suggest trying out full face masks) or just not having the mask well fitted that you do have?

Hi Julie,

You had mentioned that my charts all over the place. Can you please mention specifically. I guess Leak lines are the indicators of the mouth breathing but I guess it is not that bad to suggest I should go for a full face mask. Is there anything else in the report that that I need to fix.

Regards,
Suneesh

I think (because I don't know enough about your machine) that you want to talk to Pugsy or Robysue, someone who can really point to specifics and make meaningful suggestions. Can you edit the title of this post to say 'Please help, Experts'? Possibly just bumping the note up by answering you will catch their attention however.

The main 2 things that stand out to me may or may not be responsible for your fatigue/sleepiness.
Hours of sleep....averaging around 6 hours. You may simply need more hours of sleep but trust me...I know that is easier said than done. From what I have read (and my on personal experience) 6 to 6 1/2 hours isn't enough to feel well rested. My butt is dragging if I don't get 7 1/2 to 8 hours.

The other thing might be the varying pressures. It's a maybe and not a certainty though. Your machine is doing its job but there's a variation in pressures throughout the night. Some people find that pressure changes are disturbing to their sleep in that it causes little micro arousals and they find that they tend to simply feel better with more stable pressures. Not everyone has a problem with varying pressures though...so can't say for sure that is what is going on in your situation.
So maybe a trial in cpap mode or a tight range in apap mode might be worth looking at. Can't promise anything though.
I see you had a handful of trial nights with cpap mode. Any reason why you didn't continue with the cpap mode at 12 with EPR at 2?

Your leaks aren't bad enough to warrant a full face mask IMO if you don't want one. Since you say you don't wake up often then I assume that the leaks don't wake you up. Now if they did wake you up I would say fix the leaks if you can but because they were disturbing sleep and not because they were putting the entire night's therapy in the toilet.

Do you use a humidifier? Another possibility is that dry air or too much humidity while on cpap cause you to have nasal congestion, thus disturbing sleep.

Ok will try to do a straight CPAP tonite and see the reports tomorrow. Will post the reports. How long should I keep a pressure and experiment. I feel of late I am doing lots of experimentation without patience.

Also Pugsy, what are the graphs I need to look at. There are so many and some can be misleading.

You probably need a week at a setting unless the results are horrible before you go changing thing again.

Here's an example of the graphs that I look at. I don't bother with the others.
AHI bar graph on the left
on the right the events graph, flow rate, pressure and leak.

One screen shot. Turn off mask pressure and AHI graph