Still Tired After Many Years

[Sybert1ger]

Hello Everyone!

This is my first post but I've been lurking on various forums for years.

I've been on CPAP for over a decade now and from my doctor's point of view my sleep apnea is under control. My AHI pretty much hovers around 1.0. Unfortunately I still struggle with fatigue and the feeling of non-restorative sleep. When I've talked to my doctor about this in the past it always just ends up in "let's try adjusting the pressure" or "maybe we should do another sleep study". I've done both those things numerous times without any change in how I feel. Since my AHI on CPAP is under 5 there doesn't seem to be anything more he can suggest to do.

I'm looking for any other thoughts and options and I've attached a picture from OSCAR of what my typical night of sleep looks like.

Thanks for listening and any help.

   

[Big Guy]

Wow.....10 yrs. on CPAP therapy and no improvement. I'm into it now about 15 months and getting impatient. I'm shooting for two years and if no improvement, I'm seriously thinking of giving it up.

My AHI numbers are low. I feel as you do. I feel tired and need a nap during the day. I actually sleep better when I'm not using my machine. 

My next appt. with my sleep doc is in early May. At that time, I intend to advise him of my intentions. The last time I saw him, he said I was doing fine and to give it more time. 

Sorry I can't offer any tips and/or advice. It sounds as if I'm in the same boat as you are.

[mesenteria]

There must be something else going on if you sleep more than 6 hours on average, and awaken regularly near or after that point with a low AHI indicated.  It's nothing to do with apnea or its treatment...unless you are letting small amounts of air past the cushion and it keeps arousing you.  That is possible, but after ten years you'd think you'd be well attuned to that problem and know how to fix it, even half asleep.

Have you consulted an endocrinologist?  Have you had a thyroid titration done?  Do you get out for 30 minutes of pretty brutal (fast) walking at least three times a week?  Do you eat nutritious foods mostly?  Do you have a mood disorder?

I could go on at length, but I think you must get my drift.  There's something else...…….

[Gideon]

Welcome to the forum.

As you noted, you are considered medically treated.  

I would like to see 3 two-minute zoom views,  First right click on the Flow Rate Graph title and set the yaxis range to 70 to -70 to provide a better view of the expanded flow rate.

2300, 0100, and 0400, I want to catch the RERA there.

I want to get a good idea of your flow limits.  I know you have them because of your hypopneas and the RERAs.  

When are you do for a machine refresh?
I see the RERAs and know that you have flow limits, and they could be causing your problem.  Think of a spectrum of events from Apnea, to Hypopnea, to flow limits, to normal.  Flow limits don't "count" toward anything but you possibly not feeling as good as you would like to.

Now what you don't want to hear.  I would like you to try a ResMed machine.  The best would be the ResMed BiLevel VAuto, followed by the ResMed AirSense 10 AutoSet.  The worst would be a PR machine like you have.  The reason is the Flex does not act similar to Pressure Support and ResMeds EPR does up to its limit of 3cmw which is why a BiLevel is better>
Pressure support is the best way to treat flow limitations.

[AshSF]

I see you are using straight pressure so the variability of pressure is not messing with your sleep architecture.

Now the next suspect is low oxygen saturation on your current pressure. You can check that with a recording pulse oxymeter. If that is low, you can then consider a bilevel.

[Sybert1ger]

Thanks everyone for the support and suggestions.

 A little more background info and some more OSCAR readouts for you.

I'm nearly 40, 230 lbs, and 5'9". I was about 200 lbs and in my 20s when i was diagnosed but had been struggling with fatigue issues since at least college. I'm currently on a zoloft, welbutrin, and I just added Vyvanse. The Vyvanse helps a little during the day but doesn't do anything for how I feel when I wake up.

It's tough pinning down the root cause of my issues. Every specialist I see comes up with something that it could be from their field but treatments have always been about symptoms, never a root cause.

   
   
   

[muziccity]

Wow, your first line describing yourself could also describe me. It's eerily similar. My fatigue has just gotten worse and worse each month for the past 10 years. It's to the point that I have to time my naps just to make a doctors appointment. The main difference is that I just started CPAP. My biggest fear is that it wont help me. Like my next step would be to have all my teeth pulled cause maybe a root canal is leaking and causing something. Hell i dont know, thats how desperate I am. 

I wouldn't know what else to try if this doesnt work but I'm optimistic about it. I hope you're able to figure out what is going on with you.