Persistant slog feeling with "great" treatment. Thoughts please.

[IUsedToSnore]

Thank you in advance to everyone that has helped me here in the last few months. I've posted a couple of times about low AHI, but continuing morning grogginess, daytime fatigue and chronic middle of the night insomnia. Some folks have recommended turning the EPR on. I *think* I might feel a tinge better with it, but I can't really tell. It's not a dramatic improvement or hindrance it seems

So, I've been on APAP (Resmed Airsense Autoset For Her) since the beginning of December and, although I've had MAJOR improvement, I'm still pretty sluggish, morning headache, etc. My brain still doesn't feel "awake". I was initially diagnosed with "moderate obstructive apnea" although all of my apneas were centrals and hypopneas. (They weren't sure whether those were central hypopneas, obstructive hypopneas or reras because the sleep study wasn't that sensitive.) My AHI is low - averaging around 1.3, and my compliance is really good.

So, I had a follow up with the doc today where I asked if he would be willing to prescribe a bi-pap to see if it would help, with my thinking being that maybe there were very short events happening that my Resmed wasn't picking up - like RERAs. I'm currently using the Resmed 10 for her with a EPR of 2 or 3 each night. My average pressure is between 6.5 and 7.5. His theory is that an auto bi-pap wouldn't be helpful because my pressure is already so low. I just thought I'd get people's thoughts here about that.

Also, he prescribed Modafinil for the daytime fatigue, but after a decade of various stimulant medications (I was misdiagnosed as having ADHD), I don't really want to start with that kind of stuff again. It seems like a bandaid, and other meds like Vyvanse and Adderall made me feel miserable and strung out. If sleep is the problem, I'd rather deal with the sleep issues.

I guess my question is, is this as good as it's going to get from sleep therapy, and is there anything at all that I need to or could be doing to improve my daytime functioning?

A little background:
-Lifetime of Apneatic stuff
-Decade of orthodontia including the removal of adult teeth due to crowding
-Removal of Adenoids as a child
-Former mouth breather (that resolved when the Adenoids were taken out and has improved with APAP usage
-Snoring seems to have resolved with APAP
-Thin - 125 lbs, 5'4" female (used to be VERY thin - had a hard time gaining weight until my 40's)
-I've had all the bloodwork you could ever think of repeatedly
-Currently a participant in the Apnea/CBT-i research study at Stanford/National Jewish for people who have continuing insomnia with CPAP therapy

I don't care about money. I'm willing to buy a used Bi-pap, get a more intrusive sleep study, etc. I just don't want to waste a lot of time dicking around with stuff that isn't going to address the root of the problem.

Any recommendations would be helpful.

Here's a couple of recent nights' sleep and a copy of the sleep study again. I think some of the Centrals are me just turning over or taking a deep breath and being mismarked.

[jaswilliams]

A bilevel machine won't do any better for you than the machine you have. You need to look else where for your tiredness as your Obstructive Apnoea is adequately treated.

[sheepless]

or work toward getting an asv, the only machine that will treat ca. you're sleep test was ca & h, no oa, so it isn't treatment emergent. with your low ahi, you won't get much help from doc & insurance unless you stress that you will self fund, avoiding insurance. best to overwhelm the doc with documented complaints & be politely assertive about the need to treat your ca. that's assuming it's ca that's leaving you feel bad. could be something else entirely. I will say that 15 ca would make me feel lousy.

[SarcasticDave94]

I'd go with what sheepless says. Rely heavy on symptom continuing and voice complaints every time.

[optimalsleep]

Not feeling good with a Low AHI.... means something. It means the CA's are bothering you possibly.

Details Events Notes Bookmarks

(orange bar) AHI

Left click events, double left click clear airway events.. numbered 1- whatever. Left click a numbered event.

Post a screen shot of the 2 minute segment of a few CA's......

[AshSF]

I was in a similar situation. AHI < 1 always but feeling crappy thru out the day.

I switched to constant pressure and all that went away.

Then I researched and found a paper on pubmed that said that upto 17% of people on xPAP have microarousals (switches from deeper sleep stage to a shallower one) due to changes in pressure. This leads to bad sleep architecture with less sleep in deeper stages. For them, constant pressure is the way to go.

I would suggest you put the machine in a constant 7cm pressure and see how you feel after a week.

The other reason could be that you are not getting enough spo2 at such low pressure. You can buy a recording pulse ox and check that. One of the ways to improve oxygenation is raise minimum pressure.