08-04-2024, 01:29 PM
Persistent CA events and fatigue with low-ish AHI
Hello all.
I am new here and, while I am enormously grateful for all that I have learned in reading through the posts here over the last couple of months, I have yet to find a solution that helps with my current difficulties, so I am starting my own thread. Any thoughts or advice would be very much appreciated.
Because this is a rather long post, I will summarize it here at the start - more information can be found below and I am of course happy to answer any questions. Thank you all so much for reading.
Short version:
I have a "mild" sleep apnea diagnosis. After more than four months on APAP, my AHI is hovering around 1.5-1.7 and my daytime fatigue and brain fog is actually getting much worse. Almost all recorded events are CA events, often (but not always) occurring more frequently during the second half of my sleep period. Because AHI is low, my doctor does not believe that my fatigue and cognitive problems are related to sleep apnea - I am not sure, but would welcome any advice from those here. Thank you.
Long version:
I received an obstructive sleep apnea diagnosis just over five months ago. The diagnosis itself was "mild" obstructive sleep apnea (9.5 AHI), with "Positional component noted with an increased AHI while in the supine position, REI-26.3" - I was subsequently told that if I had not rolled onto my back for the last hour or two of my sleep, I would not have been diagnosed as my AHI remained around 2 while on my side (my usual manner of sleeping). I was only given the report summary, but no centrals were noted.
I am fairly fit and my current BMI is ~21. I get at least an hour of cardio in most days, often more.
For many years, I have struggled with insomnia and anxiety, which often inhibits both sleep onset and my ability to remain asleep - this often makes it difficult to discern the cause of sleep disturbance unless there is an obvious feature.
Possibly related to my apnea and certainly related to my sleep issues more generally, I have chronic sinus congestion and swelling. A series of ENTs have been little help in this regard. I am still a nose breather, but maintaining this often requires a lot of rolling back and forth at night, nasal sprays, nose strips, etc.
I was fortunate to get a ResMed Airsense 11 very quickly and have been using it every night since, with the exception of a 12-day thru hike when I used an AirMini.
For the first month or so, I had a lot of difficulty getting used to being on the machine, set to APAP 5-15, but eventually got to a place where I am able to sleep through the night, even if seep onset is still somewhat delayed.
Once things settled in to a routine around the second month, my AHI averaged around 0.3-0.7, with almost all events (95-99%) being CA events, with only a few exceptions outside of that. The problem came with the fact that I was not feeling less tired: spaciness, brain fog and a feeling of general fatigue not only persisted, it was worse than ever. This lasted most of month three, until, over the course of month four and into month five, my AHI began to creep up again (current average is around 1.5-1.7) and the already disruptive brain fog and fatigue became still worse, reaching a level where not only my personal life, but my employment is hanging by a thread and I may soon not be able to continue.
Because the AHI, even on my worst nights, remains well under 5, my doctor has told me that he is "not concerned" and does not believe my fatigue is related to sleep apnea and that the (often clustered) CA events are simply "normal." This may be the case - I honestly do not know. Some nights the CA events are spaced more or less evenly throughout the night, but more often than not, almost all of them occur during the second half of the sleep period. Sometimes this follows my waking up to use the bathroom, while at others I find myself waking up briefly every hour or so - I have not noticed that the subjective experience of fatigue and brain fog corresponds directly to having had a better or worse sleep the night prior.
I am currently using a ResMed n30i nasal cushion. Some nights I find that a fair number of large leaks get recorded, while on others, there are no large leaks at all - I am not sure why this occurs, but the leak frequency does not (to my eyes) appear to correspond with recorded events.
Thank you so much for reading - I would be very, very grateful for any advice. I have attached screenshots from the last two nights, which I feel are fairly typical. Fatigue felt especially bad yesterday (i.e. following the night of 2. Aug).
Thanks again.
I am new here and, while I am enormously grateful for all that I have learned in reading through the posts here over the last couple of months, I have yet to find a solution that helps with my current difficulties, so I am starting my own thread. Any thoughts or advice would be very much appreciated.
Because this is a rather long post, I will summarize it here at the start - more information can be found below and I am of course happy to answer any questions. Thank you all so much for reading.
Short version:
I have a "mild" sleep apnea diagnosis. After more than four months on APAP, my AHI is hovering around 1.5-1.7 and my daytime fatigue and brain fog is actually getting much worse. Almost all recorded events are CA events, often (but not always) occurring more frequently during the second half of my sleep period. Because AHI is low, my doctor does not believe that my fatigue and cognitive problems are related to sleep apnea - I am not sure, but would welcome any advice from those here. Thank you.
Long version:
I received an obstructive sleep apnea diagnosis just over five months ago. The diagnosis itself was "mild" obstructive sleep apnea (9.5 AHI), with "Positional component noted with an increased AHI while in the supine position, REI-26.3" - I was subsequently told that if I had not rolled onto my back for the last hour or two of my sleep, I would not have been diagnosed as my AHI remained around 2 while on my side (my usual manner of sleeping). I was only given the report summary, but no centrals were noted.
I am fairly fit and my current BMI is ~21. I get at least an hour of cardio in most days, often more.
For many years, I have struggled with insomnia and anxiety, which often inhibits both sleep onset and my ability to remain asleep - this often makes it difficult to discern the cause of sleep disturbance unless there is an obvious feature.
Possibly related to my apnea and certainly related to my sleep issues more generally, I have chronic sinus congestion and swelling. A series of ENTs have been little help in this regard. I am still a nose breather, but maintaining this often requires a lot of rolling back and forth at night, nasal sprays, nose strips, etc.
I was fortunate to get a ResMed Airsense 11 very quickly and have been using it every night since, with the exception of a 12-day thru hike when I used an AirMini.
For the first month or so, I had a lot of difficulty getting used to being on the machine, set to APAP 5-15, but eventually got to a place where I am able to sleep through the night, even if seep onset is still somewhat delayed.
Once things settled in to a routine around the second month, my AHI averaged around 0.3-0.7, with almost all events (95-99%) being CA events, with only a few exceptions outside of that. The problem came with the fact that I was not feeling less tired: spaciness, brain fog and a feeling of general fatigue not only persisted, it was worse than ever. This lasted most of month three, until, over the course of month four and into month five, my AHI began to creep up again (current average is around 1.5-1.7) and the already disruptive brain fog and fatigue became still worse, reaching a level where not only my personal life, but my employment is hanging by a thread and I may soon not be able to continue.
Because the AHI, even on my worst nights, remains well under 5, my doctor has told me that he is "not concerned" and does not believe my fatigue is related to sleep apnea and that the (often clustered) CA events are simply "normal." This may be the case - I honestly do not know. Some nights the CA events are spaced more or less evenly throughout the night, but more often than not, almost all of them occur during the second half of the sleep period. Sometimes this follows my waking up to use the bathroom, while at others I find myself waking up briefly every hour or so - I have not noticed that the subjective experience of fatigue and brain fog corresponds directly to having had a better or worse sleep the night prior.
I am currently using a ResMed n30i nasal cushion. Some nights I find that a fair number of large leaks get recorded, while on others, there are no large leaks at all - I am not sure why this occurs, but the leak frequency does not (to my eyes) appear to correspond with recorded events.
Thank you so much for reading - I would be very, very grateful for any advice. I have attached screenshots from the last two nights, which I feel are fairly typical. Fatigue felt especially bad yesterday (i.e. following the night of 2. Aug).
Thanks again.
