Still Exhausted

[jhurlbut]

So I've been faithfully using my ResMed S9 for a good 6+ months. I just downloaded my data into Sleepyhead to find out my average usage is nearly 6 hours per night. (Last night was a record at 9 hours 23 minutes). My AHI over that time averages out to 0.69. But I am exhausted all the time. I feel like I get better sleep on the nights I don't use my machine than on the nights that I do. Also, my compliance is 100% for the past month and 89% for the 6 months. So there are very few nights I don't get over 4 hours of usage and even fewer where I don't use it at all. I even lugged the whole machine, humidifier and all, around a three country tour of Europe in September for 15 days. I'm using my machine, and by all accounts it's effective. Except I don't feel rested.

My buddy that talked me into getting a sleep study in the first place talked about how life changing his machine was. I want that. What am I missing?

Honestly if the FAA didn't want to see a report of my usage when I renew my medical for my private pilot's license I may just drop the thing in the garbage!

[player]

Are you getting a full 8 hrs sleep every night with the machine?

[jhurlbut]

As mentioned above average is about 6. Last night was a record at 9 hours 23 minutes.

[player]

Well if you only get 6 hrs no wonder you're tired...

[DeepBreathing]

First thing I'd say is congratulations for persisting even though you're not getting the results. The main aim of CPAP therapy is to restore restful sleep by controlling apneas and hypopneas. Your numbers say that these events are under control, so there must be another reason you're exhausted.

There could be other reasons not related to apnea, or there could be problems with your treatment. Other reasons could include anaemia, poor thyroid function, vitamin deficiency (especially vitamin D) and so on. To say nothing of personal and professional stress. Many of these things should be covered in your regular checkups, so a discussion with your GP might be in order.

There can be a whole range of problems with your CPAP therapy which don't necessarily show up in the AHI, but which can prevent you getting sufficient rest:

1. Your mask and headgear - are they comfortable? Do they fit well without being excessively tight? Are there minor leaks which might not show up on the charts but are irritating and might rouse you? Or are there major leaks which will stop you sleeping soundly and also render the AHI numbers suspect?

2. Your pressure is pretty high. Do you have difficulty exhaling against the pressure? If so, is your EPR set appropriately? Perhaps a bilevel machine (S9 VPAP or AirCurve 10) might be better suited to you.

3. The S9 AutoSet doesn't detect RERAs. It's possible you're experiencing a number of these which are disturbing your sleep. Did these show up in your sleep test? Likewise, you may be experiencing flow limitations, which will show up on your SleepyHead charts. Or are there extended periods of ragged breathing in the flow chart? These might indicate a problem.

4. Is your bed comfortable and supportive? Do you toss & turn in your sleep and/or wake up with aches and pains?

As you can see there is a wide range of factors beyond achieving a good AHI number which could be at play here. Work through them analytically and methodically to eliminate potential causes. Good luck!

[JudgeMental]

DeepBreathing has run through a whole gauntlet of possibilities for not feeling rested. BUT.. don't throw the machine in the ocean yet.. You might not be around next year to take your flight physical. And, as a private pilot, I want you to feel well and rested. Especially, if I'm in the air at the same time as you. The 4 hour compliance figure is totally meaningless toward feeling good. Its just a figure that insurers feel will give them their moneys worth. As we age, 8 hours of quality sleep is what is going to help us feel better and keep our health up to snuff. Your higher pressure does to me, indicate a definite need for PAP usage, if you were titrated for those numbers. Sometimes struggling against more higher numbers then needed can cause restless sleep. Perhaps the un-rested/tiredness feeling is being caused by something other then loss of sleep. Perhaps occupational stress or other. Hopefully success soon in your efforts.

[trish6hundred]

Hi jhurlbut,
I’m sorry to hear that you are still feeling exhausted.
I know that this is very frustrating for you, but don’t give up on your CPAP therapy.
Hopefully, you can work through the ideas mentioned in the posts above this one.
Much success to you as you continue to work through this exhausting and frustrating time and hang in there.

[jhurlbut]

Thanks for all the suggestions everyone!

I did stop taking my Kirkland Sleep Aide this week in an effort to get more natural sleep. Thinking maybe that was keeping me groggy into the next day. We'll see how that goes and go from there. Over 7 hours on the machine each of the last two nights and over 9 two nights this week, so we'll see.