Sleep Data Much Improved, but Symptoms Unchanged

[SunMesa]

I've only been trying PAP therapy for about a week now, so it may be premature to bring this up in my case, but perhaps it's a question of general interest.

I've had daytime symptoms for many months that align pretty closely with classic OSA, and in fact a Snap Diagnostics sleep test in May did show mild-to-moderate OSA (mild using the 4% O2 decrease criterion, moderate using the 3% criterion), with negligible CSA (one event total).

My doctor recommended trying some kind of PAP therapy. I tried EPAP first (essentially silicone check valves inserted into the nostrils), but they had no noticeable effect on either SpO2 or daytime symptoms. So, I decided to try APAP.

Using the AirSense 10 (at quite mild pressure levels) over the last week eliminated OSA's *completely*, although now CSA's are more common, and presumably induced by the treatment itself. Nevertheless, the AHI index, at least as calculated by OSCAR (in the absence of SpO2 data), is generally staying well below 5. A Wellue O2Ring is showing that my SpO2 levels are also much better, rarely and only briefly dropping below 90%, whereas previously I would commonly spend 2-3 hrs below 90%.

Nevertheless, my daytime symptoms have not changed appreciably, at least not yet. So my question to the community is, what is the typical delay (if any) between significant improvement in sleep parameters (e.g., for simplicity's sake, OSCAR's AHI Index) and significant improvement in daytime symptoms (drowsiness, weakness, fatigue, headache, cognitive fog, irritability, etc)?

And, amongst those (if any) whose daytime symptoms never resolved (suggesting that OSA/CSA had little or nothing to do with them), was there eventually an alternate source of these symptoms found, and what was it?

Thanks for any feedback!

[Dormeo]

I don't think there's a "typical" length of time before people see improvement in daytime symptoms. Partly this is because people get used to the PAP experience after different amounts of time. There's also a phenomenon called "sleep debt" that will differ from one person to another.

I would give PAP therapy several months before you decide whether to pursue other diagnoses. Meanwhile, could you post an Oscar chart so we can see what's going on?

Just because you asked: sometimes several conditions contribute to the kinds of symptoms you describe -- sleep apnea plus one or more of something else. Common culprits can be detected with testing for thyroid function, testosterone levels, iron deficiency, deficiencies in vitamin D and B vitamins, and autoimmune diseases, especially in the connective-tissue-disease family. Worth exploring if they're a possibility: long Covid and Lyme disease.

[HalfAsleep]

2 things...

1. Post a night using the Oscar app and following exact directions in Apneaboard menu; someone can glance at it to confirm you're indeed headed in the right direction.

2. It can take MANY WEEKS to get the full benefit of xPAP therapy, even if your numbers are the best they can be. Your body is not data, and is very individual. It has to adjust to alot! And you might not recognize it right away when your body gets the hang of it, because you are so unfamiliar with the "I slept well last night" feeling.
FWIW I was stuporous for the first 6 weeks on xPAP. It's many months later, and I still have bad nights (like the night I forgot to turn on the unit after a bathroom break). There's so much to learn, and not just for your body.

[SunMesa]

Dormeo, HalfAsleep, thanks for your feedback.

I didn't necessarily want to focus on my own case too deeply for discussion of this broad issue, but here is my OSCAR output from last night, including the O2Ring data (yellow highlights indicate being awake):

   

The three nights prior to that are available on a previous thread (Anomalous CA/CSR output from OSCAR?).

The results of principal interest to me overall are (1) OSA's went to zero on night one, and have stayed there since, and (2) SpO2 is back at acceptable levels (maybe still a little low, but I'm also at ~6000 ft elevation).

There are definitely other possibilities in play with my case, including positive for West Nile virus, nasal structure defects (incl. deviated septum) due to skin cancer surgeries, possible cardiac issues (stress test fine, but minor signaling glitches detected, occasional palpitations... getting echocardiogram this week).

Another question that relates directly to this thread's question is: Can chronic OSA, left untreated for a sufficiently long time, cause permanent damage in some bodily organ/system, such that even if the apneas themselves are ultimately eliminated (say, by PAP therapy), your symptoms nevertheless persist?