Still exhausted with low AHI

[napnaptime]

Others already pointed out there could be other reasons for your tiredness.

I have mild apnea.

I was greatly helped by apap treatment, then it deteriorated. I recently discovered it was due to leaks. They registered in the normal range for my apap, so I didn't pay attention to it before. However, I got seriously drooping eyelid on several occasions and read somewhere this could be due to apnea. So I realized something was wrong (aside from going through life again as a zombie). I noticed that frequently my nasal pillows had shifted and leaked air. So I fixed the issue with better headgear. I've been flying since. I seem to be very high strung when it comes to oxygen supply.

Little things that may give an indication of what makes a difference for you. Are they mornings you feel better? Was something different?

The trap with this condition, at least in my case, is that when things deteriorate, my energy levels drop and I'm less likely to try new alternatives to improve matters. In the end I do, but it costs more time than when I'm feeling great.

I checked my leaks were less than 1 most nights. My AHI most days is between 0.3 and 0.8 sometimes going slightly above 1, when I wake up in the morning I am always tired, I am tired for the entire day and never feel refreshed. I get 8 hours of sleep every night I have tried less and more sleep, sleeping in different rooms, on holiday I had the same issue with tiredness so it isn't a climate or sunshine issue.

I have serious memory issues as well as fatigue, according to the doctors I am in excellent health but two respiratory consultants say my fatigue is still very bad my score has improved but I still score 17/24 on the Epworth Sleepiness Scale.

I have had the following tested

2 Heart ECG
3 MRIs
EEG test
3 Full blood panels
Psychological testing
Psychiatric testing by 4 different consultant psychiatrists
6 month observation at part time psychiatric service
Seen ENT
Seen by two respiratory experts including the top in my country
Sleep study with MSLT
Seen 4 GPs

The only time I feel normal is when I take Sertraline or get mildly drunk before sleep which both seriously disrupt REM but both options carry serious side effects for me. I got slightly drunk today and when I woke up from my nap I felt amazing.

[eseedhouse]

Have you had an overnight oxymetry? That's a continuous measurement of the oxygen levels in your blood. If you have complex apnea you can still have low oxygen levels even with a low AHI. That's what happened in my case. Make sure you know that your oxygen levels are staying above 90% the whole night. If not then this may be the cause of your fatigue. Not saying it is, just that you should get that checked if you haven't already.

[Jim Bronson]

If you're falling asleep during conversations, you may want to mention narcolepsy to your doc.

[napnaptime]

Narcolepsy was ruled out with MSLT in fact I couldn't sleep at all the next day even though I got 2 hours sleep, I lay down fatigued.
Oxymetry was tested during the sleep study and in a 24 hour period at home I got 93%
I tend not to fall asleep any more during conversations but I am fatigued most of the time it makes no difference whether I am active or not.

[eseedhouse]

Sertraline is an antidepressant and depression can cause fatigue. If it helped I would keep taking it since you usually need to be on it for some weeks before it takes effect. I used it myself many years ago. Just taper off slowly when you go off it. Antidepressants can cause bad depression if you just stop them or don't taper off slowly enough. I know this by experience.

[napnaptime]

Sertraline is an antidepressant and depression can cause fatigue. If it helped I would keep taking it since you usually need to be on it for some weeks before it takes effect. I used it myself many years ago. Just taper off slowly when you go off it. Antidepressants can cause bad depression if you just stop them or don't taper off slowly enough. I know this by experience.

I can't since it makes me very angry and depressed, they believed at first it was depression and then bipolar however I did not respond to any of the medication they gave me and all psychiatric disorders have been ruled out the only thing they noticed was that I fell asleep in conversation and had a very bad attention span but this has improved since CPAP but my tiredness and memory are still very bad, I am like this when I am very happy, when I do an activity or when I sit on my own.

[Sleepster]

I checked my leaks were less than 1 most nights.

How did you check that? I see that your leak rates may be higher than that for significant periods of time. It's impossible to tell from the graph you posted because of the scale. Statistics about leak rates may not be enough to determine if they're interfering with your sleep. Poor quality sleep is caused by apneas, but it's also caused by disruptions such as high leak rates that last for short periods of time. On average the leak rate looks good, the peak leak rate is acceptable, but the graph can still show those extended periods of higher leak rate.

I suggest that we start by you filling out your profile. That way we can see the basic therapy information we need. There are a lot of very knowledgeable people here who can provide you with a lot of help.

I got slightly drunk today and when I woke up from my nap I felt amazing.

That's a sign that the CPAP machine is allowing you to get some good quality deep sleep.

Sedatives, such as antidepressants and alcohol, will affect your sleep patterns in strange ways. It takes a long time to get over these effects after you stop taking them, both physically and mentally.

You are going to need to find a good doctor who can get your medication treatment under control.

Are you interested in abandoning alcohol and making some major lifestyle changes that might improve your condition?

[napnaptime]

I checked my leaks were less than 1 most nights.

How did you check that? I see that your leak rates may be higher than that for significant periods of time. It's impossible to tell from the graph you posted because of the scale. Statistics about leak rates may not be enough to determine if they're interfering with your sleep. Poor quality sleep is caused by apneas, but it's also caused by disruptions such as high leak rates that last for short periods of time. On average the leak rate looks good, the peak leak rate is acceptable, but the graph can still show those extended periods of higher leak rate.

I suggest that we start by you filling out your profile. That way we can see the basic therapy information we need. There are a lot of very knowledgeable people here who can provide you with a lot of help.

I got slightly drunk today and when I woke up from my nap I felt amazing.

That's a sign that the CPAP machine is allowing you to get some good quality deep sleep.

Sedatives, such as antidepressants and alcohol, will affect your sleep patterns in strange ways. It takes a long time to get over these effects after you stop taking them, both physically and mentally.

You are going to need to find a good doctor who can get your medication treatment under control.

Are you interested in abandoning alcohol and making some major lifestyle changes that might improve your condition?

I never drink at all I simply drank that one night to see if my sleep would improve prior to that the last time I drank was 4 months previous in moderation. I haven't been on sedatives or any other form of medication for two years.

[Terry]

I am still so badly fatigued that I cannot work, my memory is also really bad and getting worse. I feel like I am dying of the tiredness. I don't wake up at all during the night and my mask is comfy, it is just horrible.

Just because you don't notice yourself waking up, doesn't mean you're sleeping properly. you could easily be missing one or more stages of sleep, even if you don't have apneas. Flow limitations, for example can disturb sleep, without being scored as apneas (or even FLs on some machines).

I'd go back for another sleep study and have them see what's going on at night.

At the very least, turn on "custom event flagging" in sleepyhead for 20% and 50%, set your measurement unit to RDI instead of AHI and see what shows up.

[napnaptime]

I am still so badly fatigued that I cannot work, my memory is also really bad and getting worse. I feel like I am dying of the tiredness. I don't wake up at all during the night and my mask is comfy, it is just horrible.

Just because you don't notice yourself waking up, doesn't mean you're sleeping properly. you could easily be missing one or more stages of sleep, even if you don't have apneas. Flow limitations, for example can disturb sleep, without being scored as apneas (or even FLs on some machines).

I'd go back for another sleep study and have them see what's going on at night.

At the very least, turn on "custom event flagging" in sleepyhead for 20% and 50%, set your measurement unit to RDI instead of AHI and see what shows up.

I will try go back for another study but it will take a year maybe two before I can be seen, the beauty of socialised medicine ;(