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Unknown sleep issues/responding poorly to cpap
#1
Unknown sleep issues/responding poorly to cpap
I'm 25 year old man who's been dealing with fatigue issues for the past 10 years. I've seen numerous doctors who haven't been able to reach any definitive conclusions, and am kind of at my wit's end/looking for any other potential answers.

My primary symptoms are being very mentally exhausted, I constantly feel like mentally I'm completely drained and unable to think. I'm generally not very physically tired, but if I close my eyes for a few seconds they start to feel heavy and I can feel myself space out. I take adderall for ADHD and this persists even when I take it. I can be very focused, but just unable to grasp my thoughts together due to the exhaustion.

Previously I thought this was likely sleep apnea, and have seen a sleep medicine doctor for the past 2 years. I initially underwent an in-clinic sleep test, however I was barely able to sleep in-clinic, afterwards my results showed 0 REM sleep, and the doctors told me that the results were inconclusive. I then underwent an at home sleep study, the results of which showed that I did not have obstructive sleep apnea, however there was some suspicion that I may have upper airway resistance syndrome. I was then prescribed an auto cpap to see if it would have any effect.

Using the CPAP has been a somewhat mixed experience. When I use it, I report very low AHI (<2), however I wake up multiple times a night, and wake up feeling somewhat still tired. Because I wake up multiple times I regularly have to spend 12+ hours in bed to get an adequate amount of sleep. Throughout the day most of my mental exhaustion is gone, however I feel extremely loopy. I constantly lose my train of thought, and struggle alot more with complex tasks.  Additionally my peripheral sense is a lot worse, and I'm constantly caught off guard by things in my periphery & am a lot more clumsy.

I asked my doctor if this could potentially be central sleep apnea, as from my understanding it isn't detected by at-home tests, and cannot be treated with a regular cpap/autopap, however they told me that was extremely unlikely. My doctor has effectively run out of ideas now, and has suggested that this may not be a sleep issue.

At this point I'm literally looking for any anything suggestions for what this could be. This issue is massively effecting my life, and I'm prepared to explore any potential solutions.
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#2
RE: Unknown sleep issues/responding poorly to cpap
Welcome

We need more information to help you, but I do see that your pressure settings are too low.  Your pressure range is 5-10, and most adults need at least 7 as their starting number.  I suggest that you change your pressure range to 7-15, and see if you feel any better.

To offer more help we need to see data.  Download Oscar, our free apnea reporting program that is used to create wonderful charts that show many details about each night's sleep.  With that information, we can probably help you sleep and feel better.  There's a link to Oscar at the top of every page.  It will tell you how to set it up and use it.  Best of luck!  Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#3
RE: Unknown sleep issues/responding poorly to cpap
Just following up here, I saw another doctor for a 2nd opinion, and it turns out I actually have upper airway resistance syndrome instead of sleep apnea.

I'm now using a Bipap, and my sleep quality has improved a moderate amount, however I'm still waking up a decent number of times throughout the night.

Here's is my oscar data for some previous nights. I would greatly appreciate it if someone was able to take a look at it and tell me if they see anything of note.

           
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#4
RE: Unknown sleep issues/responding poorly to cpap
Your leaks are occasionally a bit high, and your EPAP of 4 is too low. I would move both EPAP and IPAP up by 2 to 6-12.
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#5
RE: Unknown sleep issues/responding poorly to cpap
Hi Apnea4862, Dave is spot on with his suggestions, your 99.5 percent min epap is 5.7 so set it to 6cm to begin with and raising min ipap too will help.
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