After seven years of being treated for various mood disorders, I was diagnosed with mixed apnea, idiopathic hypersomnia*, and REM behavior disorder (RBD) last year. With seven months of APAP therapy (73% compliance rate), my AHI hovers at 2.5-4.0 (down from 20.0 at my diagnosis). During the diagnostic studies, I exhibited no stage 3 sleep.
However, I'm still exhausted and my doctor's apathy is demoralizing. Since my numbers look reasonably good (I don't think I qualify for ASV), she shrugs her shoulders. In her defense, I'm not a "typical" sleep disorder candidate, since I'm in my 20s and have a BMI of 21. I eat healthily, run thrice a week, walk and hike often, and sleep 7-9 hours a night. She says there's nothing else we can do about the hypersomnia* and RBD. I'm not responding to melatonin and discontinued Adderall after unpleasant side effects. I'm on no other medication, although I take 2000mg fish oil and Vitamin D supplement.
I've attached the SleepyHead output for last night if that's of any help -- I'm still figuring out the software so sorry if it's not in the best format. It looks like a pretty good night's sleep (9 hrs and AHI < 2) but I woke up exhausted and have been dead tired since. Scanning the past few weeks' reports, I've noticed that my mask leaks during the last third of the night. However, there are almost never any large leaks. I've tried sleeping on a flat pillow and also on a wedge pillow. No difference.
I feel like I've hit a dead-end and don't know what to do next. Maybe the problem is less the apnea and more the RBD and hypersomnia, which I have no way of monitoring or addressing. Any advice or suggestions would be helpful. Thank you for reading my rant.
* All signs point to narcolepsy according to my doctor. However, we didn't proceed with confirmatory tests because she says the treatment wouldn't differ.