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[Treatment] Low AHI but still tired - please help!
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khem26 Offline

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Posts: 5
Joined: Jul 2013

Machine: s9
Mask Type: Full face mask
Mask Make & Model: mirage quattro
Humidifier: h5
CPAP Pressure: unsure
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location:

Post: #1
Low AHI but still tired - please help!
Hello everyone!

I'm new to the forum and have been lurking checking out a ton of the posts which have really been helpful and informative.

Just a little background about myself, I am a 25 year old male living in Australia. 175cm (5'8) and 75kg(165lbs) and asian decent (if relevant). I lift weights 5 x a week and have a pretty active lifestyle. I was diagnosed with a mild-moderate apnea about 3 years ago and have been struggling with it ever since. I believe my first sleep test results were 15 episodes per hour.

I've had a go with CPAP as well as a Somnomed oral device, both of which have supposedly controlled my apneas to an acceptable level, but I still wake up feeling tired, unmotivated and lethargic! The advice I have gotten from 2 different sleep specialists is that, the devices are working as intended and basically dismiss me as a patient since the data shows I SHOULD be feeling better.

I use an s9 autoset with humidifier and typically get an AHI <5 with 7-8 hours of sleep a night with most days having 0 leak rate (based on sleephead software). I use an APAP pressure setting from 7-20. Could there be a reason why I am still tired even though my AHI is consistently a low reading?

One possibility I've consider is that my machine is an American model (I'm Australian), could there be any issues with the settings and/or pressure since I'm using an overseas model? Are there any difference between the USA and Australian builds?


I can also post my sleep data if that would help. What stats from my sleep data are most relevant so I know which to include when posting.

Thank you for taking the time to read guys, any help would be much appreciated
(This post was last modified: 08-05-2013 12:19 AM by khem26.)
08-05-2013 12:14 AM
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Tez62 Offline

Monitors

Posts: 837
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Melbourne, Australia

Post: #2
RE: Low AHI but still tired - please help!
khem26, welcome, I'm in Australia too, you won't be able to post the data till untill you have made a number of posts but it will be good to see. I would query why your high pressure is 20 if you only have mild / moderate SA. We are all different but I have servere SA and my pressures are 5-15 and I only hit 15 if I have mask leaks. If you are adjusting your pressures yourself you could try lowering the high bit by bit and see if that helps. The other thing is have you had a follow up sleep study since your first one to see if you have any other sleep disorders? My sister has sleep apnea then they found she also has mild Narcolepsy on the second sleep study. There is no real difference between the Australian and US version except for price and things like temperature settings are not in celcius.
08-05-2013 12:30 AM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #3
RE: Low AHI but still tired - please help!
Hi khem26, welcome to Apnea Board
S9 machines are made in either Australia or Singapore
There are no different, just you can set temp in C or F
7/8 hours of sleep is decent, do you sleep right thru?

Whats pressure/leak stats (median, 95% percentile, maximum) and breakdown of AHI
It can be something unrelated to CPAP, how long been using the machine, any medication/food supplement
08-05-2013 01:22 AM
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khem26 Offline

Members

Posts: 5
Joined: Jul 2013

Machine: s9
Mask Type: Full face mask
Mask Make & Model: mirage quattro
Humidifier: h5
CPAP Pressure: unsure
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location:

Post: #4
RE: Low AHI but still tired - please help!
Hi guys thank you for taking the time to reply.

Tez62 - Are you based in Sydney as well? The reason I have the pressure at 20 is that it was suggested by a cpap vendor when I went in to check if my machine was putting out the right setting. She explained the upper limit isn't to important as the machine will correctly put out the required pressure - is this explanation correct? I will try put the pressure down slowly and see if that has any positive effects. I did have a follow up sleep study done about 1-2 years ago where they got me to sleep during the day and did tests every so often (multiple times over a period) which if I recall, was to test for narcolepsy. The test came back negative but I am planning to do some further testing some time soon to get a different opinion. Is there any symptoms for narcolepsy which I should look out for ?

zonk - some nights I will get to sleep through, others I wake up and will have to reset the machine since the pressure is difficult to get back to sleep with. My ramp time is 15 minutes, but if I wake up during night I will change it to 5 minutes before I try to go back to sleep.

My pressure break down is (which I have taken from a sample day recently)
PressurePressure (cmH20)
Min 5.18
Med 11.02
95% 18.44
Max 19.68

with AHI breakdown:
AHI: 6.57
Hypopnea 1.07
Apnea 0.00
Obstructive 2.82
Clear Airway 2.68

I have had the cpap machine for about 2-3 years but have only seriously used it for a brief period at the start (which I did not take seriously). But I have been more commited in the last few months to give it a shot. Could there be any problems with the machine? Should I get this checked?

I am asthmatic and take some Ventolin (or something similar) regularly. I have taken some creatine (supplement) for brief periods over the last year or so also.
(This post was last modified: 08-05-2013 07:10 AM by khem26.)
08-05-2013 07:09 AM
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khem26 Offline

Members

Posts: 5
Joined: Jul 2013

Machine: s9
Mask Type: Full face mask
Mask Make & Model: mirage quattro
Humidifier: h5
CPAP Pressure: unsure
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location:

Post: #5
RE: Low AHI but still tired - please help!
Sorry guys I also forgot to add that my original prescribed settings for CPAP was 12.
08-05-2013 07:30 AM
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trish6hundred Offline

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Posts: 6,436
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: Low AHI but still tired - please help!
Hi khem26,
WELCOME! to the forum.!
Hang in there for more responses to your post and best of luck.

trish6hundred
08-05-2013 09:26 AM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #7
RE: Low AHI but still tired - please help!
(08-05-2013 07:09 AM)khem26 Wrote:  I am asthmatic and take some Ventolin (or something similar) regularly. I have taken some creatine (supplement) for brief periods over the last year or so also.
Google creatine asthma, you find some links and discussions on body building forums
The Mayo Clinic states that creatine has been associated with asthmatic symptoms and warns against consumption by persons with known allergies to creatine http://www.mayoclinic.com/health/creatin...ION=safety

95% and maximum pressure 18/19, seem to me the pressure is running away and maybe the cause for those central events
Not always the machine find the correct pressure, as the machine programed to increase pressure in response to flow limitation and if one have a problem with flow limitation, the pressure can reach the maximum, some people do better on straight CPAP

Try sleep on your side, less pressure on the side vs on backs, a tennis ball inside a sock (or bum bag) fastened on back of pyjama tops can help to stay on the side and prevents rolling on the back while asleep
08-05-2013 05:34 PM
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Tez62 Offline

Monitors

Posts: 837
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Melbourne, Australia

Post: #8
RE: Low AHI but still tired - please help!
(08-05-2013 07:09 AM)khem26 Wrote:  Hi guys thank you for taking the time to reply.

Tez62 - Are you based in Sydney as well? The reason I have the pressure at 20 is that it was suggested by a cpap vendor when I went in to check if my machine was putting out the right setting. She explained the upper limit isn't to important as the machine will correctly put out the required pressure - is this explanation correct? I will try put the pressure down slowly and see if that has any positive effects. I did have a follow up sleep study done about 1-2 years ago where they got me to sleep during the day and did tests every so often (multiple times over a period) which if I recall, was to test for narcolepsy. The test came back negative but I am planning to do some further testing some time soon to get a different opinion. Is there any symptoms for narcolepsy which I should look out for ?

zonk - some nights I will get to sleep through, others I wake up and will have to reset the machine since the pressure is difficult to get back to sleep with. My ramp time is 15 minutes, but if I wake up during night I will change it to 5 minutes before I try to go back to sleep.

My pressure break down is (which I have taken from a sample day recently)
PressurePressure (cmH20)
Min 5.18
Med 11.02
95% 18.44
Max 19.68

with AHI breakdown:
AHI: 6.57
Hypopnea 1.07
Apnea 0.00
Obstructive 2.82
Clear Airway 2.68

I have had the cpap machine for about 2-3 years but have only seriously used it for a brief period at the start (which I did not take seriously). But I have been more commited in the last few months to give it a shot. Could there be any problems with the machine? Should I get this checked?

I am asthmatic and take some Ventolin (or something similar) regularly. I have taken some creatine (supplement) for brief periods over the last year or so also.

khem26, I live in Melbourne, the CPAP vendor is sort of right, there are two schools of thought, some people have their pressures set at large differences like you have as an auto CPAP should adjust, others prefer a minimal range between the high and low. Some people think if your pressure is too high above your required pressure it can cause centrals which is possible in some people, I already have complex SA (both obstructive and central) so it doesn't affect me. That is what Zonk was saying. Are you using Sleepyhead or Res Scan software to look at your data? You will be able to tell from that and when you can post it we can help you read it if necessary.
Re the Ramp setting again everyone has a different opinion but my pressures are 5-15, I have the ramp on 5 for 30mins that way if I go to the toilet and turn it back on I don't have to adjust the pressure settings, it stays at 5 for the next 30 mins till I fall asleep again then becomes auto.
Your AHI of 6.57 is too high it should be below 5 but that is just one night of data, you need to take it over a week or more. Some of that is made up of clear airway or centrals so lowering the high pressure may help that.
The machine should be Ok if it is only 2-3 years old, try working on your pressures and also try to minimise leaks as much as possible.
08-05-2013 06:37 PM
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Sleepster Offline
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Posts: 4,993
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #9
RE: Low AHI but still tired - please help!
(08-05-2013 07:09 AM)khem26 Wrote:  I have had the cpap machine for about 2-3 years but have only seriously used it for a brief period at the start (which I did not take seriously). But I have been more commited in the last few months to give it a shot.

I suspect that being "more committed" is your problem. You must be fully committed to using your machine whenever you are asleep, even for a nap.

Do not ever sleep without the machine.

Your mind and body must adapt to a new condition -- being able to breathe and sleep at the same time. As long as your mind is still unconvinced that you can do both of these things at the same time it will keep waking your body up to make sure it's breathing. Even if you are not aware of these awakenings they are happening and they are what's making you feel tired during the day.

If you use the machine every time you sleep you will adapt. If you spend any time at all sleeping without it you are sending that old familiar signal to your brain that it's not safe to sleep, and it says "I told you so, you just can't trust this guy to keep breathing while he's sleeping."

As you get older you will find that the extra wear and tear on your cardiovascular system will do more damage than simply make you feel sleepy during the day.

I have been on CPAP therapy for 21 months and I am still adapting. It has taken me this long to get this far. I have made a LOT of progress and I have more to make. I had 56 years to learn how to sleep without being able to breathe, and it will take time to undo that conditioning.

Be patient and don't give up. Your life depends on it.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
08-05-2013 08:58 PM
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mousetrap Offline

Members

Posts: 17
Joined: Jul 2013

Machine: Philips System One 60 Series Auto
Mask Type: Nasal mask
Mask Make & Model: Philips Wisp
Humidifier: Philips System One
CPAP Pressure: 8-16 APAP
CPAP Software: SleepyHead

Other Comments: And my nightshift manager use to say "Sleep is for the weak..."

Sex: Male
Location: Sydney, Australia

Post: #10
RE: Low AHI but still tired - please help!
Hi khem26, another Sydneysider here Smile

Sorry if you have covered this already but have you considered that giving the AHI figures you are already getting, the problem may not be sleep related but something else such as a dietary deficiency?
08-05-2013 10:06 PM
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