27 y.o. male, new to CPAP, AHI<2, extreme fatigue

[fitandfatigued97]

Hi everyone,

I'm in my late 20s, have had previous surgery for OSA and have just started a CPAP trial a week ago.

Currently, I'm struggling a great deal with what I believe are symptoms some sort of sleep disorder.

I feel significantly impacted by extreme fatigue, grogginess, headaches, and clouded thought, almost every day. I'm barely functional.

Really hoping someone here will be able to offer me some advice in relation to the PAP therapy I started through a local clinic a week ago, which doesn't seem to be working for me.

My GP is difficult to get in to see but I have got an appointment in a few weeks to ask for a referral to a sleep physician. Due to where I am located, it could take months to see a sleep specialist. The health system/infrastructure where I live is not the best in Australia.

Quick hx of my journey so far:

• Late 2019 - Diagnosed with borderline Mild-Moderate OSA. Sleep study conducted: Overall AHI = 14.5. Worth noting supine NREM AHI = 49.5
  
• Late 2020 - Surgery: UPPP including tonsillectomy, septoplasty and turbinate reduction
  
• Late 2020 - Diagnosed with positional (supine) sleep apnoea post surgery. Sleep study conducted: AHI = 7.7 
  
• Late 2020 - Issued with Night Shift Positional Device. Sleep study conducted: AHI = 3.7
  
• 2021-2023 Used Night Shift device with relatively good results. Never felt completely rested, always tired, but able to function pretty well.
  
• Early 2024 - Night shift device failed. Couldn't afford another. Sleeping with backpack on commenced, to keep myself on my side.
  
• July 2024 - Commenced CPAP trial. 1 day during trial I've felt 7/10 upon waking, but with headache still. Most of the time have felt really unwell, today (9 Jul 24) and yesterday (8 Jul 24) being the worst for a while.
  

Current state of play:

• BMI = 23.6
  
• Athletic build
  
• I'm an amateur endurance athlete who is fit. I usually train anywhere between 6 and 12 hours a week (cycling and running). Currently only able to manage 3-4 hours a week at best.
  
• I sleep between 8-10 hours a day. I can use/have so far tolerated CPAP for between 7-8 hours of that time. Usually take it off in the early mornings then doze for an hour or two until I'm able to get up.
  
• I don't take drugs
  
• I drink alcohol on occasion (1-2 drinks every few weeks). Haven't drunk alcohol for about a month.
  
• Trial machine given to me is ResMed Airsense 11 with F20 mask. Last night tried P10 but planning on going back to the F20 today.
  
• My AHI on CPAP seems to be consistently sitting between 2 and 3. First night of trial was below 2.
  
• I have 3 more weeks of therapy to get myself sorted out.
  

Current symptoms:

• Morning headaches, that almost always continues all day long. They get slightly better but don't go away. Feel like constant pressure in my head.
  
• Brain fog/not able to think clearly
  
• Low level of physical activity day to day due to extreme fatigue. 
  
• Beginning to get quite depressed as a result of all of this.
  

I've tried analysing my OSCAR data. Haven't got too far, as it's a whole new world for me and a lot to take in.

I recently learnt about UARS, by watching a video by thelankylefty27 on YouTube that explained it could be a reason someone might feel wrecked even with a low AHI. Wondering if this could be me...

Is anyone able to have a look at my data and offer any advice on what might be wrong or what I could improve?

If you've read through this... thanks so much for your time. If anyone has expertise to share that could potentially help me feel even a little more well, I'd really appreciate it.

I'm having trouble putting images in this post that are screenshots of my OSCAR data. Hopefully these links to my SleepHQ data uploads work...

7 Jul 24 - https://sleephq.com/public/4302a832-32b8...fd6cce09a0
6 Jul 24 - https://sleephq.com/public/42441721-3b89...edafb4e605
4 Jul 24 - https://sleephq.com/public/9fd3e56b-f131...55c4d340b8
2 Jul 24 - https://sleephq.com/public/fc348b91-3ac1...c1530361ba

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[SarcasticDave94]

Welcome to the Apnea Board,

Here's a few things to start with:

1. Increase your minimum pressure to 7, so the next step works

2. Turn on EPR to 3 full time

3. Use OSCAR for your chart data, post it here with the attachment option

4. Consider turning Ramp off or at least increasing the pressure up to matching 7 min

[joeblough]

have you visited an allergist? my story is very similar to yours and the CPAP definitely helps me, but i am now seeing an allergist to see if there is some other cause for my headaches/fatigue. will have results soon...

[fitandfatigued97]

Hi SarcasticDave94

Thanks for your reply!

Currently I've got the settings on Auto 4-20 EPR 3, I'll take your advice and try changing this to Auto 7-20 EPR 3 and see how I go.

I find it difficult to fall asleep with the initial pressure more than 4 so I might leave ramp on for now.

I've figured out how to attach some OSCAR screenshots to this post, hopefully they upload...

   
   
   

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Hi joeblough - Thanks, I hadn't thought of that. Will ask my GP about my options

[Narcil]

Please show us the details tab of the left column so we can see the stats and post the entire night not 5 mins zoomed in views. instructions available in the wiki

did your sleep study show centrals?

[fitandfatigued97]

Hi Narcil,

Thanks for your message. The physicians who did my 2019/2020 sleep studies didn't mention any central events. I just checked the results of them and there aren't any noted on the study reports. I'm limited to 3 attachments in this reply, so I'll try post those reports in another post below. Meantime here are some OSCAR screenshots with the details tab open. 

           

[fitandfatigued97]

Attached are the results of the three sleep studies I've had in the past (these were all long before I started CPAP in Jul 24)

1. November 2019 - Initial diagnosis study. Before surgery:    
   
2. November 2020 - After surgery (UPPP tonsillectomy septoplasty turbinate reduction):     
   
3. December 2020 - After Surgery, with Nightshift Device: