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Always Fatigued - Does anyone have advice? Please read

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4variety +0 points · about 1 month ago Original Poster

Hi to those reading,

I was diagnosed with mild sleep apnea. I'm 25 and skinny. My level-three sleep study recorded an AHI of 8, which I understand is relatively low. I find that I sleep far more soundly with my CPAP than without. Meaning, I dream more, wake up far less (down to twice per night often times, sometimes even once, though never do I sleep all the way through to the morning unbroken), and feel more "comfortable" when I wake up in the middle of the night. I have tried CPAP for almost three years now, off and on, but for whatever inexplicable reason I feel devastatingly fatigued the next day, usually for the entire day. This happens most days, though every week or so it feels manageable. In addition, my eyes are very bloodshot. I know many people will first think there is a leak problem, but I assure you there is not (which would conveniently explain both red eyes and poor quality sleep).

Why does CPAP make me feel so tired, even after using it for 8 months straight consecutively? I'm desperate for advice or guidance, and no one seems to have an answer. I feel like my youth is being robbed from me. I really appreciate those of you who took the time to read through my concerns, and I look forward to hearing back from you!

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Sierra +0 points · about 1 month ago Sleep Innovater

I think the first thing you need to keep in mind, is that you had a low level of apnea with an AHI of 8. In the UK that would not qualify for a CPAP. You don't mention what your AHI is with the CPAP, but even if it is <1, that is still not a very big change. In other words it is a bit of a stretch to say that the poor quality of your sleep (based on how awake you are the next day) was due to apnea. It would seems there must be other issues. I am not a medical professional, and can only give you suggestions based on my experience, and on a second had basis based on the experience of my wife. She was diagnosed with an AHI of >80. Now with a CPAP she is <1. She has noticed a huge improvement in her sleep quality. I was diagnosed with an AHI of 37. With CPAP I am now in the range of 2-3. I have not noticed a huge increase in my sleep quality, but my wife is appreciative of the termination of my snoring. But, I was sleeping quite well before CPAP, so to some degree there was not a problem to solve.

Long story, but I hear what you are saying, and don't have any simple answers either. Sleep can be elusive. I would encourage you to continue following up with your medical advisers. I have seen a useful website that was set up by a pharmacist and university professor that wanted to help people get a quality sleep without resorting to sleep medications. Here is a link to it:

Sleepwell, It's No Dream

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SleepDent +0 points · about 1 month ago Sleep Commentator

I am a dentist working in dental sleep medicine. Let me go at this from a different point of view. Oftentimes people with low diagnosed AHI's who are very symptomatic really have UARS. If you have access to your original sleep study, look to see if you have a large number of RERAS(respiratory effort related arousals) or a large number of spontaneous arousals(arousals of such short duration that they can not be classified). Either of these would be an indication of UARS. Many times people with UARS or with mild sleep apnea do not do particularly well on CPAP. This is because the entire CPAP experience can be too intense for people with such a low AHI. Oral sleep apnea appliances often prove to be a better solution for people in these two categories because they work well and are a much gentler experience. Arthur B. Luisi, Jr.,D.M.D.. The Naples Center For Dental Sleep Medicine.

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4variety +0 points · 18 days ago Original Poster

@Sierra. First off, my apologies for the late reply. I think you raise a good point. In fact, I took a level-one sleep study not too long ago (which is where they wire you up in every way possible e.g. heartrate, brainwaves, audio, video, oxygen saturation, etc.), and, prior to the night when I was tested, I had been using a mandibular advancement device as well as CPAP. My AHI for the level-one sleep study was 4.2!; however, I noted in the questionnaire they provide the next morning and tell you here that it was an unusually low AHI for me, or so I would like to believe. I only woke up once that night. Of course, living in Canada where there are dangerously long waitlists for specialist consultations, I felt the doctor was somewhat dismissive, which is probably partly also because I dont think I voiced myself in a way that reflected how engrossed I am with trying to improve the quality of my sleep and that I see it as "robbing me of my youth". One thing I believe was overlooked was the variable that I had been using the CPAP right up until the night I was tested, which I have read and was told afterwards by my dentist who designed the MAD that it could have allowed me to go into the study without the inflammation and tissue swelling that may have otherwise been present had I been snoring/sleeping without CPAP. I've been privileged with the opportunity to see an ENT in a few months to discuss potential less-intrusive surgery options, so I'm looking forward to listening closely to what they have to add. Thank you sincerely for taking the time to share your thoughts on this subject, as well as for sharing the link.

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4variety +0 points · 18 days ago Original Poster

@SleepDent: Tomorrow I will call the sleep specialist's office to request my report, and then get back to you. Is there anyway to glean information from my CPAP data that may provide us with information indicative of UARS? It's very interesting that you've mentioned this possibility. I've done a quick search on the internet, and it sounds well-aligned with what I feel I am experiencing. I do already have a MAD, but I did not take one of those tests to see if 1) whether a MAD could be an effective treatment option 2) Which titration setting is the most effective. In addition, I stopped using it each time after about 2 weeks of use when the quality of sleep worsened to a point where I was motivated to return to CPAP, but I've always wondered if perhaps I should give the device more time before concluding whether it's effective or not. In addition, I've only tried three titration settings (moving my mandible outwards more each time). My theory is that my threshold for arousal is lower after using the CPAP for a while (as it makes for a more peaceful though not always refreshing sleep), so when I return to using the MAD, lower levels of sleep disturbance, however that may look, may have greater consequences with respect to arousal than had I not used the CPAP prior to the MAD. Although I cant arrive at any conclusions, I feel as though my poor quality of sleep, whether that be obstructive sleep apnea or UARS, is at least partially from some abnormality of my soft palate/retropalatal region, rather than the region at the back of the tongue. The fact that mild sleep apnea is more often a consequence of abnormality in the retropalatal rather than retrolingual region is also supported by the paper I'll link here: https://onlinelibrary.wiley.com/doi/epdf/10.1111/resp.12913

I was hoping to also get your thoughts on mandibular advancement devices that have a whole at the front to allow for mouth breathing when needed. I find I have very poor nasal patency (which may have gotten me into this mess from earlier years), so I have very narrow nostrils and pretty much any congestion will completely block my airflow, which is why I'de like to hear what the ENT has to say about my turbinates, for example. This is all to say that I feel that if I have open nasal passages, then sleep disturbances occur far less frequently, but I always seem to wake up in the night, whether an hour in or closer to morning, to find that my nasal passages are congested and, in extension, I experience poor nasal patency. Thank you very much for taking the time out of your day to look into my case.

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