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CPAP and Still Tired!!!

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JenCarol +0 points · over 2 years ago Original Poster

I was diagnosed with OSA about 10 years ago and have been using CPAP religiously for about 8-9 years. Currently my machine is a Respironics System One. My pressure was at 9 when I first started therapy and every few years my doctor bumps it up because my apnea events never go below 5. In fact most times when they check my SD Card it's showing 7-8 events/hour. Now my pressure was bumped up again from 13 to 15 and I don't yet know whether or not that made a difference in my apnea events. All I know is that I am still VERY tired during the day and yawn almost constantly even though I NEVER miss a night of CPAP use! I am just so frustrated because other family members who were worse off than me before their sleep study are now doing remarkably well after just a few months of CPAP use and their events are always less than 1 per hour. I'm starting to feel like all of these 8-9 years on CPAP have been a lot of suffering for nothing. I use a full face mask (being mainly a mouth breather because of a deviated septum and nasal alergies) and I am a 63 year old and about 20-30 pounds overweight. Is all of this normal or am I simply wasting my time with CPAP therapy? I know it's got to be helping but I just never, ever feel rested upon waking or throughout the day. Any input or advice???

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SleepDent +0 points · over 2 years ago Sleep Commentator

I am a dentist working in dental sleep medicine. Your post did jog my memory and what I have may or may not apply to you, but it is something. I have had some patients over the years who had good resolution of their obstructive events with CPAP and yet never got to the point of feeling rested. A fairly high proportion of the patients, who got off CPAP and got good resolution of their obstructive events with an oral sleep apnea appliance DID end up feeling rested eventually. My anecdotal(not scientifically proven) theory for these patients is that they have very sensitive nervous systems and the CPAP experience is just too intense for them. The machine resolved the breathing problems, but kept them awake in and of itself. One key to look at on your CPAP titration studies is whether your sleep staging and sleep structure got better or worse during the titration process. In many of the patients I speak of, it actually got worse. Arthur B. Luisi, Jr., D.M.D., The Naples Center for Dental Sleep Medicine. Practice partner, dental sleep medicine. The NCH Healthcare System. Practice partner, dental sleep medicine, The Millenium Physician Group.

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sleeptech +0 points · over 2 years ago Sleep Enthusiast

Just a point of clarification: sleep architecture does not just spring back to normal as soon as OSA is resolved. The reverse is true. It usually takes some time for the brain to re-establish normal sleep patterns after OSA has been successfully treated. Because of this, abnormal sleep staging in a titration study is not an indication that the study was unsuccessful. In fact it is quite rare for a patient to have completely normal sleep staging in a titration study, based on the thousands I have done over the years and the literature on the subject. Instead, sleep staging normalises over time.

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SleepDent +0 points · over 2 years ago Sleep Commentator

Granted, but should it actually be much worse that it was on the baseline polysomnogram? Is that to be expected and O.K.?

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sleeptech +0 points · over 2 years ago Sleep Enthusiast

Well, calling it better or worse is a bit simplistic. Neither the fragmented sleep architecture and sleep stage deficits caused by OSA nor the sleep stage rebounding which often occurs in titration studies are a natural, health sleep pattern. Both of them will have deleterious effects if they remain unchanged over the long term. The difference is that one is the result of disruption by OSA and will only get worse if untreated and the other is that start of the path to health sleep. Neither is necessarily better or worse, rather both are abnormal. Think of it like food. Both eating too much and too little are bad for you in different ways (as is eating the wrong things). What you need is a healthy diet with the correct balance of various different nutrients. Anything else will cause a problem.

Also, when looking at the sleep staging on a titration study one must take into account the fact that sleep lab is not a normal sleep environment. The patient is covered in sensors, in a strange bed, being monitored by some weirdo on the other end of a camera (i.e. me), stressed by having a medical procedure (albeit a minor one), trying CPAP for the first time and so on and so forth. All of these things will lead to disrupted sleep. Then there are external factors in a patient's home environment which may disrupt their sleep, but which are not present at the sleep lab. All of these factors, and more I can't be bothered trying to think of, all mean that the chances of someone having normal sleep architecture in any sleep study, and especially a titration study, are incredibly small. This is why simply looking at sleep staging in a titration study, while being able to reveal certain information to a trained eye, is a poor guide as to the success or otherwise of the study. It is a part of the picture, but only a small part and it requires some skill and knowledge to properly interpret.

I know that explanation is getting a little technical, but I hope that it clarifies things to some degree.

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SleepDent +0 points · over 2 years ago Sleep Commentator

Actually, thank you for getting so technical. I now have a much better perspective on how to approach the interpretation of a CPAP titration. I have read many hundreds of CPAP titration studies over the course of my career. I must say that many of them have contained sweeping generalizations about the patient based on the results of the one night. Clearly, a lot of these people need a tutorial from you as much or more than I did. I withdraw my previous observation about that CPAP titration. I do not withdraw my observation that CPAP may just be too intense for a small percentage of the population. Dr. Luisi

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SleepyJules +0 points · over 2 years ago

Well JenCarol. I'm 67 and was diagnosed two years ago with an AHI of 27. I've only just relented and bought a CPAP. My machine was set at 18 originally, which I couldn't handle. I thought I would pop the next day I swallowed so much air. So I had it turned down to 13. For two weeks all went well. I slept well, with more energy during the day, and AHIs below 5. But I did develop a sore on my nose and had to stop using the CPAP for a few days for it to clear. I've since had the machine bumped up to 14.6 and struggling again. It seems the sleep dentist is right. My central nervous system is very sensitive and I'm just not getting the sleep that I need. My AHIs are now between 7 and 11, which is still too high. I'm back to sleepy during the day.

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