I'm have been diagnosed with REM-related sleep apnea (RDI:14.3) in March and was prescribed with a CPAP (DreamStation CPAP Auto with A-Flex).
I have not done a CPAP titration to determine the pressure setting of my CPAP but instead determined the setting by a series of trial and error and my subjective experience.
Although my sleep quality improved markedly with the CPAP (I feel nausea the next day if I don't use the CPAP) and I yawn a lot less often throughout the day, I'm not sure if my REM-related sleep apnea is completely treated as I feel tired and unenergetic compared to my peers (which I sometimes get made fun of for yawning and looking unenthusiastic). I also still wake up to urine at night (which I was told is a symptom of sleep apnea). However, there had been two days since I started treatment when I feel completely refreshed and energised despite having only used the CPAP for 5 hours both times, and for one of those days, my AHI according to my CPAP was 0.
My CPAP's AHI ranges from 0.8-2 every night I use. My ENT consultant told me that so long the CPAP's AHI is below 5, then my sleep apnea is treated to that of a normal person. However, I'm not sure if the data from CPAP alone is sufficient to say my REM-related sleep apnea is treated. Since REM sleep occupies the shortest duration of one's sleep cycle, with the majority being non-REM sleep. Therefore, could it be possible that the period when I don't get sleep apnea during non-rem sleep will skew the CPAP's overall AHI to a number below 5 despite I continue to have notable episodes of apnea/hypopnea during REM sleep. I believe this concept is reinforced by my sleep study's data which showed I have an RDI of 1.8 (REM RDI: 14.3 and non-REM RDI of 1.1). But please correct me if I'm wrong.
If what I speculate is true, should I look for a private hospital to conduct a CPAP titration in my area to determine an objective and ideal pressure settings? Or should I seek another service? I have already talked to my GP briefly about the situation but he is not very familiar with OSA and he said it is unlikely a referral to a publicly funded sleep clinic will be successful as my Epworth Sleepiness Scale is in the normal range (despite having mentioned I can't sleep in public setting due to anxiety following two concussions).
The reason I think my pressure setting could be a problem was because I've experienced nights when I feel like the pressure isn't high enough which woke me up and made me gasp for air with a shrivel across my body or made me remove the mask to sleep. Alternatively, if I change the pressure to a higher setting, then my central apnea episode increases and I get very painful stomach bloating that wakes me up early.
Thank you very much for taking the time to read. Really appreciate any advice/inputs.
