My diagnosis was mild obstructive, AHI of 8. 28 hypopneas and 18(?) central apneas. I went with an Apap and find my numbers are now generally under an AHI of 2. Typically between 1 and 1.5 with most of them being central in nature. My pressure is rarely over 6 or 7 which probably helps to minimize more centrals being brought about.
I don’t feel any more well rested than before but that’s another matter.
With respect to the centrals, the neurologist I’m seeing is also a sleep doctor. He explained to me that sometimes the centrals are more to do with sleep and wake transitions than with a true central apnea related to heart or brain stem issues. The more sleep disturbances you are having due to hypopneas or obstructive apneas (or even non sleep disorder awakenings) the more opportunity for central apneas to occur. I’d not be afraid to try an apap, particularly if you can exchange it for a different machine if you wind up needing something more advanced. Sierra suggested this to me and it worked well in my case.
I’m on a similar glide slope. Had a brain MRI, gallons of bloodwork, scheduled for an echo next week.
Don’t give up yet. A sleep study might indicate something that’ll be treatable and get you back to good. Call the sleep center regularly asking about cancellations. You might get in much sooner than you expected.
Edit: My symptoms were similar to yours. Fatigue but not falling asleep during the day at all...ever. My doc said not everyone is impacted the same way. In other words, not scoring high on the Epworth scale doesn’t mean an apnea problem is not present.
Assuming you’ve had all the usual suspects checked in blood? Iron, red cell count, vitamin levels? Anyway, sounds like my story. Masters athlete in his 40’s whose get up and go got up and went. My sleep study indicated an ahi of 8. Quite mild. I’m using an APAP and keeping the ahi below 2, often closer to 1, but haven’t any noticeable improvement after two weeks.
My doc suggested I sleep a bit less and try to compress my sleep a bit. Instead of 8 hours try 7 or 7.5. Force your body to use that sleep window more wisely I guess. One of my issues is frequent wakings. YMMV.
You might try positional therapy for now. Keep off of your back as this will often make obstructive sleep apnea worse.
My AHI is now regularly below 1 with some nights occasionally between 1 and 2. However, I still feel like garbage when I wake up and feel groggy for much of the day. Almost like I’m dealing with sleep inertia that won’t subside. Interestingly on nights when I just don’t sleep well I tend to feel better in the morning. On Tuesday night I was up until nearly midnight and was out of bed before 6AM, a full 2 hours less sleep than usual and I woke up a lot that night. Somehow I felt better on Wednesday after that short night of sleep than usual. I do have a lot of awakenings at night, probably close to 8 if I had to guess. I’m not up for long but it’s an interruption. I’ve started taking melatonin, 1.5mg, for last few nights to see if that helps. So far it hasn’t. Thoughts?
So far, it seems like you're correct. My numbers keep improving. I'm still feeling fatigued and off during the day and have numerous awakenings each night, but maybe this will all mellow out over the course of a few weeks.
Thanks for the advice. I've not heard back from the respiratory therapist at my DME regarding changes to my setup. My guess is that they see the AHI and want to leave things alone. I'll have a follow up with a sleep doc in a week or two and can discuss things further at that time.
Last night was my best night thus far. 5 CA and 3 Hypopneas. I've been below 5 since the 2nd night with most nights being 2's or 3's. I'm curious why the centrals are going away when my machine isn't really capable of treating them. It leads me to believe that the CA was being brought about by hypopneas and awakenings.
Looking closer, my CSR flagged area looks like my CA flags, just slightly shorter and not enough to be called an apnea.
Might I be one of these persons with Centrals that aren’t enough to justify an ASV? Could my machine be set to a fixed pressure and do a home titration? Start at 4 and work up, see if it’s effective?
I do plan to get in touch with my doc today.
With respect to the CA, I’m not sure that the APAP is causing them. I had 18 of them in my in lab study along with 28 hypopneas. So perhaps the APAP is wiping out hypopneas with little pressure and the CA’s are just hanging around for some underlying and mysterious reason.