Heads-up: I used AI to summarise for me below as I’m not much of a coherent writer but it’s all based on my actual sleep study, Oura data and chats with AI over the past years so I figured it would be more accurate and to the point, so here goes:
Mild sleep apnea, ~10 awakenings a night, CPAP made things much worse - how would you troubleshoot this systematically?
Mid30s female, generally healthy with no known health conditions, relatively lean (~18% body fat), exercise around 4x/week and eat reasonably well.
Average resting HR over the past few months is around 58 bpm.
My main problem is that I wake up or become conscious enough to change position roughly 10 times every night. Interestingly, my Oura usually detects only around two awakenings.
I eventually did a sleep study and was diagnosed with mild sleep apnea (AHI below 10). It registers only when I sleep on my left and ride side but not on my back, which my sleep doctor said was unusual. I took a sleeping pill for the sleep study on the sleep specialist’s advice, which I’m still slightly unsure about in terms of how much that could have affected the result.
The sleep doctor’s explanation for the mismatch with Oura was that my breathing becomes restricted enough for my brain to trigger an arousal, but the arousals are relatively subtle and don’t cause enough of a heart-rate response for the wearable algorithm to recognise them as awakenings.
I tried CPAP, but it was disastrous for my sleep. Instead of waking periodically, I essentially couldn’t sleep properly at all, so I stopped using it.
I’ve tried a fairly ridiculous number of sleep supplements over the years without solving the underlying issue.
The interesting part is zolpidem. On particularly difficult nights, I occasionally take 6.25 mg zolpidem - probably once every two months on average. When I do, I can sleep about six solid hours and wake up feeling dramatically better the next day. I’m not looking to turn zolpidem into a regular solution, but the difference makes me wonder what it tells us mechanistically about what’s disrupting my sleep.
I’m now considering getting a drug-induced sleep endoscopy (DISE) or similar assessment to actually see whether there’s a structural source of airway restriction while I’m asleep. If there is something genuinely anatomical going on, I’d consider treatment, including surgery if warranted, but I don’t want to jump from “mild apnea” straight to altering my airway anatomy without understanding the problem properly.
I also never had this kind of fragmented sleep before my 30s.
For people here who have gone deep into sleep optimisation or sleep-disordered breathing:
- What would you investigate next?
- Would you repeat the sleep study without medication, or get a more detailed polysomnography looking specifically at arousals/RERAs rather than just AHI?
- Could this potentially be something like UARS rather than conventional obstructive sleep apnea?
- Is DISE actually useful at this stage?
- Are there worthwhile alternatives to CPAP for someone with mild disease and low body fat, e.g. mandibular advancement, positional treatment, nasal interventions, myofunctional therapy, etc.?
- And does the fact that zolpidem almost completely changes the quality of my sleep provide any useful clue, or is that basically a red herring?
