Although getting to the root of the problem may be challenging, a thorough and methodical exploration can very often reveal the underlying cause of sleepiness, pointing you toward actionable steps to resolve the issue.
Searching for the Cause: Improper CPAP Use
One common cause of residual excess sleepiness (RES), and a good place to start the investigation, is incorrect CPAP titration. Thanks to new insurance regulations, the days of OSA patients using conventional CPAP devices with customized air pressure settings are over. Similarly, it is no longer the norm for a patient to return to the lab one month into CPAP treatment to undergo an overnight in-lab CPAP titration study during which AHI is measured and electroencephalogram (EEG) tracings are monitored to check for arousals. Patients now are given an automatically adjusting CPAP machine, or AutoPAP (APAP), which auto-adjusts air pressure from a range programmed in by the otolaryngologist. In place of the titration study, the machine uses a proprietary algorithm to determine AHI incidences, and there is no EEG. The data is stored in the APAP computer and can be downloaded by a sleep professional to gauge the patient’s progress.