What could still cause sleepiness during the day even after good compliance using CPAP with AHI < 5?

Doctor's Answer

Thank you for sharing your situation with us. May I offer a few suggestions.

Firstly, it will be good to make a distinction between fatigue and sleepiness. For someone who is fatigued or tired, some rest may help. For someone with sleepiness due to insufficient sleep or poor sleep quality at night, then a nap in the afternoon may be useful.

Secondly, it will be good to consider the onset of your daytime sleepiness. For many normal individuals, in a 24 hour period, there are two periods where a person will feel especially sleepy. One is from 11 pm onwards and this strong need for sleep will make us want to retire to bed to sleep. The other occasion when a person begins to feel sleepy is around 2 to 3 pm and in some countries, employees are allowed to have a siesta.

In view of your tiredness, it will be good to exclude medical causes like hypothyroidism as well. So it is crucial to undergo a proper medical evaluation.

At this juncture, I would like to share some tips on sleep hygiene as this will help to improve the quality of our sleep at night.

The first is to have a regular bedtime and awakening time as this will help to stabilise our circadian rhythm.

Second, to have a wake-up routine that increases exposure to bright light as early as possible after waking.

Third, to use caffeine sparingly, if at all, and always before noon.

Fourth, minimize alcohol use because it frequently causes rebound insomnia.

Fifth, avoid nicotine.

Sixth, avoid eating heavily close to bedtime. A light snack can be okay for some people.

Seven, make certain that your bedroom is dark and quiet and the temperature is comfortable.

Eighth, eliminate noise with earplugs or use a sound machine.

Nine, try to establish a bedtime ritual and ‘wind down’ as bedtime approaches. A good habit to develop is to leave worries out of bed.

Lastly, to improve the amount of deep sleep that we have at night, we need to have more aerobic activities in the daytime. So an important tip is to develop an exercise routine and complete it before 5 pm.

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