I posted this over in the Sleep Studies category, only to realize that I had posted it in the wrong place!  And then I couldn't figure out how to move it or delete it!  Guess I need more sleep.  
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I am new to this forum, and so glad that I found it!  I have been reading other's posts in an attempt to better understand what this all means.  While I have learned a lot, I still am struggling to apply the information to my situation.  Of course, it doesn't help that I have to read everything over and over just to remember.  

I have had asthma for years, with normally no meds required unless it was an rare bout of bronchitis.  Last summer I developed asthmatic bronchitis that was severe enough to have me in and out of the ER numerous times.  The "normal" meds barely did anything to clear my lungs.  The prednisone caused substantial weight gain.  I went a total of 6 weeks with NO sleep at all, and once I got to the point of being able to sleep I noticed the waking up gasping for air that others have talked about.  In Sept 2004 my doctor ordered a sleep study.

Apnea Hypopnea Index 23.9
Snore Arousal Index 4.2
Oxygen Saturation 81.4% at lowest
Total Arousals Index 27.6
PLMS Arousal Index 0
Spontaneous Arousal Index 14.3
Sleep Efficiency 27.1%
Sleep Onset Latency 119.5 minutes
Total RecordingTime 371 minutes
Total Sleep Period 251.5 minutes
Total Sleep Time 100.5 minutes
Total Stage Shifts:  36
Stage 1 Shifts:  14
Awakenings (during sleep):  11
Number of REM Periods:  0
Wake:  270.5 minutes
Stage 1:  18.0 minutes
Stage 2:  82.5 minutes
Stage 3:  0 minutes
Stage 4:  0 minutes

Central Apnea Events
Number: 36
Index: 21.5
Mean Duration (sec): 12.3
Longest Duration (sec): 18.5
Occur in Non-REM: 36
Non-REM Index: 21.5

Obstructive Hypopnea Events
Number: 4
Index: 2.4
Mean Duration (sec): 22.6
Longest Duration (sec): 35.0
Occur in Non-REM: 4
Non-REM Index: 2.4

Non-REM Summary
Apneas and Hypopneas:  Number 40, Index 23.9
Respiratory Arousals:  Number 15, Index 9.0
Non-Supine Events (Right Side):  Number 40, Index 23.9

Snore Events
Snores:  NREM 364, NREM Index 217.3
Snores w/Arousal:  NREM 7, NREM Index 4.2
Snores w/Respiratory: NREM 1, NREM Index .6

PLM Events without Arousals
Total Non-REM Events:  Total 1, Index .6

Spontaneous Arousals
Total Non-REM Events: Total 24, Index 14.3

Total Arousals: 46
Arousals Index: 27.5 arousals per hour

Oxygen Saturation
Mean:  Wake 98.1, Non-REM 94.3
Min:  Wake 83.9, Non-REM 81.4
Max:  Wake 100.0, Non-REM 97.5
Total number of desaturation w/respiratory events: 38
Total number of desaturations: 38

The study states "Respiratory events are scored only during sleep.  Apneas must be at least 10 seconds in length and accompanied by an EEG Arousal and/or a desaturation of at least 4%.  Hypopneas must be at least 10 seconds in length and must be accompanied by a desaturation of at least 4%."

Some of the review notes:  "Arousals types included spontaneous, coughing, hypopneas and central apneas.  EKG rhythm was sinus.  Patient had several mild to moderate O2 desat's in association with obstructive hypopneas and central apneas."

My doctor (pulmonologist) started me on a ResMed AutoSet Spirit, low setting 4.0 and high setting 11.0.  Average pressure really varies from day to day, but median is around 8.2.  I have been compliant with usage, never sleep without the machine.  Apnea Index from machine has always been under 3.0.  He wanted to switch me over to CPAP, but with my continuing breathing difficulties I asked to remain on the machine I have.  He refused to change meds or run any new tests.

Out of frustration of still breathing poorly, and believing that it might be the reason for not responding to xPAP use, I asked my family doctor to prescribe different meds for the asthma.  The new meds have made a HUGE difference in my breathing, but no difference in my chronic exhaustion.  I still have trouble sleeping, and it's still severely impacting my cognition and memory function.  Thyroid tests came back "normal" as did blood sugar tests.  Family doc is trying to get me in to see a specialist at a teaching hospital that has an excellent reputation.

I have tried everything I can think of to try to get some real sleep.  No caffeine, eating really healthy for the last year, and staying right around 1,000 calories a day.  Slowly starting to lose the weight I gained last year now that I am not taking any steroids.  Stopped taking decongestants at night.  Sticking to a sleep schedule and no napping during the day.  I still don't have energy to exercise, even doing small things (like making dinner and cleaning up) exhausts me completely.

After reading other posts, the only thing I can think of is maybe my O2 levels are still low, even with the xPAP treatment.  Or maybe the machine only recognizes obstructive apnea and thus isn't showing continuing central apneas?

Can anyone offer any clues for me to pursue?  Please?

I just want my brain to start working again instead of being in a constant fog.  I won't even mention how long it took me to compose this post!    

Boy, this is a bundle.  There's a bunch of things that deserve consideration.
(1)  That sleep study really doesn't provide a complete picture.  With only 27% sleep efficiency and no REM, we really don't know what's up with your sleep.  That night was a wreck.
(2)  Your situation has now changed dramatically.  Even if the first study was good, you'd need another one anyway.  Even more so if you've had a 10% weight change from the first one.
(3)  That said, the AutoCPAP might be doing it's job effectively, or at least well enough to say that any remaining OSA wouldn't be responsible for that amount of incapacity.
(4)  If that first study is what you normally do, then effort must be spent on why your sleep architecture is so awful.  Careful review of medications, etc. is paramount, a sleep specialist is needed here.
(5) There's a difference between sleepiness (lack of quantity or quality sleep) and fatigue.  Fatigue has roots in other underlying medical conditions.  And also, the fatigue syndromes can make a mess of your sleep architecture and compound the sleepiness.
(6)  There's also a difference between sleepiness, fatigue, and dyspnea on exertion (DOE).  There may be other underlying functional issues that relate to cardiac, lung or muscle function.  An excellent test to screen for this is the cardio-pulmonary exercise test.  This test will also ascertain the level of deconditioning you have.
I sincerely have great empathy for your situation, which might be a little (frankly, a lot) outside of the scope of this forum.  But any questions or support you need, I'm sure there'll be a bunch of folks willing to help, or at least to try to do what they can.  Certainly, another sleep study is absolutely in order, if you can get that and post the new results, we'll see what shows up.
sleepydave

Thank you for responding so quickly!  :)

My family doc is planning on referring me to a new pulmonologist, so the stress test is something I will make sure gets done.  I didn't even think of that before as I hoped this was all from the apnea!

And yes, a new sleep study needs to be done, but my family doc wants that to be done by the new doc (40 miles away!).  Probably just as well because I live in a very small town and the medical community here isn't always up to date on new techniques, etc.

I'll take your other advice too, and review all meds, etc.  I guess I was just hoping that there was another machine or setting that would make a difference.  Hope springs eternal, and all that.  ;)

You pointed out something else I never thought of:  the difference between fatigue and sleepiness.  The dyspnea thankfully is not an issue now, just physically and mentally exhausted.

If I find that it is something to do with the apnea, I will certainly post the results.  And thank you again!