Two weeks, CPAP is working great.. but I feel worse!

[KenC]

Does it take the body some time to get used to "better" sleep? I've been on CPAP for two weeks, and it seems to be very effective from a technical perspective. My wife says I've completely quit snoring. The numbers on my machine look good: leak rate average is 26, AHI is 4, 90% pressure is 9.8cm (set for 5-10 auto). I seem to be sleeping well. I keep the mask on all night. I've been getting 7 to 8 hours of sleep per night (same as usual).

The problem is that I feel more tired in the afternoon and evening than before I started CPAP! I *think* I feel a little better in the mornings, but that may just be wishful thinking.

I'm beginning to think that perhaps I didn't need CPAP to begin with. My sleep test showed that even though I had a high number of events (32 per hour), they were almost all hypopnias. There were only a couple of events that lasted more than 10 seconds. My O2 level never went below 90%.

ANy ideas?

[mindy]

Hi KenC,

It took me about 2 months to feel noticeably better although my brain fuzz was gone from day 1. I showed only hypopneas in sleep lab test but only had stage 1 and 2 sleep. EncorePro is showing more apneas than hypopneas although the machine may not be as good at discriminating between the two as the sleep lab equipment.

Perhaps because your numbers (and o2 desaturation) weren't too bad, the results might not be as noticeable as for someone with worse sleep apnea.

Since sleep apnea apparently results in some nasties, IMHO it would seem to be a good idea to keep going.

Other more knowledgeable folks on the forum may be able to give you better feedback.

Mindy

[ozij]

Ken,
If I had those results, I'd raise the bottom pressure - an averaga AHI of 4 means that some nights you're above it - very close to the limit at which treatment should start.

For me, a non pre treatment AHI of 4 or thereabouts (at the PSG) had me tired and unhappy - and I never feel well when my treatment AHI is 4 or more.

An AHI of 5 as a the minimum AHI to start therapy at may be a rule of thumb - but rules like that have their exceptions.

Another reason to raise the bottom pressure - say to 7 or 7.5 - maybe even set your machine at a 9-10 range is the possibilty that you have arousals insduced by the pressure changes, as the machine ranges from 5 to 10 or by breathing disturbances that the machine doesn't identify as hypopneas it should respond to, but you mind identifies as reasons to wake you up (the official term for that is UARS, upper airway resistance syndrome - you don't desturate dramatically, but you don't get to sleep the way one should). A bottom pressure slightly higher may avoid some of those flow limtations.

It does take time to get used to sleeping better, but with your 90% recommended pressure that close to the top of the range, I'm not sure you are getting the maximum benefits possible from the therapy.

O.

[Guest]

Ken,

When I first started, for many months I felt as though I couldn't get enough sleep. In bed at 9:00 on weekdays, sleeping 12 hours on the weekend, etc. Somewhere between 4 and 6 months after starting, I wake up after 8 hours and can't go back to sleep - and feel rested most of the time! Stick with it, your body is healing right now, and it'll take as long as it needs to. Trust me, it's worth it when the uphill climb is behind you.

Take care, and good luck!
Cathy

[rested gal]

Ken, great advice from the posters in this thread. I'd especially consider ozij's suggestion about raising the minimum pressure.

In addition, consider this -- for many of us cpap treatment at first means we're trading the sleep disruptions of apneas (and even "just" hypopneas) for sleep disruptions caused by equipment issues...mostly the mask. It's a crazy new way to try to "sleep."

Sleep disruptions from the equipment can leave us feeling even more sleepy, tired, worn out, exhausted than before CPAP.

Takes time and tweaking to get the whole setup comfy enough and to get familiar enough with it to sleep well.

The machine can be doing what needs to be done perfectly (I would follow ozij's advice) yet the person still not feel wide awake as the day goes on, or full of energy. Even after cpap treatment is optimized, there can always be other underlying issues to make a person feel sleepy or tired, even after getting completely used to cpap, the mask, etc.

Could be a mattress that's seen better days interfering with good sleep.

Could be the person needs a good vitamin/mineral supplement.

Could be the person has other health issues that can leave a person feeling tired -- thyroid problems, for example.

Untreated or undertreated GERD -- acid reflux...and it can be Silent GERD in which you'd notice NO SYMPTOMS at all, yet still have it.
"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.
http://www.medicalnewstoday.com/articles/32944.php

Could be side effects of some meds messing up the sleep architecture...stages of sleep.

Could be lack of good sleep hygiene -- things about the environment that disrupt sleep. TV still on, noisy household, pet jumping up and down off the bed, neighbor's dog barking, too much light coming into the room, bedroom too warm or too cold, restless bed partner, any number of things.

And the #1 problem about sleep hygiene is usually simply not going to bed early enough. Not giving oneself the opportunity to get enough hours of sleep each night.

As the others have mentioned, the healing can be so gradual that it's only in looking back that we see the small signs of "getting better." Like your noting:

I *think* I feel a little better in the mornings, but that may just be wishful thinking.

I don't think that's just wishful thinking on your part, KenC. I think that's really happening and IS a sign that you needed to be on cpap.

ozij brought up the possibility of UARS (Upper Airway Resistance Syndrome) which could very well be the issue for you from the way you described your sleep study results.

I think of UARS as a brain being hypervigilant during sleep about even the least little beginnings of the airway starting to collapse...limited air flow and hypopneas. The brain jumps into action BEFORE it can become an apnea and before the O2 drops drastically. Acts to get the airway more open. You won't even necessarily wake up or be aware of all that going on, but it can sure cause sleep distruptions called "arousals."

Not even the most sophisticated "cpap" machine can measure arousals or see if they are knocking you up out of whatever stage of sleep you were in at the time. Have to be hooked to EEG in a sleep study to see the arousals happening...the wires that were pasted on your head measuring brain wave activity.

So, UARS alone can still be a very good reason to use cpap treatment.

A good experiment to try might be to set your machine to straight cpap at what would be the single pressure a person would have been prescribed. Some do better on straight cpap than with an autopap varying the pressure.

Do give it more time Ken, but don't just mark time (which I know you aren't.) Use the time to think about and work on making your treatment as effective and COMFORTABLE as possible. Work on mask issues to the point that you can snuggle down in bed as close as possible to like in the "old days" before cpap. A mask that will let you sleep in your normal sleep positions, let you put the side of your face flat against the head pillow if you sleep on your sides. And a hose hanging arrangement that will prevent the weight of the main air hose from pulling or tugging at a mask.

Also use that time to review EVERYTHING about good sleep hygiene and be sure your sleep environment (and the number of hours you devote to sleep) is right.

Good luck...feeling a little better in the mornings is a good sign! Feeling "worse" as in being sleepier later in the day and the evening than before cpap is pretty common until we get used to this new way of trying to sleep.

If you're feeling sleepier than usual RIGHT NOW...it's because this post was too long.

[Snoredog]

why are you limiting the machine to 10cm?

I'd set the maximum up to about 14 or 15 cm. You might try increasing the minimum pressure to 6.0 cm at least, most masks require 6-6.5 cm to properly flush out the exhaled CO2.

If you put the Maximum up to 14 or so and it is constantly pegging the max, then that would be a reason to limit it to 10 cm.

But keep in mind that even in the lab the pressure suggested is at best only the 90% pressure, that means the other 10% could be higher, so by limiting yourself to 10 cm the machine is physically limited from addressing those events needing higher pressure.

We all seem to have a rouge apnea or two that need higher pressure.

WHEN will you start feeling better?

been on therapy 2 weeks? Understand if you are the avg. OSA patient, it took you 7 or more years to finally decide that you need help with fatigue or sleep. So the effects of sleep deprivation are gradual over time. You can't expect a turn-around overnight, some do but they are more the exception than the rule.

It takes most about 6 weeks to find a mask they can "tolerate" if there is such a thing where they can finally sleep through the night. Once you do that then you work on extending the amount of time you sleep, hopefully more than 7 hours a night. So it could be a month, 3 months or a year or never before you feel great again.

But one usually notices it is easier to control hypertension, if you understand cardiovascular disease you know therapy is working behind the scenes in limiting damage there. If you have had a stroke of past, you know it greatly lowers your risk for having another stroke better than anything thing else you can do.

But most find they can drive longer before becoming fatigued, naps aren't needed in the afternoon as often and you can think more clearly.

But your results may vary.

[KenC]

Thanks for all the great info all! It definately gives me some things to explore, and encouragement too.