CPAP Side Effects???

[JCGlas54]

It's been a while since I've been on this forum but with these issues I'm having I need some advice now. Diagnosed with OSA about 12 or so years ago and started using CPAP religiously every night about 9 years ago. They started me on a pressure of 9 and now it's raised to 13 and the doctor wants to now bump it up to 14. Before CPAP my sleep study showed 20+ apnea episodes per hour. They check my card about every 6 months to see how my sleeping is doing and STILL after nightly use and occasional bump-ups in the pressure on my machine I am still having 7-8 apnea episodes per hour. I wake up tired still (sometimes takes me 30-60 minutes to even have the energy to get out of bed) and have headaches every morning. And as soon as I take off the mask and turn off my machine in the morning my heart rate goes way down. I use CPAP every night because of fear - I know not treating my sleep apnea will lead to all sorts of health problems so scare tactics have been my motivation to never go a night without it. I only wish I could feel like all of what I'm going through would reflect on how I feel day after day. Still tired, still headaches and fogginess, still problems with short term memory, still short of breath all day. I've been very diligent and my card always shows 100% use for 5-7 hours nightly. It takes me at least an hour to get to sleep at night so I set the ramp to 45 minutes and am still not asleep when it reaches the pressure of 13 which makes me feel like a windstorm shooting down my throat. So much suffering for so little difference in the way I feel. I'm 63, about 25-30 lbs. overweight and have GERD, sinus issues, nasal allergies and mild emphesema also. What am I doing wrong and can anyone offer any advice to get me feeling more energetic during the day?

[Pugsy]

Where are you getting your AHI data from....Software or the machine's LCD display?

Exactly which model machine are you using?

Do you know the event category breakdown of that AHI? If so, what is it?

Waking up tired isn't unexpected if you only sleep 5 or 6 hours a night even if the AHI is 0.0. Need more hours of sleep.

Use the software and post an image of a typical detailed night so we can see exactly what is happening.

Software
https://sleep.tnet.com/equipment

How to post images using imgur
https://sleep.tnet.com/reference/tips/imgur

Examples of how we like the data available presented
viewtopic/t103468/Need-help-with-screen-shots.html

How to organize the graphs...3 pages so read all 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

[robysue]

JCGlas54,

I am sorry that you've had such a long, hard time of it.

Can you let us know a few more details?

First: What is the make and model of your machine?

Since you say that "they" check your card every 6 months to see how you are doing, it's quite possible that WE can help you find the things you need in order to check your card every day and help you figure out what is wrong and how to tweak your settings to make things better.


Second question: Do "they" ever tell you anything beyond "your AHI is still 7-8 and the pressure needs to be increased again?

Ever since around 2010, the top of the line Resmed and Respironics machines have been able to distinguish obstructive apneas from central apneas. Too many OAs does usually warrant a pressure increase; but pressure increases are not typically going to reduce the number of CAs. So it's important to know if your machine can distinguish OAs from CAs and whether your residual events are obstructive or central in nature.

You write:

I wake up tired still (sometimes takes me 30-60 minutes to even have the energy to get out of bed) and have headaches every morning.

Where do the morning headaches hurt? And can you describe the pain? Is it sharp, stabbing, throbbing, dull? Is it possible you have the mask on too tight? Have the headaches gotten better, worse, or stayed about the same since you started CPAP?

And as soon as I take off the mask and turn off my machine in the morning my heart rate goes way down. I use CPAP every night because of fear - I know not treating my sleep apnea will lead to all sorts of health problems so scare tactics have been my motivation to never go a night without it.

While fear is a powerful motivator that keeps you using the CPAP, it's also something that can destroy the overall quality of your sleep.

It takes me at least an hour to get to sleep at night so I set the ramp to 45 minutes and am still not asleep when it reaches the pressure of 13 which makes me feel like a windstorm shooting down my throat.

Are you physically UNcomfortable when you put the equipment on each night? In other words, does the discomfort start as soon as you put the mask on, or only after the ramp period is close to over and the machine is approaching 13cm? Would you be willing to take a prescription sleeping pill, at least on a short term basis, to try to make it easier to fall asleep well before the ramp period ends?

Back when I was a newbie, it took me an hour or more to fall asleep most night, and I was utterly miserable the whole time. Needless to say, I didn't sleep well the rest of the night, and I'd wake up the next morning feeling like I'd either been running a marathon in my sleep or that I'd been run over by a Mack truck. Things finally started to turn around for me when a PA in the sleep doc's office directed a several months long course of cognitive behavior therapy for insomnia (CBT-I). The main goal of the CBT-I was to teach my body how to get to sleep before the physical discomfort made it impossible, to get back to sleep in a timely fashion when I woke up during the night, and to consolidate my sleep cycles enough where I was not waking up repeatedly in mid-cycle.

Once I started sleeping well with my BiPAP instead of sleeping poorly with my BiPAP, I gradually started to recover the energy I had well before my moderate OSA developed and the brain fog started to lift.

I only wish I could feel like all of what I'm going through would reflect on how I feel day after day. Still tired, still headaches and fogginess, still problems with short term memory, still short of breath all day. I've been very diligent and my card always shows 100% use for 5-7 hours nightly.

So you are in bed and using the machine for 5-7 hours each night, but you also take at least an hour to fall asleep. That means you're getting no more than 4-6 hours of actual sleep at night. In the long run, most people cannot function well with only 4-6 hours of sleep, and so you need to not only tweak the settings to bring the AHI down, but you also need to work on getting 7-8 hours of quality sleep with the CPAP every night.

OR perhaps you are sleeping for an hour or more every night after taking the mask off on a regular basis just so you can "get some sleep". And in that case, you need to figure out a way to keep the mask on all night long. Because while sleeping mostly with the mask on is better than not CPAPing at all, the fact is the more sleep you get WITHOUT the mask on, the harder it is for CPAPing to make a positive difference in terms of how you feel.

So----please honestly answer the following questions:

1) What's your sleep schedule typically look like? When do you go to bed? When do you finally get out of bed?

2) How much actual sleep do you get each night? How much of that sleep is WITHOUT the CPAP?

3) How anxious are you when you are trying to get to sleep at the beginning of the night? How frequently do you look at the clock when you are trying to get to sleep? How focused are you on your breathing and the fact that the machine is steadily increasing the pressure throughout the ramp time?

I'm 63, about 25-30 lbs. overweight and have GERD, sinus issues, nasal allergies and mild emphesema also.

Do you take any daily medication for any of these medical problems? If so what? And what are the known side effects?

Note that the GERD can be aggravated by swallowing air from the CPAP. The "swallowing air from the CPAP" problem is called aerophagia, and aerophagia can make you absolutely miserable while you are trying to get to sleep. It can also cause middle-of-the-night wakes, and it can lead to pretty miserable overall sleep. Fortunately, there are also things that you can try if aerophagia is one of your problems.

What am I doing wrong and can anyone offer any advice to get me feeling more energetic during the day?

I strongly think that your two biggest issues are (1) latency to sleep and (2) too little sleep every night.

If you could reduce the time it takes you to fall asleep from "over an hour" to something more typical like 15-20 minutes, I think you would feel better. But reducing sleep latency takes some work for most people, even if they are willing to take a prescription sleeping pill.

I also think you would feel better if you were getting a full 7-8 hours of sleep with the CPAP every night, even if the AHI is still in the 6-7 range.

And finally, once we see some data, we'll be able to help you figure out how to tweak your CPAP settings to bring that AHI down to the "below 5" (and possibly below 2.5) range every night.