More tired while using CPAP?

[c0nsidered]

Hi all,

I was recently diagnosed with moderate sleep aponea (AHI 22) after seeing doctors about unexplained fatigue (not really sleepiness) and cognitive issues. I've been consistently using either CPAP or APAP (no perceived difference) for the last 3 months, for an average of 7:15hrs each night. Average AHI with the machine is 2.5.

I have experienced some minor improvements in cognition, but I've found that I'm significantly more sleepy during the day after using CPAP/APAP. Daytime sleepiness was not a problem for me before, but now I can barely keep my eyes open between about 10am-2pm - it's debilitating!

In terms of my experience with the machine: I can get to sleep fine, but I do find that towards the morning I wake up multiple (~4) times for a very short period (~1min) before falling back asleep. I don't know why this might happen, other than vague discomfort with the mask.

Attached is my Oscar data from last night. Has anyone had similar experiences, and how did you resolve them?

Thanks!

[zonker]

Hi all,

I was recently diagnosed with moderate sleep aponea (AHI 22) after seeing doctors about unexplained fatigue (not really sleepiness) and cognitive issues. I've been consistently using either CPAP or APAP (no perceived difference) for the last 3 months, for an average of 7:15hrs each night. Average AHI with the machine is 2.5.

I have experienced some minor improvements in cognition, but I've found that I'm significantly more sleepy during the day after using CPAP/APAP. Daytime sleepiness was not a problem for me before, but now I can barely keep my eyes open between about 10am-2pm - it's debilitating!

In terms of my experience with the machine: I can get to sleep fine, but I do find that towards the morning I wake up multiple (~4) times for a very short period (~1min) before falling back asleep. I don't know why this might happen, other than vague discomfort with the mask.

Attached is my Oscar data from last night. Has anyone had similar experiences, and how did you resolve them?

Thanks!

welcome to the zoo! first off, let me say thank you for reading the instructions on formatting and posting graphs. so many people(including me) get that wrong the first time. so goo work, you.

as to your settings-look at what the pressure graph is telling you. pressure starts at 6 (actually, with epr on, it's starting lower than that) and almost at once, it bangs up against the high pressure limit of 11.

you may want to increase your minimum until it gets to 11. i'm not saying do that straight away. you may want to increase the minimum slowly.

and there is no reason for you to have the maximum pressure set at 11. increasing that to 20 will give your machine free reign to help you further with your apnea events.

this should help towards getting rid of the tired feelings during the day. also, i just want to mention that's it's not uncommon to have those short awakenings in the night. once you get things dialed in on your settings, it's quite possible you'll sleep through them. but be advised that everyone wakes up during the night. usually, you just roll over and go back to sleep as you are now. it's just that hooked up to the machine you are no more aware of how you sleep.

good luck!

[radler]

I’m also a newbie, but it seems like you’re maybe having a lot of leaks relative to what I usually see in my OSCAR data. What kind of nasal mask are you using? Do you think you might be waking up slightly or just sleeping less soundly due to the whistling of a leak or the discomfort of breathing through your mouth? I feel like the pressure also does weird uncomfortable stuff with the mask whenever I have a leak. I wonder if a mask cover, a chin strap, or a different nasal mask might help you sleep better.

I was having a lot of jaw pain from full masks and a lot of upper teeth pain from nasal masks, and any leaking definitely wakes me up. I’ve been miserable from the face pain and stopped using my machine for a few days. I finally woke up feeling well-rested this morning after my first night with the Respironics Dreamwear nasal pillow, despite a little bit of waking from mouth breathing (which feels super wrong and wake me me up). I’m also a side and stomach sleeper and it was so much more comfortable that I slept very soundly despite a lower dose of my sleeping pill. So possibly just a mask adjustment might help you sleep better?

I also agree it might be worth raising the pressure, but since you’re already having leaks I’m not sure I would go to 20 yet. I also wonder if your ramp setting is contributing to some issues? I would maybe play with your mask fitting and experiment with turning the ramp down a little to start with and see what happens. I’m no expert, but 45 minutes seems like overkill for a max pressure of 11 to me. I personally hate the ramp because it feels like I can’t breathe to start with, and then the first bit of high pressure wakes me up. But I’m also on an ASV so it might be a little different!

Good luck!

[Miss Emerita]

To follow up on the two preceding posts: it’s generally a good idea to make one change at a time and see how it goes for a couple of days, but I think it’d be fine to raise your minimum and shorten (or turn off?) the ramp at the same time. I'm betting you would feel OK with a minimum of 8. The ramp is more personal, so you be the judge for that.

After you see how this goes, we can make suggestions for the next change.

You are indeed seeing a fair amount of leaking, so it’d be good to address that. It could be messing with your sleep cycles. It’s hard to be sure, but my guess is that you’re mostly having mask leaks rather than mouth leaks. Do you think you open your mouth during the night?

[c0nsidered]

Thanks all for your suggestions, I'll make those adjustments.

The mask I'm using is the AirFit P10 For Her (i.e. a nasal pillow). I strongly prefer that to a full face mask (which hurt the bridge of my nose) or a nasal mask without "nozzles" (e.g. AirFit N30i, which became misaligned with my nostrils very easily). I would be happy to try other light-weight nasal masks though.

Re potential leak: I largely sleep with my mouth closed, but I have caught myself occasionally (once a week or so) waking up from breathing through my mouth. So I guess mouth or mask leak are both possible.

[Pugsy]

How's your sleep quality? How many hours of sleep are you averaging? Are those hours fragmented by very many wake ups?
If very many wake ups, do you know why?
Are those leaks waking you up at all...if not I wouldn't worry about them. Only a very short time was spent in large leak territory and not enough to really have that much of an impact on therapy.
It's not a very pretty leak line but I have seen worse.
I see no need to change masks at this time if you are happy with what you are using now.

Do you spend much time with machine and mask on and you are awake?

Do you take any medications of any kind, if so, what?

[c0nsidered]

Thanks for your reply Pugsy.

How's your sleep quality? How many hours of sleep are you averaging? Are those hours fragmented by very many wake ups?

My sleep quality has dropped a bit since starting CPAP. It takes me ~45min to fall asleep (previously ~15min) and I wake up briefly 3-6 times a night (previously 1-2). I always get back to sleep within a few mins of waking though. I average about 7.5hrs of sleep a night.

If very many wake ups, do you know why?

I've not been able to identify a major reason for the wake ups, other than perhaps mask discomfort. I suppose it's possible that mouth / mask leak is a cause, but if it is I'm not conciously aware of that.

Do you spend much time with machine and mask on and you are awake?

No, I only use the machine/mask when in bed sleeping or trying to sleep.

Do you take any medications of any kind, if so, what?

I currently take an SNRI for chronic pain.

[Pugsy]

SNRI meds are well known to cause fatigue and excessive daytime sleepiness along with a long list of other symptoms that are unwanted during the day.
They also are well known to mess with sleep quality as well as suppress REM sleep.
Google "SNRIs and sleep" and start reading.
So they probably are playing a factor in your fatigue.

Also playing a factor is the fragmented sleep in general due to mask issues or whatever.

Read this article....substitute anything that disturbs sleep for alcohol. The main part is what sleep disturbances does to our sleep and how we feel during the day.
https://www.sleepfoundation.org/article ... tity-sleep

Go here and learn how to evaluate your flow rate for arousal/awake related breathing
http://freecpapadvice.com/sleepyhead-free-software
I suspect you are having more arousals than you remember which is normal. Add those into the remembered arousals points to poor sleep quality in general. I have pain issues as well. I always remember half a dozen awakenings but when I go look at the flow rate I see 20 to 30 arousals. I know my sleep quality isn't good and it's related to the pain. When I have a particularly bad night in terms of pain I always feel like crap the next day and will need a nap and my butt will drag all day.

[Pugsy]

One thought you might consider.
Your pressure graph line is all over the place. For some people the varying pressures and what is causing those variations disturbs the sleep somewhat. You might try increasing the minimum pressure a bit and smoothing out that pressure line a bit and see if it maybe impacts how you feel during the day.
Many people say they feel better if the pressures don't bounce around so much.