why is it not immediate?

[nmevan]

hello folks
I'm wondering...how come I and others don't immediately feel better after using our new cpap, apap and bi-pap machines?
Wouldn't you think that more oxygen to your brain would have instant positive results?
I'm tired today...and it seemed as if I had slept most of the night through.
I've felt odd and groggy in the morning since I started treatment. It's been just over a week.
I'm pretty good for the first few hours of the day, but then I suddenly feel like I didn't get much sleep.
Is my body just getting used to more oxygen? Am I having more rem sleep? Will that make me feel odd and somewhat tired?
I know things will take time. But why? Why wouldn't you feel immediately better with more sleep, more REM, and more oxygen?
evan

[boosmum]

For some people the result IS immediate, others it seems to be more of a gradual thing and i'm not really sure why. I wonder if severity of apnea plays into it? I was at 56ahi and that dropped immediately to 2.5ahi average. Not sure what the oxygen sats are doing now as don't have a machine at home to do that one, but before my lows were down to 74%.

I've been on cpap for about 5 weeks now and for me the morning after my very first night I was literally bouncing off walls I had so much energy and felt SO good. That effect has worn off somewhat but I do still feel like when I wake up i'm now ready to jump up out of bed and start my day rather than barely dragging myself out of bed for sheer necessity sake.

[robysue]

I'm speaking as someone who is five weeks into therapy and not yet feeling as well as I was before starting CPAP.

I think it's a whole bunch of different things, any one of which might be more or less significant to a particular CPAPer who doesn't feel better in a fairly short period of time. Some of them might include:

1) Being essentially asymptomatic at the time of diagnosis. If you weren't yet feeling particularly bad before your diagnosis, the difference with CPAP may be very subtle---once you actually adjust to sleeping with it.

2) Pet theory of many here on cpaptalk is the idea of making up a long standing sleep deficit: Now that your brain is no longer having to arouse your body every few minutes/seconds in order to keep breathing at night, it and your body start craving the sound sleep that you've been missing for years.

3) Getting use to sleeping with the mask can cause a different set of arousals: Leaks can wake you up. Getting tangled in the hose can wake you up. Worrying about whether the machine is still blowing air can wake you up. The fact that turning over in bed is no longer automatic because of mask/hose issues can wake you up. The exhaust flow blowing on your arm can wake you up. A dry nose from the humidity level being too low can wake you up. Rainout from the humidity level being to high can wake up up. There is a very real learning curve for some people in simply learning how to get to sleep and stay asleep with the mask on. All these things mean that you're swapping a (permanent) set of sleep disruptions caused by the apnea for a (hopefully temporary) set of sleep disruptions caused by learning how to sleep with the machine. Seems like (judging from the CPAPers who have been using their machines for a long time) these problems begin to go away once you, your brain, and your body have all learned how to comfortably sleep with the equipment.

4) Anxiety about the mask or problems with aerophagia or other problems can trigger insomnia in some new CPAPers---that was one of my most significant problems in the first 2 1/2 weeks. And insomnia causes it's own set of problems with obtaining a good night's sleep.

And I'm sure there are many, many more as well.

My own advice based on my limited experience so far is this: If you are feeling much, much worse than you used to feel or if you think you're developing new problems that are interfering with your daily life, then give your sleep doctor's office a call and report what's going on. I've had several long phone conversations with my sleep doctor's PA as well as three follow-up visits with her (and another scheduled) all because what I've been going through has left me completely sapped of all strength and energy on most days. After a particularly bad night about 2 1/2 weeks in my husband insisted on calling the doctor's office. After speaking in person to the PA about how sleepy I was during the daytime (seriously worried about falling asleep while driving for the first time *ever* in my life) and how much more exhausted I felt every single day and how I felt like there was air blowing in my eyes even when I knew there were no leaks and the exhaust was not bouncing off the covers into my eyes, the PA decided there was a good chance that my titration sleep study may have overtitrated me a bit. After doing a week of autotitration and looking a the data, she authorized a change to APAP running 4--8cm instead of the 9cm I was originally prescribed. The worst of the exhaustion and sleepiness began to resovle itself almost immediately after I started the autotitration. I'm sill not feeling 100%, but I'm starting to feel more like my old self. But the PA continues to want me to monitor my aerophagia issues and insomnia issues very carefully and work hard on sleep hygiene techniques for the insomnia. Fortunately the standard sleep hygiene techniques for insomnia work pretty well for me. [And unfortunately I'm quite familiar with them because I've had several really bad bouts of insomnia triggered by high stress period of my life in the last 30 years.]

Best of luck and here's hoping that your adjustment period has NONE of the problems I've been dealing with.

[robysue]

For some people the result IS immediate, others it seems to be more of a gradual thing and i'm not really sure why. I wonder if severity of apnea plays into it?I was at 56ahi and that dropped immediately to 2.5ahi average. Not sure what the oxygen sats are doing now as don't have a machine at home to do that one, but before my lows were down to 74%.

If severity of apnea plays a role, it may be an inverse relation: My own hypothesis is that the more severe your apnea, the more likely you are to start feeling (much) better relatively quickly or immediately. The less severe your apnea, the longer it takes. Case in point compare boosmum's diagnositic figures to mine: Original RDI of 23.4 (with most events listed as "hypopneas with arousal" and NOT counted in my official AHI) and minimum O2 level of 91 or 92% during the diagnostic sleep study.

Another of my hypotheses is that the length of time to start feeling better may be more directly related to the severity of daytime symptoms of apnea. The more severe those daytime symptoms are, the more likely you are to start feeling better relatively quickly after starting CPAP. And note that severity of daytime symptoms is not necessarily related to the actual severity of the disease based solely on AHI/RDI numbers. Boosmum, how exhausted and sleepy did you feel during the daytime before starting CPAP? I bet you had a whole lot of daytime sleepiness and exhaustion issues that I wasn't dealing with before starting CPAP.

[nanwilson]

Hi there
It took you years of interrupted sleep to get to this point, it's called sleep debt and it will take you awhile to get back what you have lost. Some feel better after a few weeks, some after a few months.....there's no definate time line to catching up on your sleep debt. Patience is the key to a better life with cpap. I have been at this for 6 months and I now feel sooooooo much better, my energy has returned and I feel refreshed after a good nights sleep. Of course it's going to take me months to catch up on the housework I couldn't or wouldn't do prior to cpap .
Take care and good luck on your journey.
Nan

[GumbyCT]

hello folks
I'm wondering...how come I and others don't immediately feel better after using our new cpap, apap and bi-pap machines?

Think about how long it took to get to this point in your life. How long do you think you have had this problem?

Then let us know how long you think it should take to undo that part of your life. Use round numbers

[BlackSpinner]

Also according to my sleep doctor it can take your mind up to a month to start to relax and let you sleep deeply. After all for years it stood on guard and kept waking you up to breathe to keep you alive - it isn't going to trust that thing on your face right away.

[HoseCrusher]

Evan, Oxygen desaturation during sleep is only one aspect of sleep disorders. The xPAP machines do a good job of keeping the airway open, so if your only issue is having your airway close down, you feel immediate results. However, if there are issues beyond having a closed airway, you will have to look beyond xPAP.

[Jaylee]

I slept a lot when I first got my machine. I would come home from work, eat, shower and go right to bed. I had a lot of sleep debt to pay off. I did not feel better for a few months. Now I wake up after 7 to 8 hours of sleep. I think everyone will be different, though.

[Guest]

thanks to all for your help!

I guess I'm upset because I did not feel that bad prior to just over a month ago when all this came crashing down. I'm 53, and I was told well over 10 years ago by a friend that I stopped breathing when I was asleep. In that last ten years I have felt fine, with lots of energy and without feeling spaced out.

I just did the sleep study about 3 weeks ago, started the machine just over a week ago, and now I feel groggy, drowsy, perplexed and somewhat depressed about my new state.

I wonder what the exact physiological changes were that made everything come to a head. I will probably never know.
I realize that I have been unknowingly tortured for many years and it will take time to heal, but it just seems odd to me that I would feel worse once I started receiving more oxygen to my brain and body.

I will continue my therapy and hope for the best.
Good luck to all of you as well and thanks again.

evan

[minerva]

Sleep debt is cumulative over time, and it doesn't just go away. So, if you've had apnea for a while, you've likely accumulated a very large sleep debt that you may never 'pay off' completely.

I did this calculation when I first started therapy in 2006: I judge that I've had apnea most of my life, almost certainly since my teens. I was 46 when I started therapy, which means I had untreated apnea for at least thirty years. Let's say that half of the night's sleeps I got during that time were good, that means I had 4 hours of sleep debt for each night I slept (assuming 8 hours is necessary). Over thirty years that adds up to 43,800 hours of sleep debt. If I slept for 24 hours a day, it would take me five years to pay this back. Right now I'm sleeping 9-10 hours a night, so I'm getting about 2 hours extra. At that rate, I will have paid off my sleep debt in 60 years. If I make it to 100, I might pull it off.

Sleep well!

M.

[elena88]

I would like to echo what robysue said about her exhaustion after cpap and not before..

and her titration pressure issues..

I think sometimes its very likely that a pressure maybe too high for some of us, and we were titrated incorrectly..

so that would really ruin your day... a lot of them!

so keep track of how you are feeling.. and let the doc know if it keeps getting worse after awhile, give it a few weeks..

Im in my tenth month.. starting tomorrow... and Im going to give it two more months before I say bye bye to the apap..


Im a weird case though

[boosmum]

Boosmum, how exhausted and sleepy did you feel during the daytime before starting CPAP? I bet you had a whole lot of daytime sleepiness and exhaustion issues that I wasn't dealing with before starting CPAP.

I would get so sleepy most days that my house could be burning down around me and I wouldn't have cared because I just HAD to have a nap. It was terrible!!! Now I can honestly say I haven't "needed" a nap since starting cpap.

[robysue]

So that's another data point that supports my hypothesis that part of how quick a CPAPer starts to feel better is related to how bad/sleepy the CPAPer felt before starting therapy.

Thanks for sharing boosmum!

[Twentysix]

Hi, I had the same disappointment when starting the treatment. I expected to feel fit and bouncy in the morning! Although after 4,5 weeks I still not feel bouncy, I must admit I'm not really a morning person. I do notice differences in less tiredness during the day, e.g. I have experienced often that I would doze off in the car in the afternoon as a passenger, but also when driving. Don't think that is happening as much now, but next weekend will be a testcase with a four hour drive ahead of us.
I am sleeping much better, do not wake up a zillion times a night, and am starting to make more hours of sleep. Initially did not get past 6 hours a night, but then that was already an improval over 6 hours with only 69% efficiency as my sleep study found (after having been in bed for 9!). Only downside is that I'm sleeping for too long in a position now, and wake up with sleeping limbs or backpain. Anyone tips for the best mattresses when sleeping soundly?
Anyway, I've decided I need to give this a serious try, so will purchase my 'own' machine today. Keep fingers crossed I don't get a 'monday' model.

Good luck and happy sleeping! Hope you feel better soon.