Newbie here. I'm on On CPAP but not feeling any better.

I am a 31 year old male, approximately 45 pounds overweight. I was diagnosed with severe Obstructive Sleep Apnea and placed on an APAP machine.

I have been using the APAP machine with full compliance, for about 1 month and 5 days. My AHI numbers generally vary between 1.0 and 3.0 which is obviously a vast improvement over my pre-treatment numbers.

But the truth is, I don't feel any better. I don't know if the APAP machine is preventing deep sleep. Obviously it is preventing the oxygen desaturations but I honestly do not feel rested even after 8-9 hours of sleep.

Hopefully this will improve with time, cuz I haven't received the mystical, legendary burst of energy and vigor that I was secretly hoping for.

JonathanCPAP wrote:I am a 31 year old male, approximately 45 pounds overweight. I was diagnosed with severe Obstructive Sleep Apnea and placed on an APAP machine.

I have been using the APAP machine with full compliance, for about 1 month and 5 days. My AHI numbers generally vary between 1.0 and 3.0 which is obviously a vast improvement over my pre-treatment numbers.

But the truth is, I don't feel any better. I don't know if the APAP machine is preventing deep sleep. Obviously it is preventing the oxygen desaturations but I honestly do not feel rested even after 8-9 hours of sleep.

Hopefully this will improve with time, cuz I haven't received the mystical, legendary burst of energy and vigor that I was secretly hoping for.

Hi JonathanCPAP,

Welcome to the forum! When you get a chance, can you please use the link in my signature to fill out your equipment profile? That way, members can better tailor their responses to your specific situation.

Unfortunately, it takes time to feel that vigor that everyone is hoping for when they start therapy. For many people, it takes several weeks and perhaps you are in that category.

Hang in there.

49er

Hello and welcome. Besides your AHI, how do your leak numbers look? What pressure range are you using on your APAP? Some people are sensitive to the pressure changes of an APAP and find the sleep disruptions mean they still have poor quality sleep. For some, straight CPAP pressure is preferred, but it's probably a bit soon for you to be able to pinpoint that. Do you feel like you are sleeping soundly or that your sleep is shallow and restless? Are you on any meds that could affect your sleep and/or cause you to feel bad during the day? Maybe your doctor will need to look for other possible contributors to how you feel, but lots of people on here report feeling more tired and sleepy for a while after starting treatment. I was one of those. For some there is a recovery period, same as after any other kind of trauma. At 5 weeks in, I was still in a stupor, but I was dealing with other sleep disorders too, like limb movements. Give your body everything it needs to heal itself including good nutritional support and physical activity as appropriate and hopefully you will soon be feeling the results of your efforts to regain your health and vitality.

Hello 49er and Kteague,

Thanks for the welcome I appreciate your response to my questions. I will now test your patience with a bunch of additional questions, but don't feel that you need to respond. Only if you have some free time available.

I have modified my profile, so it should now show my current equipment: PR system one APAP machine with a Mirage FX mask. My pressure is 9 - 15, but it always hovers between 9 and 11. Never goes higher than that. Perhaps I should set it to stay at 10 or 11 and see if a completely unchanging pressure setting would make me feel better.

"Do you feel like you are sleeping soundly or that your sleep is shallow and restless?"

Absolutely, I feel that my sleep is shallow and restless!!! What could be causing this? I don't take any medicine at all. I drink coffee within normal standards, 3-4 glasses per day, and never within 8 hours of bed time. I eat way too many calories, because I am a compulsive overeater. But a lot of the foods I eat are healthy, fruit, vegetables, fresh salmon, etc.

I don't really know how to evaluate the data from my memory card. I am viewing it in Sleepyhead, and it shows that my leak is 20 - 40 every night. I assume this includes the vent rate, would I presume would rule out any leak problems. I don't really understand the significance of snores, vibratory snores, flow rate, tidal volume, etc.

During my sleep study I was diagnosed with potentially having "complex sleep apnea" because the use of the CPAP machine caused me to have lots of centrals. But looking at my AHI data, centrals don't appear to be a big problem. I have them every night - yes - but they don't seem to be frequent enough for me to believe I have complex sleep apnea.

I should mention that I have a sub-optimal sleep schedule: I go to bed at 4:00 AM almost every day and wake up at 12:00 PM. I would like to blame all my problems on this crap schedule, but I suspect my sleep problems will persist even if i start going to bed at 11 PM like a normal 31 year old.

Any ideas?

JonathanCPAP wrote:Hello 49er and Kteague,

Thanks for the welcome I appreciate your response to my questions. I will now test your patience with a bunch of additional questions, but don't feel that you need to respond. Only if you have some free time available.

"Do you feel like you are sleeping soundly or that your sleep is shallow and restless?"

Absolutely, I feel that my sleep is shallow and restless!!! What could be causing this? I don't take any medicine at all. I drink coffee within normal standards, 3-4 glasses per day, and never within 8 hours of bed time. I eat way too many calories, because I am a compulsive overeater. But a lot of the foods I eat are healthy, fruit, vegetables, fresh salmon, etc.

I don't really know how to evaluate the data from my memory card. I am viewing it in Sleepyhead, and it shows that my leak is 20 - 40 every night. I assume this includes the vent rate, would I presume would rule out any leak problems. I don't really understand the significance of snores, vibratory snores, flow rate, tidal volume, etc.

During my sleep study I was diagnosed with potentially having "complex sleep apnea" because the use of the CPAP machine caused me to have lots of centrals. But looking at my AHI data, centrals don't appear to be a big problem. I have them every night - yes - but they don't seem to be frequent enough for me to believe I have complex sleep apnea.

I should mention that I have a sub-optimal sleep schedule: I go to bed at 4:00 AM almost every day and wake up at 12:00 PM. I would like to blame all my problems on this crap schedule, but I suspect my sleep problems will persist even if i start going to bed at 11 PM like a normal 31 year old.

Any ideas?

Hi JonathanCPAP,

Please don't sweat about asking questions. That is what we are here for.

It certainly would be worth a shot to see if you felt better with a straight cpap pressure vs. a changing one. Many people find this does help so you have nothing to lose by trying this.

I have modified my profile, so it should now show my current equipment: PR system one APAP machine with a Mirage FX mask. My pressure is 9 - 15, but it always hovers between 9 and 11. Never goes higher than that. Perhaps I should set it to stay at 10 or 11 and see if a completely unchanging pressure setting would make me feel better.

Your leak data seems fine so I wouldn't worry about that area. The other categories I am not much of an expert in but maybe someone else can respond.

What is your average rate of centrals? If it is less than 5 per hour, then you're right, you don't need to worry about it.

However, if you continue to have problems with your sleep, since this showed up as a potential problem, you might want to follow up with your doctor on this. The reason why I am suggesting this is I know a few people who didn't have any centrals show up on their data only to find out that they did have complex apnea.

Why do you suspect your sleep wouldn't improve if you went to bed earlier? Just so you know, I am not putting down people going to sleep when you do. I just know from personal experience that if I sleep the same number of hours during a specific time period vs. another one, it makes a big difference. Just curious.

Do you have any allergies or nasal congestion issues? That can impact sleep quality.

Sorry, I wish I had some earthshaking ideas that could explain your problems. It may just be an issue you needing to give things more time. But if you honestly feel your not progressing like you should be, please followup with your doctor to see what is going on.

49er

49er, you really got my attention with your last post. Did I understand you correctly? There are people whose data shows few or no central apneas, yet they really are experiencing central apneas due to complex sleep apnea? How is that possible, and why would my APAP machine fail to register all the centrals?

According to Sleepyhead, I usually have an AHI of between 2 and 3 per night, and sometimes as low as 1.5. But if I am experiencing centrals that aren't being recorded for some reason, that would certainly explain why I am not feeling any better.

"Why do you suspect your sleep wouldn't improve if you went to bed earlier?"

Well I really have no justification for that claim. Perhaps I would feel a lot better if I went to bed earlier. I would like to try this in the near future.

I don't have allergies, sometimes I do feel congested, but I doubt this is the source of the problem: sometimes I wake up and my nose doesn't feel congested at all, after having slept for 8 hours and I still feel bad.

Just wondering if your sleep study report said anything about limb movements? When sleep is restless that's one thing to rule out.

Hi JonathanCPAP,

I have no idea why an APAP would fail to register centrals. But that is what happened to a forum member I briefly corresponded with. So that is why I wanted to raise it as a possibility. Obviously, one person's experience does not prove anything.

You also might want to do a search for Dr. Krakow, a famous sleep medicine doctor, who posted on this forum in 2007. I can't remember exactly what he said but I do recall him staying the data couldn't always be trusted.

49er

JonathanCPAP wrote:49er, you really got my attention with your last post. Did I understand you correctly? There are people whose data shows few or no central apneas, yet they really are experiencing central apneas due to complex sleep apnea? How is that possible, and why would my APAP machine fail to register all the centrals?

According to Sleepyhead, I usually have an AHI of between 2 and 3 per night, and sometimes as low as 1.5. But if I am experiencing centrals that aren't being recorded for some reason, that would certainly explain why I am not feeling any better.

"Why do you suspect your sleep wouldn't improve if you went to bed earlier?"

Well I really have no justification for that claim. Perhaps I would feel a lot better if I went to bed earlier. I would like to try this in the near future.

I don't have allergies, sometimes I do feel congested, but I doubt this is the source of the problem: sometimes I wake up and my nose doesn't feel congested at all, after having slept for 8 hours and I still feel bad.

Hi KTeague, my sleep study did not show any restless leg syndrome or pathological limb movement.

My study showed severe OSA (which was much worse in supine position), and then when I was given the CPAP, my OSA disappeared and was replaced by central apneas. That is pretty much the definition of complex sleep apnea. However, once I started the APAP machine in my house, the data from the memory card suggests that there are virtually no problem with central apneas. Therefore I am in a quandry: I don't know if I can trust the data, or if the central apneas in my sleep study were just due to some very temporary factors due to the sleep study itself.

Hi 49er, thanks for the suggestion. I will look for Dr. Krakow's posts.

Sometimes centrals that manifest themselves with cpap pressure will go away on their own with a bit of time. That's one of the reasons if the centrals aren't present in extremely high numbers that cpap therapy with regular machine (as opposed to ASV machine) is often suggested.

If your sleep is poor quality, restless, fragmented with multiple awakenings for whatever reasons a person can't expect to see much improvement until those issues are also fixed and not all issues are related to OSA as much as we would like for them to be so that the machine can fix them.
Good sleepy hygiene is very important too and for most people that 4 AM till Noon sleep period is not what would be classified as good sleep hygiene.

The machine is designed to fix OSA and it can't fix problems that are unrelated to OSA.

I figured if it is many short CA that is less than 10 seconds and is not recorded, perhaps it can be a reason that you do not feel rested? I have so most all night. I here put into their own events that are longer than 5 seconds and the flow decreased by 20%

A friend of mine with a very high pressure had to go to an ASV type machine because his very high pressure caused centrals.I might have it wrong but I thought complex apnea is something different from having pressure induced centrals. If either of these might be an issue with you, hopefully some astute data hounds can help you uncover something. I wouldn't invest too much brain space in investigating solutions to any particular problem until the problem has been identified. Good luck in doing that.