New CPAP User with Paradoxical Reaction?

Hello All,

I'm new here and new to CPAP therapy. After an at-home sleep test I was diagnosed with moderate OSA with an AHI average over three nights of 19. I was prescribed a CPAP with 4-20cm pressure and began using it (an Airsense 10 Autoset with the F20 full face mask) last Friday night for the first time. I had done a bit of research beforehand, including browsing forums like this, so I had a fairly good idea of what to expect. My first night on the CPAP went pretty well, all things considered. The mask wasn't all that uncomfortable for me, and I slept through the night probably better than I have in ages, as I have pretty much every night since using getting the CPAP. According to the data on the Airsense, I'm only having 1-2 AHI nightly while using the unit. I do recall waking up briefly to re-adjust the mask because of an air leak a couple times, and the machine has recorded a leak as high as 17L, but I'd hardly consider it to be very disruptive to my sleep.

When I woke up the next morning, and every morning since, I've felt pretty good. Not great or amazing, but definitely not in the exhausted state I had been waking up in for years. My mind felt clear, and people even noticed I seemed to be in a better, more cheerful mood. YET, every day, around noon or shortly thereafter, I'm now getting very intense afternoon tiredness along with a mild headache-y feeling. This seems to occur regardless of eating. Although I as often tired throughout the day, I never had spells THIS BAD in the afternoons prior to using CPAP.

I know many of you in these forums talk about "two steps forward, one step back." Is it common to feel better in the morning after CPAP use but for fatigue, brain fog, and headache to return by the afternoon? I've made an appointment to see my doctor in a couple weeks about this, but I'm just curious if anyone else has had a similar reaction to CPAP therapy. I do like how it makes me feel when I first wake up, and how I don't wake up in the middle of night anymore with my heart pounding and short of breath. But these afternoon fatigue spells are awful. Is this just one of those things that gets better with time?

Obviously, your treatment is effective, in spite of NOT being actually "set".
FYI: 4-20 is FACTORY DEFAULT, and is no doubt contributing to your tiredness.
Until you get your settings dialed in, you can expect less restful sleep.
Get the clinician's manual, free at apneaboard.
Oscar can be a huge help, too.
Read the stickies at the top, where Pugsy has posted much useful information.

So how many hours of sleep are you getting?

Do you take any medications of any kind? Even OTC.... If so, what?

Any other physical or mental health issues going on that might affect how you feel?

I'm getting from about 7-8 Hours of sleep each night since getting it. At least that's what's showing on the MyAir information. I'm a little sad to report that I slept pretty soundly for about 4-5 hours last night before waking up around 2am with the same breathless, heart racing sensation as before. Took about half an hour to get back to sleep after that, during which I never took the mask off, so I think that counted as sleeping on the device. I do know that prior to the CPAP I was having to get up to use the bathroom 1-2 times a night, but since getting it I no longer have to.

The medications I take are: magnesium glycinate 200mg, vitamin D 2,000IU, and melatonin 10mg. I had been taking a prescription Hydroxyzine 50mg every night as well prior to the CPAP but I stopped it after the first night as I was mainly just using it to help me get to and stay asleep longer. As for other health problems, the only chronic ones I have at the moment (that I know of) are depression and bilateral lymphedema in both of my lower legs.

So I did the sleep study with an online outfit that seems to be associated with CPAP.com called "SleepCareOnline." I went back through the email where they sent me the RX after the telehealth appointment and this is what it says:

Auto-CPAP 4-20 cm H2O with HH/HT and mask fitting
Alternate treatment options include oral appliance therapy and/or surgeries
Weight loss if BMI>25
Avoid driving if sleepy

Should my pressure be something different then?

I really appreciate you both taking the time to reply to me as well.

I want to underline what chunkyfrog said about Oscar. People will be happy to advise you about fine-tuning your settings, but they'll need the kind of information that Oscar provides.

You'll need a laptop or desktop computer, an SD card in your machine (32GB or less), and a way for your computer to read the card -- either a slot in the computer, or a plug-in card reader. Then follow the instructions on the web site to download the program and get yourself set up to use it. If you have problems, just let us know.

Once you have done that, just take a screenshot of a daily chart and post it here.

Miss Emerita wrote: ↑

Tue Mar 22, 2022 11:46 am

I want to underline what chunkyfrog said about Oscar. People will be happy to advise you about fine-tuning your settings, but they'll need the kind of information that Oscar provides.

You'll need a laptop or desktop computer, an SD card in your machine (32GB or less), and a way for your computer to read the card -- either a slot in the computer, or a plug-in card reader. Then follow the instructions on the web site to download the program and get yourself set up to use it. If you have problems, just let us know.

Once you have done that, just take a screenshot of a daily chart and post it here.

Thanks, I've got an SD card and reader on the way, should be here tomorrow afternoon.

Okay I have at least one night's worth of data. Admittedly last night was a pretty good night, but i'm having a lot of problems with mask leaks waking me up.

I'm so glad you now have Oscar data! I have a couple of suggestions that might make your sleep more comfortable and restful.

You have a fairly active flow-limitation graph. FLs are restrictions within your airway. If they're in your nose, there's not much to do about them, but if they're in your pharynx, where your tissues may be relaxing during sleep, EPR may help.

EPR is expiratory pressure relief, it drops your pressure when you exhale. By the same token, it gives your pressure a little boost when you inhale, which can help to overcome FLs. This may make sleep more restful by making it easier for you to breathe in. Flow limitations cause extra effort breath by breath, and they have the potential for disruption the normal sequence of sleep stages. No way to know whether this is in fact a problem for you, but EPR is a good experiment to try.

So I recommend that you set EPR to the maximum, which is 3. Please also revise your starting pressure to 7, so that you can get the benefits of EPR from the start. (The machine can't generate less pressure than 4.)

Do you think you can do without ramp? If so, turn it off. If not, make sure the ramp minimum is 7.

You are having more "large leaks" than you should, but I'd say let's see how the revised settings go for you before worrying about the LLs.

When you post your next chart, there's no need to include any graphs except these:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

By including additional graphs, you make the essential ones a little hard to read.

Onward!

Hello! Thanks for the information and recommendations. I have adjusted the settings as per your recommendations. I also switched last night from a large mask back to a medium mask and I think that has fixed the leaks. Here is my data from last night. There's a gap in the data where I woke up and saw that the hose had detached from the mask. I have no idea how this happened, but I reattached it and went back to sleep.

IMO that looks fabulous and I would leave it sit. Those few snores could just be leak chatter and the FLs benign. Get accustomed to things for now.

In re: the tiredness at noon, you've been up for ~7 hours so that could simply be an expected occurrence. A lot (most?) people have an afternoon dip. Are you in a position to take a nap? How's your physical state? Exercise? Age? Caffeine? How's your overall sleep continuity? From this high level view (aka "SkyLab") it looks like you have some sleep disturbances (maybe about 18) that might be addressed by lifestyle changes.

Very nice! You solved the leak problem with the medium, it seems, which is great. I'm not sure why the hose came off the mask, so just be sure it's snugged on there when you go to bed.

Could you post another chart after another few nights getting used to things? I should have explained that in addition to the six graphs, the panel on the left should be included as well, since it has some useful information.

Daytime improvement can take some time, and the changes can be subtle. So patience should be your watchword. I think you'll see improvement in the days and weeks ahead.

Rubicon wrote: ↑

Fri Mar 25, 2022 5:26 am

IMO that looks fabulous and I would leave it sit. Those few snores could just be leak chatter and the FLs benign. Get accustomed to things for now.

In re: the tiredness at noon, you've been up for ~7 hours so that could simply be an expected occurrence. A lot (most?) people have an afternoon dip. Are you in a position to take a nap? How's your physical state? Exercise? Age? Caffeine? How's your overall sleep continuity? From this high level view (aka "SkyLab") it looks like you have some sleep disturbances (maybe about 18) that might be addressed by lifestyle changes.

Well it seems the headaches have gone. I still yawn a lot, but I'm not dead tired anymore in the afternoons now, so I think it is improving now. I'm a high school teacher with a 45 minute commute, so no real chance to take a nap. I don't really get any exercise. I'm 38. I haven't had any caffeine in 4-5 years aside from rare occasions where I have decaf green tea or 70% dark chocolate. I am working on losing weight, a process which I hope (and it seems data suggests) will accelerate with the CPAP. I'll definitely leave things as they are for now. I think the only (minor) complaint I have remaining is how sore my nose/face feels in the mornings after wearing the mask. I usually cannot breathe through my nose when I first go to bed, so that rules out nasal only it seems. Although I haven't noticed any visible damage yet my face often feels painful and on the verge of blistering in the mornings when I take the mask off.

I've noticed the F20 mask that I use has a different model with a foam cushion. Would that improve my issues or is the foam more for sealing rather than comfort?

Miss Emerita wrote: ↑

Fri Mar 25, 2022 11:46 am

Very nice! You solved the leak problem with the medium, it seems, which is great. I'm not sure why the hose came off the mask, so just be sure it's snugged on there when you go to bed.

Could you post another chart after another few nights getting used to things? I should have explained that in addition to the six graphs, the panel on the left should be included as well, since it has some useful information.

Daytime improvement can take some time, and the changes can be subtle. So patience should be your watchword. I think you'll see improvement in the days and weeks ahead.

Will do ! Thanks again for taking the time to help me out. By the way, do you have any recommendations for mask comfort? I've got the F20 full face mask, but each morning when I wake up my face feels raw and on the verge of blistering. I haven't had any visible damage/blistering yet. The mask I use has a foam cushioned model instead of the like bendy silicone style cushion it has now. Would the foam be better for comfort or is it just intended to prevent leaks?

Padacheek.com makes 'liners' for most masks - the designer was a member here - so look it up and order something for your face.

Any chance you can try the foam on or won't they let you?

Julie wrote: ↑

Fri Mar 25, 2022 8:08 pm

Padacheek.com makes 'liners' for most masks - the designer was a member here - so look it up and order something for your face.

Any chance you can try the foam on or won't they let you?

Thanks, I'll check that out. I'm paying for it all out of pocket and the foam mask is another $100 so I just wanted to get opinions as to whether or not it was an improvement before ordering it.