[CPAP] 4 months on APAP, mild apnea, feeling worse than before CPAP

[mLightSleeperman]

Hi. First time user, please let me know if I'm doing anything wrong. Charts for the past 2 nights attached below.

My main issue is that I feel more tired than I did before CPAP. I have not yet woken up refreshed with CPAP as some have experienced. Pre-CPAP, I felt groggy upon waking up, and I feel tired and in a "mental fog" throughout the day, and have some trouble concentrating on things like work or even watching TV sometimes. However, while on CPAP, all of these have gotten worse, and I have also found it hard to fall asleep without some kind of a sleep aid. Now for the past 2 months, I suspect an antidepressant that I had tried was partially to blame. But, I stopped taking it, and I want to rule out CPAP as the issue.

I am 26 and at a healthy BMI. I try to do all the good "sleep hygiene" things - no digital screens 1 hour before bed, keep a similar routine, same wake-up time every day, no caffeine after 2pm, etc.

I use a Resmed Airsense 10. Pressure is 7 min, 12 max, EPI 2. My nasal mask isn't uncomfortable. I will say I use a neck brace to keep my jaw from dropping (I have tried a jaw strap in the past but was uncomfortable), and the neck brace is a little uncomfortable, and I feel some mild neck discomfort during the day. Everything else about my setup though is not uncomfortable.

My AHI is obviously very good, usually 1, no higher than 2. On paper, my sleep is good, but I am having the aforementioned fatigue symptoms. They have gotten steadily worse since starting. It's been frustrating.

If anyone has any suggestions, please let me know.

       

[Sleeprider]

I think you know the fatigue is not related to CPAP therapy. The easy way to find out is to quit. You can come back to it when you decide to look elsewhere for a solution, and that's fine. Your health won't be harmed by a mild case of apnea at your age. But use the time to get to a doctor and get a complete workup to hopefully learn where the problem really lies. Your CPAP therapy is nearly perfect and I'm sure a lot of members would be envious of those results, and I don't think for a moment that turning the dials and fine tuning your good results is going to make a difference. I wish I had more, but the CPAP therapy was one step in your journey to find out where the problem lies. There are many possibilities, and this dart didn't hit the bullseye. It doesn't mean you should toss it out, but you should not continue to think your growing symptoms come from CPAP. If you think you will feel better without it, you have my blessing. I hope you do find the health, hormonal, mental, viral or other issue that is the problem. Where to begin? Lyme, testosterone, nutrition, making the world normal again? I wish I had a better answer.

[mLightSleeperman]

I don't know if my fatigue is because of CPAP. All I know is pre-CPAP, I was mildly tired, and using CPAP, I have been more tired. I have heard it can take many months to get used to - including from my sleep doctor, who told me to keep using it despite how I felt, because my AHI was great. And CPAP is not the first thing I have tried. 

But at the moment, I would like to give CPAP as good of a try as I can. I am in a unique position now, having finally gotten used to the machine. I used to only be able to sleep 3 hours on it before waking up and unable to fall back asleep with the mask on. Lately I have been able to do 6 and a half, sometimes without waking up in the middle of the night. If I stop and try again months later, I might have to take another 4 months to get used to the machine again.

So for now, I would like to try to turn the dials. If there is anything in my data where it's really apparent what the issue is, I'd like to know.  Or any suggestions to try as well. For example, I set my EPI to 0 last night (same min and max of 7 to 12) just to give it a try. Not as great of a night of sleep but I'll do a few more so I can get some data on it.

[Sleeprider]

In your case, what feels best, is the best. Go for comfort. Your AHI is very low, and I think EPR helps more than hurts for most people.

[Dormeo]

Right now, you don't know whether you've become more fatigued because of CPAP or for some other reason. So while I understand your interest in optimizing CPAP, I also see quite a lot of value in doing an experiment and stopping CPAP for several weeks to see whether the fatigue lessens or not. That information could be quite useful to you and your doctor.

I hope you'll try that experiment before long. In the meantime, one thought would be to see whether you would do better with fewer changes in pressure. For some people, pressure changes can be somewhat disruptive. In your case, the pressure increases seem primarily to be responses to modest flow limitation, so I'm skeptical whether the higher pressures are providing you with a lot of benefit. You could try, say, min = max = 8, leaving your EPR at 2.

I also wonder whether you can try arranging to sleep for 8 hours per night. For some people, that can be helpful.

[mLightSleeperman]

Thank you. Yes, at some point, I think I will try going off of CPAP again and see how I feel. But for now I'll try what you suggested. Thank you!