[CPAP] Feeling significantly more tired after starting CPAP

[rtbick]

Hello!

I was diagnosed with sleep apnea in 2023 and have struggled to adjust to the CPAP. I'm on day 4 of my third attempt, first night was last Saturday 11/30. My last CPAP attempt was back in March/April.

The issue I am having is that I feel significantly more tired and drowsy after 3 nights with the machine - a noticeable onset of brain fog that I have not felt in the past several months without a CPAP. It's legitimately more difficult for me to think and function during the day; I feel sluggish not just physically but also mentally.

Last night was seemingly my most successful with the CPAP (only got up to pee once!) and yet, I feel the worst since starting it on 11/30. Earlier today, I crashed for a 90 minute nap, when it's been months since I felt any need for an afternoon nap.

This brain fog sensation is a familiar from my previous CPAP attempts - the main difference from previous attempts is that I feel like I have other CPAP comfort issues (mask type & fit, etc.) in a much better place. So, it really feels like something with the CPAP is worsening my sleep quality, and I would like to figure it out.

I would like some assistance in reviewing my OSCAR data. Nothing jumps out at me, but I do have some questions.

• The data is showing CA events, but no OAs. But in my sleep study, I had zero CAs, only OAs (I can share that report if helpful). I was diagnosed with obstructive sleep apnea, not central. Could the CPAP be causing CAs, and if so how could I fix that?
  
• My AHI is quite low - my AHI in my sleep study was 21. What could cause me to feel so much worse if I'm having fewer apneas & hypopneas?
  

Thanks so much in advance!
           

[Dormeo]

Welcome! It must feel discouraging to be experiencing more brain fog and sleepiness, not less. I don't know why that is, but I do know our bodies take a while to get used to the new sleep experience. During the adjustment period, it's not uncommon to have more arousals than usual and to have some problems achieving a normal sleep architecture. (That refers to the succession of sleep stages throughout the night.)

One thing you can try doing to speed up the adaptation period is to set up your machine outside your bedroom during the day or evening and use it while you read, watch TV, or use your devices. That can really help.

Do you usually stay in bed for only around 7.5 hours per night? I'm going to guess that your actual asleep time was less than 7 hours. Do try to get more sleep.

As for your chart, in general it looks pretty good. The CAs are probably coming after arousal breathing, which is common. (Arousal breathing tends to be deeper than regular asleep breathing, and that can blow off enough CO2 to briefly delay your brain's "breathe now" signal.) If you had an in-lab sleep test, those CAs probably wouldn't be scored. The CAs you're having aren't in themselves a problem, though the associated arousals are.

You are having some flow limitations. Do you have a stuffy nose? If not, the FLs might be improved by using EPR of 3 rather than 2. I would also recommend turning off your ramp and setting your minimum to 7. That way you'll have a consistent EPR of 3 all night. (The machine can't go lower than 4, and an EPR of 3 drops your pressure by 3 when you exhale.)

It's great that you're not seeing OAs. That means CPAP is working for your obstructive apnea.

Next time you post a chart, you need post only what you have on p.1.

[rtbick]

Thanks for this info, Dormeo!

I do get a stuffy nose at night. My ENT said it is nonallergenic rhinitis. It was a nightmare to deal with in my first CPAP outing. I had a turbinate reduction + septoplasty surgery earlier this year that has helped a lot, but I tend to sleep on my side, so it's not uncommon for one nostril to get congested still. I could try bumping up the temp/humidity settings a bit more maybe, but I've avoided rainout so far this time around and I don't wanna push my luck

Is it worth trying the EPR setting changes anyway? Also, if I set the minimum to 7, should I bump up the max pressure slightly, or is 8 fine given the lack of OAs and not staying at peak pressure?

Sleep hygiene is definitely something I struggle with a bit. It's harder of course when sleeping isn't restful and feels like a struggle (CPAP or no). I'm getting a new mattress soon and hopefully that also helps me look forward to going to bed.

I'm open to using the CPAP while I'm awake, but it doesn't feel like it would help a whole lot since I'm able to fall asleep with CPAP about as easily as without. Are you saying it could help my "subconscious sleep brain" get used to it and improve sleep architecture regardless? I guess I figured me falling asleep with it = my body saying "OK this thing is fine" but I guess it's more complicated than that.

[Deborah K.]

I think you should raise your max pressure from 8 to 9 as you are bumping up against the 8.  Don't worry about not feeling great yet.  That is entirely normal.  It takes a while for your body to adjust to all these big changes.  Just don't give up!  It will eventually feel quite normal.

As to the CAs, since you had none in your sleep study they are treatment-emergent and will lessen as time passes.

Good luck with your new therapy!  It's well worth the early aggravation!

[phattyre]

@rtbick 

I completely understand how you feel.

I’ve just started using CPAP as well, and I almost feel worse. Like you, my AHI numbers are low (pre-CPAP was around 20, and post-CPAP is now under 2.5). I have no idea how to interpret these OSCAR graphs yet, but yours seem great compared to mine (just looking at spikes). I really hope we’ll eventually experience the benefits that our long-term friends here are enjoying. 

Wishing you restful sleep. 

P.S. A few years ago, I switched to a Tempur mattress and pillows (before I knew I had sleep apnea).