CPAP makes me feel worse? (Feel better without CPAP)

[Jake B]

Hi folks,
First post here but I've read a few threads that have come up via Google searches.

I've been using APAP for about a month now and I've noticed I feel noticeably worse with it. I decided to go without it last night to see what would happen and while I don't feel good per se, I feel less bad without the machine.

I was diagnosed with fairly mild sleep apnea with about 12 events per hour. I always feel physically tired, foggy headed, pressure around my eyes and head, mood issues. I've dealt with this for years until they finally diagnosed me and place me on APAP (started at 5-15, now at 10-15). The problem is, after beginning treatment I take more naps and feel stronger symptoms than before. According to OSCAR my numbers look great... AHI rarely above 2, no/leaks, sleeping 8+ hours through the night. I've tolerated the machine since day 1, however I switched from nasal pillows to full face due to mouth leaks.

So, everything seems to be going great with treatment, but something clearly isn't right if CPAP makes me worse. I mentioned it to the doc and basically only got, "So are you done using the machine then?" and offered medication. I told them I'd like to keep with it and see what happens, but it's hard to get motivated when I feel so bad.

Anyone have any suggestions, advice, opinions? Let me know what additional information I can provide and I'll be happy to as soon as I can.

[Julie]

Are you sure it's the cpap making you feel worse? Seriously, you could have some other coincidental condition and/or be taking certain meds that interfere one way or another with sleep and/or a 'hangover' effect. etc. etc. When's the last time you were checked for other things with labs, etc? Not everything's about Cpap .

[Jake B]

Are you sure it's the cpap making you feel worse? Seriously, you could have some other coincidental condition and/or be taking certain meds that interfere one way or another with sleep and/or a 'hangover' effect. etc. etc. When's the last time you were checked for other things with labs, etc? Not everything's about Cpap .

I can't prove 100% it's the CPAP, but I felt worse when starting treatment and I don't feel AS bad when I'm not on it.

[Julie]

Are you just having apnea symptoms or others?

[Jake B]

Are you just having apnea symptoms or others?

Fatigue, sleepiness, fuzzy-headed, difficulty concentrating, anxiety/depression (brought on by the sleep problems), mild headaches, pretty standard apnea symptoms.

I understand depression and mood issues can cause fatigue and I'm being treated for that as well, but I believe it's directly related to my sleep quality.

[Julie]

What if, e.g. you have a thyroid problem, or blood sugar problem, or ??

[Jake B]

What if, e.g. you have a thyroid problem, or blood sugar problem, or ??

Thyroid and blood sugar levels have been checked, and my standard yearly blood work always comes back normal.

[Miss Emerita]

Hello, Jake. It's pretty common to feel worse with the new experience (mask, pressure, hose, noise), and everyone adapts at their own pace. There's the occasional person who wakes up fresh and raring to go after their first night, but for most of us, the early experience is difficult, and then improvement comes gradually. But it comes!

With an AHI of 12, you are in effect having your sleep disrupted on average every 5 minutes. You may not be waking up each time, but your sleep cycles are getting trashed, and you are probably not getting adequate deep sleep or REM sleep. As you know, in the long run, untreated apnea can raise your risks for hypertension, diabetes, heart disease, and dementia.

That's all by way of encouraging you to have patience. But it might be that your settings could use some tweaking. If you are interested in that, could you download Oscar onto a laptop or desktop and post a screenshot of a typical daily chart? You'll find the information you need above in Pugsy's Pointers.

[Jake B]

Hello, Jake. It's pretty common to feel worse with the new experience (mask, pressure, hose, noise), and everyone adapts at their own pace. There's the occasional person who wakes up fresh and raring to go after their first night, but for most of us, the early experience is difficult, and then improvement comes gradually. But it comes!

With an AHI of 12, you are in effect having your sleep disrupted on average every 5 minutes. You may not be waking up each time, but your sleep cycles are getting trashed, and you are probably not getting adequate deep sleep or REM sleep. As you know, in the long run, untreated apnea can raise your risks for hypertension, diabetes, heart disease, and dementia.

That's all by way of encouraging you to have patience. But it might be that your settings could use some tweaking. If you are interested in that, could you download Oscar onto a laptop or desktop and post a screenshot of a typical daily chart? You'll find the information you need above in Pugsy's Pointers.

I have attached a typical night, along with some other possible useful data. Feel free to let me know what you think.

[Jake B]

Hello, Jake. It's pretty common to feel worse with the new experience (mask, pressure, hose, noise), and everyone adapts at their own pace. There's the occasional person who wakes up fresh and raring to go after their first night, but for most of us, the early experience is difficult, and then improvement comes gradually. But it comes!

With an AHI of 12, you are in effect having your sleep disrupted on average every 5 minutes. You may not be waking up each time, but your sleep cycles are getting trashed, and you are probably not getting adequate deep sleep or REM sleep. As you know, in the long run, untreated apnea can raise your risks for hypertension, diabetes, heart disease, and dementia.

That's all by way of encouraging you to have patience. But it might be that your settings could use some tweaking. If you are interested in that, could you download Oscar onto a laptop or desktop and post a screenshot of a typical daily chart? You'll find the information you need above in Pugsy's Pointers.

Here is one additional showing PAP settings, although I'd like to clarify that my temp and humidity settings are AUTO even though the the software doesn't read it that way.

[Miss Emerita]

Your chart looks generally very good: no snores, negligible leaks and flow limitations, no big pressure swings, few obstructive events, good AHI overall.

Central apneas predominate. Try taking a look at this thread from 2016:

viewtopic/t113409/Sleep-Wake-Junk-with- ... forms.html

especially the first page. Can you zoom in on your centrals to see whether some or all look like SWJ (sleep-wake junk)? You'd be seeing arousal breathing before the central; you may also notice an increase in tidal volume during the arousal. (TV isthe amount of air you move in and out during one breath.) The arousal breathing often looks raggedy and irregular.

I've attached an example from a recent Oscar chart of mine, using two levels of zooming in (same event).

SWJ CA.png

SWJ CA more zoom.png

[kteague]

I'll let others look at your data, and just give you some general things to consider about the adjustment phase. In the beginning the arousals from the brain being aware of new sensations can be detrimental to feeling better. That is something that should improve over time with effective treatment and as-comfortable-as-possible mask and headgear. Everyone's sensitivities are different, so it would be hard to put a timeline on it. Plenty of people report feeling sleepier once they get on CPAP. One theory is that once the brain knows it can safely sleep, it craves more of it until one reaches a point where the body feels "caught up" so to speak. There's a controversial term called sleep debt. It's not like you now have to sleep an hour for every hour you lost. It's more like your body needs to recover from the assault of untreated sleep apnea, and that recovery may need more than just maintenance sleep hours for a while. This need for more sleep should improve with consistent use of effective treatment. Some people sabotage their feel-good benefits by allowing themselves breaks to sleep without the machine. Another perspective I've read on here is that untreated sleep apnea causes repeated surges of stress hormones. The absence of those stimulants can result in a let down feeling. At one month in, any or all the above could still be at play.

Please stash what I'm about to say in the "for much later" file. You are not far enough into this to fully appreciate much benefit. And if your mouth leaks adversely affected your treatment, that time doesn't count for much. But if your symptoms persist after several more weeks of consistent treatment without any improvement and you've ruled out other possible medical causes, you may want to consider if other sleep disorders like limb movements or narcolepsy are at issue. Thing is, you need your OSA to be resolved to more clearly see any other possible contributors.

Hang in there, and when how you feel isn't what you'd want it to be, lean into the facts. Untreated sleep apnea is not good for you. Treating it is. Just make sure that your treatment is optimized.

[Jake B]

Your chart looks generally very good: no snores, negligible leaks and flow limitations, no big pressure swings, few obstructive events, good AHI overall.

Central apneas predominate. Try taking a look at this thread from 2016:

viewtopic/t113409/Sleep-Wake-Junk-with- ... forms.html

especially the first page. Can you zoom in on your centrals to see whether some or all look like SWJ (sleep-wake junk)? You'd be seeing arousal breathing before the central; you may also notice an increase in tidal volume during the arousal. (TV isthe amount of air you move in and out during one breath.) The arousal breathing often looks raggedy and irregular.

I've attached an example from a recent Oscar chart of mine, using two levels of zooming in (same event).


SWJ CA.pngSWJ CA more zoom.png

Thanks for the link. I glanced over it but... What does all that mean in layman's terms? Is this just saying the CAs are nothing to worry about?

[Julie]

Not unless you get lots of them all night long...just 'some' prior to being asleep or just before waking are not a big deal and most of us have a few a lot of the time... called 'sleep-wake junk'.

[zonker]

Thanks for the link. I glanced over it but... What does all that mean in layman's terms? Is this just saying the CAs are nothing to worry about?

yup. for a small percentage of people, cas can be trouble if there are a LOT of them. those people can be treated by a different type of cpap.

for the rest of us, it's something that our bodies adjust to. when we start out, we are hyper vigilant about every little thing that shows up. after awhile, you'll disregard them and soon enough, they'll disappear.

good luck!