Feeling more tired after using CPAP?

I've been using my CPAP for about a week now (every night), and I feel more tired when I wake up now than I did before! And I've felt even more drowsy during the day several days this week too. Is that a normal part of the adjustment? I know not to expect immediate positive results, but I also don't want to feel even worse. I haven't found a really well-fitting mask yet (another appt with the DME in the morning) and I do get some leaks. I remember feeling this way, that I got worse sleep with the CPAP than without, back when I first got the CPAP 6 or 7 years ago. I'm committed to making this work, but it's just frustrating to feel this tired.

If you have a machine that shows data then you cn use Sleepyhead software to see what is happening while you sleep.

The other thing is that your brain at first may not be allowing you to sleep with that thing on your face because it has spent many years keeping you safe and waking you up when you stop breathing. It is may not be happy or understanding what you are trying to do. Try to spend several hours in the evenings wearing the cpap & mask while watching TV or playing video games. The idea is to get your primitive body/mind used to this thing and that it is not a threat.

In your case I think that majority of the problems are related to high respiratory control loop gain[1]. This will tend to work with the pressure of your xPAP machine to produce hypocapnic central apneas.

With hypocapnic central apneas, I think “what can I do to help with circulation, stress, and respiratory reflexes (chemoreflexes)”?

If I were you I would:

Spend some quality time with the machine during the daytime. Time in bed learning to breath quietly as you should at rest and in bed. Go to all the normal positions and so check mask fit and hose management issues. Then time with mild distraction such as music, a book, radio, light TV.

Rig to use your CPAP data (SleepyHead – many here will help you with that). You need the feedback to see how things are going. No need to “fly blind”.

Check your vitamin D levels. Dr. Stasha Gominak has noted that areas of the brain which control breathing are sensitive to D3 levels. Those who are working with the D3 hormone (A.K.A. Vitamin D3) (e.g. Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All believe that a level lower than 50 ng/mL is not good and Dr. Stasha Gominak recommends 60-80 ng/mL for good health.

See if you can get a referral to use a dietitian for a couple of years. Better metabolic health means everything works better. Work to decrease inflammation, increase circulation, and help deal with oxidative stress. Work to best facilitate metabolic health.

See if you can get a referral to use a personal trainer for a couple of years. Better metabolic health means everything works better. This will also help with metabolic health, circulation, breathing reflexes, and muscle tone.

XPAP may become more usable over time. The above should make that more likely and should enhance health regardless.

[1]: http://www.atsjournals.org/doi/abs/10.1 ... qUA10Pfu8Z

My machine is old (M-series Respironics) and I can't get data from it. Apparently I can spend somewhere upwards of 100 bucks to buy the card reader equipment, but I'd probably be better off putting that toward a new machine. I'm not that excited to plunk down that kind of money (high deductible insurance...) but I am a data-head and would like to be able to see what's actually going on.

I wish I had time in the evenings or during the day to spend with the mask but between a full time job, chasing around a toddler, and trying to keep the house from falling into chaos, I'm lucky to even make it up to my bedroom at a decent time to sleep.

Has anyone else experienced this, and had it get better?

Emily (my eldest daughter's name), 3 years ago I suddenly could not fall asleep for almost 2 weeks. I tried about 4 kinds of Rx sleeping pills with no luck. My first Doc, an Internist, who I went to see about it, DID NOT DETECT THAT I HAVE SLEEP APNEA! Only the 2nd Internist who is also a geriatric MD suspected that I might have it and sent me right away to a sleep clinic to be tested. The next day the nurse called and said WELL, YOU HAVE A SEVERE SLEEP APNEA and your oxygen blood saturation fell to 84%.

All this time I felt tired and miserable, day and night .

To cut it short, it took me more than 3 months to have a decent 4 hours stretch of sleep. It took me another 6 month to settle on a cpap and mask and sleep for 6 hours, after taking some sleep meds and with 3 wake ups for urinations.

Only at the start of 2013 I finally got a decent treatment. Knock on wood it's still going strong! beautiful treatment and 7 hours sleep.

See my post here about the sleep meds that I still take:

viewtopic.php?f=1&t=94272&p=871068#p871068

You have the M series Auto?? At least that's what you said in another thread.
If you don't want to buy the card reader ($46.50) there is still the 7 and 30 day average AHI and leak available on the LCD screen.

If you aren't sleeping well...having lots of fragmented hours of sleep or short number of hours of sleep or having mask leaks or issues disrupting sleep...then it's real difficult to expect to feel better and very likely will feel worse.

So how many hours of sleep are you averaging?
Are those hours fragmented for any reason? If so, why?
What kind of mask issues are you having?
Is this a new mask or one left over from your past attempt at cpap therapy?
Do you know how to access the data that is available on the M series Auto?
This site has instructions on how to get to the data
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Thanks for the input. Yes, I do have the M series Auto, and I'm still debating about buying the card reader vs. saving that and putting toward a new machine. What kind of data will I be able to see using the card reader? I did just last night discover how to get the display information, but I think the 7-day averages are a bit skewed because I'd only used the machine for the past 5 nights (well 6 now). I wasn't sure how to interpret those results anyway. The leak rate said 38.1 if I'm remembering correctly -- not sure of the units, maybe L/hr? The user manual wasn't too helpful, and just said that some of that is from normal exhalation. The AHI I believe was 5.4, and I'm not sure what to make of that either--I guess I should dig out my old sleep study and compare it.

I have been getting 7.5 - 8 hours of sleep a night, and haven't really had trouble falling asleep, which is normal for me (fortunately, I know others have lots of issues with this). I don't remember waking up any in the night either. I wonder if the mask leaks are waking me -- but I don't remember being woken up to the point of being aware of it. The mask I'm using is a new one I got from the DME this time around, the Quattro FX. It leaks when I sleep on my side, mainly at the bridge of the nose (so I feel some air shooting towards my eyes). One night last week I did switch and try my old Mirage Liberty but wasn't able to get a good seal on that -- quite possibly because the cushions are ancient and probably aren't functioning properly. I finally got an appointment with the DME today and she wasn't too helpful but I basically said I thought the Quattro FX in a medium was too big for me (the Liberty and Quattro Mirage, my two old masks, are both Smalls), so she gave me a small to try. We'll see how that does. In the meantime, I will probably purchase some new cushions for the other masks so I have them available to try.

This morning was my worst one yet. I got up a bit earlier than I usually do for a PT appointment (unrelated issue), and didn't feel too bad, but after that appointment and the DME's, on my way in to work, I could hardly keep my eyes open. I tried to "will power" my way through it but it was rough -- I felt like my eyes kept crossing involuntarily. I probably shouldn't have even been on the road, and that scares me.

Emily928 wrote:
Has anyone else experienced this, and had it get better?

Yes and yes. And I know there are many others here who got worse before they got better. I was WAY more tired for maybe a month. Now I have been on CPAP about 6 months, and am feeling better. I am still adjusting to masks, trying to get best one, recently changed to a new one and am not sleeping that great yet. But one thing has improved overall, and that is less anxiety, a more relaxed happy feeling during the day. Possibly I was sleep-deprived (did not know it, didn't "feel" tired before) and the stress of keeping myself awake made me anxious. So, as people are suggesting, make sure your mask is comfy as possible, mask or tubes aren't shifting at night, vent air isn't blowing on you, etc. and eventually it should get better.

Leak on the M series LCD screen is L/min and is the total leak average and 38 would be a very acceptable number. Large leak territory is up around 90 L/min for the M series machines. Leaks are probably not an issue. Total leak does include the mask's expected vent rate so you won't ever see 0.0 on that machine.

The AHI of 5.8...a bit high and of course it is a 7 day average. I know how to reset the data so you can get a single night average if you want.
It's how we used to do things before we had the software to show each night.
Without seeing the reports I would have to assume that the starting pressure is not quite optimal and the machine can't get to where it needs to be quickly enough to effectively prevent the collapse of the airway during some parts of the night. You likely have some parts of the night where the pressure is fine. I suspect that a 1 or 2 cm increase in the minimum starting pressure would help quite a bit.
Will it help with the fatigue? I don't know because I don't know if your feeling worse is maybe secondary to having mask issues and the best AHI in the world won't help much if the problem is poor sleep in general due to mask issues. Your leaks probably aren't impacting therapy itself all that much but the mask fit and even minor leaks might be impacting sleep quality. If you wake up often for any reason..you aren't going to feel so great and if the mask is causing more wake ups...then it most definitely could be a factor in feeling worse.

The machine just fixes the sleep apnea stuff and it can't fix bad sleep if the bad sleep is related to something it can't fix.
Reducing the AHI a little would be something I would want to try though. Let me know if you want to be able to isolate a single night data instead of having to view the 7 day average.

Here's an example of what you would see if you had the software. I did change the software to show only unintentional leaks and that's why my leak averages are lower.