Feeling more exhausted after full night of CPAP

Anyone else experience increased exhaustion after using CPAP (approx 7+ hours a night with a pressure of 12-14)? I was more diligent about using my CPAP months ago and averaged daily useage 7 hours . I never noticed a difference and have required since 2 years ago the use of Adderall and now Provigil. This is to treat my excessive daytime sleepiness. Without using this medication I feel like I haven’t slept for days. Some nights that I don’t use my CPAP I actually wake up feeling more refreshed then after nights of 7+ CPAP useage. My sleep doctor is puzzled and I even had a sleep test for Narcolepsy but did not have it . I’m 33 and have had diagnosis of sleep apnea since 2014. I used to doze while driving to work in the morning which was the factor for initial sleep test. Anyone with any similarity ??

I have been on an Auto CPAP for about 6 months now, and I still will doze off occasionally in the afternoon when watching TV. I have not had any drastic improvement in my daytime energy level or wakefulness. However, I certainly have apnea and continue treatment with it while sleeping about 8 hours per night. There are numerous downsides to leaving apnea untreated, so that motivates me to continue regular use. I have not missed one night since I got a machine.

My thoughts are that you first need to try and improve the quality of your sleep. 7-8 hour are enough for most people, and it sounds like you are getting that much. However the quality of the sleep you are getting may have room for improvement.

First, I would have a good discussion with your pharmacist and then your doctor about the Provigil. Yes, it can help with the daytime sleepiness, and I have seen some information that suggests it may even reduce apnea. However it is doing that because it is a stimulant to keep you awake, and during sleep you remain more alert. The muscles controlling the tongue and throat don't relax as much and apnea may be reduced. However the downside is that you probably do not get as much REM sleep and your sleep quality is reduced due to that. So, I would ask about the dosage, and time of day it is taken. It is a long acting drug, but it would seem if taken first thing on waking on an empty stomach it would start quicker, and more importantly be less active at sleep time. I would ask about alternative such as coffee. I find if I limit coffee and caffeine drinks to 3:00 PM or earlier in the day they keep me awake but don't affect my sleep.

Second, you may want to take a close look at your CPAP machine setup. Are the minimum and maximum pressures set right for comfort and effectiveness. Do you use the expiratory relief feature? It may be increasing your treatment pressure, and reducing your comfort. I find that if your machine is supported by SleepyHead you can find out a lot about how the machine is performing, and what can be done to improve it. This software is free and can be downloaded here:

SleepHead Download

Last you may want to look at your whole approach to sleeping to see what can be done to improve your sleep quality outside of using prescription drugs and the CPAP. I have found that all the information and tools at the site below to be quite helpful in evaluating my views about sleeping and what I can do to improve sleep quality. The site was developed by a pharmacist and university professor that is interested in treating sleep disorders without or with a very minimum of drugs.

https://mysleepwell.ca/cbti/

Hope that helps some. If you post some specifics about your CPAP machine make and model and how it is set up, I may be able to make some more specific suggestions.