Getting tired *from* using the CPAP?

(I found a thread like this by searching, but it was five years old and didn't help.)

Diagnosed with mild/moderate OSA, started on CPAP, and (once I got the right mask and got the tech to lower the pressure twice so I could breathe out) and--objectively--I've been doing fine. No problems with the mask, getting to sleep, staying asleep, waking up, or pulling at the mask. No leaks, apnea gone, yay.

But any night I sleep with it I end up feeling tired and worn out when I wake up. It's bad enough that I've been giving myself a night off about once a week just to catch back up. (If I sleep without it I wake up feeling fine--actually, more like "great" compared to how I feel after sleeping in it.)

Just had my 2mo follow up this morning and was hoping there was some adjustment to pressure or rate or who knows, something that would help. But my tech says everything's great. My scores (on the ResMed) are near-perfect. She basically said that there's no way for me to be sleeping solidly through the night with it the way I am and have it negatively affect my sleep.

Since I'm not having issues with the mask or waking up in the night or anything, she was left saying "fatigue can be caused by many things...". When I pointed out that the CPAP is the only thing I've changed and asked how my diet or the meds I've been on for three years now could be suddenly making such a difference night to night depending on whether I wear it, she had nothing. She left it at "try it for another three months and see how it goes".

I can't go three months more running this low on energy/sleep, especially when she admits there's no reason to think anything will change because the setup is "perfect" now. (I guess she's hoping I get used to being suddenly tired all the time?) Does anyone have a suggestion short of just giving up on it entirely? (Right now I'm kicking myself for even following up on my doctor's off-hand suggestion about getting checked for apnea in the first place.)

One of the best ways to make exhale easier is to increase the EPR (expiry pressure relief) to 3 cm. This reduces pressure on exhale only. Higher pressure on inhale is helpful to make breathing easier. On the DreamStation machines I believe this is called Flex. On the ResMed machines it is good to use the Auto for ramp time, and make sure the ramp start pressure is high enough.

It does take some time to get used to sleeping with a CPAP, and can be a bit annoying until you settle into it.

My machine is already ramped and I'm having no problems with air pressure in or out.

If you read page 33 of that Clinical Guide I gave you a link to above, it "explains it". However, it is a really confusing explanation. I think the only thing that is clear is that if you have no SD card, no detailed data is stored. I would get a card and look at the data yourself with OSCAR. OSCAR is the equivalent of what they call ResScan.

What I see in that description is that depending on how the data is looked at (from the SD vs over the air) the frequency of collection can be different. They show the highest resolution as every 2 seconds using the SD and ResScan, while AirView is every minute. However what I see on OSCAR appears to be much more frequent than that. See the example below which is really two apnea events in a row but only the first one was flagged. I believe after 4 seconds or so the machine starts to cycle the fan speed quite frequently to see how the pressure responds. If the pressure cycles then it is classed as an obstructive event. With low or no pressure the pressure cycle is lower. You can easily see that cycle in the graph. The second event did not get to the point where the fan speed started to cycle, and it was not flagged as an event, but flow still dropped significantly. It started where the green cursor is. So it remained as an undetected event. In any case this is what you can see when looking at high resolution data. When you are looking at data collected every minute you will not see this detail.

I have a similar issue, but it has only recently surfaced.

I've been using a CPAP since August. Mostly, it's been fine, but lately I'm waking up very tired after using it (Dream Station 2). I also wear a Fitbit, and my Deep sleep percentage, and REM percentage have dropped by about 5% in the last while. Before using the CPAP, I was asymptomatic — I wasn't tired at all during th day -- but if this goes on, I won't be able to work and will have to discontinue CPAP therapy.

Does this happen? Even after a (relatively) successful start?

Hi Sierra!

Thanks for reaching out. I just downloaded OSCAR, but don't seem to be able to import anythng — to the best of my knowledge, there is no SD card on my DreamStation 2, so not sure how to get data from A to B.

Yes, unfortunately that's exactly what they did. There is an SD card slot, but it's empty.

So basically, this means I have to 100% rely on a guy who I had very little faith in anyway. He's able to access my data, but I have to schedule time off, and go to him — this way, he gets paid (by my provincial heqlth care plan — Canada) for an in-person visit for something could be acessed by me. Wow.

It's a DreamStation 2 Auto CPAP, BTW.

Brilliant! I don't have a spare, but will pick one up ASAP. Thanks, Sierra.