Question: Still tired with CPAP treatment. What is wrong?

by Ron Gronowski
(Traverse City, Michigan)

I use my Cpap machine every evening, but I still am tired during the day. What is wrong?

Answer

There are a lot of problems that can appear when you use the CPAP machine. It would be great if you give more information about your symptoms after you wake up.

• First, you need to figure out if it is the CPAP mask. The DME should have someone who can help with the mask. Once you find the right mask, then see if that is enough to make you feel better.
  
  If not, then you need to go back to the physician who diagnosed you and started your CPAP and get more help. You need to be assertive (not agressive) and for goodness sake, don't be passive.
  
  You deserve to understand what is happening and why and you need to understand the properties of the machine and masks.
  
  The mask should be snug but not tight and conform to your face without allowing large air leaks. You and your DME representative need to work together to find one that fits you well (my DME rep has OSA and is very familiar with the problems-he really helped me find the right mask despite being somewhat beholden to the brand names required by my insurance).
  
  Most masks come in small, medium, and large. Some have various parts that come in all 3 sizes and can be mixed and matched to conform to your specific face type.
  
  Some CPAP machines have smart cards with software - "data capable" machine that is able to give you an AHI number; just check the leak on that particular night, and AHI index, to know if you have a good mask fit or not.
  
  Not all machines are data capable, but in the menu it would show your recorded AHI number. An AHI of <5 and you have a small (approprate for the mask you have, see that mask manual for this number at you given pressure) leak rate you might just be still ajusting to wearing CPAP.



• What is your new pressure requirements and what type of mask are you using?
  
  If you're using a nasal mask of some sort and having dry mouth problems it's likely you are opening your mouth in your sleep and this will render your treatment ineffective.
  
  If you're using a full face mask then you may want to increase the humidity some (assuming you have a humidifier).



• Here is another situation where you can have ineffective CPAP therapy: sometimes the CPAP pressure is not enough. It could mean that your pressure is not high enough.
  
  
  Do you have the results of your sleep study and titration? Check out the test results from the sleep lab to see if there is anything obvious.
  
  Then, make (if they haven't made one) a follow up appointment with the Sleep Physician. You might have to go back to your primary/Family Doctor to do this. Tell the Sleep Physician the things you are experiencing and they should be able to offer some courses of action.

The real deal in many cases is that if you still have a problem, the sleep lab doctor can readjust your treatment without another sleep study, because he is the one who can make this decision based on your test which he can read and reread, but any other sleep uncertified doctor will not be able to take such a leap because of the liability (or simply he doesn't know) , so if you have a complaint, his only option is reorder another sleep study-

Even though, they are ususally reluctant to send you straight back to another sleep study, they ususally will investigate other areas based on their specialities first (neurology or ENT) and if all fail (which usually do) then and only then they will transfer you to another study.

So it is waste of time and many cases waste of money to have another study that could be saved if you are with the sleep certified doctor from the beginning. someone who can read your sleep study and make a decision and doesn't depend on another doctor


I hope that helps you in your journey.

Remy