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?


If you're still tired after using the CPAP machine, then you most certainly have CPAP resistant syndrome or True Residual Sleepiness.

Still Tired With CPAPThe science explains that there is a residual sleepiness in some patients with sleep apnea, which takes time to disappear (1).

You can help the residual sleepiness to diminish, by following the tips from this article.

At the end of the article you'll also get a proven treatment for the most serious cases.

Now, the first step in your "treatment" is to understand the causes behind your tiredness:

3 Reasons Why You're Still Tired With CPAP:

The CPAP resistant syndrome exists in CPAP users who have:

  • hidden problems that directly affects CPAP therapy,

  • problems that are not connected with CPAP therapy, but affects the quality of sleep

  • no underlying issues - science call this situation true residual sleepiness.
Now let's examine each risk factor:

Causes That Directly Lowers CPAP Sleep Quality

1. CPAP Mask Leaks

Inexperienced CPAP users almost always have this problem. That's why they are the majority who complain about fatigue, headache and sleepiness during the day.

If your mask leaks just a little bit, you're accumulating sleep dept. So fixing these leaks usually leads to a better quality of life.

Do not underestimate the air leaks!

Learn how to eliminate the CPAP mask leaks here.

2. Incorrect CPAP Air Pressure

Believe it or not, the CPAP titration study (where the CPAP is calibrated to the correct pressure that opens your airway) doesn't always show the accurate settings to get a good sleep (2).

This is shocking! This means you may go home from the sleep study with a wrong setup.

It also means it's possible you don't get enough pressure to open your airways.

The result: tiredness, headaches, depression during the day.

Do you have a data capable CPAP machine? If so, you can track your therapy data to spot issues.

How to read your sleep quality report (for ResMed S9 Elite Users)

However, you need to know some medical terms to understand what the sleep data shows you (AHI, RDI, CSR, etc). It's better to check the data with your doctor.

What is AHI?

3. Mask Discomfort

Unfortunately, it's not uncommon to take some time to adjust to sleeping with a CPAP mask on your face.

It's not easy. However, if you struggle a lot to adapt to your CPAP mask, you'll get poor sleep.

Here are some examples of problems caused by sleeping with a CPAP mask:

  • forehead hurts,

  • feeling of claustrophobia and suffocation,

  • sneezing after you put the mask on,

  • dry mouth from sleeping with your mouth open,

  • waking up with nasal congestion,

  • sleeping in strange positions to keep the mask from leaking,

  • the airflow from CPAP feels to dry and unbearable,

  • and many, many more...
Do you recognize any of these problems? Fix them, and your sleep quality will improve dramatically.

Learn How to Make a CPAP Mask More Comfortable

Causes Not Linked With CPAP, But Hurts Your Sleep

1. Central Sleep Apnea

Central Apnea is a sleep disorder where the brain forgets to command your body to breathe.

Your CPAP is useful only if you have obstructive apnea, but is useless for the central apnea.

Learn How to Treat Central Sleep Apnea

Some people have a combination of obstructive and central events, which is a situation difficult to diagnose in sleep studies.

Again, you need your sleep data to see if you have unusual patterns in your sleep. Contact your doctor to discuss this problem.

How to Diagnose Mixed Sleep Apnea?

Your spouse can be helpful, by checking if you still stop breathing in sleep even if you use the CPAP.

2. Medications That Can Affect Your Sleep

The most common drugs that can make you feel sleepy during the day, are:

  • Antidepressants

  • Sedative medication

  • Medication that cause insomnia
It's not uncommon for patients with sleep apnea to take drugs for depression. However, these drugs have serious side effects that can affect your quality of sleep.

If you take medication, review them with your doctor, to check if they may interact with CPAP therapy.

For a full list of medications that can make you feel tired in the morning (even if you use your CPAP), read the Harvard report.

The Mystery of True Residual Sleepines

Only 10% of patients remain sleepy on CPAP, even after you exclude the other causes of sleepiness (3).

Imagine that after you struggled to find the perfect CPAP mask, adjust the CPAP pressure, improve your sleep hygiene, and your sleep data looks perfect, you are still tired during the day.

It can be very frustrating.

Being tired with CPAP is a mystery even for scientists. However, they may have some clues that can help explain this phenomenon:

Neuron damage from untreated sleep apnea

Scientists found that long-term exposure to low levels of oxygen in mice results in sleepiness during the day that persists at least several weeks after the oxygen levels are restored (4).

This observation prompted the scientists to ask whether the neurons from the sleep control regions of the brain are damaged from long-term hypoxia (low oxygen levels).

In other words, the longer you had untreated sleep apnea, to more damaged your neurons have.

My question to you is... Do neurons regenerate?

Depression and Obesity

A study from Grece showed that sleep apnea patients with depression are still tired even with nightly CPAP usage of 6 hours (5).

The scientists also observed that obese individuals also had residual sleepiness with CPAP.

Bottom line... If you are overweight,
it's important to lose weight - your sleep will improve.

Can The Residual Sleepiness Be Treated?

The good news is that the residual sleepiness will disappear in time.

A large study from France (with 1047 patients) showed that 12% of patients using CPAP for more than 3 hours per night where still sleepy at the one year follow-up visit.

However, the sleepiness decreased significantly with longer CPAP use (6):

  • only 8.7% patients still had residual sleepiness using the CPAP 6 hours per night.

  • 18.5% patients still had sleepiness after using the CPAP 4 hours or less per night.

How Can You Treat True Residual Sleepiness?

If you don't want to wait for the tiredness to disappear in weeks or months of CPAP therapy, there is another solution: stimulant drugs that alleviate sleepiness (7).

It may be necessary for the doctor to prescribe Modafinil (Provigil) or Armodafinil (Nuvigil) as a stimulant (8).

These drugs has been proven effective over the years, where the patients experience increase wakefulness and daytime function.

However, the doctor has to be very careful with this prescription. If you don't wear the CPAP every night for 6 hours, with good sleep data, these stimulants can harm you.

You need to sleep enough with your CPAP, to get these drugs.

Hopefully, these tips can guide you towards answering your question.

Remy Thierry
Founder of Sleep Apnea Guide


1. Gasa M, Tamisier R, Launois SH, et al. Residual sleepiness in sleep apnoea patients treated by continuous positive airway pressure. J Sleep Res 2013; 22:389–397
2. Huang HC, Hillman DR, McArdle N. Control of OSA during automatic positive airway pressure titration in a clinical case series: predictors and accuracy of device download data. Sleep 2012; 35:1277–1283.
3. Vernet C, Redolfi S, Attali V, et al. Residual sleepiness in OSA: phenotype and related symptoms. Eur Respir J 2011; 38:98–105.
4. Veasey SC, Davis CW, Fenik P, et al. Long-term intermittent hypoxia in mice: protracted hypersomnolence with oxidative injury to sleep-wake brain regions. Sleep 2004; 27:194–201.
5. Koutsourelakis I, Perraki E, Economou NT, et al. Predictors of residual sleepiness in adequately treated OSA patients. Eur Respir J 2009; 34:687–693
6. Pepin JL, Viot-Blanc V, Escourrou P, et al. Prevalence of residual excessive sleepiness in CPAP-treated OSA patients: the French multicentre study. Eur Respir J 2009; 33:1062–1067.
7. Dinges DF, Weaver TE. Effects of modafinil on sustained attention performance and quality of life in OSA patients with residual sleepiness while being treated with nCPAP. Sleep Med 2003; 4:393–402.
8. Roth T, White D, Schmidt-Nowara W, et al. Effects of armodafinil in the treatment of residual excessive sleepiness associated with OSA: a 12-week, multicenter, double-blind, randomized, placebo-controlled study in nCPAP-adherent adults. Clin Ther 2006; 28:689–706.

Comments for Still tired with CPAP treatment. What is wrong?

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Oct 13, 2016
6 months CPAP, still tired even AHI = 1.0 NEW
by: Severe OSA patient

Age 36, computer programmer living in Europe, a former severe OSA patient. Pre-CPAP AHI was 50, for at least 10 years, Post-CPAP AHI is 1.0 since 6 months, but I still have all problems: low concentration, bad memory, low thinking speed, brain fogginess from 10:00 AM till 12:00 PM (noon), tired after 20:00.

I notice that if the evening before I tried to use my brain a bit instead of sleeping, then this morning's brain fogginess at 10:00 AM til 12:00 PM is high.

Extra health info: a bit worried liver functioning: high ALAT (around 100), a bit fatty liver. Probably there is a linking between fatty liver and OSA.

Doctors around me don't know enough about my body: Lung and ENT doctors don't understand that long untreated severe OSA can cause brain damage (white matter integrity), Liver doctor does not understand that fatty liver could be caused by OSA, GP doesn't know enough about the whole thing about OSA and suggests me to check for ADHD.

Aug 31, 2016
Canada same case here tired even after using the CPAP machine
by: Sameer Ali

Dear all,

Its been a good 20 years since my sleep trouble started i dont remember when was the last i slept peacefully, I was detected with sleep apnea in 2007 i have been using automatic sleep app for the last 8 years and still cant sleep well though its not as bad as sleeping without CPAP.

Recently i got another sleep study done , the doctor said i had upper airway resistance syndrome not pure sleep apnea and the automatic machien doesnt treat that . i shifted to CPAP .

Its been 2 months since i used to get up every 2 hrs now i get up every 4 hours
but iam still very sleepy during the day the its a struggle to get out of bed every morning
il'l be very thank full to anyone who has been able to crack this problem . Please let me know what can be done
mail me at

PS i dont have central sleep apnea

Jun 21, 2016
Been on CPAP for 2 years
by: Marcus

So I am a 1% type. I not only have severe apnea, 100's of events per hour, but I have central sleep apnea as well, where my brain doesn't tell me to breath. I had to have 2 sleep studies just to get a reading that worked to open my airways and it took a very long time for me to get used to my BiPAP machine. I had to set three alarms a night for a year just to get 4 hours until one day, bam, I stopped taking it off. No I have gotten both sides of the experience.

The residual sleepiness I get for sure. I still sometimes get very groggy at 10 AM and 2 PM, to where I fight sleep. I also can't stay up late on a random night anymore, it has trained my body. But also I cannot sleep as long. I used to be able to do 10 hours on a Saturday. Now, it is 6 hours and I am awake. Now my energy level is higher overall for sure, my memory and focus are WAY up and so is my mood. I still think my body is getting back to normal. When I wake up I am groggy and it takes a while to go away, but if I get up right when I wake up, I will be fine in 10 minutes.

I now realize how bad my apnea was, as since I was a kid it took my parents waking me up 10 times, or have multiple alarms blasting to wake me up. I sleep so heavy I have slept THROUGH a fire alarm. Now when I get up it is a different groggy. A more fuzzy than deep heavy grogginess. What is amazing is I don't FEEL rested, but I think that is because I was used to how I used to feel.

To truly feel best, I sleep 5 hours on CPAP and then get 45 minutes without one. But that is too complicated so I just deal with the CPAP sleepiness I get. Some days I feel perfect, some days more groggy, most just in the middle. No matter what, realize if you don't use the CPAP you are putting an incredible strain on your heart and lungs.

That is the other thing. I had a long term (3 year) cough I couldn't get rid of. Went away after 3 months of full night CPAP sleeping. Worth it alone.

Apr 19, 2016
This whole thing is just URRRRRRR!!!!
by: Katie Kae

I had a sleep study and found that I had severe Sleep Apnea, due to a combination of things. I am 26 and my resting heart rate should be 60, but my average was 86 with the highest going over 100.

I also don;t have enough oxygen getting into my blood cells, and of course I have Sleep Apnea itself. I got my PAP machine a little over 3 weeks ago, but I still feel tired. I am a hardcore stomach sleeper and sprawler. I'm getting a little used to it, but I feel more restless than ever. I feel like my movements are so confined.

A couple nights ago was the first time I was having issues with the mask. I felt so claustrophobic. Sometimes I wake up feeling rested, but it quickly turns to restless and tiredness. Which is hard when I need to sit at a desk for 8 hours, 5 days a week. Other days I wake up exhausted and with "raccoon eyes".

I'm overweight and am changing my eating and physical habbits; however, it's very frustrating that after everything with the sleep study and PAP machine, I still don't feel well rested...

Another issue I have, is the fact that I had blocked tear ducts when I was little. I had surgery to correct it, which made a clear passage from my nose to the corner of my eye. Now when then air pressure gets to 10 or higher, I have the problem of air going up that passage and creating air bubbles under my eyelids.

So then I'm forced to take the tube out, wait for it to shut off, then put it back on where the pressure is only 5... This whole thing is just URRRRRRR!!!!

Apr 08, 2016
still tired sfter 8 hrs sleep
by: Anonymous- Canada

I have been sleeping with the Mask now for 5 years, I am always tired and want to sleep. I don't drive because I am afraid I might sleep on the red light. I just checked with my CPAP provider and my episode per night are less than 5 which is good, but I am still tired in the morning and can fall asleep in meeting or even reading information.

Anyone experiencing this?
I plan to see my sleep doctor soon.

Mar 10, 2016
Only 3 days and feel worse
by: Anonymous

I have been using CPAP for only 3 days. Have just awoke and looked up info and found this. I am so tired, my body aches and I feel so much worse than before I started this. All this can't be right.

I don't snore now but wake up (eyes open) more now than I ever did before. Still, I will carry on and see if it gets better or worse but by the sounds of the people on here I can expect no miracle.

Oct 07, 2015
yes still tired and want to sleep more
by: Anonymous

I run my machine on the highest setting. To me i say it needs more volume.

Oct 07, 2015
yes just want to sleep even more
by: Anonymous

Harder to get up now only a week into cpap use it all night. Makes to much noise if it leaks. Wife says I am quiet now no gasping snoring but I could sleep all day.

Aug 22, 2015
little to no sleep w/ cpap
by: Anonymous

Don't know if anyone covered this but I have been using my CPAP for mild OSA for a few months now it started out with getting regular hours of sleep but now I am no longer tired and barely get 5 hours of sleep. sometimes none.

Anyone else have this issue? and all you people off topic there's other forums for that bs.

Apr 13, 2015
Cpap fail
by: Anonymous

I have been using an auto Cpap for almost five months now and have no relief. I did overnight pulse ox test it came back fine no evidence of leaks and recorded ahi levels are low.

I don't feel any better from before I started it, sometimes I feel worse. I am more groggy in the morning still get tired midday, almost really always feel tired. When I had to stop using it because of a sinus issue, I felt a little more rested. Any thoughts?

Mar 22, 2015
Still feeling tired.
by: Devin

I've been on CPAP therapy since December 2014. it is now March 2015 and I would like to say CPAP has been the miracle cure but it isn't. right when I wake up I still feel really tired, and I noticed that I have raccoon eyes when I wake up and that is a new thing. I did not have racoon eyes or other problems before CPAP therapy. This is a minor thing to notice, but the easiest thing to notice when looking at me...

I've been to 5 follow up appointments with a sleep doctor who reviews my sleep data (the machine reports I'm getting 7+ hours of uninterrupted sleep each night) and the doctor praises the wonderful miracle cure of CPAP. The truth is not congruent with my sleep data and I feel extremely tired if not more tired then I did before therapy. I'm actually averaging about three hours a night that's Interrupted. I actually feel like I get more rest when I take a 20 minute nap without CPAP than I do a full night of sleep with it. As I'm writing this, I just woke up from sleeping all night and am fighting to stay awake to finish this post. My life is being robbed from me.

CPAP therapy is frustrating. I just want to feel better, get at least most of my life back and the doctor doesn't seem to understand how to help me at all.

Jul 22, 2014
CPAP experience
by: Anonymous

I started my CPAP nasal mask Feb. 2014 and still continuing with it.

I must say, my malaise is like it went away and feel so refreshed, however, the last two weeks even while being on the machine suddenly, I've been feeling a lot of fatigue and tired again.

My pressure is set at 12.

I've heard sometimes other medical conditions could contribute to the tired or fatigue while on CPAP. I have fibromyalgia which causes chronic fatigue and I am on BP meds. and going through hormone changes, hopefully, the fibro is the culprit.

I feel CPAP saved me from something that could have been far more worse off (before going on CPAP) because I used to feel quite ill a lot and sometimes like I'd die.

Apr 06, 2014
Need bipap
by: Anonymous

My wife, an RN, reports " You snore through the
cpap mask and it persists a while"...why?

Also she has had to shake me to awaken me,
she almost started cpr as 1. I did not respond, open my eyes or breathe 2. my color was pale-maybe I was a bit clammy

We think a repeat sleep study is needed and I needed bipap, not cpap, Nurse Pract friend agrees

machine is Philips Respironics System On, purchased in 2013...? warranty? , will need to call preferrerd home care and ask

I should use smart card/...AHI stands for what???
smart card must be a data storage card that records your breathing during sleep, ? rate,
depth, periods of no breathing?, pressure,
and beginning low pressure which starts at 5.5 ramps up to 11.0..maybe will document need for bipap not cpap

who interprets the data card, RRT Resp Dept at Preferred Home care, Sleep Study MD?

Lastly, this machine was exposed to organophosphates/pesticide (shockwave chemical spraying in our condo due to black mold, sewer water, etc)..and also stacybotrus (toxic black mold which can cause brain damage)..was found in our bedroom..

we forgot to put in an insurance claim to have the cpap replaced...mold/pesticide exposure happened in Aug took us 6 mo to get all ins claims paid

no way to prove today machine is contaminated,,,except when my wife sleeps in same bed she gets vocal cord spasms..continuous..due to damage from the pesticide (is permanent)

maybe take cpap machine in and ask for bipap, kill 2 birds with one stone, need bipap and need new machine

comments please? thanks

Jan 09, 2014
Waking up groggy
by: Michael

I have been on CPAP for nearly a year. Using Philips Resprionics with nasal pillow. I sleep say about 8 hours a night. I wake up about 2 or 3 times in the night. My AHI is around 4.5 and 90%pressure is about 11.5. However of late I wake up feeling groggy and feel as if I am not fully rested. I don't feel tired but feel somewhat "off". Doctor prescribed me Piroxitene 10mg but I still don't feel good or wake up feeling well rested. Can anyone offer any solution?

Oct 22, 2013
still very tired while using cpap
by: Anonymous

I feel like giving up on cpap. I am severely depressed due to quality of sleep. Use cpap regularly but it just keeps getting worse. Don't seem to dream anymore. Any thoughts anyone.

Jun 23, 2013
Does anyone else wake up sore?.
by: Sal

Does anyone else wake up sore? Does it get better later on? I am not sure if it is because I don't move at all at night.. I wake up in the same position when I go to bed. I wake up stiff and with my back sore. I have been on my cpap machine for a week. I do wake up tired in the morning but I do notice I am not dosing off during the day like I normally would.. My friends have noticed too.. I have gotten used to my cpap machine. I was really scared at first.. Just seeing it and thinking it was going to make me feel clausterphobic. but I like it. Also I am glad I don't wake up 6 or 7 times a night like I used to.

Apr 16, 2013
by: Anonymous

I seem to sleep during the day,I have cpap michine my Dr. just increased the pressure,however. I still sleep in my chair in the day time.I had a second sleep not long ago.

Jul 24, 2011
More than one reason
by: Anonymous

I had been sleep deprived for over 35 years. The two years before the study I was waking 5 to 16 times a night to pee - because I was so restless during the night. I finally had a sleep study done about 1 1/2 years ago and I had high hopes for some actual sleep. However, afterwards I was still feeling AWFUL in the morning. I would "sleep" for 8 to 10 hours and it would still take me 3 to 4 hours to become alert in the morning.
We finally discovered that it was my nigh time pain medication that was causing me to feel dopy and exhausted. The titration on my CPAP has been dropped just a bit and I am doing much better. Keep looking at all the factors in your life until you find the right one.

Aug 27, 2010
my answer
by: ApeaxSZ

I guess an important question here is, yes you feel more tired in the morning, but do you feel less tired throughout the day?

I just came to this realization that most mornings where I sleep a full night with the machine I actually feel MORE groggy in the morning than without it.

My theory, and I'm not doctor, is that because I actually got deep, restorative sleep that night my body is recovering from that and 'waking up'.

On nights where I take the mask off early in the night and sleep without it, I wake up feeling more alert. I think that because I don't ever reach the deep, restorative stage 3, 4 and REM sleep my body just stays more awake.

The difference for me is that although I am more groggy in the morning I feel MUCH more rested and alert after I wake up some.

Aug 27, 2010
any answer?
by: Anonymous

Have any of you gotten any answers about why you are more tired after CPAP? I have a mild case of OSA (AHA of 9.9) and have been using CPAP at a level of 10 since 5/5/09.

After the first month with no relief, I went back to my doctor (a neurologist). He scheduled me for a battery of blood tests and a brain MRI - everything came back normal. I told him I feel worse after sleeping with the CPAP, so he suggested I try in for two weeks without it to see if any difference.

Without the machine, I wake up 4-5 times each night, so I'm tired in the morning. With it, I don't seem to wake up at all, but feel MORE tired in the morning. So last night he scheduled me for another sleep study to check the pressure, to be followed by the MLST (nap test) today if the pressure was ok.

Well, they played with the pressure last night and got it up to 17, so they said I didn't need the MLST today. The tech said I got a good amount of sleep and a lot of REM, but I feel worse today than I have in the last 3 months.

At one point in the test last night, I had to ask them to turn the pressure down - I felt like I was suffocating, almost drowning with too much air pressure. Any insight would be helpful.

Aug 27, 2010
by: Echit

I have been using a CPAP for a month and really feel no difference. Hard to compare it to anything as the first 7-10 days were really uncomfortable due to getting used the the nasal pillows I use.

I do find I dream most nights (at least I remember some) which is more than I remembered previously, but I really do not feel the "way better" I was told I should feel when using the CPAP. I also do not sleep very long - maybe 5-6 hours as compared to the 7.5-9 I usually slept before. There is no way I can go that long now. Strange...

Aug 27, 2010
by: Snorq

I started using a CPAP last week, and I'm more tired than I was when I wasn't using it.

The readings from the machine indicate that my breathing isn't stopping nearly as much when I use it, though.

So I assume the machine is doing what it is supposed to do, and I just need to get used to it.

Aug 27, 2010
funny situation
by: Anonymous

I found the problem--the wiring in my house was faulty so that the power to the CPAP was irregular. Thank goodness we found out before the wiring started a fire!

After the rewiring, the machine is quiet, gives me a strong flow of air and the mask has stopped that sucking bit.

Aug 27, 2010
you should look for...
by: Sleepy

Those who don't see success should look for mask removal, open mouths, mask leaks, non-detection of micro events, further underlying problems due to years of maladjusted hormones due to recurrent hypoxia from months or years of prior sleeping. It may take time for hormones to re-adjust.

I'd recommend a separate and simultaneous pulse oximeter test (you can usually borrow the equipment for free overnight). Just remember to turn the alarm feature to OFF so it doesn't beep at you during the night.

Aug 27, 2010
I had the same problem
by: Steve

My home care person said it takes 30 days for most people to report feeling better, and when I complained to my sleep doctor about feeling worse, he told me that people with mild sleep apnea seem to take longer to catch up on their sleep debt than people with severe apnea for some unknown reason. I don't know if it's true, but that's what he told me.

I've been feeling better for the last two days, and it's been almost a month for me. I also have mild apnea. I know it's hard while working. I have no sick time left at work, so everytime I call in sick I have to take the day without pay. But you definitely don't want to fall asleep while driving to work.

I was thinking if I wasn't doing well, that maybe I would stop and try it later when I had some vacation time and didn't have to worry about going to work.

Hope you feel better real soon. Hang in there and keep us updated on how you're doing.

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