Why You May Not Feel Better After Using CPAP Therapy for Sleep Apnea

When someone has obstructive sleep apnea, a disorder that causes pauses in breathing during sleep, the most effective treatment is continuous positive airway pressure (CPAP) therapy. A CPAP machine provides a constant flow of air through a mask. This helps you breathe at night and can also decrease snoring. Unfortunately, not everyone will respond well to this treatment.

This article explores reasons why you may not feel better after using CPAP therapy, how long it takes to notice an improvement in your sleep, and what to do if you're using a CPAP machine but still feel tired.

ResMed AirSense 10 AutoCPAP Machine
Brandon Peters, MD

You’re Not Sleepy

Excessive daytime sleepiness is one of the most common symptoms associated with untreated sleep apnea. However, not everyone has this symptom.

How tired you are can be assessed with an Epworth score, a sleepiness rating scale. If you are not overly tired prior to starting therapy, you may not notice a big difference after using your CPAP machine.

However, you may still notice a difference in your overall sleep quality. Mild sleep apnea may be associated with up to 15 awakenings per hour. Notice if you feel more refreshed as you continue using your CPAP machine.

Recap

If you don't feel exhausted before beginning CPAP treatment, you may not notice a significant difference after treatment. This may impact whether you decide to continue treatment.

You Are Not Using It Long Enough Each Night

It can feel hard to adjust to CPAP therapy. You may want to remove your mask, especially as it gets close to morning. Unfortunately, sleep apnea often gets worse as morning nears.

Rapid eye movement (REM) sleep occurs in the last third of the night. During this stage of sleep your airway muscles relax, making sleep apnea worse.

Removing your CPAP mask early can impact your overall sleep quality. Try to use your CPAP during the entire night so you can see how much it helps you.

Your Sleep Is Worsened by CPAP Problems

Unfortunately, CPAP can introduce its own set of problems. Without support, these issues can make it hard to adjust to therapy.

Some people may struggle with the fit of their CPAP mask. If it is not properly sized or adjusted, it can leak or cause pain, marks on the face, and ulcers or sores. Others may find breathing against the pressure uncomfortable as well.

Finding the right mask takes a little guidance from the equipment supplier. There are a lot of options, including nasal pillows, nasal masks, and full-face masks.

The humidity and temperature of the air may need to be adjusted to improve comfort. Nasal congestion or blockage may lead to mouth breathing and dry mouth. Too much pressure can cause you to swallow air.

These issues may make it difficult to fall asleep and sleep soundly. If you feel upset or frustrated, reach out to your provider for support and guidance.

You Only Have Mild Sleep Apnea

Someone with mild sleep apnea may not notice as much of an improvement from CPAP therapy compared to someone with severe sleep apnea. For example, going from 10 events per hour down to five may not feel significant.

Even if you have mild sleep apnea, be sure to reflect on the benefits you may be getting. Think about your sleep quality before and after using your CPAP machine. This way, you can decide if it is the best therapy option for you.

You Have Insomnia

Insomnia, a sleep disorder, is a common symptom of sleep apnea. Many people report waking multiple times a night and having trouble falling back asleep. However, people with insomnia don't necessarily feel sleepy during the day. This can make it difficult to tell if using a CPAP machine is actually helpful.

If you already have trouble falling asleep, wearing a mask that is blowing air in your face might not sound ideal. You may want to speak with your doctor about sleep aids, as well as cognitive behavioral therapy for insomnia (CBTI) to help manage your sleep troubles.

Your CPAP Pressure Needs Adjusting

You may not get the full benefit of your treatment if your CPAP settings are incorrect. These settings are ordered by your physician who has monitored your breathing. Your settings may be adjusted at your follow-up, especially if your device was set to default.

If the apnea-hypopnea index (AHI), a measurement of how often your breathing stops, goes above 5 events per hour, the pressure setting should be changed. Ideally, the goal is to get this number as low as possible.

Sleep Apnea Didn't Bother You Prior to Treatment

Some people seek treatment for sleep apnea or snoring because of a partner's request. Loud and disruptive snoring can affect relationships. It may even lead to separate sleeping arrangements.

Even if you aren't bothered by sleep apnea, you may have unpleasant symptoms related to it. Snoring, daytime sleepiness, waking frequently, urinating at night, and teeth grinding are possible signs of sleep apnea. You may also notice mood, concentration, and short-term memory problems from untreated sleep apnea.

If you haven't noticed any sleep apnea symptoms, you may not feel better with CPAP treatment.

You Have Developed Complex Sleep Apnea

CPAP therapy can lead to a different condition known as complex sleep apnea. With complex sleep apnea, the brain "forgets" to tell the respiratory muscles to make you breathe. This can lead to pauses in breathing that last at least 10 seconds about five times per hour.

Fortunately, it resolves in most people with continued treatment. However, this may take several months. In rare instances, bilevel positive airway pressure (BiPAP) therapy, which provides varying levels of air pressure, may be needed to treat it.

You Have Just Started Using It

How long it takes for CPAP therapy to work is different for each individual. If sleep apnea is very severe prior to treatment, the improvement may be more obvious. However, when symptoms are mild, it may take longer to notice any changes.

Keep in mind that it may take several weeks before you see any improvement. If you take your mask off in the middle of the night, it could take even longer to experience the benefits of therapy.

If you are not noticing an improvement, speak with your board-certified sleep physician about ways to adjust your therapy to better work for you.

Recap

It can take weeks of continuous CPAP use before you notice any improvement. It may take those with mild symptoms even longer, as symptoms are more subtle.

Summary

If you are using CPAP therapy but still feel tired, there could be several reasons why. It's possible that you haven't been doing the therapy for long enough, you are removing your mask during the night, your pressure needs to be adjusted, or your symptoms are mild.

It may take several weeks of proper and continuous usage before you feel the results of CPAP therapy. If you haven't noticed any changes, be sure to speak with your doctor. There is a chance they may diagnose you with another underlying medical condition or complex sleep apnea. In these cases, other treatment methods may be used.

Frequently Asked Questions

  • What should I do if I cannot tolerate CPAP?

    Speak with your doctor. They may determine that you need a different type or size mask, or that you have another condition that may require additional treatment.

  • What are alternatives to CPAP?

    Other ways to manage sleep apnea may include:

    • Weight loss
    • An oral appliance or other type of device to help with breathing
    • Experimenting with different sleep positions
    • Medication
    • Surgery
  • How much weight do I need to lose to cure my sleep apnea?

    Research suggests that if you're moderately obese, shedding 10% of your weight may relieve your symptoms by up to 50%. Losing more weight may reverse sleep apnea altogether.

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