Is My Sleep Apnea Treatment Working? The Seven Deadly Signs  

Joseph Krainin, M.D.32 comments

"I use my CPAP machine every night, so I don't have to worry about sleep apnea anymore, right?"

WRONG

This is a common and widely held misconception. Sleep apnea treatment is one of those cases in life when "you don't know what you don't know." Since you're asleep, you're completely unable to assess how well the apnea is being treated. Don't fool yourself: even though you use CPAP all night and feel good during the day, your body still may be suffering at night. Treating sleep apnea is definitely not a "one size fits all" or "set it and forget it" proposition. If you even have mild residual sleep apnea while on CPAP therapy, you will be at increased risk for sleep apnea effects such as:

seinfeld smothering someone with a pillow is like undertreated sleep apnea

Read on to learn about the top warning signs that you may need an OSA treatment tune-up.

1) Breathing Symptoms

If you've started snoring again while on CPAP treatment or the snoring never went away, this is a problem. The goal of CPAP is to keep your airway fully open, and snoring is a sign that you are still experiencing partial airway collapse. The same principle applies for other sleep breathing symptoms, such as quitting breathing (called witnessed apneas) and waking up gasping, choking, coughing or short of breath. Unfortunately, people who don't have bed partners, or have bed partners who are really deep sleepers, may not know whether they are having any ongoing breathing symptoms. Some folks try to record themselves while sleeping with their CPAP machines, utilizing smartphone apps to hear what they sound like. The problem is that the CPAP itself produces constant white noise that will distort what your phone's microphone picks up, so these apps aren't too helpful. If you don't have a bed partner and have the opportunity to share a room with someone while on a trip, always ask for feedback about your breathing while on CPAP.  

patient rips cpap mask off from witnessed apnea

2) Disrupted Sleep Symptoms

If you've started experiencing any of the following nighttime symptoms, it might indicate that your sleep apnea is not well-controlled:

  • waking up multiple times during the night (sleep maintenance insomnia)
  • having to urinate multiple times during the night (nocturia)
  • acid reflux during the night (nocturnal GERD)

toilet for nocturia from sleep apnea

3) Daytime Symptoms

If you used to wake up feeling great and ready to attack the day but you've noticed some backsliding in how refreshed you feel, you might need to talk to a sleep doctor. Other daytime symptoms that warrant a reevaluation of your sleep apnea treatment include:

  • feeling more tired or sleepy during the day (excessive daytime sleepiness)
  • difficulty concentrating
  • irritability
  • headaches on awakening
  • memory problems
  • inattention while driving

headache from sleep apnea

4) Weight Gain

If you have gained a lot of weight, your CPAP machine setting might need to be tweaked. You will likely need more pressure to hold the back of your throat open.  Also, added weight can cause the muscles that move the lungs to tire out during the night. This can lead to continuously low oxygen levels during sleep, which is not good for your body, especially your heart and brain. If this is the case, you might need to switch to a BiPAP machine, which takes away some of the burden on your diaphragm and other lung muscles. If your weight has made a significant movement in the wrong direction, talk to your sleep doctor about checking a machine download or undergoing a nocturnal pulse oximetry study while using your treatment to make sure your oxygen levels are in the normal range.  

scale showing weight gain making sleep apnea worse

Check My Oxygen Levels on CPAP

5) New Medications or Medical Problems

If you were diagnosed with obstructive sleep apnea, started CPAP, and then developed one of the following medical conditions, you are at higher risk for central sleep apnea and will need a new sleep study to check for this other type of sleep apnea that might not be fully treated by CPAP:

  • atrial fibrillation
  • heart attack
  • stroke
  • congestive heart failure
  • kidney failure or renal insufficiency
  • brain tumor
  • spinal cord disorders affecting the neck
  • moving to a high altitude (>4,000') elevation

heart attack from sleep apnea

Opiate pain control medications also increase your risk of central sleep apnea. If you've started taking one of the following drugs, or your dose has been significantly increased since your original OSA diagnosis, you might need another sleep test:

  • Norco
  • Vicodin
  • Percocet
  • Dilaudid
  • Morphine
  • Oxycontin
  • Suboxone
  • Fentanyl
  • MS Contin
  • Methadone

norco causing central sleep apnea

Even mixed opiod receptor agonists/antagonists like buprenorphine (Suboxone) can cause central sleep apnea. 

Order a Sleep Study

6) You Chose a CPAP Alternative Treatment and Never Had a Repeat Sleep Study

If you had a sleep apnea surgery such as a UPPP, Bimax, Inspire implant, remedē® or other procedure to help your sleep apnea, it is recommended that you have a follow-up sleep study 2-3 months after the surgery to assess whether your sleep apnea went away.

sleep apnea surgery

If you're using Bongo Rx, iNAP, or an oral appliance for sleep apnea, you should have a repeat sleep apnea test while using the treatment to make sure that it's doing the trick. The same goes for positional therapy

Order a Sleep Study

7) Download Dysfunction

A download from your machine can be a tip-off as to whether your apnea is under control.  If your download indicates any of the following, you should talk with your sleep apnea doctor about adjusting your machine or reevaluating your condition:

  • high leak rates
  • significant snoring time
  • elevated estimated AHI - in my experience, a machine-calculated AHI of 3 or more should raise an eyebrow
  • estimated central breathing events that are new or increasing in number
  • new "periodic breathing"

CPAP download showing a high AHI

Actual download from a Singular Sleep patient's CPAP machine. Notice the elevated AHI.

Schedule a Consultation to Obtain and Review a CPAP Download

The Bottom Line:

If you fall into any of the categories above, it's time to talk to a qualified sleep doctor, as you might still be at risk for sleep apnea consequences, some of which are severe. In order to evaluate how well your current sleep apnea machine is working, your doctor will take a careful sleep and medical history and might also order any or all of the following:

Note: there is a new option for checking the status of your sleep apnea while wearing a nasal pillows mask or using Bongo Rx: the NightOwl PAT device. The nasal cannula needed with a traditional home sleep test will be incompatible with nasal pillows or Bongo Rx but the NightOwl doesn't need that sensor - it measures sleep apnea by monitoring changed in the diameter of an artery in your finger. 

    Remember to sleep smart and reduce your risk!

    Check My Oxygen Levels on CPAP

     

    sleep apnea test home sleep study Joseph Krainin Joseph Krainin M.D., FAASM is the founder of Singular Sleep,  the world's first online sleep  center. He is a Fellow of the  American Academy of Sleep Medicine and board certified in both  sleep  medicine and neurology. He has been practicing medicine  for over 10 years.

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      32 comments

      Elaine
      Elaine
      Upfront I’ll just say I’m not overweight at all. I have had a CPAP machine for a week now and the more I use it the stronger the headaches become and the worst dreams are. I don’t feel better during the day, still tired. And yesterday I was more tired than I ever have been (The apparatus does not bother me, it does not irritate my skin and it’s not bothersome so this is not what the problem is ) but they say you have to try it for two weeks to two months before you know. I’m not convinced. I’m just not!
      GG
      GG
      To anyone that is worried please go and see your general doctor as soon as possible. I am a registered nurse and they will send you back to a sleep specialist or a cardiologist or whoever they think you need to see. I can relate to what someone said the sense of fear when things are not going to plan, but things won’t get better if you don’t go back and talk with doctor as soon as you can. I had a pacemaker inserted because my heart kept stopping while I slept but I would get a sense that my body was not moving take a deep breath and go back to sleep. Luckily I explained this to my fantastic cardiologist and he asked me if I snored. Luckily for me too a nurse at the hospital mentioned that I snored so then I had to get a CPAP. The first time it was a nightmare, either I had water trickling down the back of my throat which can lead to aspiration pneumonia or my throat was drying out completely. So the girl at ResMed tried tweaking the settings for the 2nd month that I trialled it and I hated the CPAP. Luckily I rang back ResMed a couple of years later and I don’t know if the training was better or what but the girl I spoke to was very knowledgeable so I thought I would give ResMed another chance. The 2 girls that work there are both incredibly helpful and I am so grateful that they have sorted me out so to speak. I have a humidifer on my CPAP to stop my throat from drying out but no longer is my throat getting way too dry. It’s really important to persevere with the CPAP but if you really cannot tolerate go back and ask them at the CPAP providers to help you figure out a solution to your problem. I also had nasal surgery and that was one of the best things I did too. I felt terrible for a month having packing up my nose so my sleep patterns went out the window, but at least I wasn’t working so I could sleep through part of the day. I am also glad that I prepared myself well beforehand making meals and freezing them, because I look after myself and when you are tired you don’t want to go out to buy food or cook it. I feel like I am on the mend, my you I was very tired today despite only have 0.1 apnoea episodes last night but there again it might be due to something else such as the Frusemide I take to help keep my blood pressure down. Frusemide can reduce the amount of pottasium you have in your body and that in itself can make you tired as you pee it out. So please anyone on this site, please see your doctor as soon as possible if you are having trouble with your CPAP they are there to help you.
      Angela
      Angela
      IVE BEEN USING MY CPAP FOR A YEAR NOW NO MORE SNORING. SLEEP IS ALOT BETTER. SOMETIMES I get a little tired but I feel a lot. Better.
      Lynn Maria Rochon
      Lynn Maria Rochon
      I’m also with you. I’ve tried 3 different masks and they have lowered it down from 4 to 15 to now 4 to 7 and in the middle of the night I wake to being suffocated, still pushing the button to lower the air. It’s been almost 5 weeks and I am still exhausted during the day I need a nap, wake up to pee, cant breath. I got so mad a few times I just removed the mask and slept for 7 hours or more and the next day I was my old self as the go go bunny. After 2 hrs last night I still wasnt sleeping so removed the mask again, today I clean the house, packed more boxes and still up at 11 pm. But they are threatening me to take my license away if I don’t use it… 😥🤨 mild or moderate she said from one week to the next pisses me off
      Tony cee
      Tony cee
      I have been using for years now. It feels like it has helped but recently I’m feeling more tired An waking for bathroom breaks more than before. And now a nose bleed. What to do, really?
      keir beard
      keir beard
      If you are having trouble with a leaking mask, try a mask cloth liner. that’s specific to your mask. Available online at CPAP stores. Good luck!
      Davey
      Davey
      i got diagnosed with 17 events per hour after a sleep study, since using my machine thats now between 0.1 and 4 per hour, i have to shave each night before sleep so the mask fits, i fill up the humidifier and go to sleep. i have woken up many times in the night all of my adult life due to having children and my partner wakes waking me up. i feel much better now using the machine, im no longer sleepy during the day despite waking up 3-4 times a night, the sleep in between is better and my partner no longer has to hear my snores.
      On the Edge
      On the Edge
      For what it is worth, I feel for each one of you. I know all to well the life-threatening side effects of sleep apnea. I was diagnosed in 1999. I tried every gimmick out there. The usual home remedies all the way to the dental device that positions the lower jaw forward. Finally, my first sleep study was prescribed by my doctor. The results were 85 apnea episode per hour. Unfortunately, the majority of them were central. Because of the insurance, I had to try the CPAP regime. No luck. Then the older style BiPAP regime. No luck. I was desperate. My apnea episodes were so bad, I started to have panic attacks before bedtime, knowing full well the horrific gasping for breath that occurs with my apnea. Finally, I fell asleep while driving home late at night on our local highway. Fortunately, it was late, the roadway was straight and my truck was a standard transmission. A semi truck blasting his horn as he passed, awoke me. I then knew I had to get desperate medical attention. I got a tracheotomy. Using a nebulizer with a special mask, the majority of my episodes seem to have relinquished. My sleep had improved greatly. However, within the last 2-3 years, my central apnea has worsened. I am on the newer versions of machines called the Bipap ASV. I have been on it for 2 days and I am disappointed. It doesn’t seem to force enough air in. If the pressure is increased, it becomes unbearable. Of course, my trach is plugged. My airway & throat are parched. The anxiety is returning. There are patients in hospitals that are on tracheotomy ventilation. Why can’t people with trachs get this type of home care? People that suffer from sleep apnea don’t live, we merely exist. This disease literally sucks the life out of us. We become zombies, literally. I wish you all the best of luck with your situation.
      Diane soikie
      Diane soikie
      I’ve been on the cpap machine just over a month. I feel tired no energy and short of breath. I feel it’s not helping. Still waking up through the night.☹️
      Lee
      Lee
      I started on my cpap two years ago. Was fine after a few days. This last couple of weeks I have been struggling with the mask and feel suffocated too. Any advice please?

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