I Use My PAP, Why Am I So Tired?

When we go in for our sleep study, get our results, and pick up our positive airway pressure (PAP) machine, we all hear how we will feel so much better and how we will have so much energy.

Yet, for some of us, that is not the case. We still feel tired and sleepy. So, what’s up with that?

Small changes over time

For some people, it takes a bit longer before they feel better. Frustrating, I know. Your body is still playing catch up from a long period of time of not getting good quality sleep.

You may notice small changes over time as your energy starts to increase slowly. I know that was the case for me. I looked back a couple of months later and realized I didn’t need to nap any longer, I was getting more done around the house, and I wasn’t going to bed as early or sleeping as late into the day.

I didn’t feel immediately better, but when I looked back at things, I realized I had been getting better after all, even though I didn’t feel like I had.

What about the 'hangover' feeling?

Some people will say they feel worse after starting their PAP therapy. They will complain of difficulty waking, sleeping longer, and sometimes of waking up feeling like they have a hangover or something they are so foggy. I know it’s hard to believe, but that last part (the hangover feeling) is actually a good sign that your body is recovering.

The deep sleep factor

When you have that “hangover” feeling, that means your body likely is rebounding in what we call slow-wave sleep (SWS) or deep sleep. Normally, you would have that at the first part of the night, and you would have mostly REM sleep in the morning. However, when you are recovering from your sleep-disordered breathing, you may find that you are having SWS most of the night and even in the morning before you wake up.

That stage of deep sleep is one that all parents know well. Children have large amounts of SWS and tend to drop into that stage quickly. Anyone who has woken a child up from that deep sleep knows how cranky that child will be and will do what they can to avoid waking them.

What if I don't feel better on PAP therapy?

So, what if you have been using your PAP faithfully every night, and it’s now 6 months later and you still feel tired and exhausted all day. What’s up with that?

You may have more than one thing going on. At times, people will go back and find that they have a second type of sleep-disordered breathing that was covered up by the first one.

Another sleep disorder could be the culprit

A good example of that is that maybe we have treated your obstructive sleep apnea, but now we see you also have central sleep apnea and may need a different type of machine that can treat both. Some people may find that they now also have a leg movement disorder where their legs constantly move, keeping them from getting good quality sleep even though their breathing disorder is controlled. Others may discover that they have narcolepsy, or maybe idiopathic hypersomnia, or even issues with their thyroid and need medications to help them.

What should I do next?

If you are tired and new to your therapy, give it a bit of time and see if things get better. Remember, you didn’t get ill overnight, and it may take a bit before you feel better.

If you have been using PAP for a while and are still feeling tired all the time, it’s best to reach out to your sleep specialist and discuss with them what is going on. They can look for other causes of your sleepiness and determine what next steps are appropriate for you.

Don't give up

Please, don’t just assume your therapy is not working and quit. Not everyone gets that burst of energy immediately after starting their PAP therapy.

Trust me, I didn’t, and I am always happy for those who do (but also kinda jealous). Yet it was worth it to keep going and working with my sleep specialist until we got an answer.

What advice do you have for others struggling with CPAP? Check out the questions in our forums and share your experiences with others.