Sleep Medicine Specialist Questions BiPAP machine

always tired

I have been using bipap for about 5 years, and even though it never made me want to jump through hoops like some people said it did for them, it did help. But now I use it EVERYTIME, I sleep but now I am exhausted for much of my life.

I go to sleep tired and wake up the same, my doc says there is not much that can be done. I have a regular high setting now and any higher than that, my mask leaks. He says I have one the best masks around, so I'm just looking for another opinion, I guess. He also says I am not a candidate for surgery. He says that won't help me, something about the back of my tongue and nothing can be done about that

Male | 63 years old
Complaint duration: 2 years
Medications: high blood, heart meds
Conditions: a/f heart- high b/p

7 Answers

SleepMedicineSpecialistBiPAPmachine
It sounds like you have been struggling and I am very sorry to hear that. There are so many more reasons than sleep apnea to be tired. Have you spoken to your primary care provider? Have you done blood work lately? It looks like you have atrial fibrillation, is your rate controlled? If you were my patient, I would inquire about your actual sleep structure and schedule. Sleep hygiene and stimulus control should be optimized. Depending
It sounds like you have been struggling and I am very sorry to hear that. There are so many more reasons than sleep apnea to be tired. Have you spoken to your primary care provider? Have you done blood work lately? It looks like you have atrial fibrillation, is your rate controlled? If you were my patient, I would inquire about your actual sleep structure and schedule. Sleep hygiene and stimulus control should be optimized. Depending on our conversation, at a minimum, I would get a titration study because are you on the best setting? A lot can change in 5 years. Have you had weight loss or gain? Why are you not a candidate for surgery? And which surgery? Are you talking about Inspire or palate/tongue surgery performed by ENT? If it is the latter, why are you not a candidate for that? If you have a large tongue then that can often be addressed by an ENT physician trained in those types of procedures. I definitely encourage you to pursue this further because no one should be brushed off. If everything has been worked up appropriately then it may be an expectations conversation. Sometimes realizing that despite optimizing everything in your control, stress and/or anxiety can be exhausting. I hope you are able to get to the bottom of your exhaustion and wish you the best of luck.

Dr. Goldenberg
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If you wake up tired, your sleep is pathological. I would love to see your sleep study on current settings. Next, a full review of your meds, since u just started some bp meds, some rob you of coenzyme Q10, a major catalyst of energy pathways.
And finally, a look at your triads is needed to restore whatever is dysfunctional and bring you back to a youthful state. In my novelette, Jane Doe, surviving cancer, I explain such triads in more detail.
Sometimes tiredness and sleepiness persist despite using BIPAP usage. There are some medications that are FDA approved for sleepiness that persists after effectively treated with BIPAP. Address with your sleep physician.
You need to consult a sleep physician to make sure pressure is at optimal setting, consider mask trials for a more comfortable mask. If the pressure requirement ids too high sometimes it can cause mask leaks, in which case you can consider combination therapy of oral appliance plus a PAP device to reduce the need for too much high pressure. Talk to your sleep doctor if you are a candidate for Inspire Device. Healthy lifestyle habits and good sleep hygiene to maintain optimal weight are helpful.
Option 1: Repeat the sleep study and titration.
Option 2: A week trial of Auto-bipap to determine the pressure requirements. Mask leaks are a problem, this needs to be addressed as a priority.
The first thing to do here is to be sure you're getting enough sleep. For some people that's a full 8 hours. Assuming there is enough sleep, the next thing to do is to look at the data recording from the BiPAP machine. Virtually all modern machines are able to track whether apnea is suppressed. If apnea is not suppressed a formal laboratory study would probably be appropriate. If it is suppressed and there is no shortage of sleep time, about 10% of sleep apnea patients will remain sleepy. There are FDA approved medicines for this.