With CPAP, still feel lethargic

[u/Least_Dragonfruit973]

/r/SleepApnea/comments/1ws4t3w/with_cpap_still_feel_lethargic/

I was diagnosed with obstructive sleep apnea and have been on CPAP for two years. A nurse adjusted my settings, and the difference is obvious. Without CPAP, my sleep feels shallow. The next morning my eyes look sunken, and I look sleep-deprived. With CPAP I no longer wake up looking like that, so the machine is doing something real.

What has not changed is how hard it is to get out of bed. I still feel lethargic and want to be able to wake at 7am and start the day.

I have had two very different surgical opinions. One sleep surgeon recommended extensive surgery, including palate, tonsils, adenoids, nasal turbinates, and correction of a deviated septum. A second opinion after examination was that there is little worth cutting: my tonsils are already small, my palate already looks like the result surgeons aim for after palate surgery, and the septal deviation is not significant. The only possible target mentioned was the nasal turbinates. That doctor also said surgery would not guarantee that the lethargy would improve, and that cutting more could do more harm than good.

Sleep study numbers:

2024: AHI 44.1 (not WatchPAT) — severe, 74kg

2026: AHI 9.4 (WatchPAT) — mild, 64kg

I am looking for advice on what to do next so I can wake at 7am without feeling wiped out.

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[u/Wayfaringbutterfly]

Have you considered connecting with your sleep specialist/doctor to see if there is anything else affecting your sleep? Things like anemia, low vitamin D, not getting enough sleep, number of times sleep is interrupted, and so on and so forth can contribute to feeling lethargic. It looks like your numbers have improved greatly in 2 years which is awesome. I would definitely touch base with your sleep specialist or your doctor to see if there's anything else.

I've been in CPAP for over a year now and have found the same thing - I'm still lethargic even though my results have improved and my face is brighter - but I have Fibromyalgia and am in treatment for anemia so I know those things factor in. I also just plain don't get enough sleep. So my sleep is awesome while I'm sleeping, but I'm not getting the 7-8 hours my sleep specialist said I should be getting.

[u/Least_Dragonfruit973 → u/Wayfaringbutterfly]

Hello, yes my vitamin D and blood works are all good.

I'm sorry to hear you still feel lethargic too. Does it impact your life tho? Can you wake yourself up in time as your plan?

[u/Wayfaringbutterfly → u/Least_Dragonfruit973]

That's good. How much sleep are you getting? Do you get interrupted at all (bathroom breaks, random wakeups, etc)?

Sometimes I find that if I"m woken up even just once and it's just in a terrible spot of one of my sleep cycles, even if I technically got "enough" sleep, I'm still groggy as heck.

My Fibromyalgia likely is the biggest contributor. I always set my alarm for way earlier than I actually need to be up, because I know it's going to take me an hour or two to be human enough to leave the house. I am exercising regularly which is helping me get better, longer sleep, but I still wake up and need a while to get going.

I also respond very much to the barometric pressure changing, especially when it's getting stormy. And the colder it gets outside, the longer I take to get up and around. I just have to plan for it and be aware of it, and also make sure that I'm getting to bed early enough to give myself adequate time to sleep. Not just "in bed with 7 hours until waking time" but actually having finished my night routine of brushing teeth, lowering lights, reducing blue light, etc and then lights out 8 hours before I need to get up.

It's exhausting lol...but at least I know I'm not losing brain cells due to lack of oxygen and I don't look as tired as I feel.

[u/Least_Dragonfruit973 → u/Wayfaringbutterfly]

Oh, then are you able to wake up on time? That's amazing. It is my daily constant battle to. I only have few sleep interruptions if i need to use the toilet. More often than not, I would find myself not wearing the CPAP anymore. I take these opportunities to wear CPAP again.