It may not be "debt," but a lot of people do seem to need extra sleep after they start CPAP. Many people feel more tired after starting CPAP. This usually goes away after a while.
I do think that rather than simply dismissing the idea of "sleep debt," we should admit that many new CPAPers experience something that feels like what we think of as sleep debt, and they should not get discouraged and quite.
On this board and others we often have to reassure new CPAPers who are about to give up due to the "pseudo" sleep debt, and many of them do hang on and get over it.
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Perhaps the difference is in the quality of sleep we get. You see many posters that write they feel worse on cpap than before. I would posit that indeed their sleep is not of the same quality. If someone does not have bad symptoms from sleep apnea (though it's difficult to imagine that person would go for a sleep test), perhaps their sleep with the mask & machine is not as deep. If leaks keep waking them up the arousals might keep them from REM and deep sleep. I learned that successful therapy means using the machine 100% of sleep time and quality sleep in all stages. I know after I started therapy I felt better, but then had a period of time back to my old symptom of excessive daytime sleepiness. I took Provigil and Nuvigil for the first three years of therapy. I didn't experience real, significant changes until I started with ASV.
I guess I can understand the objection to sleep debt not being quantitative in the same way that, say, money debt is.
If I'm supposed to pay someone $8 a day every day for five days, but instead pay only $7 on each of those days I'll incur a debt of $5. To pay back that debt on the next day I must pay $13.
If I need 8 hours of sleep a night and instead get only 7 for five consecutive nights, I can't pay it all back by sleeping for 13 hours on the sixth night.
Nevertheless, damage both physical and mental does occur because of lost sleep. And at least some of that damage can be repaired by getting better quality sleep and more of it.
So instead of calling it sleep debt and sleep repayment perhaps we should call it sleep damage and sleep repair.
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Well, not being a scientist, I can't really say whether or not sleep debt is real. I do know that there is dispute over the concept in the scientific community. But then there are those who say man made global warming is a crock despite the majority of the scientific community saying it isn't.
As a layman, I can see the validity in the concept of sleep debt, but I'd be the last to proclaim with any certainty whether or not it's true.
Even for the same person, the need for extended quality sleep to correct the damage can differ. When I was first diagnosed with sleep apnea, I slept great and felt wonderful during the titration sleep study and once I received my CPAP machine. No "sleep debt" effects to deal with and I was like a new person.
This time around, I felt like crap for about a year before learning how to turn on the reporting function on my Respironics machine. Never thought about the apnea being an issue because I used the CPAP religiously. Upon changing the settings, I learned my AHI kept repeating a pattern, cycling through a range of 7-24. New sleep study revealed need for higher pressure (10 vice 6) and SleepyHead shows better results (fewer clear airway events, lower leaks and slightly lower AHI) using Autoset. With about 2 months of using an autoset, my AHI averages in the 1.2 range but I don't feel great every day. Some days I still feel a bit tired and not high energy.
What is the difference? I'm five years older, eating healthier and exercising out more frequently. Job and life is less stressful. Except for the age, all the indicators should point to better sleep.
Bottom line - Be patient. It keeps getting better, even if the improvement isn't profound every day.
All I know is my first night on CPAP (after a long hiatus) I felt fantastic when I woke up. The day after the first night. Immediate and instant improvement. Also, I'd tend to believe in Dr. Wilborg on a medical issue like this.