Using CPAP But Still Tired All The Time – Tiredness, Fatigue & Red Eyes in The Morning

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Many CPAP users are using their CPAP but still tired all the time.

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Here is the honest truth about CPAP therapy… the entire ecosystem is, for the most part focused on the wrong thing.

When you really get down to it, all anyone seems to care about is ‘compliance’ with the therapy. In other words most providers see the goal of therapy as one thing: usage.  As long as you are using your machine, that’s success — end of story.

But that’s not the the point is it? The whole point of CPAP therapy is BETTER SLEEP!

And just using CPAP does not always guarantee better sleep, in fact some CPAP users might even feel that their sleep is worse with CPAP than it is without. They are using CPAP but still tired all the time.

CPAP Changes your Sleep Patterns, 100% Of The Time

Sleep apnea is a unique condition because you can’t see it.  You can’t observe apnea events happening in your own body because they happen while you are asleep! Because of this sleep apnea sufferers are not aware of snoring, disrupted breathing and the resulting fragmented or poor sleep.

When you have untreated sleep apnea, you are so completely exhausted from night after night of inadequate sleep that you “seem” to fall asleep easily. Of course even when you fall into sleep almost immediately, it is often a poor, damaged sleep that leaves you tired and foggy during the day.

When you begin treatment, you might find that CPAP makes falling asleep difficult and suddenly begin to experience some degree of insomnia. This can be very discouraging if your experience prior to treatment was that you slept almost immediately. And now treatment seems to make falling asleep and staying asleep challenging and frustrating. Although you may find falling asleep difficult with CPAP, once asleep CPAP helps you progress through the four stages of sleep and sleep quality is greatly improved.

Of course, insomnia is only one possible issue that might find you using CPAP but still tired all the time. It may be that your settings are wrong, pressure is too high, or your mask is uncomfortable or leaking. Any number of equipment-related issues might be causing you to get less-than-optimum sleep.   If your CPAP wakes you up every morning at 3am because the pressure ramps up too quickly, it’s hard to get good quality sleep. If your mask is blowing air into your eye all night, it’s hard to get good quality sleep.  You find yourself using CPAP but still tired all the time — not the outcome you would hope for.

Fortunately, most of these issues can be resolved.  With a few simple steps most people can sleep noticeably better than they have ever slept. And with good quality sleep every element of physical, emotional and cognitive health is properly supported. Sleep is the foundation of good health.

Any Willing CPAP User Can Optimize Their Sleep

As stated above, there are steps you can take to optimize your sleep. What we refer to as ‘Sleep Optimization’ for CPAP users includes these five key elements…

  • CPAP Therapy Optimization
    • CPAP is a complex therapy and, unfortunately, many CPAP users are left on their own after the first few weeks of therapy are over. Equipment settings adjustments, humidification improvement, mask alternatives, equipment upgrades, CPAP Mask Liners… all of these things might be required to make your CPAP as effective and comfortable as possible.
  • Weight Loss
    • Being overweight makes your airway narrower which not only makes your sleep apnea worse, it also means that you will require higher pressures while on CPAP to keep your airway sufficiently open to prevent apnea events. If you lose even a relatively small amount of weight, you may be able to significantly reduce your required pressures and get a much better night’s sleep.
  • Soft Palate Yoga
    • One of the core causes of sleep apnea, besides excess weight, is loss of muscle tone in your soft palate (the back part of the roof of your mouth). This is a natural part of aging. As we get older, we lose muscle tone. What you see on the outside is true on the inside as well, at least as far as your soft palate is concerned. And just like your outside muscles, you can tone your soft palate through exercise. A toned soft palate means a more open airway, and much more comfortable therapy for you.
  • Sleep Improvement Techniques
    • High quality sleep is more attainable than you might think. There are simple changes you can make, starting tonight, that will increase the quality of your sleep immediately. Small changes in sleep habits or environment can have a big positive impact on your sleep.
    • Sleep improvement techniques include training in deep relaxation, breathing techniques that trigger the relaxation response, desensitization exercises that diminish the sensations of CPAP therapy, protocols to reduce nervousness and anxiety, and methods of effectively producing natural melatonin and normalize sleep schedules and rhythms.
  • Engagement, Support, Tracking & Accountability
    • Beyond anything mentioned above, your willingness to engage in a process to improve your sleep is the most important element of success.   If you are engaged in the process, have the support you need, track your results in some way (like keeping a sleep journal), and set realistic goals, you will find that better sleep is easily within your grasp.

If You are Using CPAP But Still Tired, You Don’t Have to Suffer, and You Don’t Have to Go It Alone – Your TotalCare CPAP Therapist is Here to Help


The TotalCare Sleep Apnea disease management program is available free to any CPAP user and supported by qualified, professional, CPAP therapists. If you want help getting better sleep and better CPAP therapy, click here to create your free account, complete an interactive CPAP therapy checkup, and to give us some details about your CPAP equipment.


50 thoughts on “Using CPAP But Still Tired All The Time – Tiredness, Fatigue & Red Eyes in The Morning

  1. The approach that you’ve described is exactly what is needed in the treatment of sleep apnea and other related sleep disorders. The old ideas about “compliance” are outdated and ineffective. Compliance is what prisoners are expected to do. Even “adherence” is about sticking to some one size fits all treatment plan. We need to help people “succeed” at treatment by supporting them with education, assistance and an openness to a variety of treatment options. Thanks for opening a discussion about excellence in care and success in treatment.

    1. Thanks Rick. :-) Much of what you have shared with us is behind this program and we’re really happy that you have joined our advisory team. :-)

      “Compliance is what prisoners are expected to do.”

      Well put. It’s one of the many terms that are common in this industry that reveal the ‘rules’ around therapy. I’m no historian, but I think the term actually started with 3rd Party Payers and mean’t compliance with documentation and therapy practices rules. It started as payers saying, “you (DME provider) need to comply with our rules” and it became “patient compliance” defined by > 4hrs per night of usage in at least 21 out of 30 nights.

      I don’t think payers ever meant, really, to impose compliance rules on patients, they are trying to get providers to focus on success in some way.

  2. What about offering an Oral Appliance from a qualified Sleep Dentist….it could open the airway and make the CPAP more effective…or even resolve the issue. Or offer APAP??

    1. We are 100% in support of anything could make CPAP more effective, including oral appliances. As we get more patients using our platform who use CPAP + oral appliance, we’ll have a better picture, in terms of data, on what works. For now, I think Dr. Yatin Patel paints a clear picture of some good recommendations here…

      As far as APAP, my personal feeling is that everyone should have an auto titrating CPAP. For us, CPAP is the therapy — Continuous Positive Airway pressure. The therapy can be delivered with a standard fixed pressure CPAP machine, with an auto titrating CPAP machine, or with a Bi-level CPAP machine.

      What has been your experience with oral appliances and CPAP?

      1. As an update, I’ve learned a LOT about oral appliances since I posted this and the more I learn (and we learn as an organization) the more I understand that OAT should be part of any comprehensive program.

        1. Doug. I have used a mandibular advancement device (oral appliance) for about 10 years.
          However, I ultimately had to give it up as it was wreaking havoc on my TMJ causing
          pain, snapping and clicking of the joint plus referred pain to the ear and some tinnitus. Often felt like I had water in my ear. All of these symptoms have eased or disappeared with CPAP. Out of interest I have worn a recording Pulse Ox with both systems and the CPAP numbers are much better. The CPAP experience has not been without its own problems – very dry eyes and start of moderate nasal congestion ( I use a Philips CPAP PRO with Dreamware mask which I think vents air into the eyes) . I know studies have concluded that oral appliances are beneficial or on par with CPAP for mild to moderate apnea and that it is hard to find many people having TMJ problems but just a caution that it may occur with some users over the long haul. Here where I live (Thailand) oral devices vary from $1200 – $2500 depending on model. This puts them on par or more expensive than many CPAP machines.

          1. Steve, I also have TMJ and have a mandibular advancement device. I began having pain in the jaw and was about to give up on the device until my dentist suggested physiotherapy for the TMJ. Unbelievable that after 3 sessions, it was gone. This is a specific type of therapy on the jaw which is a bit uncomfortable but yields extraordinary results. It involves manipulating the pocket in the jaw and improves the pain and range of movement. Recommend you seek out a physiotherapist familiar with it.

    2. I tried a tongue holder with APAP and felt better during day-time. May be the APAP pressure is the problem and needs too to be tweaked.

  3. I’m glad to hear some one recognizes some of these problems that my local “team” has blown off completely.
    I do sleep better over all, but my back and shoulders hurt because I can’t move much at all while sleeping without creating a leak in at least one spot. The air at the vent does blow right into my eyes most of the night and I have tired red eyes and puffiness all the time now. I get the chills if I sleep in my natural back position with my hands on my chest from the excessive air flow and that wakes me up and chills me so bad I have trouble going back to sleep. My “team” tried a couple of things and the last time I was told flat out. “Sorry there is nothing else we can do”. I am thrilled with the sleep, but while these problems may seem small, when you add them together it is extremely frustrating and I have little hope of any help other than what I find on line. Thank you, just knowing I’m not alone is a bit better.

    1. Cherrie, thanks for your comments. It sounds like your mask fit is the main problem. You mentioned that you tried a couple of things, did those things include alternative masks or other specific mask solutions? Sometimes using a hose clip or hanger can help with issues like this as well, it depends on your specific situation of course.

      If you would like some help finding a solution, create an account from the home page and send us a private message. We can put in in contact with one of our CPAP therapists and see what we can do to help get the issue fixed.

  4. I had a good provider and when I went on Medicare had to change provider, had so much trouble getting phone calls to schedule finally gave up. Now I have no support when problems arise very frustrating!

    1. Unfortunately, this is a common story. The Medicare competitive bidding program was poorly executed and left a lot of patients behind. We hope to be able to provide services to Medicare patients through our network of Therapy Associates sometime this year, but right now we do not accept Medicare or any other insurance for supply orders.

      We are, however, creating the program I mentioned above which will include full-service support from our CPAP therapists and sleep coaches. It won’t be covered by insurance (yet) but we’re creating the program in a way that will keep the costs low. A big part of the program is to make sure you have support when problems arise. You don’t have to get your supplies from us to use our therapy management software or participate in any of your programs. You can use your current Medicare provider for supplies (they will be more than happy to take an order) and use our programs and systems if you want.

  5. APAP tx is MORE effective than CPAP. CPAP is a dinosaur. APAP’s are not even spoken about. Ditched my CPAP for APAP tx a few years ago.

    1. Auto titrating CPAP machines are, from our perspective becoming the norm. You may not hear about it much because they are still considered CPAP machines. As I mentioned in another comment. CPAP therapy is delivering Continuous Positive Airway Pressure — a variety of machines of different complexity can delivery positive pressure continuously — the difference is in their ability to adjust that pressure. Standard CPAPs operate on a fixed pressure. Auto titrating CPAPs adjust pressure automatically in response (or anticipation of) apnea events. Bi-level CPAPs have two distinct pressure settings for inspiration and expiration pressures.

      At this point, every new CPAP users should start on a auto titrating machine with full-time data capabilities. Standard CPAP is, indeed, a dinosaur. Pressure needs change from day to day and throughout each night, it only makes sense to operate the CPAP at the lowest therapeutic pressure. There are some downsides to auto machines, though. If the settings are not right, rapid changes in pressure can actually wake you up and sometimes other adjustments need to be made.

      Thanks for your comments!

  6. Tired and unrefreshed post 3 months of CPAP. There’s a significant chance that it’s actually obesity Hypoventilation. Only resolved with bi level ventilation not cpap

    1. Hi Liam, thanks for your comments. It sounds like you are working with a physician and have a plan and direction. If we can be of any assistance, open an account from the home page and we would be happy to connect you with a sleep coach for a free consultation to see if there might be other issues happening.

  7. I’ve been on CPAP therapy for a year. I have seen a great improvement in fatigue levels throughout the day, but I still feel the need to nap in the afternoon. I adjusted well (and quickly) to CPAP therapy, but I hate it. As a slender, athletic 27-year-old, I dont want to be tied to a machine the rest of my life. I am going to be looking into surgical options, if possible. I am tired of being tired!

    1. Well put Naomi. I’m glad to see that you’ve seen great improvement in fatigue levels. In terms of getting off CPAP, since your sleep apnea is clearly not weight induced, I think a lot depends on what pressures you require now. If your required pressures are low, you are much closer, in general, to the possibility of moving beyond CPAP. As I mentioned in the post above, we are very excited about exploring the effectiveness of ‘Soft Palate Yoga’ to, at least, reduce required pressures and at best to help people move beyond CPAP. I’m not an expert, but I do know enough to believe that the right exercises, done consistently, can only help.

    2. Naomi it’s good to hear that you’re feeling and sleeping better. Treating sleep apnea and succeeding at that treatment or grouping of treatments is incredibly and even life changing. I would remind you that a large portion of people worldwide nap daily in the afternoon. In that time often referred to as the “circadian window” our circadian function slows down its production of alerting chemicals and we get naturally sleepy. A short 30 minute nap can be very refreshing, and recent studies show that afternoon naps improve learning and memory. I invite you to take a nice “guilt free” nap the next time your body sends the invitation.

    1. Sorry to hear it Robert. The ‘better sleep’ program that we are creating is going to give you a good path to follow, but in the meantime, please create a CPAP TotalCare account and send us a private message. We’ll be happy to help.

  8. I have been using a sleep apnea machine for about eighteen months now. I am sleeping very well at nights and my bathroom visits have gone from between 5-6 to 0-1, which for me is brilliant.
    On paper my AHI’s and leaks look great but during the day, four out of seven days I am extremely tired and cannot get out of bed.
    My extreme daytime tiredness has not changed at all in the whole time I have been on the machine. I have the latest ResMed machine and change the pillows on my mask regularly.
    This is so frustrating for me.
    The Doctors at the sleep clinic have told me there is nothing more they can do for me.
    I only keep using the machine because of it helping with my bathroom trips.

    1. Gaye, thanks for sharing. It does sound like you are getting more sleep if you are not waking as often during the night. I can see why you are frustrated that your daytime tiredness has not changed.

      If you would like to open an account and get in touch with us, we would be happy to connect you with a sleep coach to explore your options. I’m certain that something can be done to help you get better results from your therapy.

      1. I have been using Res Med for alittle over a month, I to wake up with slits for eyes, the technician tells me my sleep is excellent as far as my computer print out which it has really improved but I’m very tierd in morning and most of the day? I first thought it was the air in my eyes causing the puffy eyes, so I put a index card taped to my full mask and diverted the air above my forehead. Which I’ve notice really cuts down my events per night to 1 and below. which is great but I still wake up with slits and Tierd all the Time Please any help?

        1. Hi Rob, sorry for the late reply. We find that APAP can actually cause daytime sleepiness if it is not set up correctly.

          If you would like help from one of our CPAP therapists, please create an account by clicking ‘Join’ then ‘CPAP Users’ in the top menu. There is no charge for this service.

  9. As the name CPAP Total Care suggests, yours organization is concerned with CPAP and its successful application. The implication is that CPAP, as a therapy for chronic sleep disorder, is still a much under managed intervention. The last part of your name, Total Care, implies that your organization will be concerned about all issues surrounding sleep and CPAP use. That’s such a commendable departure from the normal. The fact is, sleep and sleep problems are complex, and CPAP is just a part of the puzzle. For instance, it’s interesting that statistics indicate that patient’s typically gain weight in the first year after CPAP use–a counterintuitive stat. However, sleep apnea sufferers who try to lose weight through weight loss programs without using CPAP are not as successful in that endeavor as those who go ahead and use CPAP while participating in the programs. The key is weight managment in conjunction with restored sleep through CPAP use. As such, CPAP is not a magic pill. The same is true of sleep disorders an a broad scale. CPAP use is an important part of managing sleep problems, but is not a cure all for complicated sleep disorders. Sleep problems need to be managed, and this article is a step into the potentially complicated world of sleep disease management. It’s nice to see CPAP Total Care take a look at the rest of sleep management.

    1. Tom, thanks for your comments.

      “That’s such a commendable departure from the normal. The fact is, sleep and sleep problems are complex, and CPAP is just a part of the puzzle. ”

      With help from clinicians like you, we’re learning! :-

  10. I have been using a sleep apnea machine for about 3 years now. I am sleeping very well at nights but get up in the morning, have breakfast and am so exhausted I have to go back to be for a couple hours. I am able to function but then get sleepy again. On paper my AHI’s and leaks look great but during the day, four out of seven days I am extremely tired and cannot get out of bed.
    My extreme daytime tiredness has not changed at all in the whole time I have been on the machine. I have the latest ResMed machine and change the pillows on my mask regularly.
    This is so frustrating for me.

  11. I’ve been using an apap for 20 months and while I am better overall, I am still tired. To be honest I’ve considered taking my own life rather than fight this the rest of my days. My AHIs average between 0-1.5.

    1. Hi Rob, Sorry for your difficulties. First of all, there are *many* things that you can do to improve your sleep and get past this very challenging issue. Let us connect you with some resources. Please create an account here and we’ll add you to the Better Sleep Program — you can start improving your sleep immediately. It provides the foundation you’ll need. We can also connect you with a sleep coach.

      There are also things that we should explore relative to your CPAP therapy, sometimes a few changes with your machine settings, etc. can make a big difference. I’d like to put you on the phone with a CPAP therapist so you can begin to resolve any issues you might be having there.

      1. I like my Cpap machine its resmed I just think I need to change my mask pillows more often. What is normal interval ? Thanx, John

  12. I have been on a Cpap machine for a little over two yrs. it was so bad I was falling asleep driving and that is what made me go for a sleep study. I found out I have severe apnea but with the machine I really felt no better. My dr put me on a stimulant which has made it so I don’t fall asleep driving but I still drag through every day exhausted! I have just had major sinus surgery and weRing the Cpap is giving me a lot of swelling from the pressure so right now I am unable to wear it and I am just beyond exhausted. This has changed my life dramatically being so tired all the time. I was always out snd about having fun now I can barely stand to go to work. I am getting very depressed and I just don’t know what else to do! I am going to try the mouth appliance since that is one thing I haven’t tried! I am so grateful to know I am not alone in this. I want my life back!

  13. I have been using the cpap for about a month now. I am extremely tired and wake up with chest pain. Through the night I feel like I am struggling to breathe, I have to take my mask off in order to catch my breathe. I also suffer with high blood pressure, when I wake up I take my pressure and it is high. I have severe Emphysema and also Congestive Heart Failure, Enlarge Heart. I suffers from Insomnia as well. I noticed my Events has been in the high 20’s and 30’s. I spoke with the therapist, he told me that he sent the report to my Dr. I that’s been 2 week, no response from my Dr at this time. I am very frustrated

    1. Hi Jacqueline, sorry for the late reply. You caught us during a big transition and we missed this comment. I hope you have been able to resolve this situation. If not, it is critical that you meet with your Dr and resolve the issues.

  14. Hi guys love the site so far and the ideas behind it.

    However the site is working poorly at the moment. I have tried to confirm my account and it keeps telling me that “Whoops, looks like something went wrong” and thus cant log in yet. Also when I tried to post a message through
    “contact me” the CAPTCHA does not display and thus I cant finalise the message post. I am using chrome if that helps.

    Hope to check back in sometime when the site is a bit more optimised.

    Keep up the good work.

  15. There are several comments here that are concerning that would take some time to address to help figure out the various issues being faced. As you can clearly see here, everybody has unique experiences with their therapy and there is never an all-in-one solution that will solve every single person’s issues with CPAP. It is disheartening to read of providers basically telling their customers they are throwing in the towel. That certainly solves nothing.

    If you are a previous commenter on this blog post, or are just reading this now, feel free to use this link to sign in to the TotalCare eHealth platform,, and you will be linked directly to me and we can try to work through your issues.


  16. I had a sleep study and found that I had severe Sleep Apnea, due to a combination of things. I am 26 and my resting heart rate should be 60, but my average was 86 with the highest going over 100. I also don;t have enough oxygen getting into my blood cells, and of course I have Sleep Apnea itself. I got my PAP machine a little over 3 weeks ago, but I still feel tired. I am a hardcore stomach sleeper and sprawler. I’m getting a little used to it, but I feel more restless than ever. I feel like my movements are so confined. A couple nights ago was the first time I was having issues with the mask. I felt so claustrophobic. Sometimes I wake up feeling rested, but it quickly turns to restless and tiredness. Which is hard when I need to sit at a desk for 8 hours, 5 days a week. Other days I wake up exhausted and with “raccoon eyes”. I’m overweight and am changing my eating and physical habbits; however, it’s very frustrating that after everything with the sleep study and PAP machine, I still don’t feel well rested… Another issue I have, is the fact that I had blocked tear ducts when I was little. I had surgery to correct it, which made a clear passage from my nose to the corner of my eye. Now when then air pressure gets to 10 or higher, I have the problem of air going up that passage and creating air bubbles under my eyelids. So then I’m forced to take the tube out, wait for it to shut off, then put it back on where the pressure is only 5… This whole thing is just URRRRRRR!!!!

  17. I’ve tried everything. Pressure up, pressure down, epr on, epr off, new mask, etc. After two years I still feel terrible. Lost my job, no insurance. Hopefully whatever days I have left are few.

    1. Hello Rob,
      I use an apap machine which reduces the air pressure when I breathe out and occasionally use an oximeter Contec CMS 50e to check my oxygen levels through the night. However I often wake up feeling worn out, feeling worse than before I went to bed. What helps me cope is swimming three or for times a week, I feel a healthy tiredness afterwards, and after chatting with the regulars I feel lot better afterwards.
      I have recently started to learn to play the saxophone, an interest in life to take my mind off things. Just a few ideas that may help, all the best.

      1. I actually use an APAP, and I’m still wiped out. I don’t exercise because I’m too tired to do that. I don’t have a job, I don’t have insurance, and I don’t have any hope anymore that this will get better. Two and a half years and I’m tired of “hanging in there”.

        The therapy just doesn’t work as well for me as it does others. I have to live with this, hopefully I won’t live long.

      1. If your AHI is that low on CPAP it’s very likely that your pressure is too high <5.0 is normal. Your pressure may be keeping you awake.
        If you would like help from one of our CPAP therapists, please create an account by clicking ‘Join’ then ‘CPAP Users’ in the top menu. There is no charge for this service.

  18. I have been diagnosed with Sleep Apnoea only a few months ago after going to my GP because I was feeling so tired all the time.
    Since using my CPAP machine I can honestly say that the feeling of tiredness and exhaustion has never left me – I wake up each morning just as tired as I was when I went to bed.
    I would love an answer to my problem.

    Thank You

    1. Hi Susie, sorry for the late reply. Your issues are very likely due to incorrect settings on your machine.

      If you would like help from one of our CPAP therapists, please create an account by clicking ‘Join’ then ‘CPAP Users’ in the top menu. There is no charge for this service.

  19. I was diagnosed with mild apnea. I agreed and began using an auto-titrating CPAP 2 weeks ago. I’m using the nasal pillows and they are fine. I had to skip 1 night because of a huge sore on the Inside of my nose. It is irritated by the pillows but causes me no pain. Just not going away. I have a medium size nose with virtually no bridge…glasses don’t fit well and most over the nose masks don’t get a good seal either…so we went with the Resmed p10 pillows. What can help with the sore…help it go away? I’m also more tired now than before I began the treatment. Is this what I have to look forward to?

    1. Patti, I hope you were able to get your problem resolved. If you are still having trouble with your mask, we’re happy to help.

      If you would like help from one of our CPAP therapists, please create an account by clicking ‘Join’ then ‘CPAP Users’ in the top menu. There is no charge for this service.

  20. I tried to create an account, but because i do not have a US zip code, it would not let me register.

    Like many here, I have been using a CPAP for a long time (8 years) and am still quite tired in the morning and throughout the day. (The first week, I noticed an improvement and was thrilled – and since then, no improvement whatsoever.) I have had several studies over the years and my level has been pretty much the same (between 8-10). I have completely changed my antidepression meds, but there was no change to my fatigue. I have used a light box, to no effect. I have stopped drinking for many months – again, it did not help. I honestly cannot remember what it feels like to wake up refreshed. So I have generally been resigned to the fact that I will always be this way, but I sometimes look online again for possible help (like now). I hate this feeling so much. I am a writer and I want to keep writing, but between the fatigue, brain fog, and motivation issues, it is extremely hard. Which does not help my general mood, naturally. So that’s my story …

    (Also, during one study maybe five years ago, I woke up feeling so good, so different. I thought they had finally figured it out!! I was so happy and was anxiously anticipating the results. And then they said my current level was correct and there was no need to change anything. Needless to say, I have never felt that good after a night’s sleep again. I have no idea what happened that night.)

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