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CPAP nightmare
#21
(09-12-2016, 08:22 AM)49er Wrote: Hi berberbits,

Could going on and off anti anxiety medication be causing rebound anxiety? Might not be applicable in your case but I thought I would mention it.

Haven't been on anything for a couple months. I'd been sleeping fine since about May so I went off meds.

(09-12-2016, 08:22 AM)49er Wrote: Other ideas are to welcome your anxiety and not fight so hard against it. It might create lesser resistance when you try to go to bed and sleep on the machine. For more information on this type of strategy, google ACT therapy.

Best of luck.

49er

Yes, mindfulness and acceptance were working for the part of the night, and I drifted off and woke up several times until eventually my brain just stopped trying to go to sleep with the mask on, and the anxiety got harder and harder to control as I got more and more exhausted and unable to regulate. I suppose that's when I should have taken the mask off.

I'm going to try to get a prescription for Ambien, only to use after a particularly bad night to guarantee a good next night. If I can't get it by tonight, I'm just going to try sleeping without it. I need to catch up on some sleep before I try this again. Then I'm going to scale back to 2 hours a night until I adjust properly.
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#22
I think the Ambien is a good idea in the short rum. You probably need to be on a long term therapeutic dosage of an anti anxiety medication. Just taking a pill when you feel anxious is not going to take care of a chronic chemical imbalance.

Rich
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#23
Yeah. I went off Zoloft because it made my ADHD worse and took away my erections, but with the insomnia rebounding, I may have to. However, with the end goal being sleeping through the night on CPAP, some of those issues may resolve.

I'm also going to start seeing a CBT for insomnia this week and change my mask out for a FFM to compensate for the mouth breathing that was waking me up last night.
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#24
Got a call from my sleep doctor. She wants me to take half an ambien a night for 30 days and then wean off. I see my psychiatrist at 4. I'll mention the Ambien and ask about Zoloft.

So I'm staying on the mask tonight but with Ambien to help break it in.

Yesterday was bad enough but it was like an uncomfortable, slightly impaired vibe. Today I've been disoriented and stressed out to 11 all day, like claustrophobic in my own house. It's horrible.
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#25
hi bernerbits,

Glad you are talking with your docs for good medical advice. Take what follows as some potential ideas and not to interfere with anything the docs are telling you.

You are gonna get through this.

RE: Your comments about feeling starved for air, and also being awakened by pressure changes suggest a couple of ideas ...

1. Starved for air ... it is not unusual for people to feel starved for air when pressure starts out lower than needed. This is especially true when someone sets a ramp up from a low pressure.

I did that once and felt like I couldn't breathe since the ramp started well below the lower number in my auto range. I don't use the ramp up because I use auto mode already. So my lower limit on the auto mode is a "breathable" pressure for me even if it didn't change after I fall asleep.

So, if you do have ramp mode set, consider turning that off and make sure the low pressure limit is comfortable for you.

2. Awakened by pressure changes ... two things come to mind on this point.

.. You have mentioned mouth air leaks when the pressure increases. This is probably not caused by the pressure increase, more likely your mouth falls open when you drift off to sleep and your jaw muscles relax.

Others are already talking about chin straps, and there are lots of good ideas and advice for mouth breathers like us, so I won't go into that.

.. as for being awakened by pressure changes, it might be helpful to consider a constant pressure setting for a while until you get used to the therapy.

The trick will be to figure what that ideal constant pressure level would be. The data from the four good nights you had might be very helpful, and of course the sleep study titration report and maybe even your prescription will provide clinical data to help you get at that optimum number.

Setting a constant pressure might provide some needed stability that your mind and body can get used to in order to not disrupt your sleep with pressure changes. And it may be that constant pressure works for you permanently vs auto adjusted pressure.

The good thing about your machine is it can operate in either CPAP or APAP mode, so you have choices there.

Of the things I mention above, I would suggest you turn off the ramp if you haven't already done, and play around with the mouth-breather suggestions. And don't mess with constant pressure, keep that in your hip pocket for now.

It's possible the most effective next step of all is the Ambien suggested by your sleep doc to get you over the hurdle of getting to sleep. The rest of the ideas are merely comfort issues -- once you can get beyond the panic stage it's just tweaks to be more comfortable.

Bottom line is do what you have to in order to stabilize your panic attacks, but please don't give up on CPAP therapy just yet.

From a mentality perspective ... Remember those four good nights and look forward to more of those. The good nights are ahead waiting for you to crack the combination of settings and techniques that will clear the way for them to return permanently.

You know they are attainable because you did it for four nights in a row without breaking a sweat. The bad nights are the anomaly, and the good nights are the norm. You are simply in a learning process, and it will get better once you can get beyond the panic stage.

Believe me I know this is difficult right now for you. But it is very doable and you deserve the good things that will come from mastering this CPAP therapy.

Saldus Miegas
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#26
Not so sure how good the SleepyHead data is on good vs bad nights. I was alternating awake and asleep for all four, averaged about 4-5 hours, so it's pretty messy chaotic stuff and my AHIs aren't accurate. Also my polysomnography did not include a titration study - instead they gave me an APAP and set it to the widest range possible.

Anyway I'm sure the issue is insomnia and not CPAP. I've been dealing with a rebound of insomnia since my sleep study and I had bad sleep hygiene the day it was triggered - and insomnia tends to cause anxiety which causes more insomnia, so, snowball effect.
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#27
My doctor's nurse didn't call in the prescription last night, but I got out to see my psychiatrist's NP, and got back on Zoloft and Ativan, which cured my insomnia last time along with CBT and mindfulness meditation. Took 1mg Ativan and slept like a baby, though without the cpap because I wanted to guarantee a full night.

Feeling pretty crappy, now knowing the difference between a night on the CPAP and a night off. I cried again this morning. But I don't feel insane and freaked out like I felt yesterday on so little sleep.

So it's back on the horse tonight, with half an Ambien to help me get there. I see a new insomnia therapist on Thursday that work is gonna pay for.

Gonna get through this.
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#28
You do keep mentioning "oxygen starvation", with only a few replies to THAT (Thanks Saldus, for addressing it). In addition to pressure settings, consider your mask size.

I'm on nasal pillows too. The supplier looked at my face, and said "Oh, you look like a small". It fit my face (the CPAP wasn't running) so I agreed. At home, it only took 30 minutes or so for me to feel oxygen starved. So, nevermind *looking* like a small, I tried the next size up, a medium, and got LOTS more air through it!

The "For Her" kit of the mask brand I use only includes XS, S, and M sizes. After a year on the Medium, I asked for my monthly new-pillows to be a Large, to try it. Some people have sigs here telling me "it doesn't need to go INTO your nose; ONTO is the design". So, while "into" with a size M had been okay, I tried "onto" with a Large. The flanges go into my nose slightly, but it's mostly an "onto" fit, and the air pressure keeps it there.

MUCH more oxygen!!! I'm a much happier camper. (I have nasal passage size issues, so didn't need anything *else* restricting the flow.)

In short: consider trying other mask sizes, or if it doesn't go larger, a different brand entirely. You might really *BE* having too little oxygen, which would make anybody feel panicky!!
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#29
(09-13-2016, 03:30 PM)BadGoodDeb Wrote: I'm on nasal pillows too. The supplier looked at my face, and said "Oh, you look like a small". It fit my face (the CPAP wasn't running) so I agreed. At home, it only took 30 minutes or so for me to feel oxygen starved. So, nevermind *looking* like a small, I tried the next size up, a medium, and got LOTS more air through it!
. . .
MUCH more oxygen!!! I'm a much happier camper. (I have nasal passage size issues, so didn't need anything *else* restricting the flow.)

In short: consider trying other mask sizes, or if it doesn't go larger, a different brand entirely. You might really *BE* having too little oxygen, which would make anybody feel panicky!!

BadGoodDeb... I totally forgot about nasal pillow mask size. Good catch! I remember you talking about this in another post way back, and it resonated with me as well.

bernerbits... what she said!


Saldus Miegas

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#30
I feel for your, bernerbits. The terrible-twos are nothing to scoff at. And 14 hours of it at that!

The best advice I can give you is to resist that urge to sleep without the machine. When you do that you undo all the adaptation you've accomplished and have to start over.

I promise that if you commit to sleeping with the machine all the time you're asleep, every time you sleep, you will begin to see benefits in the form of reduced anxiety and less tiredness. You just have to strong.
Sleepster
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