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Tips for new CPAP user with insomnia?
#1
Tips for new CPAP user with insomnia?
First post (long, sorry!). After a LOOOONNNNNGGGGG over 2 year process, I think we have finally arrived at a diagnosis of OSA. I have suffered largely from cognitive issues and chronic fatigue for over 2 years now. It took 2 sleep studies to finally get here, as I also have insomnia issues, which manifest far worse in the sleep lab (first PSG, slept 2.9 hours out of 6, second was 4.4 hours out of over 8). The latter test finally picked up hypopneas, only during REM. AHI was only 2, but had 30 events per hour during REM, the longest of which was 57 seconds (and this was not on my back, as I could never fall asleep that way, so may even be an under-representation of the issues?).

I received my CPAP this past Monday, and have yet to fall asleep with the mask on. I know this will be a more difficult process due to the insomnia issue, but I am motivated to fix things. However, realistically, I need sleep to function in my job (which is more stressful this month than most), and the added sleep loss from trialing the CPAP now is making things nearly unsustainable. I have used Nuvigil the past year or so to make it cognitive- and energy-wise through my days, but with the additional sleep loss this past week, even that is not enough. I need to fix these issues ASAP.

I have a feeling that if I could fall asleep with the mask on, I will sleep (relatively) well, but my main issue is falling asleep. Without CPAP, even with insomnia, I fall asleep within 5 minutes of hitting the pillow. Now, I have made it to over 3 hours of using the mask, without falling asleep, before I give up for the night and get at least some sleep before the alarm blares in the morning.

My main issue with the CPAP I think is claustrophobia (which I don't normally have an issue with). Maybe this is not the correct term, but to me, it feels like I am breathing through straws. When I first put the mask on, I can find a position on my back where breathing feels relatively easy, but after a couple hours, it gets harder and harder, and feels like I am breathing through straws. A secondary issue is the loud-ish (admittedly subjective) sounds of hearing my own breathing, which I generally don't like. The noise from the machine itself doesn't bother me at all, just the noise of breathing in and out of the mask. However, I imagine the sounds of breathing I would eventually get used to. I can't see myself being able to overcome the breathing through straws issue, however.

Here is what I have tried so far:

--Humidity started at 5, then upped to 6, now at 7.
--Played with mask tightness. Was definitely too tight first night and hurt nose. Have mask where it feels fine on my head now, but that doesn't prevent the straw breathing sensation. No issues with leaks at all.
--Machine is set for expiratory relief and warmed hose.
--I tried ramp. My pressure is only 5, so honestly didn't make much difference ramping at 4. So have it off at the moment. The pressure at 5 doesn't really bother me, it's just the increasing sensation during the night (awake) that I can't breathe easily.
--Will be trying a contoured pillow tonight hopefully (that tilts head back some). I think that position generally helps a bit, but can't naturally hold that position through the night. Also tried a ramp-style pillow, but felt that made things worse.
--Tried SomniFix mouth tape last night. I do generally wake up in the morning with a slightly stuffy nose (never enough to treat before CPAP), so I wondered if opening my mouth eventually during the night might have been preventing my falling asleep. While I tolerated the mouth taping with no issues at all overnight, didn't help CPAP tolerance. I have also tried saline spray, antihistamines, and decongestants, but given mouth taping is not an issue, I don't think any minimal nasal congestion is my issue.
--I have tried Restoril for one night, still couldn't fall asleep.
--Ear plugs. Limit some noise, but can still hear my breathing, which is the noise that bothers me.

I'm sure I'm forgetting something, but that's where I'm at. I have an appointment Wednesday at the medical supply store to possibly try another mask (I'm assuming nasal would be best, since I clearly don't NEED to breathe through my mouth given mouth taping isn't an issue?). My current thought is that maybe I need a different sized nasal pillow? I have the small (both headgear and actual pillows). I think the mask should have also come with M and L pillows, but the respiratory therapist didn't give me the additional sizes. I will also see if I can get those to try on Wednesday.

I want (and need) this to work, but I'm so frustrated and barely hanging on during the day Sad.

Thanks for any feedback!
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#2
RE: Tips for new CPAP user with insomnia?
Humidifier... try lower settings.  

Try a larger nasal pillow.  We often need a larger size than what is recommended by DME.  And yes, you should have received all three sizes.

I've gotten used to hearing my own breathing, but know it can be bothersome.  Try some white noise, like using an air cleaner, stand alone room humidifier or even a fan in your room.

You may also need a higher minimum pressure than 5cm. You may be feeling air starved.

Download OSCAR software, follow the links in my signature line, and post some data here.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Tips for new CPAP user with insomnia?
Try listening to a good audio book. Since I started doing that I fall asleep faster. I think it makes me concentrate on the story instead of my breathing and equipment / or when will I drift off.
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#4
RE: Tips for new CPAP user with insomnia?
Thanks, Opal!

I will try lowering the humidity. How would you know whether the pressure settings are correct, or is that something I should just ask at my next appt?

Attached some data. Not sure if this is what you needed, but if not, I can dig around for some other things! Thanks so much for your help!


Attached Files Thumbnail(s)
           
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#5
RE: Tips for new CPAP user with insomnia?
Hello, welcome.

The insomnia issues that you face will diminish over time as your mind gets used to the idea that it is now safe to fall asleep.  Your brain has been doing it's job, letting you know something is very, very wrong, and it wants to wake you up to let you know you're choking.  The process of acclimating to CPAP DOES NOT need to happen overnight.  It could take months to get used to it.  For now, I would stop even trying it at night.  Put the mask on during the day while you walking around the house, ready a book, etc, just so your mind gets used to the physical sensation of the mask.  Then, when you feel ready (do NOT put pressure on yourself), try for a very limited amount of time to fall asleep at night, let's say 15 min.  Give yourself a pat on the back for trying.  Try again the next night.  If it feels like too much, back off.  You need to be very patient with yourself, knowing that eventually, your brain will be able to ignore all the stuff and go to sleep.  I know that it does not feel like that is possible right now.  But it will happen.  Laying in bed for 3 hours with a mask, not sleeping, becoming completely overwhelmed and frustrated is not helping.  Some people put the mask on and fall asleep within minutes (which will eventually happen for you), others (like myself), take a long time.

Others will be able to comment on pressure settings, but I believe that at a pressure of 5 and an EPR of 3, you're going to feel extremely air starved.  Again, I will defer to others.
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#6
RE: Tips for new CPAP user with insomnia?
Thanks for posting the charts, but would like to see the "daily page". This should include the following graphs:
Events, flow rate, flow limitation, pressure, leak rate. Include the left sidebar, minus the pie chart and minus the calendar.

http://www.apneaboard.com/wiki/index.php...ganization

From what you did post, your numbers looks very good. But in order for the EPR of 3 to be of benefit, your minimum pressure should be at least 7cm. The machine can not drop below 4, hence...7cm minus 3 EPR equals 4.

And tarah gave you very good advice regarding the issue of insomnia. Give it some time.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Tips for new CPAP user with insomnia?
It feels like you’re breathing through a straw because your minimum pressure is to low. Try 7cm, that will give you the full benefit of EPR 3.
Download OSCAR <——— Click
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#8
RE: Tips for new CPAP user with insomnia?
Nothing you have posted shows what is going on thru the night. Please provide daily charts per the organize link in my signature.
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#9
RE: Tips for new CPAP user with insomnia?
For white noise, I have an Amazon Echo dot next to my bed. I stream 'babbling brook' throughout the night.
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#10
RE: Tips for new CPAP user with insomnia?
I've become a fan of "brown noise"; there's also "pink noise." I can still hear my breathing with the brown noise, but it doesn't grab my attention.

I agree with Tarah that it is fine to adapt gradually. Your goal is long-term, comfortable use. You must certainly not lie in bed for hours hating on your mask. That just grooves in an association between mask and wakefulness.

In addition to wearing the mask around the house during the day or evening, you can try setting up the machine outside your bedroom and using it while you read or watch TV -- something sedentary and distracting. When you feel ready to try dropping off to sleep with the machine and mask, you might try a nap first.
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