Mask anxiety is making me desperate - any help appreciated!

[Tropicalhammock777]

Good afternoon everyone,
 
Seeking your expertise on a problem that has really been kicking my butt. I have been using CPAP/BiPAP for over half a year and will soon have my third sleep study to test me on an ASV machine. My biggest issue is not being able to get over mask anxiety. I use a ResMed Airfit F20 full mask. I have also tried a nose pillow without any improvement. 
 
The anxiety affects me in a couple different ways. When the anxiety is light, I become very conscious of the mask and my breathing, which causes my sleepiness to leave me and I cannot fall asleep. If I distract my thoughts I can completely forget that I have the mask on, but constant thinking also keeps me from being able to sleep. I will keep my mask on for an hour or two wide awake, then take it off so I can get some sleep. If I wake up in the night I will put the mask back on and then I can usually sleep a few hours with it on.
 
When the anxiety is heavy, I feel as though I can’t breathe, even when I take long deep breaths. Even at these times I can at times distract my thoughts and forget the mask is even on. If I can’t get the anxiety under control I will remove the mask so I can sleep.
 
This anxiety seems to be more intense at night, because I can often fall asleep with the mask during the day. I don’t believe this issue is caused by discomfort or not being accustomed to the mask, since I actually feel pretty comfy with wearing the mask while awake. I use Flonase every night, have tried staying up until very tired, even using a light sedative (zaleplon) which my pulmonologist allowed me to try, all with no success.  
 
I am dreading my next sleep study because of this anxiety. I feel so close to finally getting a resolution to my years of not sleeping, yet I just can’t seem to get overcome this obstacle. Any suggestions you can recommend are greatly appreciated.  Thank you!

[PeaceLoveAndPizza]

You could try a half-face full-face mask like an F30, F30i, F&P Evora, probably more, to see if that helps. Most likely you just need to work through it a step at a time. 

Hopefully others can offer more concrete advice...

[SarcasticDave94]

It's possible that the smaller, as in less intrusive, the mask is the better off you'll become. Do nasal pillows or other nasal masks work for you? Are you normally a mouth breather at night?

You'll likely want to get the least intrusive mask you can. ResMed P10, maybe Bleep or similar. You're in need of learning to keep the mask on, requiring you to relax. Have you attempted to get used to any mask while sitting watching TV or similar while wearing the mask and CPAP is on?

[Tropicalhammock777]

Thank you PeaceLove&Pizza and SarcasticDave for your replies!

I did purchased a P20 nasal pillow but it didn't improve my situation.  I have worn the mask while awake for many hours in order to keep myself compliant. I agree that I need to keep my mask on. The reason I usually give in is because after a couple hours awake I feel I really need to get some sleep. What was said about relaxation is a good point. I wonder if anyone has experienced something similar and found something that can relax the nerves?

[SarcasticDave94]

I didn't like masking up because it felt like a restriction on my breathing. Specific to my case, it was several things, I've got complex apnea, both Central and Obstructive, but also have worsening Emphysema COPD. I still had to burn lots of time sitting and "practicing" with the mask and machine to get used to its feel. I'm not making it out to be an easy thing to conquer, however it's doable with time, patience, and persistence.

[PeaceLoveAndPizza]

I was reading your original thread about CA issues and wondering how things are currently going. Could there be a correlation with current and past issues?

May be you need to find a better pressure to avoid the urge to remove the mask, but we need an OSCAR chart for further analysis.

[Nightynite]

Audio books with ear buds is a great distraction, you can probably download them for free from your local library. You just need to be concentrating on something else instead of that octopus on your face.

[Big Guy]

Although I gave up on CPAP after three years, the very 1st night of starting out on it was a breeze for me. No mask anxiety at all. 

I started out on an F20 Airfit, and then went to an F30 Airfit. Both served me well. The whole three years I was on CPAP, all went well and no issues at all. 

That did surprise me considering what you wear when you go to sleep. Sounds if if a good conversation with your sleep doctor might be in order.

[Tropicalhammock777]

Thank you SarcasticDave, PeaceLove&Pizza, NightyNite and Big Guy for your replies! I'm encouraged to keep on persisting!

NightyNite: I tried the suggestion of the audiobook last night, and I was able to fall asleep with the mask. That suggestion's a real keeper!

PeaceLove&Pizza: I'll be getting my third sleep test in a couple of weeks. I have complex apneas that aren’t being resolved by the BiPAP, so they want to try me out on an ASV machine. In the meantime the pulminologist put me back on the CPAP setting at a pressure of 9, supposedly to get some more data. I’m averaging about 15 events per hour, a little under half of those being central apneas.

[mesenteria]

Your anxiety might actually be the fight-or-flight response kicking in because of your complex apnea.  Your body knows when it is getting into trouble which, by the sound of your descriptions across posts, is happening often due to your breathing problems.  Imagine what it must be like for the conscious brain to know it's drowning...about six feet down.  When you are supposed to be relaxed, safe, ensconced in your bed sheets and covers, and wanting the bliss of sleep, you instead have to fight back to consciousness as you drift off in order to become aware enough to start breathing again.  So, your problem is not so much anxiety but its antecedent.  You MUST have confidence in your therapy and the way it is delivered or you're never going to get this solved.