CPAP causing insomnia, hoping for some help

[starsknight]

Hi all,

I was diagnosed with mild sleep apnea after a home test (AHI 10.5). Significantly worse whilst supine; side sleeping showed AHI of 6.67. So I switched to sleeping on my side and waited for a CPAP machine.

My first one arrived last year; I had a lot of trouble sleeping with it, we made some adjustments, but then it became clear I’d be moving out of state and would have to start over with the rental period, insurance PA, etc. My new pulmonologist wanted to try APAP and thought it might fix the issues.

Unfortunately, it hasn’t.

I just got my ResMed AirSense 11, and I am miserable. Every time I use it, I wake up within an hour or two. I tried it for one full night, got maybe 4 nonconsecutive hours of light and fitful sleep, and was nonfunctional for the next two days.

I decided to try to ease in by only wearing it til the first time I woke up. My hope was that I’d adjust to the machine and eventually be able to tolerate it for a full night.
However, even once the mask is off, I often have trouble getting back to sleep after that initial waking. Without the machine, if I wake up in the middle of the night, I generally go back to sleep within minutes. But after using the ResMed, it takes me up to 2 hours to fall asleep again.

I’m wondering if there’s anything in the (very limited) data that might point to why. The only pattern I’ve seen so far is that tidal volume often varies a lot in the half hour before I wake, regardless of AHI. But I don’t know whether that’s significant, or whether there’s something else here that my inexperienced eyes are missing. Given how mild the initial OA seemed to be, it currently feels like the cure is worse than the disease in my case—but I’m aware of the complications long-term untreated sleep apnea can cause and want to be proactive in avoiding those.

I’m posting some samples of the data, and hoping someone here has some thoughts. (Please let me know if different/more data would be helpful.) Thanks in advance!

[Babal]

Hi there,

I can't parse much of that data, but I can tell you that I was diagnosed and got my Airsense 11 in October. I had a lot of trouble with the device at first. I was told by a lot of people that it was hard to get used to a CPAP, but I would wake up in the middle of the night feeling like I was being choked because the positive pressure made it impossible to exhale or inhale if I woke up after a large inhalation. I'm not saying we had the same problem with the Airsense, but it felt like I was used to naturally waking up all the time, and if I just inhaled, I couldn't inhale anymore, and I couldn't consciously exhale against the applied positive pressure of the APAP so I just choked and freaked out. I was super motivated to get it working though so I kept at it, I learned how to quickly take it off in the middle of the night when I woke up gasping for air. Eventually, ripping off the mask became kind of rote and easy to do when I had that choking feeling. Even further eventually I stopped waking up every few minutes probably because I grew less stressed of that applied pressure. Eventually I started getting full rem cycles in. Now, nearly 5 months later I don't think I've had one of those events in about a month, and I feel fully rested on about 6.5 hours of sleep a night.

So for me it went-Extreme discomfort every time I awaken due to not being able to inhale or exhale due to applied pressure->Ripping the mask off consciously when I wake up unable to breath in/out->Ripping the mask off subconsciously/sometimes waking up confused as to why the mask is off me->No longer panicking about the mask being on and not letting me breath when I wake up->Really good sleep and way better blood pressure/daytime sleepiness.

Idk I hope someone who can analyze numbers can figure your stuff out. Good luck!

[OpalRose]

Hi starsknight,
The only thing I notice is the very low minimum pressure of 4cm.  Starting with a pressure of 4 can cause you to feel "air starved."  Plus, you are not using any EPR to help you exhale easier.  All of that would make it pretty hard to adapt to.

I know it sounds contradictory to use a little higher pressure when you're having difficulties adjusting, but you would be surprised how much more comfortable it will be if you adjust your pressure a bit.

I would like to see you with a minimum pressure of 7cm.  This is the lowest pressure you should use to receive the full benefit of EPR.

Set minimum to 7cm with a maximum of 12cm.  (The machine won't go that high unless needed) You never went higher than 9.5cm.
Set EPR (full time) to 3.

So relax and try out these settings before bed, maybe sitting up reading for an hour.

[Sleepster]

I just got my ResMed AirSense 11, and I am miserable. Every time I use it, I wake up within an hour or two. I tried it for one full night, got maybe 4 nonconsecutive hours of light and fitful sleep, and was nonfunctional for the next two days.

Unfortunately that is part of the adaptation period that a lot of us go through. You just have to stick it out and it will get easier.

I decided to try to ease in by only wearing it til the first time I woke up.

That will just make it harder to adapt.