Help Needed: Friend Struggling with CPAP Compliance Due to Anxiety and Mask Removal

[Sarin]

Hello everyone,
I'm reaching out for advice to help my roommate and friend, Sam, who has been struggling with CPAP compliance.

• Diagnosis: Sam was diagnosed with mild sleep apnea (around 7 AHI) about six months ago.
  

• Mask Issues: He unconsciously removes his mask (currently a P30 nasal pillow, which he finds comfortable) during sleep. When he consciously removes it, he feels overwhelmed by the air pressure and can't fall back asleep.
  

• Pressure Settings: He was prescribed bilevel pressures of 9/5 due to treatment-emergent central sleep apnea and hypoventilation observed during his sleep study. He adjusted the settings to 6/10 based on recommendations, but issues persist.
  

• Other Factors:
  • He has prior diagnoses of ADHD (primarily inattentive), anxiety, and gastrointestinal issues.
    
  • He experiences constant fatigue and doesn't feel fully awake during the day.
    
  • He has a deviated septum and enlarged turbinates, with surgery planned in the coming months.
    
  • He's using mouth tape to prevent mouth breathing.
    
• Recent Developments: His sleep doctor prescribed 15 mg Restoril (a benzodiazepine) to help with anxiety and staying asleep.
  

Questions:

1. Has anyone experienced similar issues with unconsciously removing the mask? Any strategies to prevent this?
   
2. Tips for managing anxiety related to CPAP/BiPAP use, especially feelings of being overwhelmed by air pressure?
   
3. Are there concerns about using Restoril in this situation?
   
4. Could his upcoming septoplasty and turbinate reduction surgery improve his sleep apnea treatment?
   
5. Suggestions for dealing with treatment-emergent central sleep apnea and hypoventilation?
   

I appreciate any insights or advice you can offer to help Sam improve his sleep and quality of life. Thank you!

[cdplatt]

I have the P30 and have often removed it in the middle of the night, sometimes unconsciously.  I find the mask very comfortable, which is why I switched to it.  But if I wake up in the middle of the night, I find it difficult to get back to sleep (light sleeper).   The volume of air rushing into my nose seems to keep me awake.  I've just switched back to the N20 for that reason.  It's a softer, less disturbing delivery of air.  It will leave a red mark on the bridge of my nose which is why I tried the P30.  I'll put up with the red mark to get a better nights sleep.  Also, my numbers in OSCAR are much better with the N20.

[Jay51]

I don't see hardly any CA's at all in these charts.  Going with pressures like 5/9 and 10/6 can help with hypoventilation (his tidal volume is a little low).   But at the same time, it could start causing more CA's the more pressure support is used.  He can always his trigger setting to try to help stop CA's also. 

I personally had the deviated septum/turbinate reduction surgery.  Better breathing during the day, less congestion, and easier to tolerate my therapy.  

It looks like he is headed in the right general direction here.  The big question may be if he is able to improve his hypoventilation and at the same time keeping his CA's at bay with this particular machine.  If not, there are machines with back up rates that can do that.

[cyberfiche]

Regarding the Restoril, I believe it can cause respiratory depression, meaning it can contribute to a higher apnea rate. Here's a thread I posted regarding pain meds that do that as well, and you can see my results.
https://www.apneaboard.com/forums/Thread...eds-Beware

I'm on low doses of Celexa and Abilify at night to help with general anxiety. Those needs don't seem to cause issues with the apnea. 

- cyberfiche

[Crimson Nape]

I would recommend that you upgrade to the latest version of OSCAR (v1.5.3).  It provides a lot more detail of the CPAP settings than currently being displayed.  You will probably need to collapse the calendar when taking the screenshot, or use the F12 to take it, and it will minimize it for you.
- Red