[CPAP] Seeking Advice for Friend Struggling with CPAP Compliance

[Sarin]

Hello everyone,
I'm reaching out to get some advice for my roommate and friend, Sam. He was diagnosed with mild sleep apnea (at 6.8 REI/AHI) about six months ago. Since then, he's been trying to use his CPAP machine nightly to reach compliance, but he's facing some challenges.

Here's the situation:

1. Masks Tried: Sam has experimented with full-face masks, nasal pillows, and nasal masks. He's currently using the P30 nasal pillow, which he finds comfortable.
   
2. Mask Removal Issues: Despite the comfort, he unconsciously removes the mask during sleep. He often wakes up to find it off, puts it back on, but it comes off again within minutes without him realizing it. When he's awake and takes it off consciously, he feels overwhelmed by the air pressure and struggles to fall back asleep.
   
3. Pressure Settings: In his sleep study, he failed CPAP due to treatment-emergent central sleep apnea and increasing CO2 levels (hypoventilation). He was prescribed a bilevel pressure of 9/5. A few months ago, based on recommendations from ApneaBoard, he adjusted his settings to 6/10 because an EPAP of 5 is quite low, and maintaining the 4-pressure interval seemed beneficial per BiPAP Guidelines.
   
4. Overall Health: Sam feels tired all the time and doesn't feel fully awake during the day. He has prior diagnoses of ADHD (primarily inattentive), anxiety issues, and gastrointestinal problems.
   

I have images of his recent sleep data that I can share if that would be helpful.

We're looking for advice on:

• Strategies to prevent unconscious mask removal.
  
• Adjustments to pressure settings that might make therapy more tolerable.
  
• Tips for getting used to the air pressure to reduce feelings of being overwhelmed.
  
• Suggestions for dealing with treatment-emergent central sleep apnea and hypoventilation.
  
• Advice on managing anxiety related to CPAP use.
  

Any insights or recommendations would be greatly appreciated. We're eager to help Sam improve his sleep and overall quality of life.
Thank you in advance for your support!

   
   

  Sam Cpap night-compressed.pdf (Size: 132.2 KB / Downloads: 1)

[Sarin]

Additional Information:


I wanted to provide some more details that might be helpful:

• Sleep Data Attachment: I've attached a zoomed-in event from Sam's sleep data last night, showing where his breathing gets disturbed. I've also included another night's data featuring a disrupted episode and a full-night overview. (See attachments)
  
• Cervical Collar Usage: We understand the importance of using a cervical collar to address leak rates. I've emphasized this to Sam, and he's planning to try using it again tonight. However, it doesn't seem to alleviate his anxiety around using the BiPAP machine.
  
• New Prescription: Sam had an appointment with his sleep doctor/pulmonologist yesterday. He was prescribed 15 mg of Restoril (a benzodiazepine) to see if it helps him sleep through the night without removing the mask, aiming to address both his anxiety and difficulties staying asleep.
  

Questions:

• Are there any contradictions or concerns we should be aware of regarding the use of Restoril in this situation?
  
• Does anyone have thoughts or experiences with managing anxiety related to BiPAP use, especially when it leads to mask removal?
  
• Any additional advice based on the attached sleep data?
  
  

We appreciate any insights or recommendations you might have. Thank you again for your support!

   
   
   

[Sarin]

I wanted to provide some more additional information that might be helpful:

In-Home and In-Lab Sleep Study Results:
I've attached Sam's at-home and in-lab sleep study reports to provide more comprehensive insights into his condition. Please note that during the in-lab sleep study, Sam experienced extreme anxiety and felt like he was suffocating. This may have affected the results, potentially skewing metrics like how much deep sleep he typically gets compared to a typical night. (See attachments for detailed reports)

Additional Medical Information:

• Upcoming Surgery: Sam has a previous diagnosis of a deviated septum and enlarged turbinates. He is planning to undergo septoplasty and turbinate reduction surgery within the next few months.
  
• Mouth Taping: Sam is also using mouth tape to ensure there's no mouth breathing while using PAP therapy.
  

We hope these additional details will offer more context and assist in identifying any underlying issues or patterns.
Thank you again for your time and assistance!


  Sam Sleep Study In Lab-redacted.pdf (Size: 35.51 KB / Downloads: 2)