New to CPAP - Struggling to sleep

[user22]

Hello - 

I've been using my CPAP for roughly a week with little to no success. I realize it will take some time to fully adjust, however this feels like more of a physical issue than a mental one. During my initial sleep study I was diagnosed with OSA and an AHI of 29.9. There were no CA events recorded during the study, only obstructive. My prescribed pressure was 5-15.

The main issue I'm facing is not being able to fall asleep. I've been close a few times, but haven't made it past the "dozing off" phase. It feels as though my body starts to go to sleep, but then I immediately wake up to a sharp inhale. Reviewing my data in OSCAR has been interesting. Almost every night there are multiple CA events recorded. This is odd, because as I initially mentioned there were zero CA events recorded during my initial sleep study.

On my second night with the machine I made some changes to try and help. Initially I felt as though I was struggling to both inhale and exhale, so I upped my min pressure from 5 to 6 and upped EPR from 1 to 3. Again, I continued to feel as though I was waking up immediately after starting to fall asleep. OSCAR continued to flag CA events. I did some more research and read that Complex Apnea was a possibility, and that EPR could potentially contribute. With that info, I again decided to make updates for the next night.

On the third night I upped my min pressure again, this time from 6 to 8. I also dropped EPR from 3 to 2. Different night, same results and OSCAR continued to flag CA events.

Days continued to pass with mostly the same results, and here is where I currently stand.

Mask: Started with F&P Brevida, now using AirFit N20 (mask is comfortable and has minimal leaks)
Pressure: 8 - 15
Ramp: Off
EPR: 1

I really want CPAP therapy to work, but it's starting to take a toll on me mentally. I do my best to keep the mask on for at least 1.5 hours, but always end up removing it around that time so I can fall asleep naturally and continue to be a somewhat functioning adult the next day. I do have a follow up appointment scheduled with my doctor, unfortunately it's not for another few weeks. Posting here in hopes that someone can help steer me in the right direction. I've included OSCAR screenshots from sleep data recorded last night.

[SwirlySauce]

Hi user22,

Its going to take some time for your diaphragm muscles to adjust to the pressure. The best thing I can recommend is to commit to using your CPAP for a certain amount of hours each day - whether you're awake or asleep - and increase this time gradually over the weeks. Wear it while you're watching TV or reading in bed. You're doing good by having it on for 1.5 hours - try to increase this to 2 hours, 3 hours etc.

It will get easier to exhale against the pressure. I struggled with 6cmw pressure at the beginning and got comfortably up to 12cmw after some time.

There's also the part where it feels like you have to breathe manually and can't drift off to sleep as a result. This is worse at the beginning and even more so when you're trying to fall asleep at night because there is nothing but your breathing to focus on. Using your CPAP while awake watching TV or reading will allow you to keep your attention focused away from your breathing and let your nervous system take over. Once you're more accustomed by doing this it should be easier to fall asleep at night.

I would try setting EPR to 1 or turning it off completely if you can and see what your results look like with that.

[Brazen]

Yup, as Swirlysauce wrote, it can take time for your body to adjust to treatment. 

I also wouldn't jump to complex apnea yet, especially if there weren't any central events during your sleep study.

Cpap can induce central apnea. The machine is removing more CO2 than your body is used to, that affects the brain signal to take a breath.
That usually improves with time but one of the experts may jump in with setting suggestions to reduce centrals and improve your treatment. 

Try to stick with it, you've landed in a great place for help and your well-being will likely improve greatly once you're able to tolerate the machine.