[Treatment] Seven weeks of misery - update

[sevenlevels]

I have been using the Resmed Airsense 10 for seven weeks. But, my average sleep time is still only 1.5 hours (one sleep cycle). My best time is 3h15m.

My sleep routine is unusual in that I go to sleep at 6:30 AM (after staying up all night). And I have anxiety/panic attacks whenever I feel restricted. Like wearing a tight fitting mask or sharply exhaling into a small air tube. Also, I am so exhausted that I take naps. This will be important when discussing pressure settings, since I have two different setups for sleeping vs. napping. Oh, and I have chronic congestion on the right side of my nose.

After reading some claustrophobia posts, I tried a few adjustments to starting pressure and using calming techniques.

For sleeping: Nasal mask, no ramp, min 7.6, max 11.0, EPR=3, auto humid, auto temp.
=I go to sleep right away, but something happens 90 mins later and I pull the mask off.

For napping: Face mask, Auto ramp, start 4.0, 7.6 / 11.0, etc.
=It takes about 5-10 mins. to fall asleep. But then 90 mins later I wake up in a panic because the face mask feels like a hand over my mouth!
Note: I switch to the face mask when my nose is completely congested.
Note: I know the start press is low, but it really helps with the panic from exhaling when I am falling asleep.

This is getting to be a long post, but here is more background:

I met twice with a CPAP Clinic nurse, who tightened the straps on my mask to stop air leaks and changed the pressure settings.
01/28/16 start 4.0 min 5.0 max 7.0 epr 1 (Initial settings)
02/19/16 start 5.0 min 8.0 max 8.0 epr 3
03/11/16 start 4.6 min 7.6 max 12.0 epr 3
But, I changed that to:
03/14/16 start 4.0 min 7.6 max 11.0 epr 3

Well, that should be enough for now!

[JudgeMental]

A question should be.."what's wrong?".. You have got good equipment but (IMO) you aren't using it properly. I think you need to adjust to some sort of consistency. Pressures for naps, and different pressures for sleep?? Apneas don't discriminate between naps and full sleep time. I also feel that perhaps a visit to some other type of Physician (for some anti-anxiety meds) is in order to help you overcome your anxiety's and claustrophobia. Are you a night shift worker? What are you doing until 6:30am. Maybe something all night is keeping you wound up.

[0rangebear]

I can empathize with you plight my, as first six weeks could also be described as Hell. I saw that my body and mind began to adjust in week seven- I am in week 11 now and my time with the mask on is 5.03 hours. It I no call it longer torture.

This How I deal with the in-somnolence

1)I tuned the ramp off
2)Start on Mask fit- The pressure will rise quickly to the max pressure setting and the cycle back to the Min pressure setting.

3)I focus my thought on eliminating the mask leaks ( I had big leaks before I started doing this) I have many 0 leak nights now.

4) When I have exhausted that thought process, I focus my mind on breathing deeply through my nose, thinking about how good the warm humid air feels. (as soon as I fall a sleep I know my mouth open a bit -but I have a mouth and nose mask so I am ok with expect that)

I usually feel the Mask Fit cycle back to the low pressure right before I fall asleep.

* no more dehydration issues
* no more Mask leak issues
* no more imaginations or fears that exalt themselves and prevent sleep.

If you need more to calm you mind try some memorization

“O sleep, O gentle sleep, Nature's soft nurse, how have I frightened thee; That thou no more will weigh my eyelids down, And steep my senses in forgetfulness?”
― William Shakespeare, Henry IV, Part 2

Good luck and my the Good Lord be with you

[Luvmyzzz]

I'm new to the forum, but old to the CPAP! I have a little experience to share and may be able to give you some insight on your dilemma. If you are new to the CPAP,
the mask itself is a great hurdle to clear, I tried wearing it around the house (when possible) to get used to it, switching to wearing it for an hour while watching TV or, relaxing activity before sleep, and plugging in when I climb into bed (my senses have been desensitized to the feeling of something on my face). Just a thought to share, hope it helps.

[PoolQ]

You kind of sound like me. I had to change to an Aircurve because I had problems exhaling into pressure. The hand on the face thing I had also, even with the aircurve (there is an adjustment on the aircurve Tmax that I had to change to stop it).

I too used and still use ramp, but my number for starting pressure is 5.6-5.8, found by trial and error without having to try sleeping with it, just laid down and see if I could relax.

For me naps and very different from the main sleeping, with a nap if I wake up I get up and usually feel fantastic. At night I try to go back to sleep and sometimes that's a fight.

Humidity and air temperature makes me feel like I am having trouble exhaling. I have humidity off, temp at 62 degrees, and a dry water tank.

Many times my flow limitations were caused by nasal congestion that took a while to build up. I use nasal strips and those inserts that look like little wings, most nights now I sleep through although sometimes I still need to get and blow out my nose.

Talk with your Doctor about the Aircurve VPAP as it is made for people with problems exhaling into pressure. If you have not tried adjusting any of the comfort settings on your machine, try them you may find out that you really don't like a setting that you thought you would.

You may be right on the edge of being comfortable and after 90 minutes of "putting up with it" you have had enough and wake up.

[0rangebear]

One thing I forgot in my post above
my original scrip from my DR had EPR off.
I would wake up unable to exhale. My Dr. recommended I upgrade to a BIPAP but I saw in sleepy head that this only happened when the pressure was above 14. I read the forum post on EPR and turned it on and set it to 3. I do not know why me Doc and Resp. Nurse did not know this, but that's fixed the problem.

I never wake up unable to exhale with the EPR on 3, so I don't need to change to BIPAP

[Luvmyzzz]

If I were you Orangebear, I'd make sure my MD & Resp nurse kn
ew what occured!!
(make sure they put in your records for future reference)

[vsheline]

Hi sevenlevels, welcome to Apnea Board and the forum.

Looks to me like the SleepyHead chart you posted shows you woke up from high Flow Limitation (FL).

FL events are obstructive in type (meaning your airway is partially obstructed) and are treated/prevented by using higher inhale pressure (higher IPAP).

When FL causes sleep problems, this is called Upper Airway Resistance Syndrome (UARS). As we start to inhale through an airway which is partially obstructed the "venturi" vacuum from trying to inhale more strongly causes the airway to nearly close itself off, so that our stronger effort results in the same or even less airflow instead of more airflow.

The feeling of being partially suffocated either causes an arousal (a transition to a shallow or unrestful state of sleep) or even completely wakes us up.

You may be able to avoid these sleep disturbances by raising your Max Pressure setting while keeping EPR set to its maximum, 3.

Typically, however, a more expensive bilevel type of CPAP machine is needed to optimally treat/prevent UARS. Especially in your case a bilevel machine may be needed, because you may prefer/need EPAP to be relatively low to help avoid claustrophobia.

Take care,
--- Vaughn

[trish6hundred]

Hi sevenlevels,
WELCOME! to the forum.!
I'm sorry you are having such a rough time with your CPAP therapy, I do encourage you to stick with it though, it takes time to get used to.
Hang in there for more responses to your post and much success to you.

[sevenlevels]

Thanks for all the posts! Working on implementing some of the ideas.