CPAP and Anxiety

[Muse-Inc]

Have any of you ever had issues with anxiety? I *never* had it before this, other than doing an MRI (have to be medicated for that and it's a much worse situation - the CPAP mask I can easily remove, you know?) I only seem to have the problem at bedtime; I have no anxiety the rest of the day. This is a new (and unwelcome) thing.

If I were in your situation, I'd talk to my doc about dropping the meds and take an antihistamine like Benadryl an hour before masking up. Any of the older antihistamine are likely to make you sleepy, thus making it easier to quickly fall asleep. I'd also add 1 mgm melatonin (3 is the normal dose which is too much for me leaves me feeling a hungover-like feeling as following sleep meds). Like many other hoseheads, I am sensitive to drugs and try all the old natural remedies first (fever/infection are the only things that drive me to a doc first).

If you are nearing 60 (or older), neurologists say avoid benzodiazapines (antianxiety drugs) because of the high risk of catastrophic side effects. 2 friends and my mom had that side effect.

Could be initial pressure is too low, might bump it up by 2. If using ramp, consider turning it off.

[nickdanger1]

Hydroxyzine is an antihistamine. It is also used off label to treat anxiety and insomnia.

[TBonz]

Thanks for all of the responses. Sorry that I took so long to get back here. Swamped with the holidays. And often, by the time I come online, I'm tired.

So I'll answer questions then update.

- ResMed Airsense 10 Autoset. Set 5-20 (supposed to be changed to 7, but my pulmonologist's office is worse than useless if you're not there in person. I guess I could bump it up. I have the exhale relief set to 3, if memory serves. This is because my main issue in trying to go to sleep is that I feel the air rushing down, so I use ramp and that and try to fall asleep before the onslaught. I'm seriously considering trying the bump up by two and shut off the ramp and see what happens. I can always turn it back on if that doesn't work for me. At this point I'm so messed up mentally with this that I don't know what to do anymore.

"Every doc who prescribes xpap and every DME person who dispenses/fits equipment should be required to wear a full face mask and sleep with a pressure of 20 for "at least 4 hours per day 70% of the time" for two weeks in order to qualify for the job. Maybe then they would "get it"."

Yes. And when they call a doctor, they should get no medical privilege, but get treated the same way that regular patients are treated. My primary is just fine, but as I said, not so happy with the other place and currently not in the position to change that fact.

"Also, not a doctor, but what was the Xanax dosage and how often did you take it?"

One tablet at night (0.5 mg) did the trick for me. Alas, I'm done with it. I was only on it for a few weeks so stopping it had no effect on me.

"I take 100 mg of Hydroxyzine every night. Works great."

I tried 1 (25 mg.) Did not work. Then 2. Worked about halfway. Doctor says I can go up to four. I took 3 last night and it was similar to taking two. I think tonight I'll try the 4 (100 mg). I'm not thrilled about needing meds but that's life.

"Regarding dealing with anxiety when using pap therapy, I have never used this myself but many people on this board have highly recommended CBT=I"

I have no clue as to what that is. Some kind of behavioral therapy?

"If you are nearing 60 (or older), neurologists say avoid benzodiazapines (antianxiety drugs) because of the high risk of catastrophic side effect."

Huh. I'll be 60 next summer. I did read online (when looking up the drug after I got it) that it's contraindicated in older people. It may well be that my primary will let me do this for a while and then switch me or perhaps I'll finally be over the hump.

"Could be initial pressure is too low, might bump it up by 2. If using ramp, consider turning it off."

This is possible. I will try it tonight. I've got nothing to lose but sleep and God knows I'm doing that already.

So since I last posted. No change in anxiety, alas, just meds. I'm really angry at my brain for this; I can't believe that I can't stick nasal pillows. I've never had anxiety issues in my life until I started this. It was a very unpleasant surprise.

My sleep schedule is a hot mess. I have to be exhausted when I go to bed, and not just sleepy. This has played holy heck with that schedule. I hope to get this sorted so I can start going to bed earlier.

Honestly? I hate this. And the irony is, even though I've done very well the past few weeks when using the stuff (99s and 100s), low APIs, etc. I STILL FEEL LIKE $#@%! during the day. I'm just as tired, still have pain, etc. I thought that things would improve. I know I have fibromyalgia which causes aches/pain/fatigue, but I thought CPAP would make a big improvement. It hasn't. I *might* have a smidge bit more energy but to be honest - all this hassle for so little gain just sucks. I can't even go to bed and sleep without it anymore (on the horrible nights when I can't stick it - perhaps once a week or less) without feeling guilty.

But I guess I just have to adapt and keep trying. But I must say, I truly regret ever going to the doctor and telling him I felt like a zombie.

[kteague]

...ResMed Airsense 10 Autoset. Set 5-20 (supposed to be changed to 7, but my pulmonologist's office is worse than useless if you're not there in person. I guess I could bump it up. I have the exhale relief set to 3, if memory serves. This is because my main issue in trying to go to sleep is that I feel the air rushing down, so I use ramp and that and try to fall asleep before the onslaught. I'm seriously considering trying the bump up by two and shut off the ramp and see what happens. I can always turn it back on if that doesn't work for me. At this point I'm so messed up mentally with this that I don't know what to do anymore.

... CBT...I have no clue as to what that is. Some kind of behavioral therapy?

...I truly regret ever going to the doctor and telling him I felt like a zombie.

Without seeing your data my input is merely experiential, so take it with a grain of salt. I am one who got off to a rough start. Over five months of a rough start. As much as I felt claustrophobic and thought I couldn't adjust to the blowing air, turned out my turnround came with increasing my pressure, as well as increasing my ramp pressure and shortening the ramp time. What I thought was trouble adjusting to the blowing air was actually a sense of suffocation at too low a pressure. I could doze off but was jolted right back awake in a panic. Haven't felt that panic since my settings adjusted. Are you able to slightly doze at all? If you are able to slightly doze then quickly jolt awake, in my mind that is a sign that inadequate pressure could be allowing apneas upon dozing off that prevent you from falling into a good sleep. Again, your data might provide insight.

CBT = Cognitive Behavioral Therapy. It's mostly about mindfulness, and some here have reported finding it helpful. I have not sought professional guidance through CBT, but find it more than believable that it could be helpful. I thought I would never be able to use CPAP due to the blowing air. Some years before I's had my lungs damaged in a chemical exposure. My airways were so reactive the least little breeze threw me into coughing fits, so I was sure this was never going to work. What I found out is that my airways were no longer so reactive, but my brain was. Took some talking myself through things for my brain to accept this air would not trigger my airways. Made me wonder how long my airways had been better but I was just overreacting based on established patterns. I imagine professional help might have expedited my adjustment.

Please don't lose heart. A rough start doesn't mean you won't work through your issues. This treatment has been second nature to me for well over 10 years now. Hopefully one day soon you'll settle in to the treatment and get some decent sleep.

[49er]

I would follow KT's excellent advice about making sure your pressure settings are correct and investigating CBT. But if you still are looking for other possibilities regarding anxiety, I would look into CBD oil (the legal stuff) as many people have found it helpful for the condition. It does take alot of trial and error but this FB group is very helpful in sorting through everything,https://www.facebook.com/groups/cbdoilusersgroup/. Of course, check with your doctor to make sure there aren't any contraindications in your situation.

49er

[Mogy]

Hi TBonz,
It is my opinion that incorrect settings on your machine are creating the feeling suffocation.
It won't matter what drugs you are taking if the settings are incorrect.
If you didn't need drugs before, it is very likely you don't need them now.
KT and Pugsy can help you get the settings correct if you work with them.

[TBonz]

Well last night I took the full dosage (100mg). I checked my settings. I did NOT have ramp on, so scratch that. I put my pressure up to 7 (according to my doctor 9 is what works best with my apnea, but baby steps).

The result? Not a $*@#ed thing. It took at least an hour to get to sleep. Same old, same old.

If you are able to slightly doze then quickly jolt awake, in my mind that is a sign that inadequate pressure could be allowing apneas upon dozing off that prevent you from falling into a good sleep

That is precisely what happens. I'm almost asleep and then I'm fully awake. Now bear in mind before the CPAP, I had zero issues with falling asleep. I used to wake up once during my sleep cycle for a bathroom run and that was it. I didn't doze and wake up with breathing issues. This is only on account of the CPAP.

Well, I'm giving this one more night. I'll take the full dose AND bump my pressure up to 9. If that doesn't work, I'm taking some time off to reset my sleep schedule. I normally go to bed at 2:30 and fall asleep within 10-15 minutes. Now? I go at 4:30 and falling asleep takes anywhere from 15 minutes to over an hour. Pretty much lately, it's over 1/2 hour. This is way too late and going to sleep after 5 AM means I lose a lot of the next day. This all happened with the CPAP, before that I was on my preferred schedule.

If none of this works, I'm going back to the pulmonologist. And taking my husband with me. Maybe HE can get through to them.

I'm just disappointed that this is so difficult. I never dreamed it would be. I'm pretty discouraged at this point.

[ChicagoGranny]

It took at least an hour to get to sleep. Same old, same old.

You might want to go through this checklist:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

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If none of this works, I'm going back to the pulmonologist.

Is your pulmonologist board certified in sleep medicine?

[Rob K]

When our body's are overtired they produce adrenaline. In other words you can be tired as heck, then in a short period of time you can be wide awake and can't get to sleep for hours until your body just shuts down completely. I went through that cycle for years before I learned why it was happening.

This would always happen to me in the evening. Around 6-8pm I would be so tired I could hardly stay awake, but I would keep myself busy since it was way to early to go to sleep with my schedule. Around 9pm I would be wide awake for hours and then could not get to sleep until well after midnight. I couldn't make any sense of this until I learned that our body's produce adrenaline when we are sleep deprived. In other words you need to sleep when you are tired. Make sleep the number one thing in your life. So many of us undervalue the importance of a relaxed schedule and sufficient amounts of sleep. Sleep deprivation can cause many health problems and some major ones also. It took me many years to learn that. I personally didn't have a choice since my body wouldn't go anymore, I had to make changes. Part of the problem was that I pushed myself way to hard and the other part was that I had apnea that was not treated properly. Both things needed to be changed.

I also learned that my messed up sleep cycle was being caused by cpap settings that were not optimized to what works best for myself. In the time that I did sleep I was not getting proper therapy thus adding to my sleep deprivation. Make sure your settings are adequate and your machine is doing everything it can to help you get restful sleep.

When I had inadequate cpap therapy, I was sleep deprived and had high anxiety. Now that my therapy is optimized and I make it a point to get more sleep, I'm not anxious anymore and find it much easier to get to sleep. I do get the occasional night where I want to smash the mask and machine, but it's usually due to caffeine, stress or pushing myself to hard and not getting enough hours of sleep. That's when the anxiety starts to creep back in and keep me fidgeting with the equipment while I toss and turn for hours.

To sum it up make sure your therapy is optimized, reduce the stress in your life and make time for rest/relaxation. This is what significantly reduced my anxiety and helped me to get to sleep when I hit the pillow.

[TBonz]

Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet - I'm better at this than I was.
- Have a regular, moderate exercise program - I do this.
-Try to avoid daytime naps - I do unless the urge is overwhelming. If it is, I nap in the chair sitting up which keeps it short.
-Practice total abstinence of caffeine including sources like chocolate (sigh) I have one coffee in the AM. Chocolate? No.
-Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep I only take an anti-anxiety drug and a garden-variety multivitamin.
-Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable. - I do and it is.
-Learn to appropriately handle emotional stress in your life - Other than this; my stress in life is very low.
-Do not listen to your breathing or the sound of the machine as you are falling asleep. - The machine is quiet. I don't hear my breath either.
-Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me. - I do that.
-Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized - Don't have a card reader. I want to see my doctor first.
-If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problem - I've done this.

Pretty much, other than chocolate at times, and the Sleepyhead thing, I'm pretty compliant with this. Had ZERO issues with sleep prior to this. It's all anxiety over the feeling of suffocation. That's what I need to resolve.

I'm catching a cold, I think. Ugh. I've gone off the CPAP because of that and to try to fix my bedtime before trying again. I simply cannot go on with this and not getting to sleep before 5 in the morning is not what I want.

I'm going to make an appointment to see the pulmonologist as soon as I can. I've had enough of this - I will demand (politely of course!) help. It's their job and they get paid enough.

[ChicagoGranny]

TBonz wrote:
If none of this works, I'm going back to the pulmonologist.

Is your pulmonologist board certified in sleep medicine?

[jnk...]

What is the mask that you are using and what is the machine and pressure?
Are you using the ramp feature?
I have an idea that might help with the suffocation feeling at the beginning of the night but I need to know exactly what mask you are using (and size) and which machine and what the settings are.

When you have time please add your equipment to your profile so we can see at a glance what you are using.

wiki/index.php/Registering_Equipment_in_User_Profile

It helps us help you better and faster.

Did I miss your response to that from Pugsy? Maybe I did. Or maybe it was in another thread. But if Pugsy offered to comment on my data, I'd sure take her up on that offer.

Disabling ramp and/or increasing minimum pressure(s) can prevent feelings of suffocation and problems with sleep-onset insomnia for some users of PAP, depending on other factors.

And it must be remembered that better sleep in and of itself can increase anxiety for some people during the day. Bad sleep can dull our perception in general in that it causes us to sleep-walk through the day half-dead to the world. It's like driving with a dirty windshield that prevents us from seeing the road ahead of us clearly and observing the results of our own driving habits. Good sleep cleans off that windshield so that we can experience our drive more aware of our own driving and the actions of other people on the road with us. That can be disconcerting when we are awake enough to experience life as it is. In fact, it can be tempting to some to self-treat, in a sense, by calming themselves by getting bad sleep on purpose, but that approach doesn't pay off in the long run. In other words, in a sense, the anxiety may have always been there, but our getting good sleep gave us the ability to feel it fully for the first time. That anxiety can begin to dissipate as we get used to driving safely with the clarity of a clean windshield.

[nicholasjh1]

If I were you I'd find the clinical settings for my machine and bump it up to start at 8. with auto pap doctors get lazy because they know nothing about it and think the range will "cover" it, but a 5 pressure almost feels too low.

In addition for me at least the exhalation relief sends me into what feels like a panic... if you quiet your mind and pay really close attention you may notice the exhalation relief kicks in BEFORE you finish inhaling. For me at least this sends a signal to my mind that I need to exhale (sooner than I would normally) and voila... hyper ventilation... when you turn off the exhalation relief you may feel like it's hard to breath out at first... this probably won't last... I'm at 14.2 starting pressure and can breath out fine (but not originally when I started. )

[Uncle_Bob]

Are you using any kind of software such as sleepyhead to monitor your therapy? Along with your leaks and AHI being in check is your respiratory rate between 12-25 breaths per minute?
Anxiety and stress are sleep killers we all know that. I have Xanax 0.25mg for urgent use and Buspirone 30mg for daily use. But on the the good days/weeks I can skip my dose and find that over the counter HTP-5 (low dose !!!) & Lecithin help me calm down before sleep.

[TBonz]

Not yet. I have to buy a card reader to use that (and I forget to check to see if I had a card in my machine, darn it.)

At any rate, things are temporarily on hold. I'm developing a cold and between that and the stress, I decided to back off on CPAP until after the holidays. Plus - I am definitely going to switch pulmonologists. I have a request in for a referral now. I'm tired of the one I have; no communication once I leave the office and it's hard to even get an appointment/my doctor. I'm glad I have the apnea boards but I really need my medical professional to step up on this and this one isn't so bye-bye.