Uncommon Issue

Fellow board members,

I have been using a CPAP machine for about 10 months or so. At first, it was good and I was getting somewhere around 4 to 6 hours of sleep every night according. Gradually, the number of hours decreased over time. First, I noticed that I am waking up in the middle of night and removing the mask because apparently I was not getting enough air.

So I started messing with the controls. and made changes, various types of changes over a long time. I cannot fall asleep with the mask on and nothing's that i tried changing worked for me even though i am using the same machine, same mask (nasal pillow) and the same routines. I put the mask on every night and try to put myself to sleep but after struggling for a while, I become frustrated and take the mask off and just lay down on my side and snore like a horse all night long and of course I am not getting any deep sleep either.

Last 4 or 5 weeks, I've been taking melatonin which makes sleepy all right but I still can't fall asleep with the mask on. I even bought a nasal mask from the same vendor and even though it fits my face fine but still doesn't work.

Unfortunately my machine is of the type you call a brick with little data to offer. However, I've created a file of what it gives me. there are two sets of charts in there: the first set is from earlier months and the second set is from recent months.

I've saved the file in OneDrive and here is the URL: https://drive.google.com/file/d/0B1rupN ... sp=sharing

you have to copy the whole URL, and paste into your browser in order to be able to view the file.

Thanks for any help you can provide.

Am I right in thinking your min. pressure is set at 3? And your max at about 8? I'm not familiar with that system, but if I (and almost anyone else here) was trying to inhale at a pressure of 3, we'd need emergency help! Way too low to be good for anything and if it is set to 3, you must bump it up to e.g. 6 or 7, and the max pressure higher as well (15-20). Too many doctors think by leaving the default pressure settings (as the machine comes from the mfgr) it will automatically be able to rise and meet events at higher levels, but that's not so, not if they're too high to be reached in time, so you don't get treated.

I wish you had noted what changes you made when and that you'd done only one at a time for a couple of nights at least, so we could get an idea of what variables might have worked or not, but changing many things at once, or at least for only one night etc. makes it hard to get a handle on anything... can you clarify any more? And can you in fact give us as much info as poss. as to what machine/model it is? Same for the mask.... then maybe we can help. In fact, your issues may be all too common btw, but usually can be fixed.

Julie the setting of 3 is for the EPR.

The pressure is fixed at 8.8 cm.
Ramp is only 5 minutes.
AHI is 7.8 but with this half assed brick we don't know event category. They could be all obstructive or all central or a mix of some sort ....we just don't know.
Leaks are for the most part within acceptable limits and I doubt they are an issue unless causing wake ups.

This is why I hate this model...there's an obvious problem but we don't have a clue what it might be.
We need that detailed event category breakdown pretty bad.

What is your primary problem right now? Falling asleep?? Staying asleep?

Do you take any medications of any kind? If so, what?

Anything preventing you falling asleep that you can put your finger on or is it more "the mind won't calm down" thing?
Do you get sleepy and then as soon as you put the mask on you are wide awake?

Pugsy,

right now, I can't fall asleep with the mask on no matter how long I try to do so. The pressure was fixed at 8.8 however, I turned the ERP back on but still no difference. I don't get it that why is it that I was fine for some long time (months) and then gradually, it started to slip away.

I take adderol early in the morning before heading out to work, one pill and it's 20 mg. in addition i also take metformin for type-2 diabetes. apart from these, i take multi vitamins and omega-3's which I have been taking these all along ever since before starting to use cpap.

lark wrote: right now, I can't fall asleep with the mask on no matter how long I try to do so.

How long is that ... all night ... for how many nights?

If you take it off and then go to sleep ... you are training yourself to not use the mask.

Any change in the dosage of the Adderall? More now than in the past?

When did you start taking it?

It's a stimulant...quite common for it to cause insomnia (and that's what you have right now).
https://www.rxlist.com/adderall-xr-caps ... center.htm
the link is for the XR version but the side effects are the same.

Why are you taking it?

Until you can actually fall asleep and stay asleep on the machine it really doesn't matter about the little tweaking...if you can't sleep.

Insomnia (either sleep onset or sleep maintenance) is a bitch to deal with even when a person knows the cause.
Much more difficult when the cause is not known.

grayghost4,

i put it on every night and try to go sleep with it for as long as I can. usually as i mentioned i get frustrated because as soon as i start to fall sleep i get woken while still on the mask, usually this takes about 30 to 45 minutes.

then i just take the mask off and then go sleep, i have no choice because i need the rest and as little sleep as i get, it's still better than staying up all night in the mask and staring at the ceiling.

How long does it take you to go to sleep with the mask on?
I get it that you wake up within an hour or so and off the mask comes.

How long does it then take you to go back to sleep without the mask?
And how long would it take you to go to sleep at the beginning of the night without the mask at all?

Pugsy,

I have ADD and was prescribed adderoll. i started it a long time ago, long before getting on cpap. and at first when i had just started on cpap, i was fine falling asleep and i was tkaing adderol back then also.

lately, i don't fall asleep at all even after staying in my bed with the mask on for a good while. sometimes, while i am about to fall asleep suddenly i wake up and then afterward, i take the mask off.

without mask, i fall asleep pretty quickly, normally in about 5 to 10 minutes.

Why were you prescribed adderall? What were your symptoms? How old were you then, and how old are you now?

Said he's ADD, dx'd when young. Thing is, I wonder if he could at least take it in the a.m. if he's not already doing so... possibly some of the effect might wear off by bedtime, or else I wonder about his taking a Very small amt of melatonin (1-3 mg) half hour before bed (I know they're sold in larger doses and docs prescribe those, but then there's a tendency to backfire on people, whereas the small doses are less likely to.

The Adderall may or may not be much of a factor since it predates the cpap therapy but I wonder if maybe something in your metabolism has changed a bit and allowing the half life to be more of a factor.
Maybe something to talk to your doctor about.

Since you have trouble falling asleep only with the mask...and can fall asleep fairly quickly with no mask..
Obviously some cpap mask related insomnia....now what to do about it?
Is the mask uncomfortable at all or is it just because it is on your face?

You might read RobySue's blog see if any of her hints might help you.
http://adventures-in-hosehead-land.blog ... er_19.html

I don't know if the melatonin is going to be much help but worth a try.
When we have insomnia from stuff like this it's usually the brain getting all messed up and wanting the mask gone.
Might consider some sort of other OTC sleep aid....docs are leery about prescribing sleeping pills for stuff like this because they are really meant to be a short term solution and fixing insomnia often means long term work.
You might also look into some CBT therapy to help the brain get to be "okay" with the mask and not keep you awake so much.

If the mask is uncomfortable in some way....obviously work on the comfort aspect of things.

There's also a couple of books mentioned in RobySue's blog...check them out. One is Sound Mind Sound sleep (or something like that and the other eludes me at the moment).

Lark, I suggest asking your doctor for a sleep aid, specifically, Ambien. Ambien has a short half life so it doesn't leave one as groggy in the AM as some other drugs. It is non addictive, but subject to habit forming. Taking Ambien might allow you to fall asleep with the mask on and perhaps overcome whatever issues you have developed with it.
In addition, look carefully for increased caffeine in your diet which could be affecting your ability to sleep. Coffee is obvious, but many other foods also contain caffeine such as soda and chocolate. Make sure you are still getting plenty of exercise, preferably early in the day. Brush up on Sleep Hygiene (Google it) and make sure you are doing your best to implement it.

I hate the replies in this thread.

1. The OP is taking Adderall which is very well known to cause insomnia in many patients.

2. It's also thought by many sleep doctors that sleep apnea is often misdiagnosed as ADHD - https://www.psychologytoday.com/blog/sl ... g-it-wrong

3. The OP likely does not have ADHD. He's had sleep apnea for a very long time, and it only recently was diagnosed.

4. The OP should discuss with his doctor a plan to wean himself off Adderall. This is not a simple tapering off the drug. The OP needs a program and close follow up with his doctor - https://americanaddictioncenters.org/ad ... w-to-quit/