CPAP and Anxiety

Hi all. I've not updated in a while because, well, things seem to be going well. I'm in my eighth week of using the CPAP.

Except one thing. The anxiety. I never had any prior to this but I've not been able to get rid of the "I'm suffocating" feeling. I'm NOT - I know intellectually. Plus - if I wake up in the morning, I have zero trouble breathing/going back to sleep. I have to assume this is just anxiety since I'm a touch OCD and do twitches and other stuff when anxious.

Anyhow - I was on Xanax for 3 weeks. Perfect! I fall asleep in the normal manner and even though I think "I'm suffocating," I don't seem to care.

But just heard today that it's not good to be on it long-term, as it's addictive. Who knew? It wouldn't be my drug of choice for addiction, as other than the cessation of anxiety, it doesn't give a "high." But I'm no doctor.

I start Hydroxyzine tonight. Hopefully this will work.

BTW - I DID try after day 7 on the Paxil to start going off of it, figuring I'd be OK with the CPAP. It was a disaster. I had to resume it. Then a few days later I had another horrible night which scared me since I had taken the anti-anxiety pill. Except next day, when I read my journal (I'm keeping a log on this to see how I'm doing and because my memory is crap), and counted my pills (I noted each day when I took it) it became clear that I had forgotten to take it that night. So it wasn't just a placebo. I changed my routine to make sure I didn't forget again.

So the good news is that I'm doing the CPAP and used to it. The bad news is I require a pill to do so. I don't like that and I'm assuming my primary didn't think that I would need one for more than a short period. I'm disappointed in myself, but what can one do?

Once I get used to this, I will try again. I mean, I've been doing this for a month and a half now and don't mind it when going to bed. If I could just get rid of the pill, it would be ideal.

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.

First, don't feel bad. Anxiety in general is more common than people realize; they just don't talk about it because of the stigma. That being said, I am not a doctor but in my own experience having more anxiety at night is typical. There are less distractions and you're dog tired. Add this thing on your face and trifecta!

Like diabetes or any other medical condition, anxiety needs to be treated when it starts to impact your life. If you need the meds, you need the meds. Don't feel bad for taking them. If there's a better alternative than Xanax, great! Use it. It often takes some time, some hit and miss to find the right one.

One more piece of advice. Find a doctor who is versed in anxiety -- a psychiatrist (an MD). I know, there's that stigma again. But the meds are changing so fast, and the side effects are so varied that you need an expert on your side.

Best of luck on your journey. I'm hoping one of the many knowledgeable people on this forum can help you adjust your pressures, as I suspect that is adding to your suffocating feeling.

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.

What machine/settings do you have?
If it is on a long ramp, starting very low, the feeling you describe is quite possible.
It baffles me how providers use such outrageous settings, that make patients feel suffocated.
I can only imagine them laughing so hard they soil their clean white pants.

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".

Neicy wrote: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".

then they should be given a XPAP with a pressure of 4 cm, set to restart the ramp over every 30 minutes. Jim

Also, not a doctor, but what was the Xanax dosage and how often did you take it? It is habit forming, and like caffeine, you can develop a tolerance to it and it will be less effective. I agree that anxiety needs to be treated if it starts affecting your life. I take Xanax occassionally, but a small dose and not continuously for more than a few days at a time. Used that way it has beed a tremendous help to me. Cpap is not one of the things that contributes to my anxiety, at least not any more. Ifmyounhave become adicted to it, expect some backlash in the form of a spike in anxiety for a couple days while you detox. At higher doses, you need to taper off of it. Lets work on making the cpap a comfort instead of a stressor!
Jim

Not sure of your history, but was wondering if you're certain your settings at the time you mask up are adequate. Having too low of a starting pressure can cause a sense of impending trouble. Is this something you've already addressed?

"I start Hydroxyzine tonight. Hopefully this will work."

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

Hi TBonz,

Even though you have only been on Paxil for 7 days, you might have to reduce the dose at a slower pace when you are ready to get off of it. How much did you cut the dose by?

Jim22 has offered excellent advice about the issue of Xanax and dependency. On a related note, I became dependent on Temazepam very quickly for sleep and am going through h-ll in slowly tapering off of it.

That is not to say your experience will be similar when you chose to get off of the med. But I think you are wise to be concerned about using it long term.

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. Might be worth looking into.

Hopefully, making sure your settings are optimized will also be helpful.

Best of luck.

49er

TBonz wrote:Hi all. I've not updated in a while because, well, things seem to be going well. I'm in my eighth week of using the CPAP.

Except one thing. The anxiety. I never had any prior to this but I've not been able to get rid of the "I'm suffocating" feeling. I'm NOT - I know intellectually. Plus - if I wake up in the morning, I have zero trouble breathing/going back to sleep. I have to assume this is just anxiety since I'm a touch OCD and do twitches and other stuff when anxious.

Anyhow - I was on Xanax for 3 weeks. Perfect! I fall asleep in the normal manner and even though I think "I'm suffocating," I don't seem to care.

But just heard today that it's not good to be on it long-term, as it's addictive. Who knew? It wouldn't be my drug of choice for addiction, as other than the cessation of anxiety, it doesn't give a "high." But I'm no doctor.

I start Hydroxyzine tonight. Hopefully this will work.

BTW - I DID try after day 7 on the Paxil to start going off of it, figuring I'd be OK with the CPAP. It was a disaster. I had to resume it. Then a few days later I had another horrible night which scared me since I had taken the anti-anxiety pill. Except next day, when I read my journal (I'm keeping a log on this to see how I'm doing and because my memory is crap), and counted my pills (I noted each day when I took it) it became clear that I had forgotten to take it that night. So it wasn't just a placebo. I changed my routine to make sure I didn't forget again.

So the good news is that I'm doing the CPAP and used to it. The bad news is I require a pill to do so. I don't like that and I'm assuming my primary didn't think that I would need one for more than a short period. I'm disappointed in myself, but what can one do?

Once I get used to this, I will try again. I mean, I've been doing this for a month and a half now and don't mind it when going to bed. If I could just get rid of the pill, it would be ideal.

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.

TBonz wrote: I start Hydroxyzine tonight. Hopefully this will work.

I recently discussed taking Hydroxyzine with my doctor for sleep because a family member was having success with it. She (doctor who is highly respected in my area) said there is no way she would prescribe Hydroxyzine for anyone over 50 years of age. In her opinion it's one of the worst meds (right up there with xanax) for cognitive issues. I take .5 xanax for sleep which I've been slowly tapering for the same reason. Just tossing out recent discussion with my doctor... I realize your doctor may have different views.

She suggested I look into the Pythagoras Memory Technique to help with sleep/memory.

1. Making sure the PAP therapy is successful is one thing.

2. Making sure pressure is HIGH enough for you to breathe comfortably is another.

3. A third thing to realize is that if your body was making buckets of panic-juice to wake you up to breathe several times a night when you were untreated, it takes a few weeks/months for your body to figure out that it doesn't need to make so much of that anymore now that you are using PAP. Meanwhile, your body looks for any excuse to release the extra stock of that stuff that it has. Give that some time to work itself out if you can--especially if the onset of the anxiety issue coincided with the initiation of PAP. I found that to be so in my case, anyway.

Lucyhere wrote:She suggested I look into the Pythagoras Memory Technique to help with sleep/memory.

Keep your hypotenuse well oiled.

jnk... wrote:1. Making sure the PAP therapy is successful is one thing.

2. Making sure pressure is HIGH enough for you to breathe comfortably is another.

3. A third thing to realize is that if your body was making buckets of panic-juice to wake you up to breathe several times a night when you were untreated, it takes a few weeks/months for your body to figure out that it doesn't need to make so much of that anymore now that you are using PAP. Meanwhile, your body looks for any excuse to release the extra stock of that stuff that it has. Give that some time to work itself out if you can--especially if the onset of the anxiety issue coincided with the initiation of PAP. I found that to be so in my case, anyway.

In other words, you need Chill Pills. Jim

I have some experience with the meds you're asking about (except the hydr-x-whatever-ine). Long term use of Xanax is terrible for your memory, and probably much more. It's really helpful as a PRN med, but not regular use. And once you become accustomed to it, it's hard to sleep without it. Paxil can help, but it takes more than 7 days, and you have gradually take less and less of the Xanax. Paxil can take between 10 - 28 days to work. I'd recommend giving it a couple weeks, then titrating down the xanax. Also, press your DME for the best mask you can get.

Getting off Paxil is tough, too, but personally, I found it easier than Xanax.