Need help adjusting to CPAP

So, after my wife told me that my snoring was becoming an issue I was diagnosed with OSA and got a CPAP. But, after three weeks of trying to use it, I am having major issues. In the first week, I was able to keep the Wisp mask with chinstrap on for at least 3-5 hours per night but after that things got worse and now I struggle with it for even an hour. I did not realize that I was so subject to anxiety and claustrophobia. I have a mid-grade pressure (11 cmH2O), but I'm getting frustrated. I cannot seem to calm down in the mask, I normally fall asleep quite quickly, but now I go through 10-15 mini wake ups before taking the mask off in frustration and fear. And my fear can be summed up in one word, suffocation,

Here are my problems in short:

• I have tried multiple cushions and I still feel like the mask rides up, cutting off my nostrils.
• Wearing the chinstrap, I don't like the feeling of wearing so much on my face.
• My face feels hot and I get itches around and under the cushion.
• I don't care for the ramp feature much, I feel a bit starved for air at the beginning.
• I forced myself to sleep on my back for the sleep study but actually sleep on my stomach, which makes it hard to sleep naturally for me with the mask on. I wanted an accurate study so that the minimum pressure needed would be right.
• I cannot seem to find the right humidification level, I have tried almost every setting from 1-5 with no discernible relief.
• I bought a Pad-a-Sleep pad for the cushions but it hasn't helped.
• I dread going to bed at night, I try every day to wear the mask, but feelings of despair seem to creep up, I know I just need to adjust but it's hard to do.
• I am using SleepyHead to track my progress and the data is reassuring, my AHI is usually less than 1 but only when I wear the darn thing.
• I am considering both a full face and nasal cushion mask, but both have positives and negatives, a full face mask would eliminate the chinstrap, but is even more intrusive. (Though not at the nostrils where I am having issues.) A nasal cushion would eliminate the itchiness on the nose but I would still need the chinstrap and I would have something over my nostrils.

Can someone that has gone through this help me please, any advice is very much appreciated.

Petro

I have tried multiple cushions and I still feel like the mask rides up, cutting off my nostrils.
Wearing the chinstrap, I don't like the feeling of wearing so much on my face.

I don't like chinstaps and use a FFM instead of a nasal interface.

I don't care for the ramp feature much, I feel a bit starved for air at the beginning.

Turn the ramp off. Many of us don't use ramp.

I forced myself to sleep on my back for the sleep study but actually sleep on my stomach, which makes it hard to sleep naturally for me with the mask on.

Here is the only proper sleeping position for stomach - http://www.uarsrelief.com/sleeppositions.html

I cannot seem to find the right humidification level, I have tried almost every setting from 1-5 with no discernible relief.

What is your climate like?

a full face mask would eliminate the chinstrap, but is even more intrusive

You are saying that. Is this something you have tried or is it something you have only heard from those who failed with FFMs?

ChicagoGramps

Petrodon,

Welcome to the forum.

First, some reassurance: Everything on your list has been dealt with by many forum members. So none of your problems are "unfixable" even if they seem that way right now.

Petrodon wrote: I did not realize that I was so subject to anxiety and claustrophobia. I have a mid-grade pressure (11 cmH2O), but I'm getting frustrated. I cannot seem to calm down in the mask, I normally fall asleep quite quickly, but now I go through 10-15 mini wake ups before taking the mask off in frustration and fear. And my fear can be summed up in one word, suffocation,

I think that you are caught in a bad "positive feedback loop" here: The frustration and fear of suffocation came from the mask feeling weird and hot on the face, but it now leads to more anxiety, which leads to more discomfort and worry, which leads to more anxiety, and so on and so forth.

Breaking the anxiety cycle is the top goal for now. How to do that will depend on a bunch of things, but a good starting list is your short list of major complaints and worries:

I have tried multiple cushions and I still feel like the mask rides up, cutting off my nostrils.

Sounds like its time to try a whole different MASK rather than just different sized cushions on the one you have. Most DMEs have a 30-return mask swap program for newbies. It's time you went back and started trying OTHER masks.

Wearing the chinstrap, I don't like the feeling of wearing so much on my face.

Do you know FOR SURE that you frequently mouth breathe when you are sleeping? Unless you know FOR SURE that you do a significant amount of mouth breathing, my suggestion is to ditch the chin strap for a night or two or three, and then look at the leak data from your PR System One Pro using SleepyHead. If the leaks are not wildly out of control when you don't use the chinstrap, then ditch the chinstrap for good.

My face feels hot and I get itches around and under the cushion.

You might consider switching to a nasal pillows mask. It touches your nostrils, which might not be so great for the "I'm suffocating" feeling, but it does let you scratch your nose without moving the mask. If you are using a heated hose, turn the temperature down, maybe WAY down. If you are using a heated humidifier, turn the humidifier down.

I don't care for the ramp feature much, I feel a bit starved for air at the beginning.

Then don't use the ramp. Seriously: Ramp is there for your comfort. If it makes things worse, ditch the ramp. If you can't stand to start at 11cm, then increase the Starting Ramp pressure up to something that is comfortable---like 7-9 cm.

I forced myself to sleep on my back for the sleep study but actually sleep on my stomach, which makes it hard to sleep naturally for me with the mask on. I wanted an accurate study so that the minimum pressure needed would be right.

Well, sleeping on your back probably made your OSA worse and you may be a wee bit over titrated rather than under titrated.

As for stomach sleeping: My hubby now uses a PAP. He was a bit worried about whether he'd be able to continue stomach sleeping. (He flips from tummy to back to tummy to back .... all night). He's had no problems at all with figuring out how to sleep on his stomach. The idea is that you have to turn your head and let the mask hang off the pillow. Google "Falcon sleeping position" and you'll see a very CPAP-friendly stomach sleeping position.

I cannot seem to find the right humidification level, I have tried almost every setting from 1-5 with no discernible relief.

Is the problem that you feel like you are sleeping in swamp? Or are you waking up with a very dry mouth and nose even when the humidifier is maxed out?

I bought a Pad-a-Sleep pad for the cushions but it hasn't helped.

If the mask is more comfortable without the padacheek pads, don't use them. If the mask is equally uncomfortable with or without the pads, you need to either refit the headgear and make sure it's not too tight OR you need change to a different mask.

I dread going to bed at night, I try every day to wear the mask, but feelings of despair seem to creep up, I know I just need to adjust but it's hard to do.

My deepest sympathies. There's no easy fix for this one. I struggled for months with this issue. I will say this: Report this issue to your sleep doctor and make it CLEAR this is seriously affecting the quality of your life. If you are willing to take sleeping pills, sometimes a very short course of taking them for 1-2 weeks helps get you over the hump. If you don't want to do sleeping pills yet, make sure that you force yourself to get up at the same time every day. For a lot of lessons I've learned the hard way about dealing with this issue, see my Taming the CPAP-Induced Insomnia Monster

I am using SleepyHead to track my progress and the data is reassuring, my AHI is usually less than 1 but only when I wear the darn thing.

Good data can help keep you motivated. At least it did me. But you are correct: The only time your AHI < 1 is when you wear the darn mask.

I am considering both a full face and nasal cushion mask, but both have positives and negatives, a full face mask would eliminate the chinstrap, but is even more intrusive. (Though not at the nostrils where I am having issues.) A nasal cushion would eliminate the itchiness on the nose but I would still need the chinstrap and I would have something over my nostrils.

Again I have to ask: Why are you convinced that you MUST wear the chin strap?

I really think the first thing you ought to do is ditch the chinstrap for a week and find out just how bad of a problem leaks might be without it. Some people do manage to learn to sleep without opening the mouth wide open. And some people manage to learn a way to place their tongue where even if their lips open up, not much air is lost.

I remember well my days in early Feb. 2014 of getting used to all of this; nearly everyone finds the first weeks or months a difficult adjustment - after all, none of us ever had to sleep this way before, and isn't natural. I have never used a nasal cushion or pillows mask so I can't speak for those. My first week was pretty rotten, like you, I managed only a few hours each night.

I was started out with a full face mask Quattro Air, and now use the AirFit F10. Since I am a mouth breather, it eliminates the need for a chin strap. I did have a lot of trouble with leaks in the beginning, but mask liners took care of that.

Do you think that as a stomach sleeper you could train yourself to sleep with your face turned to the right or the left on the edge of the pillow? That might help you with the nasal mask. I know there are some stomach sleepers on this forum who have found pillows with a hole in the middle for the mask; hopefully they will chime in with more information on that. Chicago Gramps's post mentions the Falcon Position, look at the link he provided and scroll down to it... it's a great position to sleep in if you are a stomach sleeper...

What has helped me with itching pads is to wipe my face where the mask touches with a dry cloth just before putting the mask on. If it itches later in the night (perhaps because I forgot, I find it best to just shut off the machine, remove the mask and wipe again. trying to scratch only the place it itches just does not work for me long term

You may find that this has the opposite effect for you however. good luck

Thank you all for the great advice. I am heading to bed now. My plan for tonight is to turn up the ramp feature from 4 to 8, set the humidifier to 1 and try the falcon position. If I cannot get to my compliance threshold will talk to my res therapist and look into getting a new mask. I will try a full face first I think.

So a quick update, it is day two since I posted and my sleep has shown very little improvement. One thing that did help was to reset the ramp settings, I haved landed on 6 as my ideal initial pressure. The problem is still present regarding the mask, I still cannot relax. I feel frustrated with how hot the mask feels against my face. I have even gotten a stand fan and propped it so that it blows over my face around the mask with no luck. I am going to go over and get a new mask tomorrow or at least call the DME provider. I have one of those insurances that like to fight you on every little thing. One final question. With my pressure (11) is a nasal pillow mask even in the cards for me? I've been told that it is only for low pressure.

One final question. With my pressure (11) is a nasal pillow mask even in the cards for me? I've been told that it is only for low pressure.

Not correct as many people have had great success using nasal pillow masks alot higher pressures than 11. Definitely worth a try if you can breath through your nose adequately.

49er

Petrodon wrote:With my pressure (11) is a nasal pillow mask even in the cards for me? I've been told that it is only for low pressure.

I don't know who started that old wives tale but it is totally not true.
People successfully use nasal pillows at pressures above 20 cm all the time.
I myself see pressure ranges from 9 cm to 22 cm and have no issues with any of the nasal pillow masks I have ever used ....in 5 years..nothing but nasal pillow masks for me.

I feel frustrated with how hot the mask feels against my face. I have even gotten a stand fan and propped it so that it blows over my face around the mask with no luck.

What climate do you live in? What is your bedroom temperature?

On the "hot feeling": Are you using a heated humidifier hose? If so, maybe you're not just feeling hot, it may actually be blowing hot air on your face. Try turning off the heat and see if it helps.

So, here is the answer to the responses, the climate here is damp (MD) and currently the humidity is fairly high. I tried turning the humidifier off last night after I sent out my last msg at 1:00am. It didn't help too much. I have no heated hose, just a humidifier. My temperature in the room is about 74.

I prefer not to use the humidifier unless I am visiting in a very dry climate

Hi Petro,

I can sympathize with your issues, sound just like mine when I started with my CPAP a few years ago. I absolutely could not tolerate a full-face mask at all, I felt itchy, hot and smothered every time I put it on. The tip of my nose itched ALL the time, I couldn't tolerate the air blowing around my nose, the mask leaked into my eyes all the time, it was just awful. Obviously I was already getting low-quality sleep, and then it was even worse once I started trying to apparent fix to my sleep issues. Despair was the order of the day, for sure! I eventually ended up (after much trial and error, much of it created because I was sure I wouldn't be able to use a nasal pillow because I had mouth-breathed most of my life) with nasal pillows because of a very smart sleep tech who convinced me to give it a shot. I just naturally block my oral airway with my tongue and I have no mouth-breathing tendencies any longer. I'm also a side-to-stomach sleeper and my Swift mask lets me sleep in a semi-side position, sort of a combo of fetal and Falcon with my arm in front of my face. Weird, but it works! Please see your RT or sleep therapist...it sounds as though you really need some help with your mask. Best of luck, I remember those days well and am in a much better place now, I hope the same happens for you!

Petrodon wrote:So, here is the answer to the responses, the climate here is damp (MD) and currently the humidity is fairly high. I tried turning the humidifier off last night after I sent out my last msg at 1:00am. It didn't help too much. I have no heated hose, just a humidifier. My temperature in the room is about 74.

MD in the summer time. No wonder the mask feels so hot.

Do you have AC in the bedroom or not? If you're dealing with an unairconditioned bedroom in MD at this time of the year, yeah, it's going to feel like you're sleeping in a swamp if the humidifier is turned on at all. Heck it's going to feel like sleeping in a swamp just because of the mask.

When I was a newbie, there was someone who suggested putting ice cubes made out of distilled water in the humidifier tank and keeping the humidifier turned OFF. That way the air would blow over the ice cubes (at least until they melt) and cool the air a bit. It's worth a try, particularly if you are able to stay asleep once you finally get to sleep.

Are you absolutely SURE that you can't use a nasal pillows mask? They don't cover the nose; they simply snuggle up to the nostrils. (It sounds worse than it is.) There's a lot less stuff on your face with a nasal pillows mask. And so they tend to be less hot than the masks that cover part of your nose.