CPAP Adaptation Stages

I can’t stand this mask. I can’t sleep with this equipment.
I’m not feeling any better. I still feel tired. How long does it take?

Stages of recovery and timeframes

“I look to the future because that's where I'm going to spend the rest of my life.” - George Burns
The person with Obstructive Sleep Apnea (OSA) has unknowingly suffered from this stealth respiratory disorder for years, perhaps decades or a lifetime, with it getting progressively worse. Fortunately, with good treatment, recovery is much faster, measured not in decades or many years, but in months up to a few years, depending on the person’s physical condition, quality of treatment, and other health issues. Recovery time is very individual. Just as everyone’s age, health, fitness, weight, and severity of OSA differ, progress on CPAP differs as well. There is no one right way to become healthier. Getting healthier is not a race. What is fast for one is slow for another.

There are two sensitive and compassionate concepts of recovery from two experienced CPAP users. Mike Moran lists seven stages of CPAP: denial, realization, diagnosis, frustration, immersion (obsession), ownership, and inflation (successful treatment). Perry Holzman lists four definitions of what is feeling good? – walking dead, basic treatment, advanced treatment, and mental zest. See the peer coaching article The Seven Stages of CPAP and What Is Feeling Good?

The rare person starts to feel better during their split night sleep study when first using a CPAP mask and getting their first few hours of good sleep in years. More people feel a sense of energy and euphoria sometime during the first few days or weeks of CPAP treatment, because the body is thrilled to finally get some good sleep. Often, this honeymoon period doesn’t last, as the person continues to struggle with equipment and the body demands ever more satisfying levels of oxygenation and rest.

The speed and quality of recovery depend on:

1) how good the CPAP equipment is and how able the person is at equipment problem-solving, which depends upon their accessing knowledgeable sources of therapy information.

2) how sensible, sensitive, and adaptive the person is; or their psychological, mental and emotional states. Are they able and willing to stay the course and be successful?

3) the person’s physical condition. Are there conditions that help or hinder CPAP therapy?

Most people experience four stages of adjusting to CPAP therapy and equipment:

1. intolerable

2. uncomfortable

3. tolerable

4. comfortable

1. A lucky few, with good equipment and a no-nonsense or carefree attitude, skip the intolerable and uncomfortable stages. For most people, it may take weeks or months to go through all four stages. Sleep specialist Dr. Barry Krakow in the book Sound Sleep, Sound Mind http://sleeptreatment.com/ says it takes most people one to three months to adjust to CPAP therapy, and sometimes longer. For many people, the first few weeks of CPAP therapy can be miserable. The mask and other side effects (noise, machine feel and air pressure, mask leaks, venting on arms, rainout/condensation, aerophagia/swallowing air etc.) may be intolerable at first for far too many nights. It’s normal to sleep much worse than before treatment, because not only are they now aware of having obstructive sleep apnea and being extremely tired, but the equipment is unpleasant and keeping them awake. Wearing the mask for an hour is an accomplishment. Then getting even an hour of sleep on the equipment is an accomplishment. Gone is the illusion of a good night’s sleep, now that sleep apnea is acknowledged and because equipment struggles are all night long, every night. Although the quality of sleep is much worse, the healing process is slowly beginning. This stage is a real challenge, and may feel like it will last forever.

2. With determination and persistence and equipment help from knowledgeable sources, in a few days or weeks they reach the stage where the therapy is merely uncomfortable. The therapy is definitely not fun. They are able to snatch a few more hours of sleep even with the equipment. A few improvements in energy and health begin to emerge. At this long stage, it may be hard to believe that the therapy will ever be truly comfortable. The body is used getting along with little sleep from untreated sleep apnea, even though before CPAP the person may have slept many hours a night (with poor quality of sleep and poor sleep efficiency). When the person starts getting a few hours of quality sleep using the machine, with a better sleep efficiency than when untreated, they may awaken after a few hours because their body thinks that they have had a full night’s sleep. It may take a few weeks for the body to get out of its deprived state and realize that it can enjoy a real full night’s sleep again. The process is akin to a starving person not being able to eat too much all at once when first offered food.

3. With time, continuous gaining of helpful knowledge, replacement of uncomfortable equipment, and nightly tweaking of equipment, as well as more practice, the therapy becomes tolerable or acceptable in a few weeks or months, especially as more and more good results begin to show. It takes many new users at least 4 to 6 weeks, along with trial, experimentation, and problem-solving, to get used to sleeping comfortably with their first mask. Getting used to a second mask usually is much faster, since the user has gained experience. Gradually, the struggles aren’t every night, and there are far more good nights than bad. At this stage and the next, some people begin to make up their sleep deficit, sleeping longer while the body catches up on years of lost sleep and heals. “Compliance,” or wearing the mask to make the insurance company happy, isn’t really for the insurance company’s or DME’s benefit. If your compliance is 100% of your sleep time, including naps, you are benefiting your body, mind, and quality of life, avoiding new damage and healing old damage.

4. Eventually, in a few months, the therapy is even comfortable as good results are achieved almost every night. Many people, only if they have good equipment and good advice, reach comfort in three to four months, most of the time, in most aspects of their therapy; some people sooner than that, some later. They are finally able to sleep comfortably through the night, most nights. If they awaken briefly to adjust equipment, they quickly fall back to sleep. There will probably be lingering aspects of therapy that are problematic, such as finding a better mask or reaching a plateau or backsliding, and it may take many months to find better options and equipment, but overall, the therapy is working and every day the person feels much better than before starting the therapy, or notices some improvement in energy, health, or lifestyle. There may be discouraging setbacks and progress may feel slow, but the overall results of therapy are good. It may take more months or years of tweaking and improvements in equipment and therapy practices to feel satisfied with the treatment and its results.

If the CPAP user notices signs of falling back into old symptoms after one or two bad nights of sleep, such as inefficiency, getting tired early during the day, automatic behavior, inertia, depression; then they need to isolate the therapy problem and solve it; or just wait another night for better results, since sometimes causes are hard to determine.

Discussion threads

Tracking your success

You will be well aware of equipment struggles. It helps to track them in a sleep log, so you can problem solve more effectively and see that you are making progress, because it might not always feel like it. A useful form for a sleep log is in the Appendix of Sleep Apnea – The Phantom of the Night by TS Johnson MD et al. It’s also heartening to track successes, to avoid becoming discouraged. Motivate and coach yourself. Celebrate small victories!

Your Victory List

"When you can't get a compliment any other way, pay yourself one." Mark Twain

At first, measure success by how long you wear the mask (hooked up to the machine) – one hour, two hours, etc. Next, measure success by how long you slept with the mask on. Simultaneously, track and celebrate each equipment victory you have – overcoming rainout, adjusting a mask better, not giving up on dealing with insomnia, solving the numerous problems that come up. Soon you will also be able to measure success by health improvements and the way you feel. Make a list of your symptoms (below) that may be caused or worsened by untreated sleep apnea. Then observe how they improve on CPAP. See the peer coaching article Diary of Two Hoseheads for others’ victory lists.

Some physical symptoms: snoring, gaps in breathing during sleep, morning headaches, daytime fatigue, easily falling asleep during the day, ability to take long morning or afternoon naps, heartburn during sleep, tossing or turning, insomnia, nighttime bathroom trips (nocturia), awakening tired, brain fog, difficulty concentrating, high blood pressure, overweight, heart abnormalities and disease, pains in bones and joints, congested nasal passages, teeth grinding, less interest in sex or sexual dysfunction, types of glaucoma. What else? What gets better on CPAP?

Some mental and social symptoms: procrastination, difficulty concentrating, memory loss, difficulty completing tasks, lack of initiative, doing routine tasks in a daze, arriving home without remembering the trip from work, persistent recurring dreams of struggle and failure, relationship problems, feeling out of touch, not acting like yourself, anxiety, depression, lack of interest, irritability and anger, social withdrawal. What else?

What gets better on CPAP?

These links are fantastic reading!

Can’t wait to get on the hose http://www.cpaptalk.com/viewtopic/t16692/I-cant-wait-to-get-on-the-hose.html

Tales of the comfort zone, naps, and 100% compliance http://www.cpaptalk.com/viewtopic/t13973/Am-I-alone-on-this-one.html

Success stories http://www.cpaptalk.com/viewtopic/t14494/Newbie-would-like-to-hear-success-stories-please.html

Exercising http://www.cpaptalk.com/viewtopic/t17323/I-felt-like-going-to-the-gym-today.html

Humor by Mike Moran: A CPAP Diet-tribe http://www.cpaptalk.com/viewtopic.php?t=7286 A Year of Blowing My Brains Out http://www.cpaptalk.com/viewtopic.php?t=9071 Do You PAP When You Nap? http://www.cpaptalk.com/viewtopic.php?t=5122

Sources: Based on personal experience with obstructive sleep apnea and gleaned from the collective wisdom of cpaptalk.com contributors.

Want more? See the blog peer coaching articles Diary of Two Hoseheads and Ready to Give Up? at http://smart-sleep-apnea.blogspot.com

Not written by healthcare professionals. The information and opinions offered are not intended or recommended as a substitute for professional medical advice. © Mile High Sleeper, October 2006-2008. Permission to use for free educational purposes.

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CPAP Adaptation Stages

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