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Sleeping with the Enemy

Claustrophobia or fear of suffocation may have three causes. One is machine air pressure that is too low, leading to not enough incoming air and insufficient venting of exhaled carbon dioxide. The easy remedy is to increase the machine pressure. A second cause is nasal obstruction, a blocked nose because of nasal congestion, a severely deviated septum, nasal polyps or large nasal turbinates (bony structure). Remedies may be daily nasal irrigation, a CPAP heated humidifier, or nasal surgery. A third cause is mask claustrophobia. A remedy is to overcome fear through desensitization techniques, such as reading or watching TV with the mask and machine on, gradually increasing the time; or through a few therapy sessions. A book with much good body-mind and mental imagery advice is Sound Sleep, Sound Mind by Dr. Barry Krakow, Dr. Krakow pioneered a mask adaptation technique called PAP-NAP. An abstract is at Perhaps you can work with your local sleep doctor and sleep lab using a similar adaptation technique.

Nasal pillows, nasal prongs, or nose cushions may be good choices for someone with mask claustrophobia, rather than a nasal or full face mask. Discussion thread on mask claustrophobia:

It’s easier to prevent skin breakdowns from mask pressure points than to heal them. If you can’t adjust the mask to get rid of the pressure points, such as the bridge of the nose, then switch to another mask for a few nights, or replace the mask with a better one. If your alternate mask also hits the sore area, put a Band-Aid blister bandage on the sore. Try padding the offending mask with Dr. Scholl\'s moleskin or moleskin foam, found in the foot section of the drug store. Apply the moleskin to the mask, not your face.If you experience a sore nostril from nasal pillows, inspect the pillows to see if they are damaged. Nasal pillows (not the whole mask) should be replaced every three months or when worn out. Wear another type mask while your nostril heals.

If you have APAP or BiPAP, adjust the mask for leaks at your highest pressure. If it doesn’t leak at the highest pressure, it won’t leak at the lower pressure (unless there is a reason other than pressure for the leak). If possible, remove the mask by undoing a lower clip without readjusting the headgear each time. To get up at night, disconnect the mask from the hose and breathe through your mouth while wearing the mask.