Can't tolerate mask when waking during the night

[ChrisN]

I've been using APAP since October 2018. I initially had lots of problems tolerating a FFM (ResMed) that was on the bridge of my nose, but did much better after switching to the Dreamware FFM. In fact, I had 100% compliance, usually 7+ hours per night use, in January. However, for the last 6 weeks or so I've been having great difficulties again. I'm able to comfortably go to sleep with the mask on, but I'll wake up usually 1-3 hours later, feeling that I have insufficient air and that the air in the mask is too hot (no heated tube, room temp about 72). I feel claustrophobic and usually take the mask off for good after trying to start again two or three times. I also feel slight nausea (as well as some anxiety) when I try to restart. I haven't exceeded 3 hours, and often less, in the last two weeks.

I'm confused about the cause. I have a starting pressure of 5, and that seems sufficient at my initial bedtime. Sometimes when I wake, it has gone up to 9 or 10, still not high, but sometimes it was still low. When it has been around 10 and I've taken the mask off, going back to 5 doesn't seem to help. I should mention that I occasionally have pretty good leaks from the Dreamware mask when I shift sleeping position, but I can usually fix that quickly.

After several months of pretty good results, I totally dread putting on the mask each night. I'm wondering if I'd be less anxious about the mask if I switched to a nasal pillow like the P10 or the Dreamware nasal cushion. Or should I try a different pressure setting? My AHI was typically <2 when the FFM was tolerated.

I'm attaching two Sleepyhead charts; one from the short and troublesome night yesterday, and one from a couple of weeks ago where I managed 7 hours of use. I'd love to receive any advice on things to try. (First time posting charts, so let me know if I've not done that correctly.) Thanks!

[babydinosnoreless]

Hopefully one of the experts will be along to help you with the charts.

I am claustrophobic, the dreamwear was better than the other ffm's that I tried but it wasn't until I switched to a nasal mask that I didn't dread going to bed. Go to cpap.com and look at the different masks and choose one that doesn't make you fell anxious. Turns out even the plastic forhead pieces on the nasal masks make it hard for me to sleep but everyone is a little different. Pick the one that looks least daunting to you.

[InnerGlow]

I know when I started, my prescription was for a minimum pressure of 5, but after feedback on this forum, I increased it and had much better results. With the pressure of 5, I just didn't feel like I was getting enough air. I now start at 7.5, but I think many people use an even higher minimum pressure.

[babydinosnoreless]

I know when I started, my prescription was for a minimum pressure of 5, but after feedback on this forum, I increased it and had much better results. With the pressure of 5, I just didn't feel like I was getting enough air. I now start at 7.5, but I think many people use an even higher minimum pressure.

My min is 10.6 and there are quite a few with higher minimums than me.

[Snoregone Conclusion]

Based on your graphs, 2 things stand out:

• It’d be good to resolve the leak issues, as that may be quite disruptive to your sleep quality: YMMV.

• If you set your minimum pressure at 8, you’d likely feel more like you’ve got enough air, and from the data, it seems likely that’d get your AHI down lower, which should help you sleep more non-stop on average.

You may find you prefer a higher minimum pressure. If you’re waking up, it’s a bit more involved to determine how much of the score is SWJ.

[Muse-Inc]

Might try my full-face mask, click on it in my signature to view it on our host's site www.cpap.com. It has pillows and covers the mouth so no loss of therapy air. Comes with 3 sizes of pillows and oral cushion. I have claustrophobia and this mask doesn't trigger it as I don't really see it when I'm wearing it.

[ChrisN]

Based on your graphs, 2 things stand out:

• It’d be good to resolve the leak issues, as that may be quite disruptive to your sleep quality: YMMV.

• If you set your minimum pressure at 8, you’d likely feel more like you’ve got enough air, and from the data, it seems likely that’d get your AHI down lower, which should help you sleep more non-stop on average.

You may find you prefer a higher minimum pressure. If you’re waking up, it’s a bit more involved to determine how much of the score is SWJ.

Yes, the leaks have always been there a bit with the Dreamware FFM, but I used to sleep 7-8 hours with the mask on, most of the time with the pressure averaging around 5 and almost never going over 8 or 9. The major leaks always seemed to come in the last half of the night, not the first few hours. This good progress went on for about three months, after a first month of problems using an F20. For some reason, the leaks have been worse the last month. So I thought maybe the cushion needed replacing. Put a new one on last night; felt firmer, so that probably indicated the old one was breaking down. Set the pressure just up to 6 at the start, and tried for 15 minutes to stop major leaks unsuccessfully (tried starting loose, let the pressure seal; tried tighter; nothing worked). Gave up, put the mask in time-out, slept without CPAP for the second night in a row and maybe 5th time in the last 10 days. I may set the pressure back down to 5 tonight and try again. I'm also contemplating trying a different mask, since the FFM is bothersome. Maybe a P30i? It's frustrating to take so many steps back after feeling I had gotten used to using CPAP.

Thanks for the suggestions! (Love your alias, by the way)

[ChrisN]

Might try my full-face mask, click on it in my signature to view it on our host's site www.cpap.com. It has pillows and covers the mouth so no loss of therapy air. Comes with 3 sizes of pillows and oral cushion. I have claustrophobia and this mask doesn't trigger it as I don't really see it when I'm wearing it.

Thanks so much for your suggestion. Yours looks quite a bit like the Dreamware FFM I'm using. You're right, this style is much better for sight. I didn't feel claustrophobic with it for several months, now I wake up feeling the hot air in the mouth part of the mask and get anxious for some reason and have to pull it off.

[ChrisN]

I know when I started, my prescription was for a minimum pressure of 5, but after feedback on this forum, I increased it and had much better results. With the pressure of 5, I just didn't feel like I was getting enough air. I now start at 7.5, but I think many people use an even higher minimum pressure.

My min is 10.6 and there are quite a few with higher minimums than me.

InnerGlow and Babydinosnoreless: I don't know how you stand the higher starting pressure. The few times I woke up and felt uncomfortable, not claustrophobic, in the middle of the night were when I had moved on to my back and the pressure went to 10-11. I felt I was forced to swallow air and my stomach wasn't happy. When things were going well for me, I rarely exceeded a pressure of 8, often lower as long as I didn't sleep on my back.

Thank you for your responses!