After few months I am stil unable to sleep with cpap

[CatherineF]

I am trying really hard to make it work. I've been taking sleeping pills for a while, it gave me 2-4 hours of sleep with the machine, but after those few hours I was not able to fall asleep again. I never fall asleep with cpap without taking sleeping pills (diazepam or zolpidem). It means that I will never be able to tolerate it well? I am afraid, because zolpidem is not working anymore, I am not sleeping after taking it. Benzo works but I wonder when it will stop working too. What should I do? Any advices?

[GregCavalier]

I was prescribed Zaleplon for first few weeks. Unlike other pills, it only lasts 4 hours and is non-addictive. The 4 hour limit is important. i would sleep with CPAP for 2-3 hours then wake up. If I took another type of pill at 2 a.m. I would be dysfunctional at work. With Zaleplon (Sonata) I am alert by 6-7 a.m. and ready for work. But don't allow yourself to become dependent on the pills. Use them only as an aide to adjustment and then wean yourself off.

My advice, or at least what worked for me is as follows: don't sleep with your mask at first. Wear it hooked up watching TV or reading for a few hours a night. Only after you start feel comfortable, then take it to bed with you. If you wake, don't get frustrated. Just remove the mask. Don't fight with it. Take it off, relax, and try again the next night. If you approach it this way, with no stress, expectations or anxiety, you'll gradually find that you make it through the night. With me, once I did that, it was all downhill.

And lastly, change your mask. There are 100 different styles. Your DME may show you two at most. Be pro active. Read through these forums. Lots of good advice. Search the mask styles available online. Take some risks. I had to buy 4 or 5 before I settled in. Tried nasal prong (InnoMed) and that did not work because the nasal prong inserted in my nose bothered me. Tried full face mask but felt that I was a space astronaut. Tried several nasal pillow masks, and was most happy with the Swift FX. When that started to wear out, found a new one that is pretty close, alot less expensive, but still very comfortable, a 3B Willow. I'm happy with that one. But my point is that I have a closet full of old masks. I wish there was a way to donate them. You have to go into this open minded, and willing to try new things until you find the thing that works best for you.

And last piece of advice, make sure that you have a humidifier! With a nasal pillow at least, it is not optional. Dry air will kill your sinuses.

[AnnSweeting]

Stay off meds!!! The better they work, the more dangerous they are. They are all addictive, and then you can't sleep without them. What is a 3B Willow mask? Never heard of it.

[RandyJ]

I would not encourage anyone to use sleeping meds like Zolpidem long term, but there is a version of Zolpidem that is extended release (sold as Ambien CR). It might work for you if the regular formula doesn't. Then there are other drugs (Lunesta, etc.) your doctor might be able to give you a sample or two to try.

If I were taking a sleep aid, I would have a short term plan for it, however. I know people who have taken Ambien for more than a year and then couldn't sleep if they didn't take it. Now THAT'S a nightmare...

[robysue]

CatherineF,

If you have not yet discussed your concerns and problems with your sleep doc, that's where to start. Make it very clear to the doc/PA/nurse that you do not want to continue taking sleeping meds long term and that you are waking up and are unable to get back to sleep with the mask on. The person treating you may give you an option to try a cognitive behavior therapy approach to the current CPAP-induced insomnia. A CBT approach to the problem is not an instant solution and it does require much more effort on your part than just popping an Ambien or a Sonata. But it will (eventually) give you a drug free solution to the problem.

Things to do now:

1) Read up on sleep hygiene and start working on cleaning up your seep hygiene.

2) Do NOT allow yourself to consciously fall asleep (or go back to sleep) without the mask on your nose.

3) Do NOT allow yourself to consciously lie in bed wide AWAKE and FIGHTING with the machine.

And note: #2 and #3 are not contradictory: When you wake up and find yourself unable to get back to sleep with the mask on your nose, it's time to get out of bed, go into a different room, and do something quiet, soothing, sleep inducing and relaxing until you are both sleepy enough and calm enough to face masking back up when you return to bed.

For lot s more tips on how to deal with the CPAP-Induced insomnia, click on the Taming the CPAP-innduced Insomnia Monster link in my signature

[GregCavalier]

Stay off meds!!! The better they work, the more dangerous they are. They are all addictive, and then you can't sleep without them. What is a 3B Willow mask? Never heard of it.

Ann, I found it online. I lost health insurance last year with a job change. Not happy about that. So anything I do is out of pocket for me. I needed to replace my Swift FX mask. I was very happy with it, but it runs around $120.00 which seems like alot of money for a mask and I had it 2 years without even changing nasal pillows. It was time for a new mask. I had been googling around looking at masks, and searching and came across this mask by 3B. Seemed pretty close to the Swift, at least by the photos. It is always a risk for me to buy a new mask. Some go immediately in the garbage. But I am pretty happy with the 3B Willow. It is light and comfortable, and has the same feel on my face as the Swift. The packaging is no-frills, but the mask itself seems to be a pretty high quality. I think I paid $65.00 online which is a pretty good deal.

[Pugsy]

I found the 3 B Willow mask. Looks a lot like the Swift LT.

FWIW...the Swift FX replacement parts can be found on EBay and if a person shops smart they can build their own mask pretty inexpensively (less than half of online prices). The short hose assembly will last forever if a person takes care of it and it is probably the most expensive part. Headgear and nasal pillows a relatively cheap.

[GregCavalier]

Hi Pugsy, you know it is funny. I actually thought about trying to do that. See if I could scrap up spare parts and rebuild my Swift FX. But I was worried that the parts might now be new as claimed. Felt better buying an entirely new mask, and the 3B Willow fit the bill. It isn't Resmed, but it is pretty close and feels great. And I could afford it which is the most important part. It didn't even occur to me to check on ebay for parts! People in need get creative!

[chunkyfrog]

Is this the mask?
http://www.ukcpap.co.uk/cpap-mask-willow-nasal.php
This looks like a Brit source; don't know if they'll sell to us Yanks.

[GregCavalier]

Is this the mask?
http://www.ukcpap.co.uk/cpap-mask-willow-nasal.php
This looks like a Brit source; don't know if they'll sell to us Yanks.

Don't know if it is the same one. Looks like it is: http://ridgedepot.com/willow_nasal_pillow.php

[neverbetter]

Use your "ramp". set it for at least 15 minutes and get a more comfortable mask. If that doesn't work and if you don't have autopap, insist on one and have the low number no higher than 6 in the beginning.

[VikingGnome]

There are lots of things people can do to get to sleep whether on CPAP or not. There is "go to sleep" CDs with relaxing nature sounds, aromatherapy, relaxation exercises, mind-blanking. Take a warm shower or bath before bedtime. Try herbal tea that helps you go to sleep.

Many people suffer from insomnia that are not on CPAP. I would try everything possible before resorting to medications. Because the meds don't solve the problem. They just cover it up for a while. Sleeps meds are a bandaid and are intended to be temporary. The longer you take them the less likely you'll ever sleep without them because you have not addressing the underlying issues of why you can't sleep.

How well did you sleep BEFORE CPAP?

[kteague]

Can you give us more detail about your sleep patterns? Sometimes the smallest detail can hold clues. For instance, how long does it take to fall asleep, how many times do you wake up, how long do you stay awake after you wake up, and how restful is the sleep you do get? Answer these for both with and without CPAP.

The reason I ask is when I first came here in desperation after several months of CPAP use, I was asked about the specifics of my poor sleep. I was so exhausted I fell asleep immediately, but was awake again in a very few minutes feeling like I was suffocating, and repeated this all night long. This detail brought out discussion of my ramp. Turned out my ramp pressure of 4 was like trying breathe through a coffee stirrer and it was set for something like 30-45 minutes (can't remember for sure any more). I had been instructed by the doctor and tech to any time I woke up hit the ramp and start over. Well, following this advice sentenced me to entire nights at a pressure inadequate to even breathe, much less stop apneas. My first few months on CPAP were hell and I thought I was going to die. Although I was repeatedly at my doctor's, even crying in his office pleading for him to help me in my misery, he couldn't figure out the ramp was being misued, but people here knew right away. It was suggested I increase my ramp pressure and decrease my ramp time. That was the beginning of my adjustment to sleeping with CPAP. Not saying this is your problem, just pointing out how revealing details might be. I also had to deal with RLS and PLMD disrupting my sleep and had issues with some meds, and for a while was thinking it was CPAP making me still have sleep problems, but turned out it was the limb movements. Hopefully you can rule out any other possible contributors as you work on what robysue so fittingly describes as the insomnia monster.

[classicsmom]

Definitely try nasal pillows for a couple of weeks with a chin strap such as a ladies wide head band. I use Swift FX Nasal Pillows and they are a dream. I was a mouth breather at night and now I am not

Also, be sure to check videos on this site and the various manufacturer web sites on proper sizing and use of various masks since many masks need to be lightly applied in order to work properly.

Also, it may take several trials of different masks before you find a good fit.

Be sure to follow good sleep hygiene practices such as avoiding caffeine and heavy meals at night.

Don't give up since OSA treated can be a great thing. I love my cpap and it has made a world of difference for me. It did take a little while to adjust though.

[snuginarug]

Yes, KTeague is right, we need more information to give you tailored advice. First, please enter your equipment in the equipment section of your profile so we can see what type of mask you are using. Now here are some things it would be helpful to know: are you using a ramp? Is your machine an auto? If so, what is your pressure range? What is your humidifier setting? How do you feel with the mask on? Anxious, claustrophobic...? When you awake, what do you feel? Frustration, anxiety, discomfort...? It is especially helpful to pay attention to how you feel right upon wakening. What do you do upon awakening? Take off the mask, keep the mask on? Get out of bed, stay in bed? Do you have congestion problems or other breathing problems? It might be very helpful to you to, after awakening, lie quietly, with the mask on, and really focus on your physical sensations... feel like you can't breathe? straps pulling your hair? irritation where the straps touch your face? congestion? nose irritation?

Sleep hygiene, as Roby Sue says, is very important. COMFORT is also important. If you're not comfortable, you're not going to sleep.

I had a horrible, prolonged struggle with adjusting to the mask. My turning point was when I accepted that this is for life, and made a commitment to NEVER lay down without my mask. Somehow, that made it easier. Things improved for me after that, but it wasn't until recently that I realized NASAL MASKS MAKE CRAZY. Now I have a full face mask and sleep even better. I still have the same insomnia I had before cpap, but life is so much better than before.

Once you get settled in and are really adjusted, you will feel soooo much better than you did pre-cpap.