After few months I am stil unable to sleep with cpap

[Suddenly Worn Out]

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?

Kinda sounds like you might have anxiety issues with regards to the CPAP. Some people are like that. Perhaps use a sleep medicine specialist who was a psychiatrist first...there are lots of psychiatrists first who have switched over to full time sleep specialist.

Maybe use all the comfort features on your machine, EPR if Resmed or C-Flex or A-Flex if Respironics or even consider a Bipap. I one of the reasons people use a Bipap is failure to tolerate CPAP or APAP. That is not the only reason, but Ive had a Bipap one day now and breathing on a Bipap is soooooooooooooooo much easier than either CPAP or APAP. If you add in the biflex feature if on a Respironics, it is even easier.

Diazepam in particular is bad for sleep apnea as it is a full blown benzo. And the addiction rate is high if you use it long term. Zopidem is pretty weak stuff and I would not be that concerned about it, that is just me though.

Are you claustrophobic, possibly? Your problem sounds like something that needs to be discussed with a specialist, possibly at an elite teaching hospital somewhere.

Also, there are the dental mouthpieces. Those work for mild to moderate sleep apnea. Maybe you might not have anxiety using a custom mouthpiece.

[GregCavalier]

Everyone is different. I wouldn't trade nasal pillows. Although I admit that they are harder to adjust to at first. Of course, you do need a back up mask for those times when you are congested. I won't wear my standard nasal mask, except for when I am sick and can't breath through my nose.

But back to the point at the start of this thread, how to sleep with the mask. I think a big part, the major part perhaps, is the psychology of it. That is why it is so important to start slowly. Start with the mask and device on while you are awake. Get to the point where you barely even notice it is on as you watch TV. And then later, wear it to sleep. Take it off immediately if you wake up. Isn't a big deal, and try again the next day. Eventually you will make it through the entire night. It took me two weeks.

And then something magical happens, the psychological barrier is broken and you can sleep with the mask without waking up. At least that is how it worked for me. And then, I noticed that I was no longer tired and drained during the day and had alot more energy because I was finally getting rested. But the first few weeks, were awful. So my advice is slow down. Start over and build up tolerance little by little. Be patient.

[SuperDan]

Hiya Catherine. I'm new to it myself and had the very same problems you're having. What I was actually concerned about was that I could only sleep for a few hours. I've heard from several people that CPAP is almost life changing depending on how bad it is so I REALLY wanted to make it work. Virtually everyone here will tell you that using meds to get to sleep over a long period of time is bad and for the most part, I'll side with them. It's open to debate in my book because it's very likely to stop working after a while but then again, there are several different approaches. We've brought up 3-4 different types and I use several in a rotation so my body isn't getting used to one and not working any more. If you have a ramp then play with that. I was fighting the machine and paying way too much attention to my breathing so that kept me up. I finally found a setting that was natural and now I can sleep for about 6 hours a night. There are several meds I'm going to have to take for the rest of my life so it's easier for me to get into the mindset of long term fixes. If you don't mind the thought of needing help getting to sleep over a long period of time then try the rotation idea. Anyway, enough of my babbling. I hope it gets better for ya.

[CatherineF]

Thank you for all answers, I wasn't able to respond in the last few days, that's why my answer is delayed. I filled my equipment correctly.

My main problems with inability to sleep with my BiPAP are:

*feeling anxious when I have to breathe through the mask, My EPAP is set at 7, IPAP 13 (in auto VPAP mode it is 6-15, with a ps of 6), somehow I just can't adjust to it
*my machine seems to have too long time to reach full IPAP, it is doing it gradually
*when I use Swift FX mask I have to tape my mouth, otherwise leaks are impossible to bear (those are not even leaks, it is air BLOWING through my mouth), I think this is making me even more anxious and scared...
*I am so tired and sleepy when I lay with the mask on, that robysue's advice about getting up after 30m with the mask on seems impossible to me (but it is a good advice, I know it, based on CBT)
*full face masks I own, they both leaks, quattro fx (size s) is in a good size for me, but it leaks, mirage quatrro (size xs) may be too small for me, but I can't afford to buy another one now, but with a sizing chart it seems ok, only with mouth totally closed... I've read everything about leak problems with those mask, but I just can't make it work. The only thing I didn't use are mask liners, but I amd from Europe and shipping is so expensive that I have to pass (I've tried to make my own from an old t-shirt, but I didn't work well in preventing leaks).

I can't give up and I am going to do everything to make CPAP therapy work for me. Without you guys, without this forum I would already give up. Thank you for everything.

[robysue]

Catherine,

I am so sorry that you are still having major problems.

My main problems with inability to sleep my BiPAP are:

*feeling anxious when I have to breathe through the mask, My EPAP is set at 7, IPAP 13 (in auto VPAP mode it is 6-15, with a ps of 6), somehow I just can't adjust to it

As others have suggested, wearing the machine for an hour or more during the daytime may help you get over the anxiety you feel when you have the mask on your nose. Anxiety also affects the respiration rate. The masks are designed to provide us with the air we need, but they also assume that we'll be doing normal, night time breathing, which is more regular, a bit more shallow, and often slower than our regular daytime breathing. So when you've got the mask on, consciously focus on making your breathing slow and regular, but not overly deep.

*my machine seems to have too long time to reach full IPAP, it is doing it gradually

My understanding is the the amount of time it takes for the S9 VPAP to reach full IPAP pressure is controlled by a setting called the Rise Time. (See this page at the ResMed site for more details.) My guess is that your Rise Time is set for too long of a time. If you are comfortable with getting into the clinical menu, then check those settings and let us know what they are. If you are uncomfortable with the idea of changing your settings, then call the doc or the dme back and ask them to work with you and shorten that Rise Time.

The length of time that the IPAP is maintained is controlled by a pair of settings called TI_min and TI_max. (See this page at the Resmed site for more details.) It seems less likely that TI_min and TI_max are causing your problem with the sensation that the machine is too slow to increase the pressure to IPAP. But it may still be worth asking the doc or dme about these settings as well.

*when I use Swift FX mask I have to tape my mouth, otherwise leaks are impossible to bear (those are not even leaks, it is air BLOWING through my mouth), I think this is making me even more anxious and scared...

It's easy to understand why this would increase your overall anxiety and discomfort. Are the FFMs any better in this regard?

*I am so tired and sleepy when I lay with the mask on, that robysue's advice about getting up after 30m with the mask on seems impossible to me (but it is a good advice, I know it, based on CBT)

It's hard advice to follow, but lying in bed is just making you more anxious and less able to sleep. Force yourself to get up just long enough to go to the bathroom and get a drink of water. You don't need much time out of bed. And in the long run, you'll probably get to sleep faster by getting out of bed for a few minutes.

And don't forget the rest of your sleep hygiene. What time do you need to get up by? Can you stomach the idea of getting up at that time seven days a week? What time is bedtime? Can you distinguish between feeling sleepy and feeling tired/exhausted? They are not the same thing. How much time do you spend worrying when you find yourself awake in bed when you want to be asleep? What do you worry about? How often do you look at the clock when you are in bed and you can't get to sleep? How late is dinner? How much physical activity do you get each day? What do you do in the last 2 or 3 hours before going to bed? All those things and more can contribute to your insomnia problem.

*full face masks I own, they both leaks, quattro fx (size s) is in a good size for me, but it leaks, mirage quatrro (size xs) may be too small for me, but I can't afford to buy another one now, but with a sizing chart it seems ok, only with mouth totally closed... I've read everything about leak problems with those mask, but I just can't make it work. The only thing I didn't use are mask liners, but I amd from Europe and shipping is so expensive that I have to pass (I've tried to make my own from an old t-shirt, but I didn't work well in preventing leaks).

I wonder if some of the problem is that PS = 6 setting. With that setting, on every inhale, your pressure is going from a low to moderately lw pressure setting of 7-9cm (which should be rather "easy" to seal) to a moderately high pressure of 13-15cm (which can be much more problematic to seal). You might ask the doc if you could decrease that PS setting a bit and increase the EPAP setting. But this might trigger problems with aerophagia.