Hypopnea and claustrophobia

[ljferrante]

I had a sleep study done that showed zero apnea events, but 113 hypopnea events (19.6 index) saying I had moderate obstructive sleep apnea. So, I had a second sleep study w/the cpap mask. When the tech put the mask on me, I had a complete panic attack about not being able to breathe (or talk) from my mouth and every time I tried to open my mouth I couldn't breathe at all, so had to close my mouth (obviously). Plus, I started to cough and almost passed out because I couldn't cough due to the pressure from the air -- I had to pull the thing off my face (not to mention the bruises it gave me on the side of my nose)! It was awful! I'm supposed to be having gastric bypass surgery (which was a difficult decision in and of itself), but if I can't find a cpap machine/mask that works, they won't do the surgery on me (something about the narcotics for pain and apnea being a deadly combination)! HELP! I am so upset and been searching the internet hoping for something to give me hope, but am not getting a good feeling! I realize that all these machines stop you breathing from your mouth (or your nose depending on the type), but what do you do when that causes a panic attack from claustrophobia?!

[Selena (but really Julie)]

Hi. First of all, the masks used during studies are often badly fitted by the techs, and roughly put on. Secondly, you need to get used to anything, and what a lot of people do once they've chosen a mask they feel most comfortable with after trying various ones at their DME's, is put it on while sitting up during the day and wear it for increasing periods of time with the hose unattached from the machine, so no air blows into it and you can talk more or less normally and breathe through your mouth, which may take a little getting used to for you (or do you breathe that way all the time and therefore that's the problem?). In any case, once you've got the mask on, unattached, lie down with it and see how comfortable you can get in your best sleeping position - see if there are either obvious gaps between the mask and your face, or places it's too tight, etc. after fitting it as best you can according to the DME's advice. I don't know what setting was recommended for you to start at, but if you can lower it yourself (or get someone to help you) to a very low setting, and only gradually build up to the other one, you should have a lot less trouble breathing. Attach the hose thing, keep breathing normally 2-3 times and the machine should kick in at the low setting. Just breathe through your nose normally, but do keep your mouth closed and exhale through your nose once your inhalation is done. Continue on, not inhaling excessively each time, but normally, and exhaling at the same rate. If you have an auto-pap machine, it should eventually raise the pressure very slowly to a more effective one (to address the apnea), and you might not even realize the difference. If you don't have the auto. then you'll have to set the CPAP yourself to higher and higher increments with the ramp button. Always remember though that YOU are in control of it all, and do try your hardest to breathe normally, which will help the machine do its job. Keep your mouth closed AFTER the first nasal inhalation (without the NI, your wasting your time & money after all), and just take your time, one step after the other. Good luck.

[Selena (but really Julie)]

I should mention that if while you're using it, you hear whistles or feel tiny puffs of air from somewhere around the mask, lift it straight up a bit off your face and reseat it with a little wiggle or two so it 'seals' better all around. If it's too tight to even lift up a bit then you have it too tight altogether and you should very slightly let out all or some of the straps and try again. Too tight doesn't always make the best seal, and it should not be actually uncomfortable, just different!

[Fromaginator]

[quote="ljferrante"]I had a sleep study done that showed zero apnea events, but 113 hypopnea events (19.6 index) saying I had moderate obstructive sleep apnea. So, I had a second sleep study w/the cpap mask. When the tech put the mask on me, I had a complete panic attack about not being able to breathe (or talk) from my mouth and every time I tried to open my mouth I couldn't breathe at all, so had to close my mouth (obviously). Plus, I started to cough and almost passed out because I couldn't cough due to the pressure from the air -- I had to pull the thing off my face (not to mention the bruises it gave me on the side of my nose)! It was awful! I'm supposed to be having gastric bypass surgery (which was a difficult decision in and of itself), but if I can't find a cpap machine/mask that works, they won't do the surgery on me (something about the narcotics for pain and apnea being a deadly combination)! HELP! I am so upset and been searching the internet hoping for something to give me hope, but am not getting a good feeling! I realize that all these machines stop you breathing from your mouth (or your nose depending on the type), but what do you do when that causes a panic attack from claustrophobia?!

_________________

Like yourself, I went through my sleep study as a work-up to gastric bypass.

The best advice I van give is to try each type before you decide it's hopeless.

The full mask - while some people don't like the sensation - allows me to breath through my mouth. I'm a mouth breather by necessirty - I could not tolerate the nose mask the tech in my first study put on me - got the "drowning" feeling. But the full mask - despite covering everything - allowed me to get comfrotable and it was 180-degrees of difference.

Some people do well with nose pillows that fit in the nostrils rather than "on" the nose.

The other thing that could give you that "feeling" is the pressure being too low or too high for your needs. Turns out, I need a "high" pressure to get the nasal passages open,. The original study tried pressures that were a full 10 cm/h20 below what I needed - so it explains why I had trouble that first night.

The other thing to keep in mind about the bypass surgery - I haven't had mine yet, but people who have been diagnosed with apnea and told to bring their machines with them have mentioned that they end up not being able to use them for the 2 days they're in the hospital due to being hooked up to other devices/not being able to sleep a full night due to blood draws, etc. It's *weird* - but I believe the diagnosis is more to cover the anesthesiologist's butt - putting an undiagnosed OSA patient under general anethesia is dangerous.

And - look at this for the long term. THe apnea may explain LOTS of different issues. I know for me it explains certain symptoms that I had always just chalked up to the "weight." Whether you have the surgery or not - it's important to get the apnea properly diagnosed and a mask/machine combo that you can live with long-term.

My doc told me straight out during my inital consult - the weight certainly isn't helping the apnea, but losing the weight in and of itself may never eliminate the apnea or my need to be on xPap.

Best of luck to you in finding what works!

[Guest]

Ok first before we all go throwing suggestions out there, what exactly are you having problems tolerating? The mask or the air pressure? There are enough mask coices out there that soething can be tolerable for you.

I regards to your comments about bruising this should have never happened. If this was done by the technician perhaps you should find yourself another doctor. Is your doctor not willing to work with you and aide you in being compliant with treatment?

In regard to the second posters comments about technicians who don't know how to fit masks properly and roughly put them on patients. They should know how to fit them perfectly, they should be able to accomidate the patients needs in regards to a cpap mask, and they should never be putting them on a patients face roughly. If this is the case perhaps you should be reporting them to the doctor and or switching doctors. Are you being treated at an Apnea R Us Sleep Lab? You and you health and the way you are treated should be your primary concern!

[Selena]

When I said 'roughly' I was thinking of an optician who just quickly thrust her hand (and lens) at my eyes one day when I asked to try on colored contacts just for fun years ago (I didn't say 'just for fun' though!), and it was obvious she didn't want me to do it or she would've approached more slowly and carefully! I was not suggesting all or most techs are rough, but sometimes maybe a new one could be something less than sensitive.

[Guest]

in your quote you were of course discussing quite clearly PSG techs...