I thought I couldn't fall asleep

[cmmarti3]

I was given a CPAP almost 2 months ago. I put it on every night. The night goes like this: put it on. Can't fall asleep. Try another mask. Can't fall asleep. Get out of bed. Wait until I feel sleepy. Get back in bed. Put the mask back on. Can't fall asleep. Get back out of bed. And so on. My sleep apnea is severe, but I feel a lot worse since going on this therapy. The neurologist has sent me to a psychologist to help me make this work. I try to do what he says (get up if I can't sleep and leave the bedroom). I have missed many days at work. I have fallen behind on my work and I can see my boss and coworkers are becoming increasingly frustrated with me.

I have tried: Airfit P10 for her, Nuance nasal pillows, Swift FX Nano, full face Quattro Mirage, Dreamwear, Pico and Wisp. I am at my wit's end. I will try tonight AGAIN. But today I had to stay home from work because I couldn't sleep last night with the mask and hose - again. I have friends who went on CPAP after me and are doing just fine. Why am I having such trouble? I want this to work.

I put myself on a diet when I found out how sick I was with this issue. I weighed 266 (I'm a female, 5 ft 4 and have gained 80 pounds over the past 12 years or so) when I started my treatment. I felt a lot better when I was lighter. I now weight 248. I plan on getting town to 170; that's my initial goal. I have no idea what it will do for my AHI but any improvement is better than none.

How do I make this work while not losing my job? I can't keep calling out sick. But I feel much worse now than before. I have a Dreamstation and have viewed some of the wave form reports - when I am actually asleep I don't have events. But most nights that's only an hour or two. The rest of the time I'm awake struggling and multiple centrals, apneas and hypopneas are flagged. My AHI according to my machine each morning is around 20. Again, when I manage to actually sleep my AHI is close to 0. But sleep is few and far between.

I need encouragement. Thank you.

[library lady]

I had nights like yours when I started this journey almost 2 years ago, and almost everybody does have difficulty adjusting to cpap. There are a number of reasons for this, and the number one reason is that your brain doesn't recognize the "alien" on your face. You know it's there and it's OK, but your brain doesn't. In the beginning, you can "train your brain" by spending some time with the mask on with the machine running during your awake hours while reading or watching TV for a couple hours each day. Take it off afterward and then go to bed with the mask and machine on again. Gradually your brain will learn that it is OK to let you go sleep with it. This was hard for me because I need my glasses for reading, and I don't watch much TV, but they don't fit over my mask for sustained reading.

I was also bothered by mask leaking, which was very noisy and I would take it off because of that.
I experimented with several kinds of mask liners about two weeks in.They helped immensely, and within 6 weeks or so I was sleeping through the night most of the time. I also have strap covers to eliminate chafing from my F10 mask. Some people have to try many masks before finding THE ONE. Figure out what your discomfort is, and then work on that... mask liners and strap covers available from http://www.padacheek.com. RemZzz liners are available from many DMEs, they are what I use. You can also google "cpap mask liners" or go to the sponsors of this forum, https://www.cpap.com for liners and other comfort items.

Stick with it, and come back here whenever you need to with questions; there are many knowledgeable users here who helped me, and have helped countless others.

[BlackSpinner]

When you get home long before you go to bed, put on a good exciting / entrancing movie, put on your cpap and watch with it on. That way you can get your mind used to this thing on your face. Do this for as many days as you need to.

Before you go to bed, sit still and try to remember a time when you felt good and sleepy. Many people like to remember a day at the beach for example.
Very carefully remember everything. Start with the visual, in your mind look around you, then the sound - listen to the waves, the birds the insects, then the smell - suntan lotion, the sand the ocean, then the feel - the warm sun, the sand the heaviness, the drowsiness, the cold beer. Now that you have this fixed in your mind put your mask on, turn on the machine and go back to the memory and repeat as needed. Every time you mind looses track and starts fussing go back to the beginning and find each sense in detail.
If a beach is not a pleasant memory then find another one. Somewhere in your past there is a pleasant drowsy afternoon.

[jilliansue]

The neurologist has sent me to a psychologist to help me make this work. I try to do what he says (get up if I can't sleep and leave the bedroom). I need encouragement. Thank you.

Hi! I am glad you are really giving it a try, including going to a psychologist!

Another suggestion I would make is to try hypnotherapy -- with a reputable hypnotherapist, which is much, much different than the stage hypotists we see on tv. That is purely for entertainment. But actual hypnotherapy can help people make significant changes in their lives in a short period of time. I think that learning to be relaxed and fall asleep and stay asleep with the CPAP mask on is something that hypnotherapy could help with. It is possible that the psychologist you are seeing may incorporate hypnotherapy into his/her practice. If not, s/he should hopefully be able to recommend someone to you. Depending on where you live, I may be able to be of some help to you in locating someone.

Good luck! This therapy has a real learning curve, but it is worth sticking with it.

[knothead]

[quote="BlackSpinner"]When you get home long before you go to bed, put on a good exciting / entrancing movie, put on your cpap and watch with it on. That way you can get your mind used to this thing on your face. Do this for as many days as you need to.

CM,
What blackspinner said is how I overcame my phobia(not saying u have one), I sat with my mask on without it being hooked up to machine. I also had a fear of electricity going off and I would not get air...this is NOT true. I got plenty of air just sitting letting my brain get accustomed to the mask. This is a tried and true exercise from many on this forum, give it a try...

[kteague]

Is there anything outside of CPAP that could be contributing to your wakefulness, like meds, supplements, or other sleep disorders such as limb movements? While you are working on adjusting to the treatment it's a good time to also assess other aspects of your sleep. It may be a combination of efforts that ends up paying off.

[WindCpap]

I think your therapist may have missed out on (or you didn't here it) the most important peace of advise you can get. Never sleep with out your mask. There is no way you have gone two months, and never slept. It is not possible. You cannot control when you fall asleep, but you can control when the mask is on your face. If you never allow yourself to sleep without it eventually, you will have to sleep with it.

I would recommend that you arrange 1-3 days off work before or after a weekend. Don't even bother with the CPAP until then. It's not doing you any good now anyway, because, even though it is not mentioned in your post, the only time you are really sleeping is when you don't have the mask on. Pick the mask that is the most comfortable, and don't change it. No mask will be 100% comfortable initially, so don't worry that it is not. Get as much rest as you can in your OSA condition up until then, but be sure not to take a nap on the day of your first night, and limit your caffeine to one cup of coffee very early in the morning if you drink any at all. You are welcome to wear your mask while watching TV up until then to get more used to it. Follow your therapists advise about getting up and doing something else if you want to take your mask off. Above all, don't worry about how much sleep you are getting. This is the number one thing that is keeping you from succeeding.

Don't plan on doing anything critical the day after the first night. I made a very expensive mistake because I did something I should have put off. Don't sleep during the day, and stay out of your bed unless you are going to sleep for the 2-5 days you will be doing this. I promise you that you will do much better once you have removed the stress of having to get sleep.

This is all coming from someone who had to order a pillow from Germany to replace the 20 year old pillow his Wife was making him get rid off. I did the 3 day weekend by coincidence (got my machine on the Friday of a holiday weekend), but I would recommend it to anybody. Sit down between now and your next try, and really think about the logic of doing it this way. You are controlling what you can control (like when your mask is on) and not trying to control things that are out of your control (like when you fall asleep).

Good luck. I know you can do it.

[Wulfman...]

I was given a CPAP almost 2 months ago. I put it on every night. The night goes like this: put it on. Can't fall asleep. Try another mask. Can't fall asleep. Get out of bed. Wait until I feel sleepy. Get back in bed. Put the mask back on. Can't fall asleep. Get back out of bed. And so on. My sleep apnea is severe, but I feel a lot worse since going on this therapy. The neurologist has sent me to a psychologist to help me make this work. I try to do what he says (get up if I can't sleep and leave the bedroom). I have missed many days at work. I have fallen behind on my work and I can see my boss and coworkers are becoming increasingly frustrated with me.

I have tried: Airfit P10 for her, Nuance nasal pillows, Swift FX Nano, full face Quattro Mirage, Dreamwear, Pico and Wisp. I am at my wit's end. I will try tonight AGAIN. But today I had to stay home from work because I couldn't sleep last night with the mask and hose - again. I have friends who went on CPAP after me and are doing just fine. Why am I having such trouble? I want this to work.

I put myself on a diet when I found out how sick I was with this issue. I weighed 266 (I'm a female, 5 ft 4 and have gained 80 pounds over the past 12 years or so) when I started my treatment. I felt a lot better when I was lighter. I now weight 248. I plan on getting town to 170; that's my initial goal. I have no idea what it will do for my AHI but any improvement is better than none.

How do I make this work while not losing my job? I can't keep calling out sick. But I feel much worse now than before. I have a Dreamstation and have viewed some of the wave form reports - when I am actually asleep I don't have events. But most nights that's only an hour or two. The rest of the time I'm awake struggling and multiple centrals, apneas and hypopneas are flagged. My AHI according to my machine each morning is around 20. Again, when I manage to actually sleep my AHI is close to 0. But sleep is few and far between.

I need encouragement. Thank you.

All nasal masks? Maybe it's the direct airflow into your nose that's disturbing. Maybe a full face mask may spread it around a bit.

Also, we don't know what any of your settings are


Den

.

[cmmarti3]

I think your therapist may have missed out on (or you didn't here it) the most important peace of advise you can get. Never sleep with out your mask. There is no way you have gone two months, and never slept. It is not possible. You cannot control when you fall asleep, but you can control when the mask is on your face. If you never allow yourself to sleep without it eventually, you will have to sleep with it.

I would recommend that you arrange 1-3 days off work before or after a weekend. Don't even bother with the CPAP until then. It's not doing you any good now anyway, because, even though it is not mentioned in your post, the only time you are really sleeping is when you don't have the mask on. Pick the mask that is the most comfortable, and don't change it. No mask will be 100% comfortable initially, so don't worry that it is not. Get as much rest as you can in your OSA condition up until then, but be sure not to take a nap on the day of your first night, and limit your caffeine to one cup of coffee very early in the morning if you drink any at all. You are welcome to wear your mask while watching TV up until then to get more used to it. Follow your therapists advise about getting up and doing something else if you want to take your mask off. Above all, don't worry about how much sleep you are getting. This is the number one thing that is keeping you from succeeding.

Don't plan on doing anything critical the day after the first night. I made a very expensive mistake because I did something I should have put off. Don't sleep during the day, and stay out of your bed unless you are going to sleep for the 2-5 days you will be doing this. I promise you that you will do much better once you have removed the stress of having to get sleep.

This is all coming from someone who had to order a pillow from Germany to replace the 20 year old pillow his Wife was making him get rid off. I did the 3 day weekend by coincidence (got my machine on the Friday of a holiday weekend), but I would recommend it to anybody. Sit down between now and your next try, and really think about the logic of doing it this way. You are controlling what you can control (like when your mask is on) and not trying to control things that are out of your control (like when you fall asleep).

Good luck. I know you can do it.

I saw the psychologist tonight. He told me that this advice is spot on. I tried doing this over Thanksgiving but I didn't try hard enough. Also, I kept changing masks to try and find something more comfortable even though I shouldn't be doing that. They are all uncomfortable. I accept it. I am going to go with the Airfit P10 for her for and have put all the other masks in my garage.

I am off of work from December 22 - January 3 for Christmas break (I work at a University) so during this time I will never go to bed without the mask on. I will set my alarm to be up at some reasonable hour each day (I'm thinking 8:30 in the morning) and once I have the mask on, if I can't sleep, I will get up out of bed and go to the living room and read or do something else until I'm sleepy and ready to try again.

My therapist said that I might have to go through two cycles of this. After a couple of very tiring days with little sleep, I'll probably sleep and then may have to go through the process again.

Separately, I think I've learned a bit about self hypnosis. The therapist asked me to read the Insomnia Workbook, which I did read over the weekend. In the book are some relaxation techniques. I tried one last night when I got in bed and got so relaxed that I had an itch on my neck and could not move my arm to scratch it! I don't think I slept during the relaxation exercise, but I was very drowsy and my head felt heavy. Unfortunately my bladder got the better of me and I got up to use the bathroom and then started the cycle of not sleeping, getting out of bed, switching masks, etc.

Tonight I am going to attempt to sleep with the CPAP and the ONE mask that I'll use going forward. If I'm not asleep in a few minutes I'll take it off. I was doing this when I first started and without the pressure of HAVING to fall asleep with it and knowing I have to get up and go to work the next day, I was able to fall asleep more often.

The psychologist also said that while sleep apnea is not good for my organs or heart, the stress that I have put on myself by forcing myself awake into the wee hours of the night (morning) and getting almost no sleep at all is not good for me either.

My settings are currently 7cm to 10cm. They used to be 6cm to 16cm and I asked the doctor's office to raise my minimum a point which they did. When I went in for my last checkup, they apparently changed the maximum pressure to 10. Do you think they did this on purpose? I am going to call tomorrow and ask. I know how to reset the pressure myself, but am wondering if they did it because they saw so many central apneas.

One last question: will my weight loss help with my apnea? I am not asking if I can be cured. I am asking if weight loss necessarily helps or not always? I am severely overweight. As I mentioned in my earlier post, I have lost 18 pounds and plan to lose about 80 more. After how much weight loss should I request a new sleep study to see if my pressure needs have changed? I was going to ask for a new one after I lose 50 pounds more. But I'm not sure.

Thank you for all of the advice. I will put it into action and hope to feel better soon.

[RogerSC]

I haven't read anything about sleep aids yet, but may have missed whether the OP has tried them or not. I remember very clearly that the first night I tried cpap I couldn't get to sleep and just gave up. Since I had to go to work the next day, I had to get some sleep. The next day, I called my doctor and asked for a prescription for Ambien. Took that for about a week, and by the end of the week my body was apparently used to sleeping with all the gear. Stopped taking Ambien, and have been fine ever since.

I do have a problem trying new masks in general, the only time that I had an easy time trying a new mask was when I got the AirFit P10. Most likely because it's so similar to the Swift FX. Unfortunately, I have problems with the headgear on the P10, so I haven't been able to get it to work well for me. Too bad, since it is lighter and quieter.

Anyways, using a sleep aid for a few days (if they work for you) can be really helpful in getting your body in sync with cpap. I also use earplugs, those are helpful in muting external noises, leaving you with just the sound and rhythm of your own breathing.

I'm sure that you'll find your way through this, you're motivated enough to stay with it. Good to see.

[WindCpap]

My settings are currently 7cm to 10cm. They used to be 6cm to 16cm and I asked the doctor's office to raise my minimum a point which they did. When I went in for my last checkup, they apparently changed the maximum pressure to 10. Do you think they did this on purpose? I am going to call tomorrow and ask. I know how to reset the pressure myself, but am wondering if they did it because they saw so many central apneas.

One last question: will my weight loss help with my apnea? I am not asking if I can be cured. I am asking if weight loss necessarily helps or not always? I am severely overweight. As I mentioned in my earlier post, I have lost 18 pounds and plan to lose about 80 more. After how much weight loss should I request a new sleep study to see if my pressure needs have changed? I was going to ask for a new one after I lose 50 pounds more. But I'm not sure.

Thank you for all of the advice. I will put it into action and hope to feel better soon.

I doubt you will need the alarm clock. If you can sleep in with your CPAP gear and not notice the time, you are pretty much fully adjusted.

In all likelihood they changed the upper pressure because you are not doing well adjusting.

I am not a pro, so I cannot comment on if weight loss will help. I am obese, and this is the way I look at it. Obesity and apnea contribute to each other, but that is the end of their relationship. Both are independent causes of a number of health issues (some of which they have in common). Apnea can be fully treated with CPAP, after which time it is no longer relevant to your weight, and will no longer be a detriment to your health. I haven't tried my next weight loss stint yet, but I am hopeful that the not having untreated apnea any more will be helpful. I have a couple of real life friends who both agree that while losing weight or correcting things like a deviated septum may lower pressure needs, there is no real need to do another titration unless the higher pressure is bothering you. As a fellow weight-loss hopeful, I would like to encourage you to try and maintain your weight even if you stop losing for a while.

Something that you can do between now and your break is start to practice proper sleep hygiene (google it). The never sleeping without the mask thing is really just an extension of this. The more control you can take over your sleeping habits the more confident you will be when you start using your cpap again.

Can you let me know your pressure relief (or c-curve or whatever they call it on your machine) settings are, and also if you are using ramp. I can give you some suggestions of what worked for me although you will choose settings based your own preference. There may be a couple of things you can do to reduce the struggle while you are still awake.

[Wulfman...]

I think your therapist may have missed out on (or you didn't here it) the most important peace of advise you can get. Never sleep with out your mask. There is no way you have gone two months, and never slept. It is not possible. You cannot control when you fall asleep, but you can control when the mask is on your face. If you never allow yourself to sleep without it eventually, you will have to sleep with it.

I would recommend that you arrange 1-3 days off work before or after a weekend. Don't even bother with the CPAP until then. It's not doing you any good now anyway, because, even though it is not mentioned in your post, the only time you are really sleeping is when you don't have the mask on. Pick the mask that is the most comfortable, and don't change it. No mask will be 100% comfortable initially, so don't worry that it is not. Get as much rest as you can in your OSA condition up until then, but be sure not to take a nap on the day of your first night, and limit your caffeine to one cup of coffee very early in the morning if you drink any at all. You are welcome to wear your mask while watching TV up until then to get more used to it. Follow your therapists advise about getting up and doing something else if you want to take your mask off. Above all, don't worry about how much sleep you are getting. This is the number one thing that is keeping you from succeeding.

Don't plan on doing anything critical the day after the first night. I made a very expensive mistake because I did something I should have put off. Don't sleep during the day, and stay out of your bed unless you are going to sleep for the 2-5 days you will be doing this. I promise you that you will do much better once you have removed the stress of having to get sleep.

This is all coming from someone who had to order a pillow from Germany to replace the 20 year old pillow his Wife was making him get rid off. I did the 3 day weekend by coincidence (got my machine on the Friday of a holiday weekend), but I would recommend it to anybody. Sit down between now and your next try, and really think about the logic of doing it this way. You are controlling what you can control (like when your mask is on) and not trying to control things that are out of your control (like when you fall asleep).

Good luck. I know you can do it.

I saw the psychologist tonight. He told me that this advice is spot on. I tried doing this over Thanksgiving but I didn't try hard enough. Also, I kept changing masks to try and find something more comfortable even though I shouldn't be doing that. They are all uncomfortable. I accept it. I am going to go with the Airfit P10 for her for and have put all the other masks in my garage.

I am off of work from December 22 - January 3 for Christmas break (I work at a University) so during this time I will never go to bed without the mask on. I will set my alarm to be up at some reasonable hour each day (I'm thinking 8:30 in the morning) and once I have the mask on, if I can't sleep, I will get up out of bed and go to the living room and read or do something else until I'm sleepy and ready to try again.

My therapist said that I might have to go through two cycles of this. After a couple of very tiring days with little sleep, I'll probably sleep and then may have to go through the process again.

Separately, I think I've learned a bit about self hypnosis. The therapist asked me to read the Insomnia Workbook, which I did read over the weekend. In the book are some relaxation techniques. I tried one last night when I got in bed and got so relaxed that I had an itch on my neck and could not move my arm to scratch it! I don't think I slept during the relaxation exercise, but I was very drowsy and my head felt heavy. Unfortunately my bladder got the better of me and I got up to use the bathroom and then started the cycle of not sleeping, getting out of bed, switching masks, etc.

Tonight I am going to attempt to sleep with the CPAP and the ONE mask that I'll use going forward. If I'm not asleep in a few minutes I'll take it off. I was doing this when I first started and without the pressure of HAVING to fall asleep with it and knowing I have to get up and go to work the next day, I was able to fall asleep more often.

The psychologist also said that while sleep apnea is not good for my organs or heart, the stress that I have put on myself by forcing myself awake into the wee hours of the night (morning) and getting almost no sleep at all is not good for me either.

My settings are currently 7cm to 10cm. They used to be 6cm to 16cm and I asked the doctor's office to raise my minimum a point which they did. When I went in for my last checkup, they apparently changed the maximum pressure to 10. Do you think they did this on purpose? I am going to call tomorrow and ask. I know how to reset the pressure myself, but am wondering if they did it because they saw so many central apneas.

One last question: will my weight loss help with my apnea? I am not asking if I can be cured. I am asking if weight loss necessarily helps or not always? I am severely overweight. As I mentioned in my earlier post, I have lost 18 pounds and plan to lose about 80 more. After how much weight loss should I request a new sleep study to see if my pressure needs have changed? I was going to ask for a new one after I lose 50 pounds more. But I'm not sure.

Thank you for all of the advice. I will put it into action and hope to feel better soon.

Possibly the Centrals. There has been a traditional belief that "pressure induced Central Apneas" occur above the pressure of 10 cm. This is why ResMed used the "A10" algorithm for several generations of machines that were reluctant to address apneas above the pressure of 10 cm.........unless there were certain conditions present.


Den

.

[BlackSpinner]

Tonight I am going to attempt to sleep with the CPAP and the ONE mask that I'll use going forward. If I'm not asleep in a few minutes I'll take it off. I was doing this when I first started and without the pressure of HAVING to fall asleep with it and knowing I have to get up and go to work the next day, I was able to fall asleep more often.

NO - you are rewarding your not sleeping by taking off the mask. This is the worst thing you can do. Either decide to spend the night with it on or don't put it on.

Note if you are doing the relaxation techniques and you need a bathroom break, take the break and start the techniques again. Just keep repeating them.

[49er]

cmmarti,

What happens when you try to fall asleep with the mask? Do you feel like you're getting too much air, too little air? Is your nose stuffy or does it feel fine? Do you feel like you want to take the mask off yesterday?

The reason I am asking the last question is I had that feeling with all the masks I tried until I switched to the nasal elan cloth mask listed in my profile. Problem disappeared.

Because of nasal congestion issues, I am revisiting trying a full face mask again. Hopefully my experience will be different but it took a long time for me to get to the point of wanting to try this option again.

Anyway, in case this situation was relevant which I realize it may not be, I wanted to mention that since this mask is rarely suggested as an option even though I think it should be.

I like RogerSC's suggestion of looking into meds on a temporary basis. You also might consider downloading podcasts to listen to that would be interesting but yet relaxing enough to make you drowsy to get to sleep.

Hang in there.

49er

[WindCpap]

Tonight I am going to attempt to sleep with the CPAP and the ONE mask that I'll use going forward. If I'm not asleep in a few minutes I'll take it off. I was doing this when I first started and without the pressure of HAVING to fall asleep with it and knowing I have to get up and go to work the next day, I was able to fall asleep more often.

NO - you are rewarding your not sleeping by taking off the mask. This is the worst thing you can do. Either decide to spend the night with it on or don't put it on.

Note if you are doing the relaxation techniques and you need a bathroom break, take the break and start the techniques again. Just keep repeating them.

BlackSpinner is absolutely right about this. If you take off your mask to fall asleep, you will train your brain that remove mask=sleep. Wait until your vacation. It is only a week away.