panicking + sleep trouble

[cybermom53]

I went on CPAP Nov. 17 and was proud at how quickly and easily I adapted. I was sleeping 7 hours straight in no time. (I started with an Escape and switched to an Elite so I could monitor my numbers). My numbers also looked good.( Average leak 0.14, AHI 1.91, AI 0.24, HI 1.6). My problem: All this week I am having trouble going to sleep and staying asleep. One night I was up ALL NIGHT long. I started to feel panicky for some reason about the mask. I usually read before I go to sleep. This week, I get very tired but then when I shut the light off I start to panic and can't sleep. Last night I finally slept for about four hours, but then woke up and couldn't get back to sleep. Toward morning, I took the mask off and finally dozed. Before I fell asleep I readjusted by ramping time. That seemed to help a bit. I have low pressure levels (from 4 to . Originally, I started with a 20 minute ramp time. Last night I made it 40. Any ideas? At this point, I'm starting to psyche myself out. I hate going to bed and worry about not sleeping. Next week I have to get more sleep because vacation is over. Any suggestions? I don't get why I started out fine and then got worse.

[PST]

I think one of the biggest reasons for panic is too low a starting ramp pressure. I'm certain many other people have made the same comment. At 4 cm, it may simply be impossible to pull enough air to feel comfortable. My problems went away when I increased my starting pressure to 7. I reduced the ramp time as well, but I think that was more an individual choice. Although I use a full face mask, I remember having the same feeling in a nasal mask during my first sleep study. I ended up calling for the tech to get that mask off me. It was only much later I figured out what the issue was.

[scrapper]

I would agree with PST.........I had similar feelings at beginning pressures of 6. 4 is just not enough pressure, unless you are the size of a mouse.

[BlackSpinner]

My problem: All this week I am having trouble going to sleep and staying asleep. One night I was up ALL NIGHT long. I started to feel panicky for some reason about the mask. I usually read before I go to sleep. This week, I get very tired but then when I shut the light off I start to panic and can't sleep. Last night I finally slept for about four hours, but then woke up and couldn't get back to sleep. Toward morning, I took the mask off and finally dozed. Before I fell asleep I readjusted by ramping time.

You checked that your machine is working properly?


Look around at your life and see if there is other things to make you anxious (like christmas bills)
Are you eating different, drinking more?

If you can't see it then take a note book to bed with you and when you panic sit up and write down everything going through your mind - including the four letter words. In the morning after breakfast write a few more pages on what ever comes to mind and then read it all and see if there is a pattern - it may take a few nites. Then address the pattern.

For myself the first few weeks were a breeze, my body needed the sleep so badly it over rode everything. After the first few weeks my claustrophobia acted up a bit and I had to tell it to shut up and get with the program.

[ozij]

Next week I have to get more sleep because vacation is over. Any suggestions? I don't get why I started out fine and then got worse.

Because vacation is over, and instead of sleeping, and enjoying your sleep whichever way it comes, you've started thinking of how many hours you have to get?

All of us have some bad nights interspersed with the good. Just take them as they come.

[kteague]

Just want to cosign a couple things. First, that your exhaustion may have enabled you to sleep better in the beginning. Secondly, that your starting ramp of 4 could be an issue. Your panic/anxiety could be your body trying to tell you something's wrong with your treatment. If that's the case, by increasing the ramp time you are prolonging the need for the warning sensations. I think you should reduce your ramp time and increase your ramp starting pressure. Another problem with a long ramp is if you happen to fall asleep right away, the rest of the ramp time you are subject to events without adequate protection. Having a long low ramp was nearly my downfall. Those who wake frequently but fall right back asleep are to me in the greatest danger when using a long ramp time. If you add all the minutes asleep unprotected, it can end up being a great portion of the night for those people. I was one of them. Some nights I figured I'd been sleeping under ramp nearly all of my time asleep. My exhaustion caused me to fall asleep immediately, but I woke up before it was even out of ramp, then hit it again to go right back to sleep. Increasing my ramp pressure and reducing my ramp time ushered in the beginning of my cpap success. Ramp is intended to be a comfort feature to be utilized at the user's preference. Only problem is most new users aren't given enough understanding of the feature to make helpful decisions about how to use it. I'm guessing a few changes will get you back on track, able to relax and trust the treatment.

[Lee Lee]

I agree 100 percent with the other posters. I had the same problem for the reasons mentioned. 4 is just too low for most people.
Also, your body is not used to all the sleep you've been getting. It will adjust soon.
Since you had such great success at the beginning, you will have it again. I bet you're going to be great at this!
Please let us know.

[DoriC]

Ramp is an individual comfort feature and most people even turn it off a few weeks after adjusting to their pressure setting. I don't think you mentioned your setting but if it's not too high and you feel comfortable you might try turning ramp off and see how it goes. kteague gives a GREAT explanation of the ramp feature.

[cybermom53]

I start with 4 and eventually go to 8 - both relatively low settings. The weird thing is it worked so well in the beginning.
I think I went with the longer ramp because I (at least in my head) feel more panicky when it's blowing harder. On an Elite, can I readjust my own settings or if I want to try a higher starting pressure do I need to take the machine back to be reset?

[ozij]

Do you think it's possible you may have inadvertently changed your EPR? That's something you can control, and drops the pressure when you exhale: 1 give you the smallest drop (or relief) and 3 the highest.

My deepest sense of panic used to come when I had the ramp on -- I kept waiting for the moment the pressure would be unpleasantly high, and could not relax. Try to raise the ramp starting pressure while you awake and relaxed -- and raise only as high as you feel comfortable - let yourself breathe for about 5 minute after you've change it.

You can change your treatment pressure too, but do try to change the ramp minimum first - you can do it in 0.2 increments. Be sure to make the adjustments during the day, when you're awake an relaxed -- not when you're in a panic.

You can find instructions for adjusting your machine here:
http://www.apneaboard.com/CPAP%20Adjustment.htm

You'll find the clinicians manual here: http://www.apneaboard.com/manuals2/ResM ... lSetup.pdf


O.