New Guy- Trouble sleeping with mask.

[Kotengu]

Hello everyone, my name is CJ and I'm new to the forums. (I had posted before but now my profile has been filled in)

I have had my machine for almost a year now and I'm having a lot of trouble falling asleep and staying asleep with the Cpap mask. When I put the mask on, it seems to wake me up, like it's telling my brain I can't go to sleep yet because there is something on my face. When I actually sleep with it on, I rip it off my face in the middle of the night and have no recollection of doing it. One of my problems with falling asleep with the mask on, is that I have chronic Sinusitis, so it's very difficult to breath through the mask. I have tried various nasal sprays and a Neti pot with no success. In spite of having this problem, my sleep doctor told me to continue using the nasal mask as it is much more natural to breath through your nose while you sleep. When I asked if the Sinus problems could be the cause of my sleep apnea, he said that it is highly unlikely.

Does anyone have any insight or advice for my situation? Thank you.

[Julie]

Hi, well first thing would be to ask if you keep your humidity set high, because that alone causes congestion for many people (occasionally though, the opposite occurs). The second would be to say that your MD is not necessarily the brightest bulb when it comes to this situation, and you probably should see an ENT doctor (ask for the referral - he shouldn't refuse to do it) to get a proper diagnosis on your sinuses - whether anything really is 'wrong' or it's just e.g. a humidity problem or something else. The last thing would be to try a full face mask because when you can't breathe through your nose (whatever the 'ideal' is) you need to breathe through your mouth, but on Cpap, that would mean losing all the 'good' air that way, but in a FF mask, your mouth can be open and you'll still get treated. Another thing would be to ask you what your pressure settings are... your prescribed one and the machine one(s). So often MD's prescribe (initially) a very low pressure at which no one can breathe comfortably, so we often do a little tweaking on our own to reset it. As well, if you're using the ramp feature, that too is likely set to begin low and take too long (for comfort) to reach the presribed pressure, even if that is reasonable, so most of us no longer use the ramp after a very short initial period. Also, using an Apap vs Cpap machine (you can use straight Cpap on one if you want, but have the advantage of Apap when you need it) would be a good idea as it doesn't cost more to the insce. co. (codes are the same) and you can see (at least through the window, if not on a computer) how you're doing and what pressures you actually need overnight.

[freshair]

I agree with julie about the humidity and ramp feature--When I first started therapy I use the ramp 4cm-10cm, now I don't use the ramp feature, I go for the "Whole Blow", as with you I have always had sinus problems especially here in the Ohio River valley area--so now my therapy consist of Large Tan breathe Right strips, Nasonex 1 hr before bedtime, a sleep aid and the quattro ff of which is a life saver, I'm waiting for the quattro fx to come out and give it a try--The one thing that does irritate me is I do have to adjust my mask every nite, its not like I can set it one way and never have to change but I do--but I am alot better off now than I was 3 months ago with major problems that I have had for years--FA

[DocWeezy]

Since you have chronic sinusitis, I'm surprised that your sleep doctor is insisting that you say with a nasal mask. More natural for whom? Some of us are lifelong mouth breathers for whatever reason, and to try and make a forced change in breathing preferences at the same time as trying to adapt to a cpap seems cruel and illogical to me. So many different mask styles are manufactured for a reason--not everyone is the same and not everyone can use a nasal mask. I wish I could use one because they seem so nice and small....but it is only a dream for me.

There are places online where you can buy masks without a prescription--is there anything stopping you from buying a different mask and trying it? It seems as if you've given the nasal masks a good try and now it is time to try something different.

If my doc had forced me to use a nasal mask, there is NO WAY I would ever be able to adjust to a cpap machine. As it is, it has been a 5 week struggle trying out different masks, then hacking one mask that had the most potential. Now I can actually get through a night without ripping the mask off in my sleep.

Also, if your doc is so adamant and won't listen to YOUR needs, is it possible for you to find and go to another sleep doc? Why stay with one that is not helping you because of some misguided notion that a nasal mask is "best"?

Weezy

[ChelseaChestnut]

I am new to all this, so I am learning lots of tricks to help me fall asleep with my mask on. One thing I do is make sure I am extremely tired before I go to bed. If I am at all not sleepy, I usually can't fall asleep with my mask on. Another thing I do is get all my gear ready way before bedtime. That way when I am tired, all I have to do is slip the mask on, get comfy and fall asleep.

I too have woken up to find that I took my mask off, put it away, and turned my machine off, all without remembering it. I have been told that this will eventually go away as I get used to it.

I have been a mouth breather my whole life and my nose is always congested, so I use a full face mask. One of the most important keys to success with cpap is having the right mask. If your doctor is not willing to let you use a full face mask, then get a new doctor.

You have been going at this a long time and it's very possible that you need to be retested to check your pressure settings. If you are not getting enough pressure and not getting enough air, then your body's natural reaction is to take off the mask.

Good luck!!!

[brazospearl]

CJ, welcome to the forum! Like Julie said, you need to pay attention to your pressure and whether you're using the ramp and/or exhalation relief, and try adjusting your humidity as well. What you're describing sounds like your pressure might not be at the best level for you right now. I also think you need to investigate more mask options. Many in your position do much better with full-face masks. Yes, breathing nasally might be "better" in some ways, but if that isn't happening it seems that mouth breathing while on the cpap is better than mouth breathing without the machine. If your doctor likes the nasal mask so much he is certainly free to use one, but YOU need to do something different. And it isn't a question of what he "lets" you do; his job is to diagnose & write the prescription, your job is to maximize your therapy. You do NOT need his permission to change masks. I like the Hybrid, but there are many masks that allow you to breathe through your mouth as well as your nose. Keep reading here, keep asking questions, you can make this work!

[SleepingUgly]

When I put the mask on, it seems to wake me up, like it's telling my brain I can't go to sleep yet because there is something on my face.

I also have problems just strapping a mask on and going to sleep. All the adjustments, seating and reseating, etc. wakes me up too much. So my technique is to get in bed, put on the mask, adjust it, and then read something really boring for a bit. This is not easy to do because I wear glasses and I have to hold the book up to either side of the post, basically reading up close with one eye.

When I actually sleep with it on, I rip it off my face in the middle of the night and have no recollection of doing it.

Some people use medical tape or painters tape to tape the mask on to the face enough that if you were to take the mask off, the sensation would wake you up. Some machines have alarms that sound if you take the mask off.

One of my problems with falling asleep with the mask on, is that I have chronic Sinusitis, so it's very difficult to breath through the mask. I have tried various nasal sprays and a Neti pot with no success.

Did you try these sprays and neti pot with no success in breathing through your nose PRIOR to when you started CPAP? If so, I doubt that it's the humidity or the ramp issue that is causing your problem, although it can be exacerbating it.

In spite of having this problem, my sleep doctor told me to continue using the nasal mask as it is much more natural to breath through your nose while you sleep.

As someone else said, you should go to an ENT. If the ENT determines that nothing can be done, then you can switch to a FFM. If something can be done (e.g., switch to another medication), I am not a fan of the FFM and I generally agree that nasal is better. But the importance of breathing should not be underestimated.

When I asked if the Sinus problems could be the cause of my sleep apnea, he said that it is highly unlikely.

What were the findings on your sleep study? Full apneas, hypopneas, RERAs? AHI?

When I had my last sleep study, they made a point of telling me that the measurements are at the nose, so if I can't breathe well through my nose... (Gee, don't you wish I could remember the last part of that sentence?) I don't remember exactly how they worded it, but the sense I got is that I will register as if I have apnea if I can't breathe well through my nose. Furthermore, in a often cited study (often cited by me, that is), apnea was induced in healthy, normal volunteers by occluding their nose, but could not be induced by occluding their mouth (this was complete occlusion, mind you). In another often cited article (again by me), opening the mouth can cause airway collapse, even in the absence of mouth breathing. In a case study, a physician treated his apnea by wearing a chin strap only. I assume that worked for him due to the mouth-opening-->airway collapse.

Get your nose looked at and maximize your nasal breathing. God knows the nose is the key to happiness.

Does anyone have any insight or advice for my situation? Thank you.

I hope this was insightful advice, but if not, at least it was free.

[Kotengu]

Thank you everyone!

About my ramp settings, pressure, AHI and such, I can't remember any of that information and I'm not sure how to check those settings myself, but I'm going to take a list of questions with me on Wednesday when I see my sleep counselor. As soon as I get that information, I'll fill everyone in a little better.
On the subject of the mask; When I asked my counselor about it, he left me with the impression that it was not just uncomfortable, but it was less effective at treating sleep apnea in general. He said that it was much more prone to leaks, and that you can swallow air when you're sleeping. He said that if I really toughed it out and stuck with the nose mask, it would benefit me in the long run. On Wednesday, I'll buy a full face mask. I'm sure he'll just be happy that I haven't given up.
Someone was asking if I had trouble breathing through my nose on a previous post. I've had nasal congestion since I was very, very young. I don't have any obstruction, like a deviated septum or anything. It's just chronic inflammation. I've seen a couple allergist but none of that treatment seemed to help. They always just flare up no matter what pills or sprays I use. I even went as far as seeing an Alternative medicine doctor. She had me do a hypoallergenic diet where I stopped eating foods such as dairy and gluten. That also proved to be a huge waste of money. When I first saw my sleep doctor, he noticed right away that I was breathing through my mouth. He then looked inside my mouth and said that the back of my throat was red and irritated. At this point, I don't really see anyway to "fix" my sinuses. I'm still going to see an Ear nose and throat doctor but until then, I will just have to get the FFM and hope for the best.
Well, thanks again and I'll be back soon with an update...

[MoonBear]

Hi,

For whatever its worth, I just started and am a mouth breather. I use the Mirage Quattro, and apart from it's weight, I like it, and am shocked at sleeping through the night with it on. It is heavy, but I decided it was too hard to try to adjust to a nose mask ( so tempting) because just doing cpap was enough of an adjustment for a while. For me, a higher humidity setting has left me uncontested and with an only slightly dry mouth in the morning.

My pulminolgist's sleep tech, who has had apnea for 10 years, had me try the quattro and while I have no track record of ease of use, needless to say I am very encouraged. I can't imagine it will get anything but better over time.

The heck with what is ideal. What is ideal in my head is being compliant, and getting my life back. You sound like an extraordinarily patient person to have stuck with this for a year without it working for you. If I were in your position, I would find another doctor without this prejudice. It seems downright cruel to me to tell you to breathe in a way which is anatomically difficult for you.

I hope you will write back and let us know what happens after your Wednesday appointment. Off to sleep, perchance to, well, sleep.

Namaste,
MoonBear

[Julie]

Hi - you can get the 'clinical manual' for your machine at Apneaboard.com (make sure you get it for the exact model) which will allow you to change your own settings. It's also a good idea to read whatever you can under the lightbulb at the top of the forum pg here, which explains everything you ever wanted to know about OSA and Cpap.

[BusyLyn]

Another newbie here...

Yes, a full face mask is more prone to leaks, but that's because it's a bigger mask, covering a larger surface area and with a larger perimeter. I have had nasal/sinus issues for most of my life, some related to allergy, some not. I was so congested at the time of my titration study that the only way I could breathe at all was with a full face mask. I was amazed that the air flow while I wore the mask actually cleared out some of the congestion so that I breathed mostly through my nose during the titration study and, now, here at home.

Would I love to have a smaller, lighter mask? Sure -- maybe some day. Right now I am working hard to fully adjust to cpap therapy and getting my nasal/sinus issues under better control, so using a FFM is the price I'm willing to pay to be compliant, and it allows me to get as much benefit as possible from my therapy. I sleep all night with my mask, and my average AHI is down to 1.1 - not too shabby with a FFM if I do say so myself.

Adjusting to cpap therapy isn't trivial - it's a war with many battles. The overriding goal is to derive as much benefit as possible from therapy with the fewest number of ongoing problems. One size definitely does NOT fit all, or there would be no need for the selection of full face masks, nasal masks, nasal pillows, hybrids, or cpap, apap, bipap, etc. machines with different pressures. Someone insisting that you use his theoretical 'ideal' equipment to achieve your own, real-life therapy benefits is delusional. The goal is maximized therapy benefits. Your ideal equipment is what works best for you, my ideal equipment is what works best for me.

Hang in there. Learn as much as you can about OSA and therapy -- it's your life!

Lyn

[sleepyb]

I use both a FFM (Liberty hybrid) and nose pillows (Swift LT). On the occasions that I am not congested when I go to bed I use the LT, but as my congestion is pretty bad during the winter I use the FFM more and more. It's strange but using the FFM I end up breathing through my nose after awhile. Maybe the filtered warm moist air clears my sinuses. When I am somewhat congested the LT makes me nervous that my nose will clog and that just causes things to be worse. Yes there are more leaks with the FFM but I know that if my nose clogs I can still get that air by opening my mouth and that is comforting.