Having trouble adapting

[eloylb]

Hello,

I've been using my APAP machine for 3 weeks now and I'm having trouble adapting to it.
It's preventing me from sleeping, mainly because of the breathing noise from the mask and some noise from the machine. In all three weeks, I have put it on average 1 hour each night and then removed it because I couldn't sleep. Only one night I managed to sleep with it for 4 hours. I think I managed this because I slept on my side, but when I tried this (sleeping on my side) for the subsequent nights, I had aerophagia.

I tried changing the mask for a nose pillow one, but it was worse.

I don't know if I can continue trying on using the machine.

Any advice on how to make this work?

Thank you.

[Pugsy]

What pressure is being used?

Machine noise can be disturbing for some people. We do get used to it over time. Perhaps using some "white noise" in the background can help get the mind off the machine and mask noise.. Some use music.

Members here will likely chime in with ideas and what helped them. I can't offer specific ideas on that part of your problem because the noise never bothered me. So I never experienced that particular bump in the therapy road.

[eloylb]

The pressure used is 5-20

[Pugsy]

What is the machine showing as AHI average, Leak average? Pressure average?
Do you know how to get to that information? If not take a peek here.
http://www.apneaboard.com/PR-System-One ... -Setup.htm

5-20 wide open, that alone can affect your sleep if it goes up a lot for whatever reason.

[Lizistired]

Did you have a titration sleep study done to determine a more specific pressure?

[eloylb]

Did you have a titration sleep study done to determine a more specific pressure?

My doctor determined this pressure after I've done a study

[eloylb]

What is the machine showing as AHI average, Leak average? Pressure average?
Do you know how to get to that information? If not take a peek here.
http://www.apneaboard.com/PR-System-One ... -Setup.htm

5-20 wide open, that alone can affect your sleep if it goes up a lot for whatever reason.

The AHI and pressure average is 8. No leaks.

[Pugsy]

Are you sure about that zero leak? Your machine should at least report the normal vent rate as a leak...

AHI average of 8

and pressure average of 8

If pressure is only going to 8 most of the time then there isn't a huge difference between the starting 5 and the 8.

Did you get copies of your sleep study results to compare to? AHI of 8 is considered higher than the accepted 5 for effective treatment. Though it isn't hugely high. It does warrant improvement but that only comes once you figure out how to keep the mask and machine on throughout the night.

I would think the first thing to work on is keeping the mask on and figuring out what you need to do to get to sleep and stay asleep. Have you spoken with your doctor about these issues? Lots of things can keep us awake and thus make it seem like we focus on the machine noise. Kind of a viscous little circle.

Have you thought about using the machine and mask while awake and maybe watching TV so that you get more accustomed to the sounds? Take a hard look at your normal routine regarding good sleep hygiene to see if anything there could be improved upon. Meds? Caffeine? Anything that might tend to make a person more aware of machine noise. Mask bugging you?

Machine noise, where is the machine in relation to where you lay? Can you set it lower so the sound is farther away?
Try setting it on something soft like a towel to help muffle the sound. Vent noise? Can't do much about that except try to keep the air vented from touching anything because that can increase the sound.

Need to work on using the mask and machine much longer obviously. Trial and error on things to help with the noise.
I think a lot of it will be training your mind not to "hear" the noise as much. Also take a good long look at your overall sleep hygiene. Google sleep hygiene if you don't know what I mean. See if anything you do might be impacting overall sleep.

[robysue]

Hello,

I've been using my APAP machine for 3 weeks now and I'm having trouble adapting to it.
It's preventing me from sleeping, mainly because of the breathing noise from the mask and some noise from the machine. In all three weeks, I have put it on average 1 hour each night and then removed it because I couldn't sleep. Only one night I managed to sleep with it for 4 hours. I think I managed this because I slept on my side, but when I tried this (sleeping on my side) for the subsequent nights, I had aerophagia.

Have you tried contacting the sleep doctor's office to report both the insomnia and the aerophagia? That's the first thing that I think you should do. Tell the receptionist who answers the phone that you absolutely need to speak to a nurse, a PA, or doctor because trying to use the CPAP is leading to serious problems with your sleep and that you are just about at the point of giving up.

It may not help: You may be told, ``It just takes time.'' But it's still important to contact the doctor's office. Talking to a nurse or PA maybe better than talking to the doctor: The training of nurses and PAs stress dealing with a patient as a whole person in a way that seems to be lacking in the typical training of doctors.

Any advice on how to make this work?

For the insomnia:

• 1) Work on improving your overall sleep hygiene. Two standard variations on the good sleep hygiene rules can be found at http://www.umm.edu/sleep/sleep_hyg.htm and http://www.sleepeducation.com/Hygiene.aspx .
  
  2) The most important of the good sleep hygiene rules (in my opinion) --modified for the specific purposes of learning to sleep with the mask on---are
  • A) Do NOT lie in bed AWAKE with the mask on and for long periods of time. If you have not fallen asleep within about 30 minutes, you are likely MORE awake and alert than when you first went to bed. Cruel as it sounds, the best strategy is to get out of bed, go into a different room, and so something relaxing and soothing for a while. Return to the bedroom and your bed ONLY after you've become sleepy enough to try again: Remember to mask up when you return to bed.
    Rationale behind this rule; You need to consciously teach both your MIND and BODY that (1) being in bed means you SHOULD be asleep and (2) being asleep MEANS being masked up. Lying in the bed with the mask on and NOT sleeping, however, teaches your MIND and BODY exactly the opposite: It teaches your mind and body that it's ok to be WIDE AWAKE in the bed and that "CPAP = anxiety, discomfort, and insomnia"
    
    B) Don't watch the clock! If necessary move the alarm clock to somewhere where you CANNOT see or check it when you wake up or when you are lying in bed trying to get to sleep at the beginning of the night. For the "30 minute rule" in item #2, just estimate in your mind when 30 minutes is up. The actual time between first trying to get to sleep (or back to sleep) and deciding to get up is LESS important than your brain's impression of the time. Focusing on the clock will FEED the insomnia. Try to NOT worry about how little you think you've slept and how little time there is until you have to get up. Such worries are counterproductive and make it harder to both get to sleep and to stay asleep.
    
    C) If you do have to get out of bed because you are not sleeping, do a quiet, relaxing activity that will get your mind off of both the CPAP and the insomnia. I've used listening to soft, quiet relaxing music in a semi-dark room for example. Reading something NON-work related and NON-exciting may help: But don't read in bed---go into a different room to do the reading. Web browsing and watching TV are not particularly good activities since they are stimulating---it's got something to do with the kind of light that the screens emit.
    
    D) Learn how to distinguish between feeling sleepy and feeling tired or exhausted. It's not enough to be tired or exhausted when you go to bed. You must be sleepy enough to fall asleep in a reasonable amount of time.
    
    E) Do NOT consciously allow yourself to fall asleep without the mask on. Remember you must work HARD on teaching both your MIND and BODY to form a deep association that Time for sleep = Wear the mask. Every time you consciously allow yourself to fall asleep without the mask on, you undermine establishing this deep association.
    
    F) If you rip the mask off in your sleep and wake up without it on, don't beat yourself up. But do calmly put the mask back on and then go back to sleep.
  3) Consider using sleep meds if you think they might help. This is a personal choice in my opinion, and not everybody is willing to use sleeping pills (I am not). But they do make a real difference for some folks. If you decide to use sleeping pills, make sure you talk to a nurse, PA, or the sleep doctor about which ones are most appropriate: Some sleeping pills have a tendency to aggravate OSA. Be careful of just using OTC sleeping pills. Be cautious about triggering rebound insonmnia. If you do opt for asking for a prescription sleeping pill, be sure to talk to the person who prescribes it about how long you should plan on taking the medicine and how to wean yourself off the medicine in such a way as to not trigger rebound insomnia.

For the breathing noise from the mask issue:

• 1) One thing that can trigger being over conscious of your own breathing noise is conducted noise coming from the tubing. It can magnify the sound of your breathing as it affects the pressurized air being blown into your mask by the machine. Moving the hose even slightly can help with this problem.
  
  And just what is conducted noise? All solids are capable of transmitting sound waves. It's just that we're usually not attached to a solid that is carrying sound waves in an environment that allows the conducted noise to be particularly noticeable to us. The sound waves the hose are carrying, by the way, include the sound of your breathing as well as the sounds the machine itself is making. And every inhale/exhale you make affects the flow of the air in the hose, which affects the sound of the flow of the air ....
  
  In general, conducted noise that we notice is from sound waves that are transmitted through solid substances (the hose, your pillows, covers, body) to your head and skull, and directly into your inner ear; thus conducted noise completely avoids the usual transmission route for sound through the outer ear through the ear drum, into the middle ear, through the three small bones in the middle ear and into the inner ear. Because conducted noise gets to your inner ear without going through the outer ear at all, using earplugs to dampen or block noise can actually intensify annoying and irritating conducted noise because the earplugs fit into your outer ear and only block the NON-conducted noise.
  
  As to how to move the hose if the sound of your breathing is bugging you: If it's lying on your pillow or actually touching your head---particularly the area around the back of your ears, try to move your head and the hose to minimize the contact between the hose and the pillow and your head. The hose touching the pillow is the usual number one suspect in conducted noise from the hose. (That's also part of why the special CPAP pillows with the cutouts for the mask not only help stabilize the mask and reduce leaks, but also may help with conducted noise issues.)
  
  Another thing to try is to give the conducted noise some competition. Using a white noise generator is one possible solution. Or listening to a CD of nature sounds. Listening to very quiet music also lets you ignore the conducted noise. All of these work on the same principal: In general irritating noises (be they real or nasty tinnitus) are often easy to ignore in the presence of a more pleasant auditory stimulus. And note: You do NOT need to have the volume of the white noise, nature sounds, or music on high enough to drown the conducted noise out---no it's actually more effective in the long run if the music is at a comfortable (quiet) level for sleeping that's just barely loud enough to give the conducted noise competition for your attention. That's all it takes to get your mind off the conducted noise--competition from a more pleasant auditory stimulus that you'd rather listen to. Then the conducted noise fades into the background and you don't notice it. Same trick works for my tinnitus by the way.
  
  Because my husband doesn't object to it (in fact he tells me he enjoys it), I've dealt with the conducted noise issue myself by leaving my iHome on all night repeatedly looping through a Gregorian chant playlist playing at a reasonable volume. I can't stand headphones or earbuds and I was noticing that I kept waking up when the iHome was turning itself OFF when I was using it's Sleep feature. So it's better for my sleep to just leave the Gregorian chants playing all night long. And the Gregorian chant keeps my mind off the conducted noise from the hose unless I've got a migraine or tension headache brewing. But that's another issue all together.
  
  2) Do NOT use earplugs to try to deal with the conducted noise! Earplugs only block sound entering your ears through the OUTER ear. Since conducted noise gets to the middle and inner ear through your SKULL, placing earplugs into your outer ears is likely to make the conducted noise LOUDER and MORE IRRITATING!

For the aerophagia:

• 1) Even if you don't have any symptoms of GERD, you might want to be tested for it. There is apparently a link between CPAPers with GERD an CPAPers with aerophagia.
  
  2) Use GERD self-help, lifestyle and home remedies even if you don't have GERD. A decent copy of the self help for GERD guidelines can be found at http://www.mayoclinic.com/health/gerd/D ... e-remedies
  
  3) Don't eat close to bedtime. A smaller, earlier supper (and a bigger, earlier lunch) may help a lot.
  
  4) If EPR or Flex is OFF, consider turning it ON. Sometimes a bit of pressure relief at the beginning of each exhale is enough to help with aerophagia. If EPR or Flex is ON, consider changing the setting to see if that helps. And though it is counterintuitive, if EPR or Flex is ON, you might also want to consider turning it OFF since for some people, the change in pressure towards the end of the exhale winds up making the aerophagia worse.
  
  5) Report the aerophagia to the sleep doctor's office. If it gets worse, report it again. (And again and again if you have to.) For some people, aerophagia may indicate a pressure setting that is simply too high. And a slight reduction in pressure may help. For some people, it may be necessary to switch to a BiPAP in order to bring the aerophagia down to tolerable levels. [That's one of the reasons that I'm now on a BiPAP instead of an APAP/CPAP.

[/list]

Good luck!

[eloylb]

Thanks for all your answers. I did contact the doctor's office and booked an appointment with him. Meanwhile, I'll try your advices as of today.

[Janknitz]

The PR system one shows only 7 and 30 day averages for pressures, leaks, and AHI on the screen. The leak info is almost useless--it records only "large leaks" and for a large leak to register as a 7 or 30 day average it has to be a giant leak that goes on for a very long time. Your average pressure of 8 may not tell much either, because in the first few days it was probably highest, and that's figured into the average. To get more detailed data you need to purchase Encore Viewer software, which you can purchase from online CPAP suppliers. Your doctor has to have Encore Pro software in order to read your card, so it will be interesting to see if your doctor even has the software.

If you had a titration, it's unclear why you have such a "wide open" pressure setting of 5 to 20. Some professionals mistakenly think that will "cover" all of your apneas, but it really doesn't work that way. A wide open setting makes your machine "chase" your events, and that constant change in pressure can disturb your sleep. So you need to talk to your doctor about narrowing the pressure range.

Here's a trick for the aerophagia--try to keep your tongue on the roof of your mouth. This seals off your mouth from the nasal pharynx and stops the air from being swallowed.

Definitely try some white noise to mask the machine noise--a fan, sound machine, MP3 player, etc. It's OK to lie on your side, BTW. If necessary, "hang" the mask off the edge of the pillow. Try wearing the mask and using the machine during the day when you are not trying to sleep to get used to it.

[Vladesch]

Practice using the machine while you're awake. For example, instead of watching TV in your lounge at night, put one in the bedroom, and watch with the cpap machine connected. That way you will get "used to it" quicker.

[robysue]

Practice using the machine while you're awake. For example, instead of watching TV in your lounge at night, put one in the bedroom, and watch with the cpap machine connected. That way you will get "used to it" quicker.

I'd caution putting a TV in the bedroom if you're having ANY trouble at all getting to sleep or staying asleep. The light emitted by TV's can seriously aggravate insomnia. And watching TV in bed will leave your mind MORE alert and LESS sleepy---even after you turn the TV off. The very first thing folks with insomnia are told to do is kick the tv out of the bedroom along with the laptop and any other electronic devices such as smart cell phones that you spend significant amounts of time on doing such things as texting, web browsing, email reading, game playing, etc.

However, dragging the CPAP out to the living room or den and putting it on when you're in the recliner, lounge chair, sofa, etc. and watching the TV may very well help you get accustomed to the flow of air. And it's not like dragging the CPAP out to another room is hard work for most folks. They are pretty small and light.