DOES SLEEING WITHOUT "IT" FOR 2 HOURS RUIN THE AFFECT?

[SUEBRIT]

I have been using the CPAP for about three weeks now and it is taking me sometime to getting used to having something on my face when I sleep! I am using a half mask, which is comfortable but annoying! Nose pillows did not agree with me. I fall asleep between 10 and 11 and sometimes wake up at 4 or 5am and then take off the mast and it is a pleasure to go back to sleep without the mask!! Am I ruining the positive affects by doing this? Should I force myself to keep it on all the time, while I get used to it?

[nanwilson]

Sue
It all depends if you want to wake up or not. Using your cpap is a must for the WHOLE night, if you ever had a central while not using the machine the results could be devastating.
N

[NancyAZ]

I'm new at this (5 weeks) so I don't know whether or not it ruins everything but I do know that you need to get to the point where you can enjoy sleeping WITH the machine and mask. I'm afraid that sleeping without the mask just prolongs the process of getting used to therapy. But as I said, I'm just one of the "new kids" here so I will defer to the experts on this forum. I do know that I now feel as though the mask and machine are just part of my bedtime routine and it actually causes me to fall asleep quickly. Good luck.

Nancy

[avi123]

Medicare's requirement for paying costs coverage for those insured are that the CPAP has been used for at least 4 hours per night on 70% of nights during a 30-day consecutive period.

So, I assume that this is the min time for effective treatment. However, even if it does not say specifically that sleeping more time with the CPAP will improve the treatment, it is known to be so.

I also been cutting corners and stopping the CPAP often, especially when I happened to sleep more than 8 hours. Last night, appereantly, I skipped 3 hours by stopping the machine and removing the mask. I can tell it by looking at the CPAP display in the morning showing only 5 hours of sleep. Of course it effects some of the data such as AHI which are averaged over the sleep time if I want to compare last night's number to other nights.

And also, I been loosing treatment time. But saying that if you don't have the CPAP on at a certain time during the day or night, you could be missing an event, sounds a bit kookoo to me.

[Janknitz]

Every time you sleep without CPAP you are harming your body.

They say that sleep apnea is a "death of a thousand cuts". One cut, or two or three won't hurt you that badly, but as you add them up, the damage is catasrophic. And you are negating any healing that is going on from the restorative sleep you are getting with your mask by sleeping without it. So yes, it absolutely ruins the effect.

You must get used to sleeping with your machine ALL night, every night. It is hard to go back to sleep with the machine on when you wake in the middle of the night.

Maybe you need to look at trying to eliminate whatever is causing you to wake in the first place. Is there anything you are noticing (i.e. leaks, increased pressure, feeling of not having enough air) that could possibly be corrected for?

[trytryagain]

I have been using my machine faithfully every night since I started therapy in September. My machine shows 7-8 hrs every morning. I wake up almost every night around 3am and toss and turn for 3 more hours with maybe a few 10 minute dozing. I just can't get through the entire night asleep. There have been times when at take my mask off at 6:00am and fall asleep without it for another 30-45 minutes. I didn't think that would be harmful? My AHI has improved and gone down to <2 every night and have less leaking too. I alternate masks from FF to nasal to pillows. Have yet to find my dream mask.

[billbolton]

I just can't get through the entire night asleep.

CPAP is not, by any means, a silver bullet solution for all sleeping problems. It just addresses some of the more common Sleep Disordered Breathing (SDB) problems related to Obstructive Sleep Apnea (OSA).

You may need to talk to your sleep clinician about whether there are other sleep issues for you that need addressing.

Cheers,

Bill

[jdm2857]

Medicare's requirement for paying costs coverage for those insured are that the CPAP has been used for at least 4 hours per night on 70% of nights during a 30-day consecutive period.

So, I assume that this is the min time for effective treatment. However, even if it does not say specifically that sleeping more time with the CPAP will improve the treatment, it is known to be so.

That's a pretty bad assumption. Medicare needed a black-and-white standard for determining compliance. One that would work for everyone, including those that claim they only sleep for 5 hours a night. So they set a standard that no reasonable person could claim was longer than their normal length of sleep per night.

Medicare certainly did not do studies to determine that 4 hours of CPAP use per night was sufficient therapy.

Think about it for a minute. CPAP does not supply something positive to the body. For such a therapy, it might be possible to determine a minimum effective amount. Instead, CPAP prevents a negative condition which has severe effects on the body. And that negative condition should be prevented whenever it occurs.

[Georgio]

If I fall asleep on the couch for even 20 minutes, I often wake up from my "nap" with a headache. A sure sign my O2 sats dropped lower than they need to be!

Good luck with your therapy!

[robysue]

In my humble opinion, to really get to the point where you've fully adjusted to xPAP therapy, you need to actively work on teaching your body, mind and soul to make a deep association that Time to Sleep = Time to Wear Mask.

So leaving aside the medical implications of sleeping without the mask---which others have done an excellent job of pointing out---there's another real problem with consciously choosing to sleep without the mask for part of the night---particularly for folks who are still adjusting to CPAP: You are, in effect, teaching both your mind and body that it is OK to Sleep Maskless. And this, undermines the work you need to do to make that deep connection that Time to Sleep = Time to Wear Mask, which in turn, makes it much more difficult to become fully accustomed and adjusted to sleeping with the mask on when you hit one of the inevitable difficulties in learning how to sleep with the mask: Rather than doing the necessary work to address the difficulty, it's tempting to just "take the mask off"---because your mind is thinking It's OK to Sleep Maskless and it's "easier" to fix the problem by ignoring it and just sleep maskless.

[LinkC]

Darn! I was about to point out that the biggest negative is it will take longer and be harder to adjust to the CPAP if you keep "cheating". Even a little.

Then I got to robysue's post and she beat me to it! So, I second what she said!!!

[hobbs]

Well it interferes with the ability to spell for a start.
You just have to decide how long you want to go without breathing correctly. My wife will sometimes take hers off the last 2-3 hours she is in bed and wakes up feeling like crap. It amazes me that she know this and still does it.

[Janknitz]

Sometimes I sit down in the recliner and fall asleep. It only takes about 10 minutes in for me to start snoring and then drowning in reflux because of an apnic event (YUCK!). Every minute I sleep without my CPAP is bad news (so I stay out of the recliner these days!).

[Lizistired]

Don't beat yourself up. It's a process.
Did you get the full reports from your sleep study? That's what convinced me I need to wear a mask.
I did not know I stopped breathing in my sleep. Or how many times and for how long.
I did not know I EVER slept on my back.
I did not know my O2 dropped to 82% while I was sleeping.
I did not know that all of this was happening during very fragmented REM sleep.

All I knew was thay I was exhausted and my brain didn't work right anymore.
That's why I wear my mask.

But sometimes I take it off, and that's ok, but I know I need to wear it.

[robysue]

I have been using my machine faithfully every night since I started therapy in September. My machine shows 7-8 hrs every morning. I wake up almost every night around 3am and toss and turn for 3 more hours with maybe a few 10 minute dozing. I just can't get through the entire night asleep.

One of the WORST things you can do for insomnia (and that's what you are describing here) is to lie in bed for hours at a time NOT sleeping. Lying in bed for three hours tossing and turning after you wake up at 3:00 AM is likely making it harder to fall back asleep on subsequent nights when you have a middle-of-the-night wake up.

Rather than lie in bed NOT sleeping for hours on end, insomniacs are traditionally encouraged to get out of bed if they've not gotten back to sleep in a timely fashion* and go into a different room and do something else while waiting to start feeling sleepy enough to go back to bed. The "something else" should be a quiet activity that encourages you to get sleepy again. But it's also important to do something you enjoy rather than something that allows you to fret about how little sleep your are getting, is a chore, or is job related: Sit in a semi-dark room listening to nice, soothing music. Or read a non-job related book (but not in bed) for a while (it helps if the book is not too entralling). Or do a crossword puzzle or soduko on paper (not the computer). Or simply sit and pet the cat or dog for a while. Or maybe a game of solitaire with real cards.

*And getting back to sleep in a timely fashion is often defined as "getting back to sleep within 15--30 minutes (at most)" where the time is based on a mental guesstimate rather than actually staring at the clock. [Insomniacs are also encouraged to put the clock somewhere where it is impossible to see it while lying in bed.]

The rationale behind this non-intuitive strategy is this: Lying in bed wide awake first of all encourages you to worry excessively about the insomnia and all the other stresses in your life. And that typically makes it harder to get back to sleep. And lying in bed not sleeping night after night also teaches both your mind and body that Being in Bed does not mean Time to Sleep. And in fact, that It is OK to be in Bed WORRYING about things INSTEAD of Being Asleep. And that in turn makes it more likely you'll have problems getting back to sleep on future nights when you wake up in the middle of the night.

So my humble advice is this: When you find yourself wide awake at 3:00 AM struggling to get back to sleep with the mask on, don't let yourself struggle for sleep more than what seems to be about 15 -- 30 minutes. If you're not sleeping by then, go ahead, get out of bed and go into a different room and do something to get your mind off both the mask and the insomnia for a few minutes. Return to bed only after you start to feel sleepy enough to try going to sleep with the mask ON once again. And never go back to bed WITHOUT putting the mask back on.

There have been times when at take my mask off at 6:00am and fall asleep without it for another 30-45 minutes. I didn't think that would be harmful? My AHI has improved and gone down to <2 every night and have less leaking too. I alternate masks from FF to nasal to pillows. Have yet to find my dream mask.

Let's do a little math here:

You are SLEEPING with the mask for about 4 to 5 hours with the mask on. And lying awake for about 3 hours with the mask on. Your AHI is now being reported as < 2. So we'll say the AHI = 1.5 on a night where you had the mask on for 8 hours. So you had a total of 12 events (1.5 events/hour of machine time times 8 hours when the machine was running.) Now we'll make another assumption: Let's suppose that all of those 12 events actually occurred when you were sleeping. You laid awake tossing and turning for 3 hours. So you really only got 5 hours of sleep. Your effective AHI is:

(12 events)/(5 actual hours of sleep) = 2.4 apneas and hypopneas per hour of sleep WITH the machine on

Now, that's still a perfectly acceptable AHI, but it's also almost a full point HIGHER than what the machine's LCD says because the machine cannot tell when you are awake.

So extremely long periods of WAKE when you've got the mask on are capable of skewing the AHI numbers reported by the machine.

And then, how many additional apneas do you go through when you finally fall asleep for the last 30-40 minutes of the night sans mask? Well, to get an idea: Take your diagnostic AHI figure and multiply it by .5 to .67. Even if you've got moderate apnea (say a diagnostic AHI = 20), that's roughly 10--13 apneas in that maskless sleep period, which is an "extra 8--11" apneas your body went through that it would not have, if you'd had the mask on.