Panic attack/Hyperventilating

Hi. I just started CPAP therapy for severe obstructive sleep apnea (chronic swollen tonsils and adenoids).

I'm only on day 2 of using my machine (Airsense 10, Airfit N30i, air pressure 6.8, humidity 4... sorry if I'm not listing the specs right). Last night I was able to keep the mask on for 3 hours before it became too much. Just as I'm drifting off to sleep, I feel like I'm suffocating, which causes me to panic. Breathing in is fine, it it's breathing OUT into the mask that makes me feel like I'm hyperventilating.

Tonight, I tried switching out the nose piece to the nose pillow (the one without nose plugs), thinking that it would make a difference, but it doesn't. I still feel like I can't breathe out, which causes me to panic.

I have a history of panic disorder, of which hyperventilatelion is a major trigger and I also insomnia, which causes sleep anxiety.

I am now worried that I won't be able to continue treatment, because it is impossible to sleep like this. This of course is making me even more anxious about failing at my CPAP trial, the health risks involved and the crazy expenses involved with everything so far.

So, yeah, basically not sleeping and freaking out right now. This will be my second night with very little sleep. Does anyone have any helpful advice?

Hi Mandy, welcome to the forum.

Try this little trick: Take a tall glass and put 70mm water in it (about 3 inches). Put a straw in the water and blow bubbles. That's how much pressure the machine is giving you. Once you can comfortably do this, a lot of the panic will disappear.

A couple of other things to try:

1. Although your pressure is really quite low, try using EPR to reduce the pressure as you exhale. Then, over a period of time wean yourself off it.
2. Try wearing the mask while reading or watching TV to get yourself accustomed to it.

Do you have RAMP on?
Where did you get the number 6.8?

When I started CPAP therapy, at a pressure of 6.6 I too felt breathing out difficult, and I couldn't stand waiting for the ramp to drive the pressure from the Ramp minimum to the final pressure - I was too afraid.
I cancelled the ramp and trained myself to breathe against the 6.6 pressure.

I just wanted to second Respirator 99's two pieces of advice.

* With a fixed pressure of 6.8, you have room for EPR of 2.

* Using your machine during the day or evening while you do something distracting like watching TV or reading will really help your body get used to the new sensations.

I had panic attacks when I first started with CPAP too. But like you, I had very severe apnea. And failure was not an option. Don't talk yourself into giving up because it's hard. Many things in life are hard.

Here's how I handled it.

I forced myself to breathe deeply and count to 10 slowly before I took off the mask. If I made it through counting to 10, I counted to 10 slowly again. Usually at that point I was calm enough to continue with the mask on, but if not, I allowed myself to take it off . . .

BUT . . .

It had to go on again. The rule I made for myself is NO sleeping without the mask. The mask had to go back on again once I'd calmed down. Even if my sleep was fragmented and terrible, I knew I had to keep going. It was awful at first!

It took a few weeks, actually, to be able to go through the night without taking the mask off. Nobody said this was easy. It's not. I was exhausted and grumpy and hated it all. But dying from the medical issues caused by untreated severe sleep apnea is not much of a picnic either. Failure to adjust to CPAP was NOT an option for me.

I also set small goals for myself. Keeping the mask on for 1 hour, then 2, then 4, and then . . .

One night, I slept 8+ hours with CPAP on. I woke up feeling so calm and comfortable, there was a nice flow of cool air from the mask and I didn't even want to take it off. It reminded me of when I was a toddler. I remember waking up in my crib, slowly and calmly, becoming aware of the world around me. And that's the last time I remember ever feeling so calm when I woke up, until the morning after sleeping all night with CPAP, finally. After 50+ years of horrible mornings, it was like the nicest drug I ever took, with no side effects. And I wanted more. I had a lot of bad nights/mornings and the occasional good one after that. So my next goal was to have more good nights than bad. More calm, comfortable mornings than not. That took some time, but I got there. Now, I have the occasional bad night, but it's rare.

You can choose to fight for your health, or let this derail you. It's a choice you make. Choose wisely.

MandyH wrote: ↑

Thu Mar 16, 2023 9:22 pm

Hi. I just started CPAP therapy for severe obstructive sleep apnea (chronic swollen tonsils and adenoids).

I'm only on day 2 of using my machine (Airsense 10, Airfit N30i, air pressure 6.8, humidity 4... sorry if I'm not listing the specs right). Last night I was able to keep the mask on for 3 hours before it became too much. Just as I'm drifting off to sleep, I feel like I'm suffocating, which causes me to panic. Breathing in is fine, it it's breathing OUT into the mask that makes me feel like I'm hyperventilating.

Tonight, I tried switching out the nose piece to the nose pillow (the one without nose plugs), thinking that it would make a difference, but it doesn't. I still feel like I can't breathe out, which causes me to panic.

It's important for you to try to distinguish between the following sensations:

1) Are you feeling like you cannotexhale fully because there is too much pressure?

2) OR are you feeling like the machine is rushing you to inhale before you are ready to inhale?

3) OR are you feeling like there's simply not enough air in the mask while you are exhaling and that causes you to panic and rush the next inhalation?

All three of these can be described as feeling like you are suffocating and not able to breathe out. But the fixes for each of these three problems are quite different, and the fix for each of these problems can make the other problems feel worse.

If you can try to specify which of these three problems you are dealing with, I'll be able to give you some ideas on how to handle them.