Cannot Keep Mask On

I was diagnosed in October 2014 with OSA. At the time, I was only able to sleep about 90 minutes the entire night. I initially was sent in for a sleep study because of sleep walking, sleep talking, and waking up multiple times per night, occasionally with nightmares. My initial AHI was diagnosed as 13. The first night, I was able to keep the mask on for a full 8 hours. After that, I've had anywhere from 30 minutes to, on a very rare occasion, 7 or more hours of uninterrupted use with the mask. Initially, it was suggested that I try different masks and settings. Since I had no titration as part of my sleep study, it became clear from my data that my pressure range, of 4-10 was too low because the majority of the time the machine was running in APAP mode at a pressure of 10. I returned to the doctor with revised settings and a few new masks to try. Still no luck. I do not ever remember removing the mask. I have a deviated septum, bruxism (which I use clear retainers for at night), nasal allergies, obsessive compulsive disorder (OCD), generalized anxiety disorder, and mild asthma.

I tried:

- Using medical tape to tape the mask to my face and/or cover the loops on the straps to prevent me from taking the mask off
- Various masks including the Resmed F10 full face mask, Resmed N10 nasal pillows, Resmed Quattro Air, Phillips Fit Life, and Phillips Amara View
- Adjusting humidity/temperature settings/pressure ranges/EPR
- Wearing boxing gloves
- Using a CPAP mask liner
- Sleeping on side instead of stomach by using a side sleeper pillow
- Sleeping on Back
- Melatonin
- Nasocort

After that I changed doctors to one with a speciality in sleep neurology. I also tried the following:

-Luvox (150mg) to help with the OCD (very successful and I continue to use this)
-Clonazepam before bed (discontinued-did not improve adherence)
-Sonata (discontinued-did not improve adherence)
-Belsomra (initially kept me on the mask for 4 hours+ but after a week it stopped helping this although I continue to take it for other benefits to my sleep patterns)
-Fluticasone Proprionate (intranasal-did not improve adherence)
-Cromolyn Sodium (intranasal-did not improve adherence)
-Hose management clip/adjustment to CPAP machine height/positioning

My second doctor agreed to a titration to see if we could catch me pulling the mask off in my sleep. I slept the whole way through without taking the mask off. The results were as following:

"...revealed a favorable response to CPAP. At 13 cm although for only 4.2 min AHI was 0 with adequate back and fair REM. At 12 cm for duration of 23 min. the AHI was 4.9, at 11 cm the AHI was 2.1 at 9cm the AHI was 35.8, at 8 cm the AHI was 1.2, at 6-7 cm AHI was 0. At 5cm the AHI was 67. One central apnea was seen at 11 cm, 2 central apneas seen at 12 cm. Snoring was nearly eliminated. REM was achieved at 8 cm. O2 normalization above 90%. He did take 10mg Sonata/zaleplon tablets prior to sleep study initiation and was able to achieve a total sleep time of 381 min. REM 15.6% with a sleep efficiency of 86.5% and a sleep latency of 50 min."

My doctor lent me a bipap machine to try for a weekend but my best night was still less than 5 hours on it.

I still take the mask off every night without remembering. I would greatly appreciate any help.

The only mask I have been able to wear without taking it off is the Sleep Weaver Elan Mask listed in my profile. Perhaps it might be worth trying?

Have you consulted an ENT to evaluate your nasal potency as perhaps your nasal issues are leading to discomfort which is causing the premature removal of the mask?

49er

I have not yet consulted with an ENT but I have one I can call. I'll definitely look into that. I'll also check out that mask. Thanks.

What are all of your settings? Please add them to your profile.
Also, if you're not using Sleepyhead software, you need to get it and use it.


Den

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Wulfman... wrote:What are all of your settings? Please add them to your profile.
Also, if you're not using Sleepyhead software, you need to get it and use it.


Den

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I just updated my settings in my profile. Thanks for pointing that out. I have used Sleepyhead but I need to check my most recent data. This is what I have from a while ago. If it doesn't have the needed information please let me know and I'll make sure to select/zoom in on the right information next time.



From just a few nights later..

Thanks for the info.
From what I see, I would suggest trying a straight pressure of 11 cm.
Sort of a compromise of what I read in your sleep report........it's between 8 cm. and 13 cm.
I think the pressure increases/variations are part of your problem.

Anyway, try it for several nights and see what happens. You might also try some nights with EPR turned off, too. They wouldn't have used it in your sleep study/titration.......and, for some people it sometimes has an effect on their events because with ResMed, it DOES drop the "effective" pressure (in centimeters) by the number of the EPR setting.


Den

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Thank you for the advice.

I went to the ENT my sleep neurologist had recommended to me. I brought my machine, all of my doctor's notes, and my sleep study/titration results. After he asked what I was there for (CPAP intolerance), I explained how I was taking my mask off in my sleep. Before I even listed two things I tried, he said he wasn't here to judge me and instead asked if I was ready for the next step to get a sleep endoscopy and prepare for a Inspire implant. After he spoke about the Inspire implant, I asked about current clinical trials and what was available and he said none were going on that would be for me and it would be all through insurance/direct billing. He then did a very brief physical examination after I tried to ask what might be causing my CPAP intolerance and noted enlarged turbinates, but he wasn't making any promises that doing any sinus revisions would help. After that, he got up saying he would send me more Inspire brochure information and have his people get in touch with me. He offered to work on the turbinates/deviated septum, but only when I am already under anesthesia for the sleep endoscopy to check my eligibility for the Inspire implant. Needless to say, that was a hard sell.

I am not really prepared to try to the implant with so few user experiences. He stated that it has been an incredible success, but gave me no supporting information/reports.

Any tips on what to try next? I tried the straight 11 CPAP mode setting and am still taking it off in my sleep.

Have you tried a short term sleep aid like Ambien just to get you used to not waking up?

Julie wrote:Have you tried a short term sleep aid like Ambien just to get you used to not waking up?

I have tried melatonin, Klonopin, Sonata, and currently have an RX for Belsomra (20mg). I can fall asleep within minutes with the mask on (with any I've tried), but I never remember it coming off. In fact, I once woke up with the machine in my bed (off the nightstand) and the mask and hose at the foot of the bed. During my recent titration however, I didn't move once and had few restless movements, which at home, happens rarely (maybe once every month or so).


On another note, I have been looking for some kind of circuit alarm to indicate when my machine turns off, but it seems the current Resmed stays powered up in standby mode so I'm not sure the alarm system would actually sound when the pressure has turned off.

Carbon wrote:Thank you for the advice.

I went to the ENT my sleep neurologist had recommended to me. I brought my machine, all of my doctor's notes, and my sleep study/titration results. After he asked what I was there for (CPAP intolerance), I explained how I was taking my mask off in my sleep. Before I even listed two things I tried, he said he wasn't here to judge me and instead asked if I was ready for the next step to get a sleep endoscopy and prepare for a Inspire implant. After he spoke about the Inspire implant, I asked about current clinical trials and what was available and he said none were going on that would be for me and it would be all through insurance/direct billing. He then did a very brief physical examination after I tried to ask what might be causing my CPAP intolerance and noted enlarged turbinates, but he wasn't making any promises that doing any sinus revisions would help. After that, he got up saying he would send me more Inspire brochure information and have his people get in touch with me. He offered to work on the turbinates/deviated septum, but only when I am already under anesthesia for the sleep endoscopy to check my eligibility for the Inspire implant. Needless to say, that was a hard sell.

I am not really prepared to try to the implant with so few user experiences. He stated that it has been an incredible success, but gave me no supporting information/reports.

Any tips on what to try next? I tried the straight 11 CPAP mode setting and am still taking it off in my sleep.

For how long?

But, now you've apparently changed your pressure settings to.......

Additional Comments: Pressure: APAP 10-20cm;

What do you see in your reports when you take your mask off? Any clues? Anything?

Lots of users take their masks off early in their therapy. That's not unusual. But, at some point they persevere to keep it on.


Den

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I didn't change my profile but I've been at the straight 11 pressure since my last post. I've been trying CPAP therapy since October 2014.

I do see rapid increases in respiratory rate right before I take the mask off as if I'm hyperventilating but I'm not sure what would cause that.

Part of the complication here is my history of sleepwalking/talking seems to make staying in one place pretty hard.

I'm not sure just "trying harder" alters my subconscious sleepwalking that has been part of my life since early childhood. I do not recall taking off the mask during the night.

Some people tape the straps to their face at night so that they'll wake up enough when pulling on masks to not take them off.

Could you try some sort of hat with chinstraps or scarf on, over the top of your cpap mask. Something you could tie in a knot

Thanks for the extra tips! I've tried a skullcap hat before but I'll look into some other things like that to try. I just ordered the oral (not full face) mask from cpap.com to see if that might help.

Anyone know why it doesn't reccomend the oral mask if I have bruxism? I wear upper and lower (separate) clear plastic retainers to protect my teeth (I wore these during the titration as well and they didn't cause a problem and my sleep tech knew about them).

Carbon wrote:Thank you for the advice.

I went to the ENT my sleep neurologist had recommended to me. I brought my machine, all of my doctor's notes, and my sleep study/titration results. After he asked what I was there for (CPAP intolerance), I explained how I was taking my mask off in my sleep. Before I even listed two things I tried, he said he wasn't here to judge me and instead asked if I was ready for the next step to get a sleep endoscopy and prepare for a Inspire implant. After he spoke about the Inspire implant, I asked about current clinical trials and what was available and he said none were going on that would be for me and it would be all through insurance/direct billing. He then did a very brief physical examination after I tried to ask what might be causing my CPAP intolerance and noted enlarged turbinates, but he wasn't making any promises that doing any sinus revisions would help. After that, he got up saying he would send me more Inspire brochure information and have his people get in touch with me. He offered to work on the turbinates/deviated septum, but only when I am already under anesthesia for the sleep endoscopy to check my eligibility for the Inspire implant. Needless to say, that was a hard sell.

I am not really prepared to try to the implant with so few user experiences. He stated that it has been an incredible success, but gave me no supporting information/reports.

Any tips on what to try next? I tried the straight 11 CPAP mode setting and am still taking it off in my sleep.

Sounds to me that he is rushing you into a surgery that has not been proven to help sleep apnea...Personally I would never agree to an unproven experimental procedure. I have never heard of a "sleep endoscopy" only a regular endoscopy of the esophagus. I don't know what relationship an endoscopy has to sleep apnea or your problem with keeping your mask on.