Can't fall asleep

I am brand new to this forum but I have read the last several months of postings and discovered that compared to the forum members I know almost nothing about the subjects of sleep apnea and Cpap machines.

My problem is simple, I simply cannot go sleep with the equipment on.

I was originally prescribed a standard cpap machine with a full mask headgear and could not get used to it enough to go to sleep. Next I tried changing the headgear to a nasal pillow style---still no luck.

I visited my Dr. again, he suggested a second sleep study after which I was prescribed a Bi-level machine which I have had for about six months. I believe the settings are 5 for exhale and 14 for inhale. I tried to confirm this by going to the machine menu but found that the R.T. had not enabled the more detailed menu view on the machine.

Next I visited my Dr. again and told him of my problem of still being unable to get to sleep with the equipment and he suggested " just keep on trying" and also prescribed some sleep aids. I have tried both of the suggested sleep aids and found that Rozerem does not seem to work for me and that about half the time the Ambien works for an hour or so. Additionally I am somewhat concerned about becoming too reliant on the sleep aids.

Most nights I go through two or three cycles of the 45 minute machine ramp up and after being unable to fall asleep I then finally give up, turn off the machine and then go immediately to sleep.

Are there any suggestions out there for this issue?

What's the main issue you have when you try to fall asleep with the machine? Is it the noise, rainout, dryness, generally being uncomfortable with the headgear, restricted in movement...? Basically, what's bugging you? Lots of things at once? What are those things?

Welcome to the boards. Also, please consider filling out your profile so the advice we give actually pertains to your specific equipment.

Thanks so much for the response.

The odd thing about it is that nothing by itself seems to be a real big problem.

I have noticed that the noise of the machine and the air bleedoff from the nosepiece is distracting and that the sound of my breathing (the Darth Vader effect) seems quite loud and makes it hard to relax.

I also have noted that there is almost a timing problem while breathing as if the machine is somehow interrupting my normal breathing pattern. But the headgear itself is not too uncomfortable and the machine is not extremely noisy, however it is noticeable.

Without the equipment on I often (but not always) sleep face down and the sense that I must sleep face up while wearing the equipment, can also be distracting.

You don't have to sleep face up.

Many of us sleep on our sides and toss and turn all night. A proper mask with a good fit is the key. I use the Aura mask (it goes by a new name now), and it allows you to sleep in any position - even on your stomach.

Also, if you get a fan or a white-noise machine, the constant sound will distract you from the cpap/mask noises.

Hang in there and keep trying.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, Aura

The other suggestion I would have is if you have a time when you have days off, or time that you don't have to be functional, just lay in bed until you fall asleep with it. My first night it took me 6 hours to fall asleep, but I'm on break so it didn't matter at all. Now I can fall asleep with it right away. Basically you could just sleep deprive yourself until your body gives up. Not the most pleasant of things, but it might be a way to force your body into getting used to it.

My guess though is that the biggest thing stopping you from falling asleep is the mask. It shouldn't be constantly leaking in small doses, nor should you really have to adjust it when you move around to keep a good seal. (Sometimes I have to grab mine and wiggle it a bit, but then it seals right back up).

why do you think that is?

a) cannot turn off your thoughts from the day to fall asleep?
b) discomfort from the mask (straps too tight etc.)?
c) noise from the mask/machine or both?
d) cpap pressure itself preventing you from sleeping?

If you can isolate exactly what bothers you then address them one at a time, pretty soon you've eliminated everything that is preventing you from sleep.

Start with the noise aspect: If it is noise, the pillow style interfaces are the noisiest ones you can buy. The quietest most comfortable nasal interface I have ever used is the Somnotech Soyala. It is absolutely silent compared to any other mask out there. There is no exhaust hiss, no noise from the cpap air flowing through at all.

If the machine itself is keeping you from sleep, first understand the higher your pressure is the louder any machine or mask combination will be. This is a good reason to use any Ramp feature, you can start out with a much lower pressure making falling asleep much easier and hopefully by the time pressure does kick in you will be asleep. Nearly all machines have some sort of a ramp feature.

An autopap will be the quietest machine, there are many concepts behind the different machine therapies. I like the one that offers the quietest operation and delivers the least pressure. If it delivers the pressure I need when I am a sleep that is all I need. Bipap is the first thing offered by doctors (they don't have a clue), they are simply pulling the wool over your eyes when they do that, they are still giving you a basic straight cpap but only in a bipap machine, sure exhale pressure will be lower making it easier to breathe out but your IPAP or inhale pressure will still be high just like you were on straight cpap with a plain jane machine. That does nothing if cpap pressure is what is preventing you from falling asleep. If your IPAP pressure is 14cm, then an autopap set to 6cm to 14cm will do the same thing, the advantage is the autopap will start at 6cm and hopefully stay there until you are well into sleep. A machine running at 6cm pressure will be a lot quieter and more comfortable than a machine running at 14cm. Try it with your bipap, set both pressures to 6cm and give it a try, that is what you would have with an autopap. Try to fall asleep with your bipap at 6cm, the worst that could happen is you wake up gasping for air. With an autopap like the Remstars, you also have Cflex which adds in comfort on exhale.

Put the machine on the floor: If machine noise is the problem, put it on the floor or even under the bed. You will have to clean your filters more often but it will be quieter. You may also need a longer hose, they sell longer hoses at cpap.com for under $20 bucks.

Comfort: None of these interfaces are what I would call comfortable, even I at times become frustrated with the discomfort from them and sleep without, but the next day/night it changes my mind again on that concept. If a mask is not designed right it will be leaky and require more strap pressure to stop it from leaking. The FF masks are harder to seal because there is a larger footprint to seal with the cushion, it can have its good and bad, but if you are a mouth breather they can work well.

I have no connection with Somnotech whatsoever, I only know about them from my mask purchase after spending $100 for their Soyala from cpap.com. It was expensive compared to other nasal interfaces but well worth it. I have to say it is the best interface I've used in more than 5 years on cpap, that includes all the Respironics Comfortxxxx series, All the Ultra series from Resmad, the Hybrid, the breeze, nasalaire, the swift you name it I have pretty much purchased them all at one time. The Soyala is the best sealing requiring the least strap pressure (even over the Activa, got one of those in my dud drawer also).

So my suggestions:

1. Address the noise.
2. Address the discomfort (reduce/eliminate strap pressure).
3. Address the cpap pressure discomfort by using a lower machine Ramp pressure.
4. Consider a sleep aid like melatonin, been using it for more than 15yrs every night, has NO side effects compared to any other sleep aid on the market, prescription or non-prescription.
5. If you cannot find an acceptable quiet mask, consider the Soyala, it is comfortable and quiet.

Man, I SO feel for you.

That is EXACTLY what I went through.

I'm not going to tell you what my solution was, though, because I don't want to encourage you to give up on your treatment.

I'm sometimes afraid I gave up too early (I didn't, I tried for quite a long time), and that maybe if I'd just stuck it out a couple of days longer, I would have figured out how to make it work.

I toyed with not posting this, because mine isn't really an inspirational story for you, but I thought it was important for you to know that other people have had the same problem.

Please, if you do come up with a solution to the problem, do let me know. Because I never could find one, and so my CPAP machine sits idle in a box in my closet, because poor sleep is better than the no sleep I was getting using the machine.

Liam, the poor example your mother told you to learn from the experince of.

cpapcpa wrote:Without the equipment on I often (but not always) sleep face down and the sense that I must sleep face up while wearing the equipment, can also be distracting.

If I had to sleep on my back, I'd have the same problems. It's almost impossible for me to sleep in that position in bed.
I would suggest finding a mask that is multi-positional. Depending on which full face mask you started out with, it may have been set too tight and/or the wrong size.....and just the wrong FF mask.

Your whole configuration seems a little strange to me.....like being set-up for failure. I've never used a Bi-PAP/Bi-Level machine, but an IPAP of 14 doesn't seem all that high (for bi-level use) and an EPAP of 5 seems awfully low (and makes for a wide variation in the pressure)
I agree with Snoredog.....find pressure settings that you can sleep with (for starters)......being jolted from 5 back to 14 would be extremely disruptive to me.

Best holiday wishes,

Den

Boy, are you not alone! I absolutely could not fall asleep with it on. Every little thing bothers me when I'm going to sleep, so the mask was a HUGE intrusion.

My doctor said I was the only person he'd ever heard of using my solution, but it worked for me. I tend to wake up in the night. I'm much sleepier and less fussy at that point, so that's when I put the mask on. At that point I could sleep with it. Gradually, I got to where I could fall asleep with it on - it seemed kind of comforting.

There are a couple of other things I did:
I switched to a Mirage Swift mask because it felt less claustrophobic. That and the Comfortlite series were the the only alternatives offered to me that would allow me toss and turn and sleep on my belly.

I wore it - sans tubing - around the house and to sit and read, etc.

I wore it to read in bed before sleep.

All those things helped. The other issues that come up needed to be addressed, too. Leaks, rainout, noise... I started out with a C-Flex with a ramp-up feature and never had some of the problems people describe. Ramping up really helps.

I think the biggest help has been sheer determination. I'm usually a person who will walk away from something annoying, but I was truly desperate - high blood pressure, no energy, depressed, and my *daytime* breathing was messed up. I'm only a couple of months in and I have a ways to go to being completely compliant, but I'm getting there. Good luck, and stick with it!

Exactly my sentiments. I just cannot fall asleep with these gadgets, or stay asleep. I try to wait till I feel sleepy, to put on machine and mask, but then I fall asleep before then most of the time. And when I do wake up, because I wake up everynite after 3 hours of sleep with or without machine, I sorta say, "heck with it". I know I need to learn to use equipment.

Snoredog, how much mg of melatonin are you using each night? Thank you for your advise and as well as everyone on this Message Board. It's a gigantic learning curve for me.

Sometime ago, when I was unaware of my apnea yet, I took 3mg melatonin, sometimes it worked, sometimes it didn't help me fall asleep. I was always a bad sleeper ever since I was in my 20's. Now in my 50's I'm blessed with sleep apnea, and I definitely cannot fall asleep without intervention of some sleeping pill.
Thank you all for the many helpful information.
After 3 months, I have yet to learn to keep that stupid mask on.

I use Ambien. Noise and such is not an issue for me because I'm pretty much Deaf. My wife though says that the machine does not make much sound that she is aware of. As far as the mask goes, when I started CPAP I was so tired really that I just fell asleep, though like I said I also use Ambien. 1, 12.5 mg. I actually started on this road because I had been taking 2 of them and wanted to get off the pills (2 is the max by the way and does real strange things to you.... I was waking up all night... walking around and doing things and was not aware of it when I woke up in the morning). I went to the sleep doc for this reason and we found the Apnea problem. He actually encouraged me to continue to take 1.

Don't give up......

I had the same problem... took me several months in fact to actually get used to using the cpap. Many nights I would wake up after having ripped the mask off, plus the hose kept getting in the way.

My Dr. told me to find some way to adjust the hose so that it was over my head.. I have a headboard that allows me to loop the hose directly over my head so that it doesn't get in the way.

Now after 4 years I cannot sleep without the machine...

The few times I've had to go without it I was miserable... no sleep, tired all day and sore throat from snoring.

Keep trying, you will be glad you did.

You mention you tried Rozerem? How long have you been taking it? Rozerem doesn't really work like most sleep aids, it takes time to build up in your body before you feel the full effect. (at least this is what my sleep doc told me)

I've been on it for a few weeks and it's just now starting to help me, So if you have olny tried it for a couple of nights you might want to continue and see if it does the trick.

Thanks to all of the forum members for the suggestions and support.

I was finally able to check the machine settings and found that the bi level machine was set at 9 exhale and 16 inhale.

I put the machine on the floor and that helped with the noise. I may try some white noise but will wait a bit to see if the other changes will help as I don't want to disturb my wife's sleep any further.

I put on the old mask, the Mirage Activa, (vs the nasal pillow style) and have found it to be much quieter than the Resmed Swift mask so I think I will begin using this mask again. I am unclear if I need to change the machine mask setting as the only choice on my machine that seems to fit is "Mirage" which would seem to cover both the Activa and the Swift masks.

I will try using the Rozerem sleep aid over a period of days to see if that will help in getting to sleep.

I can't seem to get comfortable with the mask if I try to sleep on my side, the various mask bits dig into my face and the mask seems to leak more.

Thanks again for all your help.