Breathe Heavy, Cant fall asleep

Hey all!

I have been trying to use my CPAP machine for a few months. I have a ffm because I always have one nostril that is stuffy, and I usually breathe with my mouth. I have I guess a biPAP (Pressure reduces when I exhale). My problem is that I am a big guy, and I breathe really heavy. So sometimes I take really deep breaths which keeps me up because I feel like it is not pumping in air quick enough. Also when I exhale, it seems that I have to force the air out. This keeps me up for hours until I take the mask off. Sometimes I will fall asleep with a mask on and wake up with the mask off. Majority of the time I try to keep the mask on, but with the constant trying to get a deep breath or deep exhale, it keeps me up. As soon as I take the mask off I fall right to sleep.

I was considering using a nose mask so if I need to take a deep breath I can just use my mouth. I figure that having it on with just my nose is better then nothing. I have read on here that some mouth breathers have converted into nose breathers by using a nose mask. I also find that when I do get through a night with my mask, my nose is pretty clear since I have the humidity turned up...

Do you guys have any suggestions to my problem. I want to use my mask, but I need to be able to breathe without hassle!!!! HELP!

Thanks
Carter

Well i guess my question is... Can I get away with just a nose mask?

Hi, it sounds to me like you haven't had a lot explained to you, and that's unfortunate, but it's not that hard - you can go to the lightbulb icon at the top of the page and start reading to understand more about cpap, and if you complete your 'Profile' in the User Ctl Panel (just under the search window above) then everyone will know what equipment you have and can advise better - it will appear under your posts each time.

It sounds to me like you are a poster child for needing a full face mask vs just a nasal one, as any air coming in through your nose will be lost out your mouth rather than going down and opening your airway, the whole point of Cpap, and therefore you either need to have some way of keeping your mouth closed (e.g. by taping... do a search here on what that's about) or a chin strap, which is not always that helpful....whereas a full face mask (like a nasal one extended just a bit lower to cover your mouth, allowing you to have it open when sleeping but not lose cpap air) may be what you really need... there are various types, such as the above (see Resmed UltraMirage II on Cpap.com) or the Quattro full face mask... very popular, and/or Hybrid, etc. Look at all of them on the website and come back here with any questions.

As far as breathing heavily, that could be because your pressure has either not been set properly to the prescribed number, or because you are using the ramp feature beginning at such a low level (e.g. 4-5) that no one can really breathe properly there - most of us don't use the ramp at all after a short time and let the machine go straight to the scripted pressure (e.g. 10), another thing to think about... put your pressures on the Profile as well.

Thanks Julie

I dont really use the ramp function. It does get worse that way. I know what CPAP is supposed to do... But I will not use it if I cant fall asleep... So i am trying to think of a different option. I dont have a problem with a full face mask, since I scuba dive and am quite comfortable... I just want to be able to use it. I am a bodybuilder as well, so sleep is very important. IF i dont get good sleep I dont grow.

Hi, well as far as being able to sleep goes, it's often hard to adjust at first, and a lot of people take off their masks in their sleep, or else have insomnia, but if everything feels relatively comfortable at first, it may just be a matter of time, getting used to wearing the mask altogether, being sure it's not too tight (often creating new micro leaks) or loose, maybe playing some 'white noise' music in the room, being sure it's not too warm in there as that doesn't help you to fall asleep... other people will have ideas for you I'm sure too.

I have tried white noise... It is not so much that the mask is uncomfortable. It is how the air makes it hard to get a deep breath and making me have to force to exhale... So i never get relaxed enough to fall asleep. Also have tried relaxation breathing, no dice!

What settings on the machine? Pressure? Flex ( exhale relief) ? Software?

I was able to learn to keep my mouth shut and use nasal pillow mask. I normally breath through my nose just fine during the day. My nighttime mouth breathing was just habit probably from gasping for breath before I found out about OSA. If you have nasal congestion all the time in one nostril that won't clear up, you won't be comfortable with trying to move enough air with nasal mask and you will be forced to open your mouth which of course lets all the pressure out.

Your profile shows the PR System one Pro. It is not a BiPap machine. It does offer exhale relief in its CFlex 3 settings. The exhale relief is not as great as with a BiPap. Can you please confirm your machine and its settings? This is so important that you understand which machine you have so that you can fully utilize its comfort features. It is possible that a change in the Flex setting may help you breathe easier with the mask.

Do you know how to get to your clinical menu to even check to see what your settings are? Do you have the clinician manual so you can see in great detail what your settings are?

Regarding using the nasal mask (over the nose or pillows like I use) you will have to be able to breathe comfortably through your nose. If your congestion could be cleared up then it might work for you. Sometimes people say that their congestion is relieved by the pressure going up the nose. Sometimes the air helps the nose to clear up. Sometimes it doesn't though. It would sure be worth a try if you think you can get the congestion cleared up. You can't use a nasal mask with one permanently close nostril and use your mouth to supplement the air exchange though.
The air pressure will go up the nose and exit out the mouth and you get zero benefit from the pressure.

Let's find out exactly which machine you are using and what pressure and what Flex settings to see if you can make it more comfortable to breathe so you can get to sleep. Have you discussed your problem with DME or your doctor?

Carter,

First welcome to the board.

Second, a sad welcome into the CPAP & Insomnia Club. In this reply to your post I want to focus on the general theme of the insomnia and not the discomfort with breathing. And give some tips for dealing with that. Because I think part of your discomfort with breathing is simply a very keen awareness of the novelty of your own breathing that leads to worrying too much about it. And you've gotten some good advice already about why you might be having trouble and what to do to try to make breathing more comfortable.

You write:

Also when I exhale, it seems that I have to force the air out. This keeps me up for hours until I take the mask off. Sometimes I will fall asleep with a mask on and wake up with the mask off. Majority of the time I try to keep the mask on, but with the constant trying to get a deep breath or deep exhale, it keeps me up. As soon as I take the mask off I fall right to sleep.

Sound to me that a large part of what's going on here is this:

You are aware of the necessity of trying to keep the mask on, which is GOOD.

But you are allowing yourself to fight the machine----for hours at a time, which is NOT SO GOOD. And much of the fight with the machine is being triggered by discomfort with exhaling being hard and worrying about not getting enough air when you inhale. And this (sometimes) leads to you taking the mask off in frustration and falling asleep without the mask on, which is BAD.


The whole point of working (hard) on adjusting to CPAP therapy isto get your mind and body to make the deep, profound association that Time to Sleep = Time to Mask Up.

And my guess is that the unconscious part of your mind has not yet fully accepted the need to sleep with a mask on your nose every night. And until that unconscious part of your mind does learn to accept the mask as the new norm that's not going away, it will continue to be a struggle to get to sleep with the hose on your nose. And unfortunately, every time you take the mask off and "fall right to sleep", you are REWARDING the unconscious part of your mind's resistance to the mask and letting it continue to believe that you don't really need the mask. And this in turn undermines the effort to make that deep, profound association that Time to Sleep = Time to Mask Up. The only way to fix this part of the problem is to quit rewarding the resistance by NOT consciously choosing to take the mask off to get some sleep.

But that leads to the question: How the heck are you supposed to get some sleep when you can't (apparently) sleep with the mask on and you shouldn't take the mask off just to get some sleep?

My own recommendation is an old anti-insomnia trick: Don't FIGHT for sleep for hours at a time with the mask on.

But that doesn't mean "sleep without the mask" either. The key idea here that you need to actively teach your body how to go to sleep with the mask on your nose. I'd suggest the following things (all of which are in Taming the CPAP-Induced Insomnia Monster:

Step 1) Never allow yourself to consciously got to sleep without the mask on your nose---regardless of whether it's at the beginning of the night or later on after you feel like you must take the mask off just to get some sleep.

Step 2) Give yourself about 30 minutes or so to get to sleep---as in really asleep, not dozing. Estimate the 30 minute time window, don't look at a clock. If at the end of 30 minutes you are still awake---or semi alert, reassess the situation. If you think you are pretty close to sleep, fine stay in bed and give yourself another 10 minutes or so to really get to sleep. But if you are not really feeling like you are making any progress towards getting to sleep, get up out of bed and go into a different room and do something to take your mind off the mask for a while.

Step 3) When you are out of bed, try to do something that will make you feel sleepy enough to try masking up (again) and going to sleep. And be keenly aware that feeling sleepy is not at all the same as feeling tired or exhausted. Because the sad fact is, that no matter how tired or exhausted you are, if you are not sleepy you won't be able to fall asleep soundly and quickly when you put the mask back on and lie down in your bed. Think of an over tired 2 year old child who badly needs a nap but cannot settle herself down at nap time. That's what happens when you're over tired, but not sleepy.

And repeat Steps 2 and 3 as many times as necessary until you actually fall asleep in your bed within 30 minutes of lying down with the mask.

And what are some good sleep inducing behaviors to do when you are out of bed in the middle of the night?

• Sit in a quiet semi dark room doing nothing----if you can prevent your mind from starting to worry about things---especially about the fact that it's the middle of the night and you're not in bed.
• Listen to some quiet, soothing music.
• Make yourself a cup of warm milk or sleepy time tea and sip it slowly.
• Do some deep breathing or relaxation exercises. Or meditate if you're into that.
• Read a real book (that's not too interesting) or work a crossword or soduko (on paper, not on the computer)
• Play some solitaire with real cards instead of on the computer.

And there are also things you need to specifically AVOID when you're up in the middle of the night trying to get sleepy enough to go back to bed and try, try again to sleep with the mask on your nose. In particular:

• Do NOT get on the computer, start texting on the cell phone, or watching the TV. These activities are often too stimulating mentally and the blue light from electronic gadgets may mess with your sleep cycles.
• Do NOT do anything work related. This can cause you to start worrying and worry is an enemy of sleep. Moreover, you don't want your mind and body to regard getting up out of bed as a severe punishment because then it's too hard to force yourself to do it when it's clear you're not getting to sleep in a timely fashion.

It is how the air makes it hard to get a deep breath and making me have to force to exhale..

This is purely psychological. Your mind is assuming it needs to breathe deep because of the mask, it doesn't. When you are asleep you don't breathe deep and heavy. All masks have an anti-asphyxiation valve, you can breath enough to not die if the power goes out.

Tonight and for at least a week wear it all evening while watching tv so your mind/body gets used to it without you constantly focusing on it. Your subconscious needs to learn some new tricks.

Cjsimmons0 wrote:I have a ffm because I always have one nostril that is stuffy, and I usually breathe with my mouth.

As you and others have commented, this stuffiness in one nostril is leading to part of your current discomfort---even with the FFM that you are using. And you'd like to try to convert to a nasal mask, but you know you're a mouth breather---in part because of the stuffy nostril.

Any idea what triggers the congestion in the affected nostril? Has it ever been evaluated by an ENT? And what (if anything) do you try to do to alleviate the congestion?

For me, a critical step in finally getting over the hump of extreme discomfort with the mask was developing a zero tolerance towards my own (allergy-based) nasal congestion. For information about how nasal congestion makes the whole CPAP thing harder to get used to AND lots of practical tips on dealing with nasal congestion, you should go to both:

• Nasal Breathing Video Series is from Dr. Barry Krakow's web pages
• Unstuff Your Stuffy Nose is from Dr. Steven Y. Park's web pages.

Another thing to keep in mind is that the relationship between humidity and congestion is not straightfoward. Some folks find that setting the humidifier to one of the higher settings helps their humidity; others find that too high of a humidity setting aggravates their humidity. So you might want to also play around with the humidity setting---and try turning it down as well as up.

I agree with the others:

1) Get checked by an ENT to evaluate the nasal congestion. It is interesting, to me, that it is just one side continuously blocked. Could you have a deviated septum? The ENT can give you tips on clearing the congestion if it is just mucous.
2) Keep using the full face mask. Make sure it is not too tight. Switching to the nasal mask, and breathing through your mouth sometimes, would just defeat the whole purpose of using the CPAP. Maybe later you can use a nasal mask or pillows after you have fully adjusted and you can breath through your nose consistently.
3) Don't use the ramp & keep communicating with the experienced folks here & with your doc about the settings and equip. (I wish I had come here when I was just starting out.)
5) Keep trying and don't give up. Continue to work to train your brain and body. This is for the long-term health of your body and brain. Be stubborn about this.

(My story is a little different, but I will share just in case it helps to know what someone else did.) Even though I was not a mouth breather, I ended up switching to a full-face mask after trying a week or two with a nasal mask. I found that being able to exhale/inhale through my mouth, when I needed to, help me relax and breath easier. Using the full mask let me do this without losing pressure and negating the function of the CPAP. I remember, at first, it felt like I was breathing too hard, or the machine was making me breath too fast, like driving me faster and faster, but it was really my brain, not the machine. Going to sleep was really hard and I was already so tired. I swallowed air and stared waking with a very, very painful and swollen abdomen in the morning. I was switched to a BiPAP Auto and that helped. I learned to take Gas-EX and that helped a little. I just kept wearing the damn mask over and over, every night, and must have started sleeping sometime. Finally, finally it clicked together and sleeping with CPAP/BiPAP now feels as natural as I think it can feel. I use a nasal mask now and keep my mouth closed and feel comfortable. I occasionally swallow air into my stomach, rather than exhaling, but not badly, and I know what to expect if it happens. I finally feel rested when I wake.

Hang in there. Glad you are here. Best wishes!

Near the display on your machine, it should say "REMstar blahblahblah." Tell us what it says there.

What is your pressure setting? If you don't know, it will say it on the display when you turn it on.

By the way, your Quattro Mask has an anti asphyxia valve in it. If you try to suck in more air than the machine is providing, the valve should open up and give you more air.