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Tue, Aug 21 9:10am · Behavioral Strategies for Adjusting to a CPAP After a Diagnosis of Sleep Apnea in Living with Mild Cognitive Impairment (MCI)


As a psychologist, behavioral change to impact health IS my area of expertise. So, while I’m not an expert in the range of device options for you, assuming you’ve explored all that with your physician or medical device provider (see last week’s post), here are some behavioral techniques that may help you adjust to your device if you are still struggling.

What is your reason for even trying?

For all of us, it is more meaningful to make a difficult lifestyle change if we have identified why this is important. This also sets a positive tone to even trying. So, what is your reason for wanting to adjust to the CPAP when it clearly is a challenge for many? The answer isn’t “Because my doctor told me to” or “Because my spouse says I snore.” Of course, your physician wishes it was as easy as telling you to do something, but meaningful change comes when you identify a personal reason that is meaningful for you. Is it perhaps because you are so sleepy you can’t have meaningful interaction with our spouse in the evening? Is it because you know you have other risks for heart disease, and you want to be around when your grandchildren graduate from high school or college or get married? Is it that you want to have more energy during the day because you love restoring antique cars, and you notice you’ve been too fatigued to do that lately? Whatever the reason, make it personal. You’ll be more likely to be successful, and you’ll have a more positive attitude about making the change.

Wear your mask during the day while awake

This strategy is effective for many problems with CPAP adjustment. Do you feel claustrophobic? Do you just feel that you are so aware of the mask that you can’t fall asleep? Do you find you’ve taken the mask off at night and didn’t realize it (also see additional tip below)?

If your problem is claustrophobia, you may need to start very slow. Consider starting with a relaxation exercise  (such as this 5 minute guided relaxation exercise) or a mindful breathing exercise (such as this 3 minute mindful breathing exercise). Then, just hold the mask up to your face during the day, multiple times per day. Hold it there for progressively longer periods of time. Eventually, strap the mask on. Do all of this  without even turning the machine on. When you move through these steps, keep in mind your personal reason for wanting to do this. Visualize watching your grand-daughter get married or that next antique car you wish to restore. When you are able to tolerate wearing the mask with strap, then trying turning on the device during the day when you are awake. Read a book, try a relaxation exercise, watch TV, do a brain fitness exercise on the computer. Eventually, you’ll find you adapt. If you do not really feel a significant claustrophobic feeling but you are just aware of the mask, you can use the same process, but perhaps you can start all the way with wearing the mask during the day with the machine on while awake.

Consider a fan or other white noise

Some people find the sound of a CPAP or other device bothersome. The noise of a CPAP has improved significantly over time such that now most devices are very quiet-nearly silent. But for some, any noise is notable. If this is an issue, consider a standing fan or other white noise in the room. However, DO NOT use a TV or radio as background noise—this is disruptive to your sleep pattern in other ways.

Use an alarm at night to get the device back on

Another common problem after conquering falling asleep with the mask, air flow, and machine sound, is taking the mask off at night without realizing it. For some, just sticking with it and putting the mask on every night when they go to bed and putting it back on if they wake in the middle of the night to find it off is enough to eventually make it through the night with the mask on. However, if that isn’t enough, try setting an alarm for the middle of the night so you can briefly wake up and put it back on. Or, if you bed partner starts to hear your snoring or gasping during the night, ask them to wake you to get the CPAP back on. Before long, you’ll find you are wearing it longer and longer until you eventually wear it through until the morning!

Keep trying!

Unfortunately, during this adjustment period, you may actually feel that your sleep is worse than when you were just sleeping with your sleep apnea untreated. My husband was convinced he was barely sleeping during this time! His reason to keep trying was that he was feeling so sleepy by 6 or 7pm that he wasn’t able to enjoy any of his off time in the evenings. His main challenge (after mechanical issues solved with the proper equipment) was taking the mask off at night without realizing it. Despite feeling even sleepier, he diligently tried, night after night. I would estimate that it took him a good six months to feel completely adjusted and sleeping well. But now, he feels great!  And I feel great knowing he’s managing this heart health risk factor, and I’m sleeping better without the snoring! Despite having to get up at 4:30am to be at work on time at 5:30, he feel refreshed enough that he is quite alert in the evenings, and we had some fun family time then! Now our problem is that he can’t sleep WITHOUT the CPAP! What a change. I certainly understand that adjusting to the CPAP or other device is difficult. But as a professional, I know how important succeeding in that adjustment is for your cognitive and physical health. So, please keep at it!

And if you have another tip that helped you, please share it so that others have lots of idea about how to make this work!




Sun, Aug 19 4:20pm · Cpap and sleep in Sleep Health

Thanks @colleenyoung

I would love to see some comments here! Also just a heads up that the article above is just the first in a two-part series. Next week’s post is more about how to adjust when the issues are not just equipment related. Suggestions for things like feeling claustrophobic or having trouble taking it off at night without knowing if. So I hope part two may be helpful to this group as well!

Thu, Aug 16 2:40pm · The Importance of Treating Sleeping Apnea in MCI: Getting Started in Living with Mild Cognitive Impairment (MCI)


Why are we talking about sleep apnea in MCI?

Sleep apnea is a very common sleep disorder in the general population and also a common sleep disorder in our patients with Mild Cognitive Impairment (MCI). Sleep apnea is a sleep disorder where individuals stop breathing at night (and then gasp themselves into breathing again). Take a look at this link if you want more information on sleep apnea. My husband actually has sleep apnea, finally diagnosed after we were married, and I discovered the extent of his snoring and gasping for breath at night (in between the scary silent pauses when he wasn’t breathing at all).

In our patients with MCI, sleep problems are a significant cause of “excess disability”—it makes a person’s memory or thinking problem worse. One of our major aims in the Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking © program is to identify and treat anything that could make MCI worse. Sleep apnea is one of those that is very common.

Using a CPAP machine, or continuous positive airway pressure machine, or a related device, is a very common treatment recommendation, and CPAPs are very effective treatment. The problem is many, many individuals, including my husband, have trouble adjusting to using a CPAP machine. But treating your sleep apnea goes beyond just helping your memory: treating sleep apnea also has a major impact on your physical health. Importantly, complications of sleep apnea also increase your risk of heart problems and heart disease…Not to mention sleep deprived bed partners!

First steps to adjusting to a CPAP

Some individuals take to a CPAP or related device right away. For others, it is a struggle. I will get to some behavioral strategies for helping yourself adapt next week, but first, it is important to be sure you’ve done all you can to be sure you have the equipment that is the right fit for you. Sometimes, all it takes is the right mask and voila! CPAP and (quiet) dreamland are all yours. The variety of device options is not my area of expertise, so first, be sure you’ve explored with your physician or device supplier the following:

  1. Have you tried a variety of different masks? For my husband, he finally needed to move from a mask that covered his nose to a “nasal pillow” type mask that fit at the bottom of his nose.
  2. Have you confirmed that the pressure is set optimally for your needs? This is typically done at your sleep study visit, but it never hurts to ask if you feel that the pressure is too much or too little (if you feel it is too much, but your physician has confirmed it is correct, I’ll be providing some behavioral options next week).
  3. Have you explored other device options that may help ease the adjustment? For example, does your device offer a humidifier? Do you even need a humidifier? Does your device offer a “ramp up” period so that the pressure gradually increases when you turn it on? Perhaps you could benefit from a BiPAP rather than CPAP. A CPAP has the same continuous air pressure all the time while a BiPAP has two levels of pressure—one that is harder when you breathe in but lower when you breath out. Do you need a chin strap to help keep the mask on through the night and your mouth closed?

These are just a few observations as a spouse of a loved one who had to explore lots of equipment before finding what was right for him. Turns out, he needed the pressure ramp up because he couldn’t tolerate the full pressure right away. He also really needed the humidifier. We live in Arizona, and his first machine didn’t have one. Talk about a dry mouth in the morning!

Now that you know why it is important, and some important first steps to try with your doctor, check back next week for more behavioral strategies if adjustment is still difficult.

Tue, Aug 7 10:28am · Summer Recipes! in Living with Mild Cognitive Impairment (MCI)


In the Mayo Clinic HABIT Healthy Action to Benefit Independence and Thinking © program, we typically recommend a balanced, Mediterranean style eating plan for brain health. One of the recommended food groups in that plan is BERRIES! This is my favorite food group on the plan, so I wanted to share a couple of refreshing summer recipes with you.

These treats come from the Mayo Clinic Dan Abrahams Healthy Living Center. The strawberry sorbet is so cool and refreshing in this summertime heat! The summer salad is light but full of flavor. I also include my favorite berry—the blueberry! I enjoy the milder and crunchy daikon radish rather then the red radish (which I find a little spicy!) Also, if you go for a leafy green like spinach as the base, you’re also getting in a second recommended food group on a Mediterranean style eating approach—GREEN LEAFY VEGETABLES.

Strawberry Balsamic Sorbet


-3⁄4 cup balsamic vinegar
-2 tablespoons basil, finely chopped
-4 cups strawberries, hulled and halved,
-plus 5 berries, coarsely chopped
-1 tablespoon dark honey

Fresh Summer Salad


-12 oz baby greens
-2 oz goat cheese
-2 cups assorted fresh berries
-1/2 cup julienne red onion
-1/3 cup Balsamic vinegar
-1/2 cup julienne red or daikon radish

I hope you try these and enjoy! Also feel free to post your favorite healthy berry recipe to share with the readers!

Thu, Jun 21 12:30pm · Living alone with Mild Cognitive Impairment in Living with Mild Cognitive Impairment (MCI)

Hi @user_cha272278. I’m so glad you asked! Mayo Clinic has the HABIT program, which is solely designed as a treatment program for those just diagnosed with MCI. Please take a look at the Program Overview tab on the Living with Mild Cognitive Impairment page for more details on what we do. Feel free to ask more questions after that!

Thu, Jun 21 12:23pm · Living alone with Mild Cognitive Impairment in Living with Mild Cognitive Impairment (MCI)

Hi @1gusto. My recommendation is that if you have concerns about your memory or possible Mild Cognitive Impairment that you start with a conversation with your primary care physician. He or she can then arrange an evaluation which often includes medical evaluation, sometimes a consultation with a neurologist and ideally a comprehensive neuropsychological evaluation.

Tue, May 15 9:16am · Living alone with Mild Cognitive Impairment in Living with Mild Cognitive Impairment (MCI)



Some of our patients with MCI live alone, perhaps with just occasional “check-ins” from family members. For many people, this is not a problem and they continue to manage well independently despite short-term memory loss. However, we would like to recommend that if you live alone and have been diagnosed with MCI that you consider putting some “safety nets” in place, just in case you need more support. Here are some tips from us here at the HABIT Healthy Action to Benefit Independence & Thinking® team.

  1. Inform a group of people you trust of your diagnosis.

This can be a small group of family members, such as adult children or siblings, or even trusted friends and neighbors. For many people with MCI, their friends and family may not even notice the short term memory changes at first. So, informing them of your diagnosis can start you off in building your support team safety net. In other cases, close friends and family may have noticed some short term memory changes, and you informing them of your diagnosis may come as a relief to those who care about you that you are being proactive about your health and care. This also can open the door to helping them feel comfortable asking you if they can support you in some way. Maybe you don’t need more support now, but you can have people who care about you helping to maximize your independence and ready to step in and support you if you do need help down the road.

  1. Consider a plan for driving supervision.

Many patients with MCI continue driving and can do so safely. However, driving safety is often a concern in MCI and certainly a concern if MCI progresses. We encourage you to empower a trusted loved one or friend to give you feedback about driving and possibly help you stop driving if there are safety concerns. Then consider how you might get around if you cannot drive–Do you live somewhere that you can use public transportation? Perhaps begin looking into ride services or determining if your church or other faith community has a volunteer ride service available.

  1. Consider a plan for financial supervision.

Managing finances, from routine household bills to complex investment or estate trust plans, can be complicated. People with MCI often make good decisions about finances, but short term memory loss can sometimes interfere with implementation. Therefore, we encourage you to consider enlisting professional help with financial management and/or involve a trusted family member in your financial matters. You may not need their help in making financial decisions at this time, but they can be a “safety net” for helping be sure you’ve gotten that utility bill paid on time (and not double paid), helping you talk through larger financial decisions, and serve as a memory back-up for implementing a decided upon investment strategy.

  1. Consider a plan for medication supervision.

Many patients with MCI use supportive tools, such as a pillbox, to help ensure medication accuracy. If you are not yet using one, we strongly encourage you to start. There are a number of models on the market that include multiple times per day dosing if needed. In addition, however, we would encourage you to enlist a trusted friend or family member to occasionally check in on your medications or perhaps oversee when you fill your pillbox to ensure accuracy.

  1. Consider joining MCI support or engagement groups.

Living alone can be isolating for any of us. Unfortunately we often see our patients with MCI withdrawing from their social networks. We’d encourage you to fight against this tendency (perhaps by letting some trusted social connections know of your memory loss so that you don’t have to worry about having a memory slip with them). In addition, many local Alzheimer’s Association chapters have social groups or support groups for those with MCI (sometimes called early stage support groups or social groups). Take a look to see what is available in your area, as being able to connect with others also experiencing memory loss may help you stay socially connected and engaged in addition to helping you find a source of encouragement along the way.

  1. Plan for your future.

It is important for all of us, with or without memory impairment, that we’ve made decisions and communicated our wishes including medical treatment wishes, financial planning, and end-of–life care. However, a diagnosis of MCI, with the possibility of progression of cognitive impairment, increases the urgency of these decisions. If you have already established a power of attorney for health care and a power of attorney for finances, do those individuals know your wishes?  Do you need to update them on any changes?  Do you need to revise any your advanced directives or living will? Do you need to revise anything related to your estate planning? Now is the time to make any changes and be sure to inform those who care about you of your wishes. You can seek out an elder law attorney in your area for help with these issues. Again the Alzheimer’s Association can also help guide how to handle some of the above planning issues.

The above topics are those we see coming up most often in our patients with Mild Cognitive Impairment. We’re hoping to encourage you to make some plans now, not because you need help right now, but so that there is a plan in place.  We want to see you live as independently as possible, but also have a safety net should your short term memory loss cause some bumps in the road. For many, MCI progresses, but we don’t know how soon or how fast. So we encourage you to make plans now, before you need them.

Your local Area Agency on Aging and the Alzheimer’s Association have additional resources related to living your best life as you age and additional considerations for living alone if MCI progresses to dementia. We would encourage you to also view these resources. Our goal is to help you live a full life as independently as possible by pre-planning for common challenges in MCI.  We would like to see you in the driver’s seat about decisions for how you might accept additional help if it is needed, rather than one day possibly having it dictated for you.

Fri, Apr 6 4:34pm · Depression and MCI: Part 2, Treatment options in Living with Mild Cognitive Impairment (MCI)

@judymcd –Wonderful! Thank you for sharing your story.