Behavioral Strategies for Adjusting to a CPAP After a Diagnosis of Sleep Apnea

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Aug 21, 2018 | Dona Locke | @DrDonaLocke | Comments (18)

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!