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Tue, Aug 21, 2018 9:10am

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

By Dr. Dona Locke, HABIT AZ Director, @DrDonaLocke

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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!

 

 

 

It's kind of strange for me looking back because I would have never guessed I had sleep apnea. A Mayo doctor in vascular medicine had asked me some key questions and ordered multiple tests for me. One of the tests was the home oximeter test. The results showed that I had obstructive sleep apnea so I had the following overnight sleep apnea study done at Mayo which gave a more definitive answer and I was prescribed a CPAP. I had made the decision that I am going to do what's necessary to get the full benefit of using a CPAP to hopefully take a step to a better quality of life and more energy during the day.

The only tip I can offer is if you are told you need to use a CPAP, find a way to make it work for you. Whether it is taking time gradually to get used to it or just jumping all in and using it. It may save your life and your loved ones will be happy you will still be around.

Helpful and great advice for anyone using CPAP to treat Obstructive Sleep Apnea.

I have used a CPAP for over ten years, and had no issue with adapting, though I anticipated problems. The tangible bonus is the reward of an uninterrupted full night’s sleep in decades put the other issues in the shade. I had undergone a uvulaplasty in hope that would solve the issue and avoid the CPAP. Terrible procedure from which to recover, and it didn’t work. Do whatever to get used to the mask, and use it. Your life will be changed, and likely extended.

I snored and made gasping weird noises for many years. I was tired and fell asleep during driving or sitting in a chair. I am a mouth breather, so I now use a full mask. Previously I never knew what a full night sleep was like. What a difference it has made in my life. I really like the improvements in masks and machines.

@john4pack

I snored and made gasping weird noises for many years. I was tired and fell asleep during driving or sitting in a chair. I am a mouth breather, so I now use a full mask. Previously I never knew what a full night sleep was like. What a difference it has made in my life. I really like the improvements in masks and machines.

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Hello @john4pack — Welcome to Connect. As a new user to CPAP I can relate to your story. I too have a habit of falling asleep in a chair in the evening. When I get sleepy driving I pull off the road or roll the window down rain, sleet or snow to keep air blowing on my face. Wakes you right up in the winter time ☺. I'm glad there are a lot of choices and devices to make the CPAP experience better. I'm still working at having it make a difference but I do know I need to keep at it.

@john4pack what type/brand CPAP mask do you use? Do you have any tips to share?

Thanks! John

I've had my ResMed Quatro Air for about 4 yrs, so maybe there are newer/better full masks available. I had an scary event with chemo induced acid reflux, and have not reused it. I have heard that manufacturer makes an air tube that has a heater wire in it to prevent invisible mold/mildew from forming inside. A preheating feature would also be on my next unit, since I hate the cold room air , blowing in my face. I took early retirement, so I can sleep as long as I want now

@john4pack

I've had my ResMed Quatro Air for about 4 yrs, so maybe there are newer/better full masks available. I had an scary event with chemo induced acid reflux, and have not reused it. I have heard that manufacturer makes an air tube that has a heater wire in it to prevent invisible mold/mildew from forming inside. A preheating feature would also be on my next unit, since I hate the cold room air , blowing in my face. I took early retirement, so I can sleep as long as I want now

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Hello @john4pack — I think most of the newer CPAP machines have a humidifier with a heater and you can get a heated tube to go with it. They also have features that allow you to adjust the hose temperature and the humidifier temperature. I use the Dreamstation CPAP machine but I'm sure others have similar features.

https://www.usa.philips.com/healthcare/product/HCNOCTN447/dreamstation-cpap-bi-level-therapy-systems

@elwooodsdad

I have used a CPAP for over ten years, and had no issue with adapting, though I anticipated problems. The tangible bonus is the reward of an uninterrupted full night’s sleep in decades put the other issues in the shade. I had undergone a uvulaplasty in hope that would solve the issue and avoid the CPAP. Terrible procedure from which to recover, and it didn’t work. Do whatever to get used to the mask, and use it. Your life will be changed, and likely extended.

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An update…I got a different nose pillow headgear, and did ‘enjoy’ a few minutes of getting used to it and making adjustments. Ten minutes out of my life, and I slept for eight hours. The new mask is an upgrade to more current design. If you have issues getting started, please stay with it. The value of sleep is amazing. Sleep apnea is deadly, and causes or exacerbates depression, anxiety and multiple physical issues.

@elwooodsdad

I have used a CPAP for over ten years, and had no issue with adapting, though I anticipated problems. The tangible bonus is the reward of an uninterrupted full night’s sleep in decades put the other issues in the shade. I had undergone a uvulaplasty in hope that would solve the issue and avoid the CPAP. Terrible procedure from which to recover, and it didn’t work. Do whatever to get used to the mask, and use it. Your life will be changed, and likely extended.

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That's great news @elwoodsdad. Thanks for sharing!

I started using a cpac machine about 4yrs ago. My husband always criticized me of snoring and so have other family members. I was on a cruise one time and my roommate kept asking me do you have you nose plugs, or cpac machine. I told her no. She just knew that this would be the worst 7days since she is a very light sleeper but she told me later l didn't hear you snore the whole cruise trip. I wonder if she had a couple extra drinks. I am sometimes still having problems with sleeping. I told my doctor that my mouth is so dry the next morning when l wake up. She said l probably need the mouth guard or full mask. I just don't care for the full mask it seems like l am suffocating. So now they have new mask and l like them but l prefer the pillows. They have another mask that just blows across the nose without having the full mask. I know there are new cpac machines and l think l like the Philip's new one. Has anyone use the mask cleaner? I just want to get anyone's opinion about it since insurances doesn't cover it.

@techi

I started using a cpac machine about 4yrs ago. My husband always criticized me of snoring and so have other family members. I was on a cruise one time and my roommate kept asking me do you have you nose plugs, or cpac machine. I told her no. She just knew that this would be the worst 7days since she is a very light sleeper but she told me later l didn't hear you snore the whole cruise trip. I wonder if she had a couple extra drinks. I am sometimes still having problems with sleeping. I told my doctor that my mouth is so dry the next morning when l wake up. She said l probably need the mouth guard or full mask. I just don't care for the full mask it seems like l am suffocating. So now they have new mask and l like them but l prefer the pillows. They have another mask that just blows across the nose without having the full mask. I know there are new cpac machines and l think l like the Philip's new one. Has anyone use the mask cleaner? I just want to get anyone's opinion about it since insurances doesn't cover it.

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Hi Lisa @techi, I use the SoClean 2 unit that sits next to the CPAP machine. Just have to take the mask off in the morning and put it in the SoClean unit with the hose still connected and close the lid. It sanitizes the mask, hose and humidifier. I have so many "morning" routines that I didn't want to add mask cleaning as another one. I think there is still a monthly cleaning/washing of the mask and hose but it sure saves a lot of messing around for me. It is spendy at $319.00 but I figured I'm in it for the long haul and I will get my money's worth.

I have the Dreamware full face CPAP mask and I like that it does not fit over the nose but snugs up to the nose so you can still breath through the nose or the mouth. I'm on the third week with it and still getting adjusted but I do like it.

John

@johnbishop Thanks John so much. You know you hate to buy things that's just await of your money. I haven't used my Cpac machine in 2wks because today l am approved to get a new machine so they didn't want to give me new supplies when l will be getting a new machine. What is the name of your machine? I have been looking online on reviews of different machines and l saw that the Philip's has great reviews. I can only get a new one every 4yrs. I have the reamed and they have good reviews but l want the best one if possible. Glad to hear from you and you always have great advice. Thank you !!!

@techi

@johnbishop Thanks John so much. You know you hate to buy things that's just await of your money. I haven't used my Cpac machine in 2wks because today l am approved to get a new machine so they didn't want to give me new supplies when l will be getting a new machine. What is the name of your machine? I have been looking online on reviews of different machines and l saw that the Philip's has great reviews. I can only get a new one every 4yrs. I have the reamed and they have good reviews but l want the best one if possible. Glad to hear from you and you always have great advice. Thank you !!!

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Hi Lisa @techi I have the Dreamstation with humidifier. The doctor at Mayo recommended it because it has an auto ramp up feature. The machine is set to start at 8 and go to 18. If the 8 is too much to get to sleep there is a ramp up button which drops it to 4 for 15 minutes. You can adjust the ramp time yourself. I changed mine to 20 minutes. Here are a couple of links:

Philip's Respironics Dreamstation CPAP Machine Review – YouTube 8:29

Philips – DreamStation CPAP & Bi-level Therapy Systems
https://www.usa.philips.com/healthcare/product/HCNOCTN447/dreamstation-cpap-bi-level-therapy-systems

John

@johnbishop Thanks John that's the one l saw and liked but do you have to order it or were you able to get it from your medical supply store. This is the day l csn get a new one.

@techi I got mine at the Mayo store but most medical stores that sell CPAP equipment probably carry it.

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