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Sleep apnea is kind of a big deal. But what happens when you get diagnosed and suddenly find yourself trying to sleep with a Darth Vader mask strapped to your face? Will sleep ever be normal again?
Living with CPAP can be frustrating. The very thing that is supposed to improve your sleep can also make falling asleep nearly impossible. Unfortunately, not complying with treatment can have some serious consequences for your health.
In this guide, we’ll go over what CPAP therapy is, how the equipment works, and give you 9 tips and tricks for sleeping better in your mask (plus some alternatives if it’s not working out).
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. The problem is, many people don’t even know they have it! In many cases, a partner identifies the issue or a person may seek answers to their daytime fatigue and stumble across some info on OSA.
The telltale symptoms include loud snoring with pauses in breathing multiple times throughout the night. This pause is kind of like a yawn or holding your breath momentarily before a sneeze, only it lasts for 10 seconds or longer. When this happens, the levels of oxygen in the blood drop and microarousals from sleep occur.
In most cases, OSA happens because muscles in the throat become relaxed during the night, collapsing or blocking the airway. Kind of like a hose that becomes kinked, airflow stops and the person may temporarily wake-up or snort and return to sleep. This can go on all night with as many as 100 episodes or more.
You may be shocked to know that an estimated 22 million Americans suffer from sleep apnea according to the National Sleep Apnea Association. Alarmingly, 80% of the moderate and severe cases remain undiagnosed.
While people of all ages and ethnicities can develop OSA, it’s most commonly seen in males over 40 and those who are overweight or obese. If you have type 2 diabetes or depression, you also are more likely to suffer from OSA.
Compliance is a term that you may have heard your doctor or respirologist mention before. Being ‘compliant’ means that you are using your CPAP machine as prescribed. ‘Noncompliance’ is when you are not following your therapy recommendations, either not wearing your mask regularly or not for long enough.
Most people fall into a pattern of either compliance or noncompliance within the first week of therapy. If you’ve ever had to sleep with a mask forcing air into your nose or mouth, you know that it’s not an easy task. Unfortunately, sticking with CPAP treatment is a problem that many people face.
If you struggle to wear your mask every night, you’re not alone. Up to 35% of patients prescribed CPAP therapy aren’t complying with treatment, according to over 20 years of data. In some cases, they only use their machine for a few hours each night, and in other cases, they stop using it altogether.
People struggle with compliance for a number of reasons. The mask doesn’t fit right, the tubes get blocked when they sleep on their sides, or they struggle to fall asleep with the forced air. Some people seek help and try a different mask or adjust the settings, but many just give up on therapy entirely.
If you are a pilot, drive for a living, or have an insurance carrier that tracks compliance, not using your machine as directed can be a big deal. Most modern CPAP machines have advanced tracking features that monitor usage. This data can be tracked with precision and automatically sent to your doctor, insurer, or employer.
Not complying with treatment could cause serious issues with keeping your job or having your machine covered through insurance. Obviously, these financial repercussions can cause a lot of stress when you’re trying to adjust to therapy. But for many people, it’s the serious health effects of noncompliance that cause the most alarm.
The consequences of sleep apnea go far beyond the loud snoring and feeling exhausted despite getting a “good night’s rest.” In the early stages, forgetfulness, irritability, and daytime grogginess are the most common symptoms in adults, and hyperactivity is commonly seen in children. This can significantly impact the ability to function at work or school and could put a serious strain on relationships.
If you struggle with complying with your CPAP therapy, you may want to think twice before getting behind the wheel to drive your kids to school. The ongoing sleep deprivation from microarousals at night can lead to serious accidents in the workplace or on the road. Drivers with obstructive sleep apnea are at least twice as likely to be involved in motor vehicle accidents as those without the condition.
Left untreated, OSA can place a significant strain on the heart and other organs in the body, increasing the risk of developing a number of health conditions. Sleep apnea has been linked to insulin resistance, obesity, type 2 diabetes, parasomnias, high blood pressure, heart disease, stroke, and memory loss.
If that wasn’t enough to scare you, research has found a link between the repeated drops of oxygen levels in the blood from sleep apnea and early or premature death. In a study that tracked 1,500 adults over 18 years, the risk of death for those with untreated sleep apnea was 3.8 times greater.
CPAP therapy is the most common treatment for obstructive sleep apnea and usually the first thing your doctor will recommend. CPAP stands for continuous positive airway pressure and involves gently blowing air into the nose and/or mouth to keep the airways open.
Once your doctor has performed a sleep study evaluation to confirm a diagnosis of OSA, the next step is to choose a CPAP machine. Depending on your doctor and the degree of your apnea, your physician may refer you to a respirologist or a medical supply store that specializes in fitting masks.
CPAP therapy is covered by most insurance providers as long as you are compliant with therapy. Some workplaces may require that you show proof of CPAP compliance if you have a job that requires a high degree of alertness. Air pilots, truck drivers, and heavy machine operators are some of the examples that may request proof of treatment.
A CPAP machine is a small electronic box that connects to a mask with a hose. Most machines have built-in humidifiers that help to moisten the air before delivery. This can help to prevent a dry or stuffy nose.
Your doctor will determine the pressure-settings that you need, and these can be programmed into the machine. Some machines come with features like ‘ramp’ which can start you off at a lower setting and gradually increase to keep you more comfortable. Many people prefer this because it gives you a chance to fall asleep before the maximum pressure is reached.
Blowing pressurized air through the nose or mouth helps to prevent the muscles in the throat from collapsing and forces the airways to remain open. CPAP therapy uses regular room air but filters, humidifies, and pressurizes this air before delivery. While this type of therapy isn’t a ‘cure’ for OSA, using CPAP as prescribed can effectively treat the condition and help to prevent many of the complications of sleep apnea.
While you may not be excited about the thought of having to fall asleep with a mask strapped to your face, you’ll be happy to know that there are many options to choose from. CPAP masks have come a long way since their initial designs, so you no longer have to worry about looking like something out of a Halloween horror flick.
Modern masks are much smaller and more lightweight with soft padding and cushions to enhance comfort. Masks may fit over both the mouth and nose, which is an ideal option for mouth breathers. Or, some masks are small enough to sit right over or under nasal passages alone.
Most masks are designed to attach to the headgear that wraps around the back of the head. Getting the right fit is important to keep you comfortable and to prevent leaks that can minimize the effectiveness of therapy and irritate the eyes.
Masks come in many shapes and sizes, and some are even specifically designed for females. Certain nasal masks are available for mouth breathers and come with chin straps that help to keep the mouth closed.
Choosing the right mask for you can all the difference in complying with therapy. Certain factors to consider are what type of sleeper you are, how easy it is to disconnect your mask if you need to get up in the night, and whether you need to be able to see for reading or watching television in bed.
The most important thing to know going into CPAP therapy is to be patient with yourself. Getting used to sleeping with a mask and forced air is going to take time and initially may make it harder to sleep at night. Baby steps are key for helping you to gradually adjust to CPAP and to set you up for long-term success.
Don’t expect to put on your brand new mask and make it through 8 hours of therapy the first night. You’ll want to start by wearing your mask around the house and getting used to the feel, then slowly adding in pressurized air while you have some sort of distraction like catching up on celebrity gossip or watching Netflix. Starting with smaller goals and gradually adding longer increments of time will help you to adjust and work your way up to a full night of therapy.
Have you ever tried to fit into a pair of jeans you had no business wearing or walked around in shoes that were a size too big? Comfort matters and getting the right fit on your mask is an important step. Your doctor, sleep technologist, or CPAP supplier are the best people to turn to when it comes to fitting your mask.
Once you’ve chosen a mask, the next step is to schedule a fitting where you’ll choose the right size and adjust the headgear according to the shape of your head and face. If the mask is too tight, you’ll be uncomfortable and wake up with lines on your cheeks where the straps were. If the mask is too loose, you won’t have a proper seal and air will leak out around the mask, irritating the skin and eyes.
If you find yourself struggling to tolerate the forced air or struggle to fall asleep, starting off at a lower pressure setting may help. Many machines have a built-in feature called ‘ramp’ that allows you to fall asleep at the lowest pressure and automatically increases to the pressure prescribed by your physician.
If your machine doesn’t have a ‘ramp’ setting, it may be worth looking into switching to a machine that does. Over time, many people adjust to therapy enough that they no longer need to use ‘ramp.’ But, in the beginning, it can be very helpful.
Your CPAP machine pulls air from your bedroom, so if you have the air conditioner on or the heat running during the winter months, the hot or cold air could be uncomfortable and irritating to the airways.
If you find yourself suddenly waking with a runny nose or even the occasional nosebleed, using humidified air may help. Likewise, using a nasal saline spray before bedtime may help to prevent the nostrils from overdrying.
Similar to sleeping with a wedge pillow, an adjustable base bed elevates the head of the bed which may help to minimize snoring. Sleeping at an incline can improve some of the symptoms of mild sleep apnea, but may also be a great option for those using a CPAP therapy.
By helping to maintain open airways, an adjustable bed could mean your pressure settings can be lowered. This may help you to be more comfortable with therapy and increase your likelihood of sticking with it. Another positive of an adjustable bed is it gets you a little closer to your machine, giving you a little extra room on your hose for moving around.
If small rooms and tight spaces have always bothered you, wearing a CPAP mask could be equally challenging. For some people, having a tight-fitted mask over the airways causes feelings of claustrophobia and anxiety. On top of it all, the hurricane-like wind blowing into the mouth or nose causes some people to experience a choking sensation or to panic and hold their breath.
If you are prone to anxiety, start off by wearing the mask around the house without any pressure. Gradually add in the air at the lowest setting, using some form of distraction. Visualization and positive self-talk may also help, but if you still find yourself panicking every time you put your mask on, it may be worth seeking treatment for your anxiety.
Speak to your doctor about what options may be available to help you work through your feelings around CPAP therapy. They may recommend seeing a therapist who can teach you certain techniques to calm your anxiety, or help you to explore CPAP alternatives.
Similar to the ‘ramp’ feature, expiratory pressure relief (also known as CFLEX) is another optional setting that may increase your comfort. While most CPAP machines deliver airflow at a steady pressure rate, expiratory pressure relief lowers pressure while you exhale, helping to alleviate feelings of breathlessness.
Most machines will reduce the pressure by 1, 2, or 3 settings during exhalation, making it easier to release your breath. Some even have advanced features that adjust automatically based on each user’s own breathing cycles. Expiratory pressure relief is a setting that may increase compliance for patients who struggle with adjusting to forced air.
Your sleep position is an important factor in treating OSA. Sleeping on the back can make symptoms worse, because this position allows the tongue to fall back, blocking the airways.
Certain masks work best for back sleepers, and others are ideal for side sleepers. Keep in mind that sleeping on your side could kink your tubing, reducing the airflow and pressure through your mask. Thankfully, there are many masks that are designed for side sleeping and have features that prevent the tube from becoming kinked.
Learning to sleep on your side may also help to decrease some of the symptoms of sleep apnea, decreasing your required pressure settings. While this may not mean you can stop therapy right away, it could be one positive step towards eventually no longer requiring CPAP.
Another bonus of side sleeping is being able to use a nasal mask instead of a full face mask. Nasal masks are smaller and usually more comfortable to wear, but many users who sleep on their backs require the highest pressure settings that can only be delivered using a full face design.
If you are a die-hard back sleeper and find it hard to transition to sleeping on your side, a bumper belt may help. The belts are designed to comfortably hold you on your side. Most have an adjustable strap that goes around the waist or upper body with little pockets for the inflatable bumpers.
If you frequently fall asleep on your side only to wake up and find yourself on your back again, sleeping with a bumper belt may help. When you try and roll over onto your back during sleep, these bumpers make it uncomfortable for you and could help to gradually train yourself to sleep on your side.
Once you’ve finally gotten used to CPAP therapy and can fall asleep at night, another problem you may encounter is waking to your machine’s alarm signaling that airflow is blocked. The most common cause of this is a kink in the hose. Adding an elbow adapter angles the CPAP hose in a better direction so you aren’t fighting with your tubing all night long.
Elbow hoses are designed to work with most CPAP machines and prevent crinkling or torsion during sleep. These L-shaped adaptors create a 90-degree angle, providing better airflow and allowing you to sleep more comfortably while connected to your machine.
If you just can’t get your head wrapped around wearing a mask to bed each night or have tried CPAP therapy for months but are still struggling to adjust, you may be wondering if there are any other treatment options. While CPAP is the “gold standard” of treatment for OSA, there are some alternatives worth considering.
Nearly every medical disorder can be improved (notice I didn’t say the “c” word – cured) with lifestyle changes. You likely know that exercise, diet, and reducing stress are important for heart disease, but you may be interested to know that many of these same lifestyle changes can improve the symptoms of sleep apnea too.
Oral appliances are specialty dental devices that are designed to correct anatomical problems that may be contributing to sleep apnea. For example, if your jaw is short or recessed, shifting the jaw forward reduces crowding and may help to keep your airways open. Other devices may hold the tongue in place to prevent it from falling back and blocking the throat during sleep.
In some cases when all other treatment options have been exhausted, your doctor may recommend surgical options. During surgery, some of the tissue in the back of the throat is removed to create more space for airflow. In many cases, the surgeon also brings the tongue forward and may even insert a nerve stimulator that is designed to keep the airways open.
For sleep apnea in children, one of the most common forms of surgery is the removal of the tonsils and adenoids. This is usually the first treatment doctors recommend for children and is often enough to stop snoring and apneic episodes in kids altogether.
If you are struggling with using your CPAP mask because of anxiety or feelings of claustrophobia, it may be worth considering treatment options to help you feel more relaxed about therapy. Seeing a counselor that can help you develop coping skills to manage your anxiety may be an option, but you might also be wondering if medication to treat anxiety is right for you. In some cases, a prescription for low-dose anti-anxiety pills could be enough to calm your body and mind so you are more likely to stick with treatment.
CPAP therapy is often the first treatment your doctor will recommend, but if you are worried about adjusting to sleeping with a mask on your face then it may be worth exploring some other options. Ask your doctor about which CPAP alternatives may work best for you. Depending on the severity of your apnea, lifestyle changes like sleeping on your side or losing weight may be enough to improve your symptoms.
If you’ve been diagnosed with sleep apnea, chances are you’ll be faced with using CPAP therapy at some point along your journey. It may not be the sexiest looking thing and it definitely will take some time getting used to, but it might just save your life. The dangers of leaving sleep apnea untreated are real and as frustrating as adjusting to therapy by may, the outcome is worth it.
Thankfully, there are many options to help you increase your comfort while using CPAP or even alternatives if you just can’t make it work. The important thing to remember is that the adjustment period takes time. If you’re uncomfortable or struggling with compliance, speak to your doctor about options to adjust your therapy and to help you stick with it.