See pap run. See pap on my nose. See pap on the floor when I wake up.

March 8, 2014 3:58 PM

I have a CPAP machine that I am trying to get used to. How do I keep from taking the mask off in the middle of the night and falling back asleep?

I have the kind of mask that just comfortably under the nose, cushioned by little gel-rings under the nostrils, and fastened to the head with comfortable gel-cushioned rubberfoam and velcro straps. The machine ramps up the air pressure automatically, so I have no control over that. I can fall asleep with it on, no problem. It has humidified, warmed air, and is actually very soothing. I wear earplugs so I don't hear any of the white noise (unless there's a leak, and the earplugs make it easy to hear if there is a leak and adjust the mask). Then, usually a few hours later, I wake up, take it off, and fall back asleep without realizing what I am doing, or not caring that I've done it.

Before I go to sleep every night, I remind myself that if I wake up in the middle of the night and take the mask off, that I should try and be mindful enough to realize what I am doing, and try and to summon the willpower to put it back on. But when it happens, I don't become fully conscious or aware of what I am doing, and my lizard-brain says "no way." In the morning when I wake up, I usually have no recollection of having taken it off in the first place.

It's important that I solve this problem -- not only because I want to let the machine help me get a good nights sleep eventually (I have moderate/severe apnea), but also because I am renting this CPAP machine, and it's subsidized by my insurance company. If, by May, I don't have the mask on for 4+ hours/night, 70% of the days in a 30-day period, the insurance company will no longer subsidize it.

I have tried sleeping with a hat on so that if I wake up and try to take the mask off, I go that extra step toward consciousness before realizing what I am doing, because I figure, taking a strap off my head before taking the hat off, that should wake me up, right? Nope. That strategy did work for two or three nights, but then it stopped being an effective deterrent.

My SO suggests I fashion a chinstrap, but I don't want to turn this into a DIY project. I am thinking I should sleep with the light on and the hat over my eyes (because I can), so when I take the hat off, the bright light will jar me awake. Anyway, I welcome any suggestions on how I can get myself awake and in a positive state of mind enough that I put the mask back lovingly back on after my lizard-brain loathingly rips it off.

posted by not_on_display to Health & Fitness (19 answers total)

I don't have any excellent hacks but can share my personal experience of doing the same thing for the first several weeks, and worrying about the compliance rules.

Mine's a Respironics Remstar C-Flex. It's amazingly quiet and gentle compared to the original Remstar I had.

In my case the insurance company helped me purchase the CPAP, and had similar rules for compliance. But they never called or checked up on it.

Anyhow, the problem solved itself in about six weeks. I still take the mask off efvery once in a while, and usually my snoring wakes up my S.O., she kicks me, and I put the mask back on.

I think my lizard brain finally figured out that I feel much better in the morning if the mask stays on.
posted by Kakkerlak at 4:08 PM on March 8, 2014

Any idea what's happening that makes you want to take off the mask? I have the same type of mask, and while I didn't have that specific problem, I did find it difficult to breathe through while trying to get to sleep. Moving up to the "large" size (with larger holes for the air to go through) solved that completely. So maybe experimenting with different sizes or different brands of masks might be helpful?

Or even just adjusting the straps a bit might help. It took me a *long* time to get mine set up exactly right for me, in part because I think they expand slightly as they warm up. So what feels perfect at first, ends up being too loose a fit, resulting in leaks and noise.

Aside from that, as a temporary "hack" what about drinking a glass of water before going to sleep, to ensure you wake up after a few hours to use the washroom? Seems like that might give you a second shot at having it on again for a few hours.
posted by FishBike at 4:24 PM on March 8, 2014 [1 favorite]

I had a similar problem and solved it by making sure my arms were under the covers when I went to sleep.
posted by kindall at 4:34 PM on March 8, 2014

Can you fall asleep with mittens on?
posted by bq at 4:36 PM on March 8, 2014 [4 favorites]

This fixed itself for me after the first month or so - eventually your brain seems to get the message. But I've seen people suggest wearing mittens or socks on your hands during that adjustment period, medical tape to hold the strap on, buying a chinstrap, all sorts of stuff. If you don't find an idea that works here, check out some of the cpap forums for lots and lots of advice. I think cpaptalk was a helpful one for me.
posted by Stacey at 4:38 PM on March 8, 2014

You should call up the DME company supplying your CPAP, or the sleep clinic that diagnosed your apnea, and make an appointment with a respiratory therapist to get their advice about this.

Have you tried one of the over-the-nose face masks yet? I think the first thing to do in a circumstance like this is to experiment with using a few different mask types and see if you tolerate another one better.

Also, check that the straps are well-adjusted and it's fitting right - usually I find that if I'm waking up and putzing around with my mask in the middle of the night, it's because it's come unseated and started leaking air in my face. It could be that's what's going on with you and you just don't realize it because you're not forming memories during the time it happens.
posted by strangely stunted trees at 4:55 PM on March 8, 2014 [1 favorite]

I could never get the hang of keeping the CPAP on, but before we gave up, I tried many, many, many different masks, including one that had straps above and below my ears and over the top of my head. I still managed to get it off in my sleep, but maybe something like that would be enough to slow you down and break you of the habit?
posted by looli at 4:55 PM on March 8, 2014

CPAP pillows might be a big help. It's shaped so the mask has space to go no matter what position you sleep in.

It does take a few weeks or more to get used to the cpap, but a pillow designed to make it more comfortable might help you.
posted by colin_l at 5:29 PM on March 8, 2014 [1 favorite]

I use mask liners. They make a huge difference in comfort and fit. I use a nasal mask, and I have to crank up the humidity to the maximum level in order to be comfortable. When I don't use mask liners, the mask won't seal to my face or else I wake up in the middle of the night to the sounds of slurpy noises and the feel of a swamp on my face. With the liners, I sleep soundly through the night.

You also might want to try different masks. I have a friend who swears by nasal pillows. In fact, many CPAP users love nasal pillow masks as they are the least cumbersome. I prefer a nasal mask that goes over my nose, and use a ResMed Mirage for Her in the small size. I have a small nose and face and the mask designed for women fits me better. Men, too, have different face sizes and shapes, so one brand or style will be a better fit than others.

Many people need to try on several different masks before they find one that fits well and is comfortable. Talk to the company that rents your CPAP and get an appointment with someone who can help you make your CPAP more comfortable for you. It's definitely a learning curve for almost everyone. Don't give up! If necessary, see if the CPAP rental company will give you more time to get acclimated.
posted by Rosie M. Banks at 6:05 PM on March 8, 2014

I am a PA who works in sleep medicine but this isn't specific medical advice for you, just a summary of causes I see with my patients experiencing the same thing. You could be slightly under treated and need higher pressure. You may need a mask that goes over your nose and mouth or a chinstrap. If the mouth is dropping open at night often it is so loud and disruptive that people will arouse enough from sleep to pull it off. Either way you should contact your Physicians office. They may be able to look at the data from your machine and provide some insight.
posted by teamnap at 7:25 PM on March 8, 2014 [1 favorite]

For myself at first I'd take the thing off randomly some time in the middle of the night. The frequency decreased after a month or two and now it's pretty rare. I guess I got used to it? Maybe it will be the same for you. I still despise wearing the thing though.

Good luck!
posted by DrumsIntheDeep at 8:34 PM on March 8, 2014

I would hit a CPAP forum for this, such as the one I have used in the past, Apneaboard. Free signup, and I bet they've bothered me maybe twice in 18 months through email-- very low annoyance.

While you're there, check out Sleepyhead (didn't know it was cross-platform-- it's not 100% compatible with all CPAP machines) and the other software downloads they have, including the official software that your sleep medicine doc is using to read your CPAP's SD card. Then you can see quantitative results for when and how often your machine is performing, as well as how close you are to meeting that milestone for insurance coverage-- that particular functionality is built-in because it's so common. Plus you can see your AHI (it has some other names, but it's the # of apnea-hypopnea events per hour) is for a given sleep period.

How does your mask release? Can you add velcro, or a zip-tie or something to make the unthinking mask removal more difficult?

As for chinstraps, my DME supplier, the same place I get replacement parts and filters, had several designs, so yours probably does too-- you don't have to go the DIY route. But I think their respiratory specialist, as suggested above, is the one to talk to. Good luck and stick with it.
posted by Sunburnt at 8:36 PM on March 8, 2014 [2 favorites]

When I first had my CPAP, I did the same thing: I'd take it off in the middle of the night without realizing it. I stopped that behavior by taping the mask to my face with surgical tape. It seems weird, but it worked for me. When I'd try to remove the mask in that middle of the night half-awake state, the tug of the tape would wake me up and remind me to leave it alone. After a month, I tapered off the use of the tape and haven't needed it since. That was in 2010 and I've used several different kinds of masks since then. I think it's just training yourself to get used to this thing clinging to your face, more than getting past the flow of air into your nose, etc. Good luck!
posted by LOLAttorney2009 at 8:43 PM on March 8, 2014

Is it possible to get a full face mask instead of nose only? My wife started off with nose-only, but eventually moved to a full face. She says the latter fit better (Though she switched due to nasal blockage/mouthbreather reasons, not fitting problems, though maybe the two are related, what do I look like, a breathologist?), and has more straps, attaching more securely to the head. If it's harder to remove, it may force you to be more conscious of what you're doing when you do it.
posted by Alvy Ampersand at 9:40 PM on March 8, 2014

I think the above advice is pretty good!

If it's nasal CPAP and you've got a degree of nasal obstruction (eg from hayfever, a previous broken nose, a deviated septum) it's much less tolerable; in that case you should see your doctor, get your hayfever treated and/or see an ENT surgeon. It's not all that uncommon to need to have a procedure to fix your nose so that you can tolerate CPAP better.

All in all not a bad idea to see your GP and/or respiratory physician again for some advice. Seems like a pretty common problem!
posted by snipergirl at 3:26 AM on March 9, 2014

Certainly can't speak for anyone else, but at least in my experience, the number one drawback of the full-face mask (while it's absolutely necessary if your nose is congested) is that it fills with drool.
posted by colin_l at 7:59 AM on March 9, 2014

How long have you been using it? It's pretty normal for this to happen in the first few weeks of use.
posted by wintersweet at 11:27 AM on March 9, 2014

Response by poster: Thanks, all good suggestions. I think I am going to wait it out; I've been using it for five weeks, adjusting the straps occasionally. It's the nasal pillow variety, I believe -- I've also tried all the nose-piece sizes, and I'm definitely a medium. The fit is good; I don't even notice it on my face much. The reasons I took it off in the past from what I can remember were that it was either mushed up against my nose (in which case I adjusted straps) or that it seemed to have too much air pressure (which I can't control, said the woman who trained me on it). And I have a scheduled follow-up appointment with the sleep-doc in late April.

I'm definitely going to try that sleepyhead app to see if I can discern any patterns, and to check that I am in compliance range.

Thanks!
posted by not_on_display at 11:49 AM on March 9, 2014

Anecdote: I have OCD and have trouble sleeping on my back. Most nights I would fall asleep with my CPAP mask on, then take it off and roll over to my stomach in the middle of the night to be comfortable. I tried the mask for over a year before I finally started keeping it on all night regularly. I had to learn to fall asleep on my stomach with the mask on to make it work.

In other words, when I was letting the CPAP make me uncomfortable, I couldn't keep it on. When I forced it to fit my normal sleep routine, it started staying on.
posted by tacodave at 3:14 PM on March 10, 2014