Why can’t I fall asleep with my CPAP?

Are you having issues adjusting to wearing your CPAP mask? Do you have claustrophobia? Do you suffer from insomnia? If you have eliminated all other possibilities (see our blog on mask choice), claustrophobia or insomnia may be the culprit. These are two of the most common challenges we hear from patients and we have ways to overcome both!

Claustrophobia With CPAP

First, we will tackle Claustrophobia. The first step towards overcoming claustrophobia is making a firm commitment to the attempt. The key is slow, gentle exercises; you must start small and slowly build on your time wearing a mask. You have to initially desensitize your mind to the mask being on your face, and remind yourself that anytime you want to take it off, you can.

You can put this into practice with the following exercise:
Make yourself comfortable in a chair or on the couch and take some deep cleansing breaths. When you are ready to start, grab the mask and hold it with one hand against your face. Don't put on the headgear at first, just hold the mask part against your face. Keep in mind you can remove it from your face if needed. After you put it on your face, immediately distract your mind with tv or music and continue to do your breathing. Try to get comfortable with the feeling of being uncomfortable and breathe through it. If you feel the pulls of claustrophobia, remove the mask from your face and take a few breaths, but always start again. The key is to keep trying; it will get easier, trust me. At first do a minute, then work up to 5 minutes, then 10 minutes, then 15 minutes, and so on.

Once you can work up to 15 minutes, you are ready to put the mask/headgear on and secure it. Most headgear come with magnets which make taking it off super easy & fast. If your headgear does not have magnets, it has clips. Familiarize yourself with the magnets/clips of your headgear and how they “unsnap” prior to putting the headgear on. The ability to take your mask off quickly will help you in the long run. Leave the mask on around the house, do your housework, watch tv, read, whatever you can do to take your mind off the fact that you have a mask on your face. Once you are able to do this for 30 minutes, you are ready for the CPAP machine.

Again, start out on the couch with your headgear secured and your brain distracted, then attach to the machine and turn it on. We are starting out during non-sleeping hours to desensitize you to how the machine feels. Go at your own pace, but also trying to push yourself a little. When you are ready try to fall asleep with it on, that may be on the couch for a nap or trying it in bed at night. Being in bed at night is the goal we are working towards and being able to fall asleep with it on.

Most people, whether they have claustrophobia or not, will have to start at this phase of desensitization. It is a whole new habit we are trying to form – falling asleep with a mask on and a machine pushing air pressure at you does not come naturally! This added air pressure is a new sensation for your body to adjust to. Some report that it doesn't feel any different, some say it feels good, and some report that it feels weird exhaling. If you feel any discomfort, rest assured there are some settings that can be adjusted on your machine to make it more comfortable for you (the lowest the machine pressure can be set to is 4cm; I suggest starting there with a ramp setting).

 Insomnia with CPAP

Now onto Insomnia: the other challenge we hear from patients on a regular basis. Insomnia happens to be the most common sleep disorder. People with insomnia often have feelings of low energy, fatigue, difficulty concentrating, mood disturbances, and decreased performance in work or school. This condition cannot be cured, but it can be treated. As we know, getting a good quality sleep is essential for a person's mental and physical health, and treating insomnia starts with making behavior and lifestyle changes. Try these recommendations below to help combat insomnia.

1. Exercise Regularly - just 20/30 mins a day can help a person sleep better.
2. Limit your intake of caffeine and alcohol, and do not use nicotine.
3. Establish a regular, relaxing bedtime routine - keep your bedtime and wake time consistent and try to avoid or limit naps.
4. Get plenty of natural light exposure during the day.
5. Try a warm bath before bed, and maybe add some lavender essential oils for extra relaxation.

 Natural Remedies For Better Sleep

Some other natural lifestyle remedies to get a good night’s sleep include:

1. Maintaining a healthy weight - keeping active is key and can keep your airways clear and reduce many sleep apnea symptoms.
2. Use a humidifier - it can help to open your airways, decrease congestion, and encourage clear breathing.
3. Body positioning - it is best to avoid sleeping on your back, which is called supine position. Sleeping on your side can help breathing return to normal.
4. Yoga - yoga breathing exercises help to strengthen, tone, and open the upper airway muscles.
5. Raise the head of your bed - it will allow for better oxygen saturation and less sleep apnea incidents.
6. Sip a nice cup of herbal tea for a calming, soothing effect which can become a pleasurable part of your sleep routine. My favorite is Chamomile, a flowering herb that has shown to improve sleep quality.
7. Meditation – can help to regulate sleep with various forms of breathwork.
8. Create a comfortable sleep environment - make sure the bedroom is cool, quiet, and comfortable - especially your bed and pillow.
9. Shut off your electronics - reading, emailing, texting, and watching TV can ramp up your brains activity rather than relax it.
10. Hungry? Snack on foods that promote sleep - foods that contain components like calcium, potassium, melatonin, tryptophan, and GABA (Gamma-Aminobutyric acid) make great sleep aid snacks. For example, walnuts, bananas, kiwi, romaine lettuce, tart cherry juice, or maybe add some barley grass powder to a smoothie.

To conclude, we want to make your sleep therapy as comfortable as possible. It is a big lifestyle change and will take some work on your end to be successful. If you can give yourself time to push through the difficulties, you will eventually adjust. With hard work and willingness to push through the hurdles, the work will pay off and you will soon feel like the best version of yourself. You can do it!!!

- Leigh Foley, RT & Laura Pratt

*This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.