Unable to fall asleep with CPAP

[Almindor]

I've recently been diagnosed with severe (> 30) positional (on the back only) sleep apnea. I'm 39, male borderline normal/overweight (175cm at ~75kg), definitely out of shape.

I also have high blood pressure which has no other known cause. I've suffered migraines and headaches all my life and it's possible I've always had sleep apnea, probably due to my neck/mouth genetics.

I've been given a ResMed airsense 10 to "test out" for a month after a CPAP sleep test. The test itself was "succesful" in the sense that my last ~1h of sleep was without any events however from my perspective it was quite terrible as I fell asleep perhaps at 3am in the morning. This was done with sleep medication as well.

I tried using the machine two times now and failed to fall asleep completely both times. The mask is comfortable enough, I'm using pillows and adjusting the straps to be less strict actually helped a lot. I get used to the breathing fairly quick and do not feel short of breath.

The problem is when I start falling asleep I always "jerk awake" again. Sometimes (about 50%) it's with actual hypnogogic jerks, leg or arm. The other times it's like my heart jumps up my throat followed by adrenaline. I do not get either when not using the machine. It's so bad that when it happens 4-5 times I cannot sleep for hours after even without the machine.

Does anyone know if this is something some adjustment might help with? Most online material seems to concentrate on the generic "comfort" level stuff and "get used to the mask" but that's not my problem.

[vandownbytheriver]

The problem is when I start falling asleep I always "jerk awake" again. Sometimes (about 50%) it's with actual hypnogogic jerks, leg or arm. The other times it's like my heart jumps up my throat followed by adrenaline. I do not get either when not using the machine. It's so bad that when it happens 4-5 times I cannot sleep for hours after even without the machine.

Does anyone know if this is something some adjustment might help with? Most online material seems to concentrate on the generic "comfort" level stuff and "get used to the mask" but that's not my problem.

What you describe is exactly how I feel when sleeping *without* PAP... my body knows when I'm about to go into O2 desaturation and I get a panic shock response. It's actually training my body to hate sleep... at a recent ('failed') sleep study I could not allow myself to meet their criteria of sleeping enough to develop an AHI number or desatting down to the 70's. It was torture and messed with me afterward for some time. Like Pavlovian conditioning to hate sleep... physical jerk, suddenly wide awake, panic breathing. If you were wearing an O2 monitor (I use O2Ring) it would record a desat there I wager.

It's normal for there to be a very small desat when drifting off... what you may be experiencing is a bigger one of these. Do you have EPR turned on? I'm betting you do, and it's at max. You need CO2 in order for your body to want to breathe... EPR can strip the CO2 out and reduce or remove your breath drive momentarily. If you could share a night's data using website SleepHQ we could see all your settings and peruse your graphs.

I believe this is just a stage you can get through... we're here to help.

[Almindor]

The problem is when I start falling asleep I always "jerk awake" again. Sometimes (about 50%) it's with actual hypnogogic jerks, leg or arm. The other times it's like my heart jumps up my throat followed by adrenaline. I do not get either when not using the machine. It's so bad that when it happens 4-5 times I cannot sleep for hours after even without the machine.

Does anyone know if this is something some adjustment might help with? Most online material seems to concentrate on the generic "comfort" level stuff and "get used to the mask" but that's not my problem.

What you describe is exactly how I feel when sleeping *without* PAP... my body knows when I'm about to go into O2 desaturation and I get a panic shock response. It's actually training my body to hate sleep... at a recent ('failed') sleep study I could not allow myself to meet their criteria of sleeping enough to develop an AHI number or desatting down to the 70's. It was torture and messed with me afterward for some time. Like Pavlovian conditioning to hate sleep... physical jerk, suddenly wide awake, panic breathing. If you were wearing an O2 monitor (I use O2Ring) it would record a desat there I wager.

It's normal for there to be a very small desat when drifting off... what you may be experiencing is a bigger one of these. Do you have EPR turned on? I'm betting you do, and it's at max. You need CO2 in order for your body to want to breathe... EPR can strip the CO2 out and reduce or remove your breath drive momentarily. If you could share a night's data using website SleepHQ we could see all your settings and peruse your graphs.

I believe this is just a stage you can get through... we're here to help.

Thanks, that kinda makes sense. It did feel sometimes that I was "inhaling only". I'll see if it helps next time I use it. My pressure is pretty low (6) as well.

[onward60]

Have you tried getting used to the mask by wearing it in the daytime? Your brain may not want to sleep with this weird new thing on your face.

[Almindor]

Have you tried getting used to the mask by wearing it in the daytime? Your brain may not want to sleep with this weird new thing on your face.

Not yet but I'm almost sure that's not the problem, at least in the sense of feeling fidgety. I feel fine with it on after maybe 5m, I get adjusted to the pressure and breathing and mostly forget I have it on. But the moment I start falling asleep I jerk awake with a start (sometimes with a feeling of "heart in the neck").

The tech is at a loss now too we tried EPR off with slightly lower overall pressure. He wants to try "constant pressure" (no ramp up) next to see if that might not be it, followed by a prescription of sleeping pills. I'm starting to get skeptical.

[vandownbytheriver]

The tech is at a loss now too we tried EPR off with slightly lower overall pressure. He wants to try "constant pressure" (no ramp up) next to see if that might not be it, followed by a prescription of sleeping pills. I'm starting to get skeptical.

I was just thinking it might be Auto Ramp that gets you... the machine thinks you're asleep now and jacks the pressure. Most of us with sea legs turn off all Ramp features. Stick with it, entirely worth it.

[Almindor]

Changed the mask to a full face (the new type with nose being soft/from the bottom) and it seems to have helped. It's still not easy to fall asleep with but much better, quieter especially on the side and I was able to get my first night actually sleeping with the machine on.

Woke up 3x but it wasn't too bad and registered only one event throughout. I'll see how it goes now, but I'm more hopeful. Thank you for the suggestions.