What to do

[steved]

I have being using a CPAP machine now for about 12 months,and I'm really struggling to get used to it.
I find it very hard to get to sleep,and will wake up after about 2 hours
and will end up removing the mask.
I am now in a blind panic about using the machine,as I'm due for my check up at the hospital next week.
At my last check up, the sleep technician said that if I didn't get used to using the machine every night, they would report me to the DVLA
and have my driving licence revoked.
This would be a disaster for me as my job and living requires me to drive,but I am not driving HGV vehicles,or driving for long periods at a time.
I am know really worried as what will happen next week at my check up.
Anybody any advice.

[ElleCee]

You don't say why you are struggling with it.
What makes you want to take it off?
A bit more information and we may be able to help.

All the best
Lorraine

[steved]

You don't say why you are struggling with it.
What makes you want to take it off?
A bit more information and we may be able to help.

All the best
Lorraine

I am finding it takes me a long time to get to sleep,and I get very agitated and end up removing the mask.
When I do get to sleep i will allways wake after a few hours,with what feels like a hurricane blowing into my face.
This is when i tend to remove the mask as I feel so uncomfortable,and just want to get to sleep.
I also find that the mask sometimes irritates my chin,and I have developed a rash.
I have also experienced,runny eyes over the last few weeks,but the mask seems to fit ok.

[Barely Awake]

So is this a full face mask Steve or is it the strap of some other type affecting your chin?

[symmit]

Hi Steve.

It's my understanding that if you're making 4 hrs a night most nights that that will satisfy the clinic enough not to inform DVLA, regardless of how well or badly it's working.

However the most important thing is to get it working for you.

What mask have you been given? It will be worth trying alternatives at your visit, or if you have the means buying something else (I've got four now...) to try.

It sounds like you're using a full-face mask, did you try a nasal only one? If you are suffering with irritation and discomfort then a gel or cloth mask may be a better bet (I'm a convert to the Sleepweaver cloth mask myself)

Finally are you using the "ramp" or "soft start" feature on your machine - if so and if it's adjustable you may get some benefit from setting it as long as possible to give you time to get to sleep, also try going to bed an hour or two earlier and just lying in bed with the machine running, it'll help condition you to breathing with the machine and give you the opportunity to find the best adjustment of the mask for you, and at least it'll stick another hour or two on the compliance chart...

The hurricane is normally caused by leakage and mis-fitting of the mask - you may need a larger, smaller or completely different mask. Experiment with tighter or looser strap adjustment (either too tight or too loose will cause leakage)

[Fredxx]

The other question is what is your machine...if it is an APAP (Auto) not a CPAP, some people have a problem with the max pressure being too high; clinics will often leave it at 20). If the mask starts to leak, the machine will ramp up the pressure to compensate, making the leak worse, making the pressure higher...not a great way to get it to work!

[Tigers Fan]

All the right questions

Hi steved

All the right questions have already been asked - and I have a few more.

Do you know the current pressure settings on your machine? If not, find out at your clinic - call them asap before your appointment.

What type of machine - or tell us the name from the machine label. Ditto for the mask.

In the meantime, call Intus HealthCare and order some REMzzs liners for your mask - you'll need to know its name and size to do that. Whatever is causing the chin rash, these liners will more than probably cure it.

The problems you have described so far are easily fixable, leaving only the need to get you calmed down and relaxed.

TF

[Richard]

Hi Steve,

It's not up to the sleep-technician to tell the DVLA to revoke your licence! The decision is purely for the DVLA to make. And the essence is 'compliance'.

Your CPAP machine is fitted with a smart-card, which, when put through the reader at the clinic, will show how often and for how long you have used the machine. The card does not lie! You should be wearing the mask 'during sleep', not for four hours a night.

Look at the experiences of others on this site with similar problems and what they have done to overcome them.

Putting on the mask should be as normal as putting on your pyjamas. Ensure you are in a calm state of mind before you get into bed. No food for at least two/three hours before bed, certainly no cheese and no alcohol either. Go to bed when you feel tired and a quiet bedroom with a flow of cool air, not too warm, is important and perhaps a mug of warm milk. Keep the CPAP on your bedside-table so before you put out the light, turn on the CPAP before you put on the mask. Adopt a regular bedtime routine so the whole thing becomes perfectly natural for you.

Tell the sleep-techie you have problems with getting a comfortable mask and ask for his advice.

Once you have a mask you're happy with, and can sleep through the night, you will be compliant and the DVLA will recognise that by handing you your licence back.


Best of luck

[Grumpy]

me too!

I'm still struggling to get more than about 40 minutes sleep at a time and am worried about compliance. I get up several times a night; and almost aways replace the mask when returning to bed. I even put the mask on if I need to have an afternoon nap.

I've got a Mirage Liberty mask and have no problems with discomfort or leakage.

[zonalfootball]

im a driver to but it was my doctor who informed dvla of my condition and my license was revoked until i was on cpap and complient ,i suppose i was one of the lucky ones and was determined to get my license back but i took to cpap straight away ,dont get me wrong there were a few niggles along the way with leaks, removing mask etc, a few morning nose bleeds but i stuck with it and these days its just part of going to bed ,i went from about 1-2 hrs sleep a night to having to set my alarm clock ,these days with my trusty cpap its usually 8 hrs of blissful sleep ,my clinic was fab in the initial stages and couldnt help me enough ,if i had a problem i rung and got advice until i was comfy with my set up ,im afraid though your clinic have a duty to inform dvla if you are not meeting compliance and then its up to dvla to decide the outcome ,im afraid with sleep apneo the outcome is usually a revoke of license until you can meet compliance,it doesnt matter if you only drive a little you have sleep apneo and are at present not meeting compliance,if you had a accident and really hurt somebody you would not forgive youself ,as you most probably know being deprived of sleep is awful and you feel like a zombie most of the time and it only takes a second to nod off ,i would explain all your problems in full to your clinic and stick with cpap because the benefits of cpap certainly outweigh those against ,good luck for the future

[steved]

Update

Many thanks for all the replys,some great advice.
The machine I am using is ' RemstarAuto M series ' pressure set to 9.
The mask is a full face Resmed Ultra Mirage.
I do use the ramp function,but it seems to blow quite strong even after a short period.
I'm going to try going to bed a little earlier tonight,and leave the radio on until I get to sleep.
I couldn't get to sleep even after 3 hours last night,and ended up removing the mask in order to get to sleep.
I have my hospital appointment next week .and I really need to get some mask time under my belt.
Once again thanks for the advice.

[Tigers Fan]

Thought so .....

Hi steved

Figured you have an auto from your reference to gales. If your minimum pressure is set to 9 and the max left at default - a common practise - then every time you have an 'event' - apnoea or hypopnoea - the machine tries to correct your breathing by increasing the delivered pressure. Your machine will go to the max of 20 cm (or whatever high maximum is set) and the inevitable result is gales and massive mask leak. (You adjust the straps for 9 cm and suddenly they have to resist 20 cm!)

Ask your clinic to adjust the max pressure to 2 or 3 cm above your 90% pressure.

Is this your first follow-up? Maybe you've had an APAP for titration purposes and they'll swap it for a CPAP when you attend (another common practise). A few clinics dispense autos for keeps.

TF

ps my NHS CPAP (not APAP) only records time the machine runs and compliance is four hours running time per night.

[James @ Intus]

You have a few days left to clock up some good stats. Getting agitated before use won't serve you in any way. You have to address that, like Insomniacs have to through CBT. It's simple at the moment, if you don't use CPAP, you're in trouble. Music, meditation, having a relaxing bath, whatever you can do, do it to go to bed calm, relaxed, and tired.

Add in the mix all the other "good sleep hygiene" things like no eating and drink X hours before bed etc. They help make it easier to drop off.

Use and if possible tweak the ramp time. If it starts off at too high a rate, reduce the pressure and increase the ramp time. Discuss this with the clinic but already try and do this before you go.

When you wake up, reactivate the ramp. If need be, take the mask off briefly to relax, but try not to fall asleep without it.

Many people sleep better with CPAP due to some small investments in CPAP comfort accessories. Mask pull, sores etc. can all be prevented with largely inexpensive products. If anything in particular other than the pressure frustrates you, mention it here for suggestions to remedy those.

[steved]

Update

Had my checkup today at the hospital,and have to carry out the oxygen test tonight.
The technician was not happy with stats from the machine,but was very supportive and helpfull.
I have lost 6lbs from my last visit and dropped a collar size,so that's a bit of good news.
The technician said my mask was well overdue for replacement and was now outdated,the soft cushion had become stiff and inflexible.
I was given a new type of mask, a Resmed Mirage Liberty,with nasal pillows.
It's much smaller than my old mask,and when I tried it at the hospital it seemed no where near as noisy.
Will let you know how I go on tonight.
Thanks once again to everybody who replied for there encouragement,and support.
God Bless You.