The reflex that ruins it: trying to last the whole night
Sleeping with a mask from the very first night, when it frightens you, is the fastest way to tear it off at two in the morning and put the machine in a cupboard. Your brain needs to learn that this object is not a threat, and it learns awake, not asleep.
The method that works is gradual desensitisation, in short steps, at your own pace. It takes a few days, sometimes two weeks. That is always quicker than giving up and starting again six months later.
The progression, step by step
- Simply hold the mask against your face, no headgear, machine off, while watching television. Ten to fifteen minutes.
- The next day, put the headgear on, still without the machine, for the same length of time.
- Then connect the tube and turn the machine on, sitting up, awake, for the length of one episode of something.
- Next, take a nap with it, or at least lie down for half an hour.
- Finally, wear it at bedtime. If you take it off during the night, put it back on when you wake up, without guilt: a partial night beats no night.
The least enclosing masks
Not every mask feels the same. Nasal pillows leave the face completely free: you can see your hands, wear your glasses and read. Under-the-nose nasal masks come next, with nothing in your field of view.
A full face mask, on the other hand, covers nose and mouth: it is the most oppressive at first. If you breathe through your mouth and a full face mask frightens you, talk to your provider before giving up: there are alternatives to discuss with them.
The settings that help
Ramp starts the machine at a low pressure and raises it gently while you fall asleep: it is often what changes everything in the first weeks. Expiratory relief, called EPR at ResMed and Flex at Philips, reduces the feeling of breathing out against the air.
These sit in the comfort menu on most machines, but your therapeutic pressure is set by your prescription. Ask your provider to show you what you are allowed to touch.
When to ask for help
If the anxiety goes beyond the mask, if it keeps you awake even without it, or if it comes with panic attacks, that is a subject of its own, to raise with your doctor. CPAP is not a test of willpower, and nobody should experience it as a punishment.
