Troubleshooting

You have to learn how to use the machine. Success with a PAP machine mostly depends upon your attitude. If you think, “For the rest of my life I have to sleep with this thing stuck to my face!” then you are going to have trouble. If you understand that sleep apnea is a chronic disease that has many negative consequences for your daily functioning, for your general health, and for your longevity, and that it is going to happen to you every night, then using a PAP machine nightly is greatly to your advantage. You can go to bed every night for the rest of your life, choke yourself repeatedly, drop your oxygen levels, stress your brain, heart, and other body organs and threaten your life, or you can use a PAP machine and have a good sleep without these breathing-related problems.

If your attitude is right, then there are basically four things you have to learn:

1. How to use the humidifier – the Respiratory Company will teach you how to adjust the temperature and how to fill the humidifier properly. The humidifier is for your comfort. You only need to use it if your mouth/nose gets dry or too moist. Distilled water is only to prevent salts from precipitating onto the metal/heat plate in your water reservoir. So, if you go somewhere that does not have distilled water, use “safe” tap water or bottled water. Clean the metal plate in your water reservoir when you get home.

2. How to adjust the headgear properly – if it is too tight, you will hurt yourself (red nose, ulcers on nose, mask tracks on your face; if too loose, it will leak. You need to find the Goldilocks’ zone to get it right.

3. How to roll around in bed without knocking your mask off. Essentially this involves fixing your pillow. You need to get a pillow that does not bulge up to far on the sides of your head; if so, try a thinner pillow. You can also buy pillows from your Respiratory Company with cutaways on the sides. If leaking is a big problem, check it out in the daytime when you are wide awake. Turn your bedclothes back; put your mask on and turn on your machine. Now practice rolling from side-to-side. Find out what is too far; when does it start leaking. If your pillow is bulging up, then proceed as above. When you turn your head, might also bump it against your hand if you sleep with it up under your cheek? Check whether your hose is pulling the mask and making it leak. If so, you can buy a mask elevator. The HoZer is a good one. You can check them out online or see what your Respiratory Company has. Another cause for leaks can be identified as follows. Lie flat on your back and just turn your head from side-to-side – the friction of your headgear against your pillow may be causing the problem. If so, change your pillow slip to a smoother one or buy a slider for your mask. Finally, it may be the mask that is not fitting your face well. Go to your respiratory company and try other masks. Remember the one-month warranty you get from your manufacturing company that allows you to replace your mask within one month for another one at the same price for no fee.

4. How to get your brain to ignore this “thing” (your mask) stuck to your face. To do this quickly, it is most important that for the first few nights that you use the machine, you should try not to take it off. Your brain will wake you up every hour or so, telling you there is something stuck to your face and “get rid of it”. Resist this. If you start taking it off and going back to sleep without it, you will sensitize your brain to the presence of the mask, and it will continue waking you up. Be careful about telling yourself, “Well that is enough for tonight, I will try to use it longer tomorrow”. You will likely just train your brain to continue giving you a disruptive sleep.

If you spend a few bad nights struggling with it and not taking it off, your brain will learn quickly to ignore it and your nights will become more comfortable. If you keep on taking it off, you will have weeks even months of difficulty. If you say “I can’t get to sleep or back to sleep with it on” then you have let your brain win. You have to discipline it. It is trying to protect you, but it will always adjust to its circumstances if you insist on it. The sooner you insist on it, the sooner it will become comfortable.

Remember, when you wake up in the middle of the night and consider not putting it back on for the rest of the night, your choice isn’t having a more comfortable or less comfortable night, it is whether you want to “suffocate” yourself for the rest of the night or not. The more often you do do not put it back on, the longer it takes to get comfortable using it. And many patients discontinue their PAP therapy because they don’t help their brain to adjust to having this weird thing stuck on their face.

Patients often think they are waking up so frequently because of mask discomfort, leaks, or pressure that it too high. Sometimes, it is one of those things; many times, it is just your brain that is waking you up saying, “Get this off my face”. You can spend a lot of time and money trying and buying different masks and headgear.

If you are very anxious having a mask on your face, it is likely that you are claustrophobic. We can help you with this. Don’t just give up. Don’t think, “I have never been able to tolerate things on my face. I can’t do it.” I can help you get around this; help you to get your comfortable with the mask before you have to sleep with it on your face. Call the Lab and get an appointment to deal with this.