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Comment by taeric | Hacker News Reader

The number of people that are using a CPAP is honestly mind boggling to me. The number that have gotten one, and then refuse to wear it is even crazier.

I remember when I first got one, I assumed it was some niche thing that was going to be unheard of from everyone I talked to. Turns out, not so much.

I don't think it has been a miracle device, by any measure. But I'm curious what makes it so hard to stick to for so many.

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Mine is a pretty high pressure, and a full face mask. The high pressure means the mask has to be strapped pretty tight. It also makes it tough to get into a regular breathing pattern, making just the act of breathing a major chore. You can't talk, or cough. You have to stay in certain positions to prevent the air from leaking out. The air echoes down the tube. I was a stomach sleeper before, which is impossible with the mask, so had to learn to sleep on my side. Every now and then, I do skip the mask occasionally, and it's words can't explain how much better it feels to sleep "normally". So I can see why a lot of people skip it.

Once you're above 15 cmH2O, you probably qualify for BiLevel, which some people tolerate better than CPAP.

See if you can turn on EPR where it lets off the pressure during an exhale.

Some of us are just unlucky and face a bunch of challenges with CPAP.

I was first prescribed a full face mask. I didn’t tolerate it well. I swallowed air and woke up every morning feeling like I was going to vomit.

I had to teach myself to breathe through my nose while sleeping (with no help from the sleep clinic, of course) and then switched to a nasal mask. This was extra challenging because I have a deviated septum and can only really breath through one nostril.

I’m a side sleeper and it took me a long time to find a pillow and sleeping position that didn’t hurt or break the mask seal.

Along with all that, I just find it uncomfortable to have a thing strapped to my face all night. I still really can’t fall asleep without some sort of sedative.

It’s just hard for me.

For me, I have an unrelated sleep disorder that makes sleep extremely important, and sensory issues that made sleeping with CPAP difficult to impossible. I tried lots of kinds of masks at my expense, but got no material support from the providers involved. After many months of trying I found that I have far better sleep without it, and got sick less frequently as well. I cleaned it fastidious and fiddled with it regularly but couldn’t find a sustainable way forward with it.

The mechanical sound of breathing, the mask getting stuck in my long hair, the intentions posture and breathing form… and dear mercy the pooling moisture on my face.

I shaved a sick beard for it. I stopped sleeping with my partner. It was a saga that I had tried a decade earlier with the same outcome.

Ultimately it turned out that simply staying hydrated and adding a little incline to my mattress is all it took. My O2 concentration has held steady and the snoring has stopped. I’ve taken my alcohol consumption down to near zero, and I have to imagine that helped as well. My weight and body fat have been pretty stable throughout.

I’ve kept my gear in case I have an occasion to try it again. Also they wouldn’t take it back and have got legislation passed to ban CPAP resale. Maybe one day I’ll get around to hacking on an IoT smell-o-vision project and have a decent use for the thing.

How are you measuring O2 levels?

I’ve also been experimenting with a slightly elevated mattress recently, it seems to help quite a lot for my OSA.

I've gotten a full bed foam wedge in the past. I can't find the original one I bought before but I think the below is similar. Its much better than a short wedge pillow if you are a side sleeper. The only problem is initially you will slide down slowly but it gets better over time. I used it for a different reason because I used to get GERD issues in the past and elevation would help a lot.

https://www.amazon.com/stores/page/20D27239-CBE7-4150-BEA7-A...

Wear the gear every time you have had alcohol, and you will definitely feel much better the next morning. Bonus points if you can crank the humidifier to help keep you hydrated while sleeping.

Is it really difficult to understand why people don't like sleeping with a mask that makes noise?

If you are asleep, can you hear it?

Falling asleep with noise might be difficult for some.

Also, some people have parters in the room where they sleep and the noise might bother them as well.

Your partner hears it, you may hear it when it has moved a bit and the air is leaking, you hear it when you try to go to sleep and the overpressure safety valve is next to your pillow and making a wheezing sound, when you end your sleep cycle and could go to another one except that the mask moved a little and it's bothering enough to wake you up (and then you have to find sleep again), you worry about keeping it and yourself in just the right position that will allow you to go back to sleep, effectively preventing you from falling asleep because of the stress...

And I have a few reasons more,if you really need.

My swift pillow on a Resmed A10 is 0db. I can’t tell if it’s running sometimes. It’s not for everybody but people should expect to have to experiment for a few weeks.

It isn't that it is hard to believe it can happen. It is so many people, though, that it is hard for me to comprehend.

And yes, the mask can make noise, but typically not as much as the person makes snoring for your partner. Modern ones, in particular, are fairly quiet and can be tucked under the night stand such that they make about as much noise as basic forced air venting systems do. Which is not much.

The mask can be uncomfortable some nights. They do have a variety of masks to try, though. And if it isn't working, they have other options.

That last point is actually refreshing for me in this story. So many bounce off a CPAP into nothing. Hopefully efforts like this story will help people find something that can work.

When I wear it I wake up in the middle of the night and feel like I am suffocating. Like it’s smothering me in my sleep. Even the expensive biPAP makes me feel this way. I have no such issues when I sleep without one.

That sounds like you’re not using it properly. Let me guess, a doctor set it up for you and set the pressure to 4cm or something ridiculously low. They love doing things like that.

I went through that phase a couple weeks after starting and it lasted for a few weeks. That was almost 5 years ago and now I love my CPAP.

Not as mind boggling as the obesity rate.

I’m very aggressive towards friends about cpaps. I bother them until they do a sleep study. It is life changing for many of us.

Agreed, and one does not preclude the other. :D

I'm muy experience with a Reamed one, on one hand, the noise. It took a lot of time for me to get used to it and fall asleep. I did some adjustments to the machine using the hidden medical menu to improve it (basically, disabled "Expiratory pressure relief (EPR)™" which "maintains regular airflow pressure while you inhale and reduces pressure to make it easier when exhaling")

On the other hand, the masks. I started with moderate success with a nasal pillows one and at some point I started opening my mouth having the worst dry mouth experiences in life.

Then I switch to a full face mask that covered my nose and it itched so hard at night that I woke up just to scratch.

Then I switched to another full face one that left my nose out, but couldn't get it to not leak (I have a lot of facial hair).

Then I got back to the nasal pillows one but I'm taping my mouth close. I've finally had moderate success with this.

I took me like 3 years to get here.

I sweat where the mask contacts my face, so that's one issue. As others have said, it can be noisy. I find the noise highly variable based on how it sits on my face and if there are things (a pillow, a sheet, my hand) in front of the discharge vent. At times it feels claustrophobic. I feel vastly better in the morning if I've used the device for more than half the night, so I'm very motivated to make it work.

They make a stupid number of different masks, so it is worth trying the different types. Also worth pursuing the dental ideas linked in this story. Looks fairly promising.

CPAP causes a sense of suffocation, nasal congestion, face masks are weakly effective while nose masks often run into the issue of switching to mouth breathing during resistance. It also prevents total airway collapse but not increases in effort. Basically it's way less effective than people assume, while introducing its own sleep disruption

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