Read time: 7 minutes
What this blog covers:
- Claustrophobia versus suffocation
- 5 tips on air-pressure and how you can control it
- 3+ tips for overcoming mask disorientation
- Can wearing a CPAP mask cause anxiety?
- The silver lining
Last week, Jenny, one of our email subscribers asked for some advice on why she sometimes felt like she was suffocating when putting the mask on. The ‘sometimes’ bit is important as, in Jenny’s own words, it seemed like an irrational thing to happen. Sometimes it happens and sometimes it doesn’t.
I had to confess that I didn’t know much about why this happens, despite experiencing the same sensations myself… again, on irrational ad hoc occasions.
So, I said I would dig into it a bit to try and find out why this happens. Here’s what I found…
Claustrophobia versus suffocation
First off, the suffocating experience has sometimes been described as claustrophobic. But are they the same thing?
Claustrophobia is a fear (the phobia part) of enclosed spaces (the claustro bit). It is not a fear of Santa, although there probably is a phobia for that too.
Suffocation, on the other hand, is the physical act of being deprived of air to breath.
So, while they are very different, it is perfectly understandable for someone in a confined, claustrophobic, space to feel like they may run out of air and suffocate.
Now, a CPAP mask doesn't exactly lock you in a tiny room, but it does snugly cover a good portion of your face. The bits of your face you need to work properly.
After all, you can’t breathe through your ears, can you?
For some, this can feel a bit like being trapped, especially if they're not used to having anything covering their nose and mouth.
Imagine you've spent your whole life breathing freely, and then one day, you've got this thing strapped to your face. It is understandable why your brain might go, "Eh, what's happening here? I can't breathe the way I'm used to!"
Even though you can breathe just fine with the mask on, the sensation is different. It's kind of like scuba diving underwater for the first time. Even though you know you've got an oxygen tank, it can still feel weird and a bit scary.
5 tips on air-pressure and how you can control it
Because CPAP therapy (and BiPAP/APAP too) does its job by sending a pressurised stream of air into your nostrils or mouth (or both) to keep your airways open while you sleep, it can be a bit overwhelming at first, making you feel like you're not in control of your breathing, which – in turn – can add to that claustrophobic feeling.
The natural reaction to the ‘Jeeze, I can’t breath!’ panic is to think you need more air. Kinda makes sense. However, your mind could be making up stories to tell you things that simply aren’t true. Before turning up your air pressure, try these options to see if they help:
- Relax: Sometimes all it takes is to lay in your normal sleeping position and breath deeply, filling the top of your lungs then breathing right into your stomach until you feel like you can’t fit any more in. Then slowly breath out from the stomach first, then the top of the lungs. And repeat. This can help regulate your body and mind into one rhythm.
- Heat: If you use a humidifier (and sometimes a heated hose), and this step won’t cause another issue like dry-mouth, try turning it down a notch. Test how this works and maybe turn it down again… if that works for you. This can help your body get air at a similar temperature to what your brain expected.
- Air Pressure: Try lowering your air pressure. Yep, goes completely against what your brain is telling you to do but often the problem is not too little air. It could be your brain is simply experiencing different air pressure than it was expecting and takes a short-cut in problem solving to declare an air emergency. So, maybe try turning the air pressure down a notch and test how that goes.
- Ramp Features: Again, this can go directly against logic, but some people find getting air at full whack from the beginning helps. So, turning the ramp feature off can sometimes do the job. Start as you mean to go on, I suppose.
- Head Position: It may have absolutely nothing to do with your machine. Pressurised air won’t be much good if your position stops you from breathing freely. Try adjusting your pillow position, or even your pillows type and/or number. This will be even more important if you also have lung conditions like COPD.
3+ tips for overcoming mask disorientation
Also, when you've got the mask on, especially a full-face one, your peripheral vision gets a bit limited. You see the edges of the mask, and it can make the world seem a bit smaller. This can make some people feel confined, even if they're in a humongous room. Imagine a horse wearing blinkers or blinders… its that kinda thing.
Try these tips to help you get used to the mask:
- Check you have the correct mask type and size. Some come with a little card to help you confirm the size yourself. Others may need a bit of testing to find the right one. Your medical sleep practitioner can help you here.
- The best time to remove your CPAP mask is when you don’t need it. So…
- Just hold it up to your face (or nose, if it’s a nasal one only). No air, no hose, no straps... just hold the mask in position and walk around for a bit. Watch some telly. Do anything you can do with only one hand… coz the other hand is holding the mask. If you feel like you need to remove it… just remove it. Then, try again later.
- All good with the first bit? Grand. Now try wearing it with the straps, ensuring you have it fitted as you would when sleeping. No hose required here. To check if you have an air-seal temporarily place the palm of your hand over the hole where the hose would go and breath in. If no air gets in then you have a good seal. Again, go around doing normal stuff for a bit to get used to wearing it.
- Repeat the last bit, but with the hose attached to the mask. This bit can be tricky as you are carrying around a hose, but it helps get you used to it. After all, its going to be there when you’re rolling around in bed.
- Finally, try lying down on your bed while wearing the mask and hose. You’re not trying to sleep here, just getting used to looking around from that familiar sleeping position while having some strange thing in your eyeline. Only it shouldn’t be that strange this time.
- Bonus bit: If you can, try reading something like a book or magazine while wearing the mask. Personally, I can’t do this as I’m old and my glasses won’t sit on my nose properly with the mask on, but it’s worth trying if you can. Looking at something close to your face while also wearing the mask is a sure way to get used to it being there.
Can wearing a CPAP mask cause anxiety?
Lastly, there's a psychological part to this. If someone is already anxious about their sleep apnea diagnosis or the idea of using a CPAP machine, that anxiety can show-up as claustrophobia. The mind's a powerful thing and sometimes our fears and anxieties can increase those physical sensations.
Those who spend their time studying this kinda thing have shown that although anxiety is more common in sleep apnea patients, using small tactics to improve your ability to control anxiety and even depression can help massively. This includes getting over that claustrophobic feeling.
Given anxiety is generally hidden from view, it can be difficult to even recognise what is happening to you. Recognising the fact that ‘feeling of dread’ is usually brought on by an external stress is a good start. In our case, the external stress is the belief this thing strapped to our face is going to stop us breathing. So, here’s 3 quick steps to face it head-on:
- Recognise it: Pay attention to how your body is reacting and the flow of your breath as it goes in and out.
- Be aware: Notice what you are thinking and feeling as you breathe in and out. Talk to yourself as you would talk to a friend who is experiencing the same thing.
- Accept it: It is what it is right now, in the moment. Wishing it were different won’t change a thing. Being able to bring yourself to a calm state will, however, change everything.
The silver lining
And here's the good news: We’re on CPAP therapy for a reason.
Every day you reduce your sleep apnea events, the less stress you are putting your body under… and the healthier you are as a result.
For most people, this claustrophobic feeling tends to fade over time. As you get used to the mask and the sensation of the air pressure, it becomes just another part of your night-time routine. And remember, the mask is helping you breathe better, sleep safer and live longer. It's like a friendly sidekick watching over you while you dream.
Importantly, although those of us on CPAP all have similar therapies… in that we all strap a wind-tunnel to our faces when prepping for sleep… what got us here as individuals can be hugely different.
So, if you or someone you know is struggling with this, the best person to speak with is your medical team.
That may be your local doctor, sleep therapist or another professional. They may have tips, tricks, or mask alternatives to make your experiences more comfortable.
After all, everyone deserves a Cracking Sleep!