Practice wearing CPAP / Exposure therapy (aka systematic desensitization)
(1) To supplement the exposure (aka systematic desensitization) sessions, I recommend you learn and practice relaxation exercises, specifically diaphragmatic breathing and progressive muscle relaxation. The idea would be to use these for 5-10 minutes prior to engaging in the exposures. Instructions for these exercises can be found here:
(2) When you practice wearing the mask, I would start with an interval of time you feel you are willing to tolerate. It is better to start small (e.g. somewhere between 1 to 5 minutes) and work up gradually from there. While you are wearing the mask, see if you can relax and adopt an attitude of allowing and accepting the sensations of wearing the mask. You can also engage in other sedentary activities, such reading, browsing the internet, or watching TV.
(3) You can use a rating system called Subjective Units of Discomfort (SUD) to rate the amount of anxiety you experience during and at the end of an exposure session. Imagine a scale going from 0 to 10, with 10 being the highest level of anxiety you can imagine. For any exposure session, you can rate the peak anxiety level and the level at the end of the session.
(4) I would repeat exposures until your SUDs ratings fall to a 3 or lower at the end of an exposure before increasing the amount of time spent during the exposure. For example, repeat a 5 minute exposure as many times as is needed for this to happen. You will want to allow a break between exposure sessions (e.g., 15 minutes), and also limit the number on any given day (e.g., perhaps up to 3 sessions).
(5) Once your SUDs rating is a 3 or lower, decide on what increase of time you are willing to do. It is better to gradually increase the amount of time (e.g., from 5 minutes, to 7 minutes, to 10 minutes, to 15 minutes, etc.).
(6) In one study on using this method, they had patients work up to spending 1 hour with the mask on while awake. Then they had people practice while taking timed naps. I’d suggest starting small (e.g., set a timer for 15 minutes). Then, they had people wearing the CPAP at night for the first 3-4 hours of nocturnal sleep. Finally, they had people wear it for a whole night.
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https://www.thecpapshop.com/blog/cpap-exposure-therapy-and-increasing-cpap-therapy-compliance
CPAP therapy-induced claustrophobia often results in different muscles tensing in the body. This can exacerbate the feelings of claustrophobia and anxiety, producing a trifecta for the opposite state of total relaxation necessary to enter sleep cycles. A technique for lessening this claustrophobic feeling is known as Progressive Muscle Relaxation (PMR).
Study participants would first wear the mask while awake during the day for about an hour with the CPAP machine switched on in order to practice breathing through the mask. The patients were allowed to engage in normal sedentary activities such as reading or watching TV in order to provide a distraction. Patients would then progress to using CPAP during hour-long naps, build up to using it during the first 3 to 4 hours of nocturnal sleep, and finally try it for an entire night.
Within a month of starting the exposure therapy, researchers reported that 10 patients were able to use CPAP and 7 adhered fully with the group experiencing a significant increase in minutes undergoing CPAP therapy. While the study was quite small and researchers characterized the improvements as “modest,” the positive results pave the way for much needed future studies.
https://www.medpagetoday.com/meetingcoverage/chest/42526
https://blog.easybreathe.com/cpap-study-cpap-exposure-therapy-improves-compliance
https://www.tandfonline.com/doi/abs/10.1080/15402000701190572?journalCode=hbsm20
https://www.thoracic.org/professionals/clinical-resources/sleep/sleep-fragments/2015-september-2.php
https://www.sciencedirect.com/topics/psychology/continuous-positive-airway-pressure
Means, M. K., & Edinger, J. D. (2007). Graded Exposure Therapy for Addressing Claustrophobic Reactions to Continuous Positive Airway Pressure: A Case Series Report, Behavioral Sleep Medicine, 5:2, 105-116.
DOI: 10.1080/15402000701190572
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Dettenmeier, P., et al. (2013). Evaluation of a continuous positive airway pressure desensitization protocol for CPAP-intolerant patients: A pilot study. Chest, 144: 979A.
DOI: 10.1378/chest.1700938.
According to Dettenmeier, patients were instructed to wear the mask while awake for an hour each day with the mask attached to the CPAP device and the device switched on in order to practice breathing through the mask. Patients could do this while watching television, reading, or doing some other sedentary activity.
Patients were recommended to wear the CPAP mask while watching TV, reading, and doing other sedentary activities. After that, patients were urged to wear the CPAP mask while taking a one hour nap. Then researchers asked patients to wear the CPAP mask for the first three to four hours of sleep. Finally, they were asked to sleep with the mask on the whole night through.
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https://www.aastweb.org/hubfs/Technical%20Guidelines/Updated%206.14.2017/PAPacclimation.pdf
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Edmonds, J. C., Yang, H., King, T. S., Sawyer, D. A., Rizzo, A., & Sawyer, A. M. (2015). Claustrophobic tendencies and continuous positive airway pressure therapy non-adherence in adults with obstructive sleep apnea. Heart & lung : the journal of critical care, 44(2), 100–106. https://doi.org/10.1016/j.hrtlng.2015.01.002
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Attitudes to CPAP Treatment Inventory
Adherence Barriers to CPAP Questionnaire
Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD007736. DOI: 10.1002/14651858.CD007736.pub2.
D’Rozario, A.L., Galgut, Y. & Bartlett, D.J. An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults. Curr Sleep Medicine Rep 2, 166–179 (2016). https://doi.org/10.1007/s40675-016-0051-2
https://link.springer.com/article/10.1007/s40675-016-0051-2#citeas
https://www.uptodate.com/contents/adherence-with-continuous-positive-airway-pressure-cpap
CPAP adherence
https://www.corvallisclinic.com/sleep-medicine/cpap-tips
To get on the confidential email list for AWAKE meetings, a free support group, call Samaritan Sleep Lab at 541-812-5470 and leave a message.
More info can be found at www.sleepeducation.com and www.sleepapnea.org.
Orego Adapting to CPAP machine
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https://www.oregonsleepassociates.com/dme-articles
Clinical sleep educator
https://www.asante.org/services/sleep-center/cse-program/
https://www.asante.org/services/sleep-center/cse-program/common-cpap-problems/
https://www.onetonline.org/link/certinfo/11734-C
https://www.aastweb.org/Career/Sleep-Health-Educator
https://sleepeducation.org/patients/cpap/
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https://academic.oup.com/sleep/article/42/12/zsz178/5546131
https://www.medpagetoday.com/clinical-challenges/sleep-sleep-disorders/80549
https://www.sciencedirect.com/science/article/abs/pii/S1389945722000405
https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.705364/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972705/
https://link.springer.com/article/10.1007/s40675-016-0051-2
https://blog.circadiance.com/blog/bsm-and-cpap-compliance
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947399/
https://www.mdpi.com/2077-0383/8/12/2220
https://cbti.directory/index.php/search-for-a-clinician/home-directory/browse-by/state?value=OR
https://cbti.directory/search-for-a-clinician/home-directory/search?searchword=CPAP
BSM Specialties: OSA / CPAP adherence training
CPAP adherence training Oregon
https://www.cpap.com/blog/commercial-driving-dot-sleep-apnea/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406627/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499811/
https://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html
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CPAP Adherence: Factors and Perspectives 1st ed. 2022 Edition by Colin M. Shapiro (Editor), Meenakshi Gupta (Editor), & 1 more https://link.springer.com/book/10.1007/978-3-030-93146-9
Crawford MR, Espie CA, Bartlett DJ, Grunstein RR. Integrating psychology and medicine in CPAP adherence-new concepts? Sleep Med Rev. 2014;18:123–39.
Shapiro G, Zalai D, Trajanovic NN, Mallea J. Sleep apnea. CPAP and Me Joli Joco Publication Inc: Toronto, ON, Canada; 2011.
Crawford MR, Espie CA, Bartlett DJ, Grunstein RR. Integrating psychology and medicine in CPAP adherence–new concepts? Sleep Med Rev. 2014;18(2):123–39.
Sweetman AM, Lack LC, Catcheside PG, Antic NA, Chai-Coetzer CL, Smith SS, et al. Developing a successful treatment for co-morbid insomnia and sleep apnoea. Sleep Med Rev. 2017;33:28–38.
Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700.
Sweetman A, Lack L, Lambert S, Gradisar M, Harris J. Does comorbid obstructive sleep apnea impair the effectiveness of cognitive and behavioral therapy for insomnia? Sleep Med. 2017;39:38–46.
Sweetman A, Lack L, Catcheside PG, Antic NA, Smith S, Chai-Coetzer CL, et al. Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial. Sleep. 2019;42(12):zsz178.
Alessi CA, Fung CH, Dzierzewski JM, Fiorentino L, et al. Randomized controlled trial of an integrated approach to treating insomnia and improving use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea. Sleep. 2020;44(4):zsaa235.
Ong JC, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, et al. A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: main outcomes from the MATRICS study. Sleep. 2020;43(9):zsaa041.
Edmonds JC, Yang H, King TS, Sawyer DA, Rizzo A, Sawyer AM. Claustrophobic tendencies and continuous positive airway pressure therapy non-adherence in adults with obstructive sleep apnea. Heart Lung. 2015;44(2):100–6.
Means MK, Edinger JD. Graded exposure therapy for addressing claustrophobic reactions to continuous positive airway pressure: a case series report. Behav Sleep Med. 2007;5(2):105–16.
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The Overlooked Epidemic: Inside the World of Sleep Apnea: From Diagnosis to Recovery - Your Journey to Healthy Sleep Kindle Edition by Audrey Porter
Sleep specialist Dr. Barry Krakow in the book Sound Sleep, Sound Mind http://sleeptreatment.com/ says it takes most people one to three months to adjust to CPAP therapy, and sometimes longer.
https://barrykrakowmd.com/2019/02/05/osa-facts-pearls/
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Sleephoria HELPING WOMEN OVERCOME EXAUSTION THROUGH BETTER SLEEP HEALTH www.sleephoria.com
https://sleephoria.com/sleep-apnea-in-women/
Why Is Insomnia More Common In Mid-Life Women? https://sleephoria.com/why-is-insomnia-more-common-in-mid-life-women/
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“Women Are Tired: 10 Medical Conditions Explain Why”
https://sleephoria.com/women-are-tired10-medical-conditions-explain-why/
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Sleephoria (with Valerie Cacho, MD - Board Certified Sleep Physician):
What Is The Best Fitting CPAP Mask? https://www.youtube.com/watch?v=opTxBj6K1M0&list=PLz5ObWevhqwtiMpEOhpi-I-7EU-bBFXRP
Do You Struggle With Your CPAP Machine? Top 4 Reasons And What To Do About it. https://www.youtube.com/watch?v=-EXRni3LjGw
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Vik Veer, MD Can't sleep with CPAP? Watch this! https://www.youtube.com/watch?v=7DDgIuEtew8
Vik Veer, MD - How I think sleep apnoea should be treated https://www.youtube.com/watch?v=YQ5KpAvp_YU&t=10s
Costco Sleep Meds: THREE options - which one is BEST?https://www.youtube.com/watch?v=GllaJSVkky8
Which SLEEPING PILLS Work Best for SLEEP PROBLEMS | How To Treat INSOMNIA with Sleep Medication https://www.youtube.com/watch?v=ABbhkfh7ijQ
What Is The Best Way To Treat Insomnia? Sleep is the Foundation: https://www.youtube.com/watch?v=PgPtVFK4a-s
https://www.youtube.com/results?search_query=CPAP+adherence+training+