At my site www.sleeptreatment.com, we talk about many of the connections between sleep-disordered breathing and mental health symptoms, including insomnia.  In my clinical and research experience, we have discovered many pearls to help patients adapt more rapidly to positive airway pressure (PAP) therapy.

First and foremost, we rarely prescribe CPAP anymore.  The fixed pressure causes too much anxiety in our patient population of mental health patients with sleep apnea.  Instead, we routinely prescribe bilevel, a PAP device that allows the patient to breathe easier on exhalation.  Most importantly, in our clinical experience this single symptom, intolerance to the pressure, is the most important barrier to using a breathing mask treatment.  We can actually spot this problem on the breathing sensor in the sleep lab while the patient is sleeping.  That is, when the patient is using CPAP but having difficulty adapting to it, the breathing sensor will show subtle irregularities.  When the same patient is switched to bilevel, they have an easier time breathing while asleep and the breathing sensor looks smoother.

Another critical pearl is to teach patients to realize that the PAP therapy machine is not a ventilator.  It does not control your breathing.  You are still in control, so to speak, but because the sensation of pressurized airflow is so odd, you initially imagine the machine is trying to breathe for you.  The irony in this situation is that the problem is caused by the patient's innate belief that he or she "controls" their own breathing. 

In fact, we teach patients to recognize that for the most part you are not in control of your breathing; your body just breathes without much conscious input or effort from you.  It's only when a mask is placed on your face and air is pumped into your nose that you think you have to do something to work with the machine, something get into rhythm with it.  In fact, you have to do nothing but just let yourself breathe.  When you learn to do so, you soon forget about the pressurized airflow and you adapt very quickly.

Last, the quickest way to achieve this goal when first using PAP therapy is by use of your mental imagery.  When you picture something pleasant in your mind's idea unrelated to breathing, your mind and body are distracted from the sensations of PAP therapy, and you return to your normal relaxed way of breathing.  In a short time, mental imagery can completely distract you from the pressurized airflow and you will find it much easier to use the machine.  In our sleep lab in New Mexico, our sleep techs are trained to instruct patient's on the use of imagery the very first time the patient attempts PAP therapy.

You'll find lots more ideas on adapting to PAP therapy in my new book Sound Sleep, Sound Mind,which you can find at my other website www.soundsleepsoundmind.com.