The problem in a nutshell: When it comes to using CPAP or BiPAP, claustrophobia amounts to anxiety about having the mask over one’s face, and anxiety about losing control over one’s own respiration due to the mask and the flow of pressurized air. The anxiety can range from trepidation to outright panic. Sometimes it generalizes to other areas of one’s life (e.g., enclosed spaces such as elevators), and sometimes it’s restricted to having something over one’s face. And it can either be rooted in a traumatic experience (e.g., wearing a gas mask during threatening military operations) or without obvious precedent. We all have a degree of adaptive anxiety about having our airways obstructed, and the irony of claustrophobia with CPAP is that the machine is meant to prevent such obstruction, but can nonetheless provoke our natural anxieties because it entails placing a mask over our noses (and sometimes mouths) and altering normal breathing.
Should you seek professional help or use the techniques offered here? It is actually fairly straightforward to treat claustrophobia, and I will explain an approach for milder cases here. If, however, your problem is severe, I would recommend that you skip the technique and instead seek professional help. With a skilled clinician you can expect to use a tried and true technique called “exposure therapy” in which you construct a “hierarchy” of increasingly anxiety-provoking situations (perhaps ranging from merely looking at pictures of a CPAP machine to using it all night long). Each step on the hierarchy would ordinarily provoke more distress than the previous step, but by taking your time with the first step until it ceases to upset you, and then very gradually and progressively exposing yourself to each step in turn until it ceases to upset you, the steps will feel more or less similar to one another, and you will soon be able to handle the hardest step. More info here soclean CPAP cleaner and sanitizer machine.
Some clinics are also equipped with virtual-reality technology so that you can, say, “be inside” a realistic elevator without having to travel with your therapist to a real elevator that others need to use, and so that the intensity and particulars of the environment can be well controlled and customized to your needs. Treatment usually also includes a “cognitive” component, meaning you learn the facts about the situation you fear and have the opportunity to challenge false assumptions about it, as well as learn how anxiety can temporarily distort thinking. In the case of CPAP, this could mean learning why it is impossible to suffocate with the machine on, why you would wake to remove the mask (rather than suffocating) if there were a power failure, and how having a panic attack with the machine on is not dangerous and is transitory. You would also remind yourself of things you already know, such as how you are always in control of whether you have the mask on and how no one will force you to use the machine. You might additionally be taught relaxation techniques to help moderate your anxiety.
Self-help measures for milder claustrophobia: The same basic principles of mastery of anxiety through exposure and challenging false assumptions apply when one is treating one’s own, milder claustrophobia, but here you can be a little more flexible in your approach, a little more makeshift with materials. You also don’t necessarily need to construct a formal hierarchy (though if you do, each step should be about ten “units” more distressing than the previous step on a 100-point scale, and your final step should be about a 100). Also, you can play a little fast and loose with the traditional approach to exposure to suit your own preferences. For example, you may choose to moderate the intensity of any given step by using distraction (e.g., reading, watching TV, doing a crossword puzzle) during the exposure at first, and gradually moving toward full attention to the anxiety-provoking situation over the course of several minutes or several days (you decide on the pacing as long as you’re neither failing to progress nor overwhelming yourself).
So what progression should you use for exposure? You get to decide. Here are some ideas for various stages to get you started: looking at the machine, writing about what you imagine it would be like to wear the mask, looking at pictures of someone else using the machine, asking someone you know who does use CPAP or BiPAP to let you watch them use it for awhile (maybe even during sleep), asking them questions about what it feels like and whether they have fears about it, wearing the mask with the machine on (at lowest pressure) for just a few seconds, breathing through a swim snorkel around the house, using a snorkel in a swimming pool or the bathtub, wearing a dust mask or surgical mask around the house for increasing periods of time, taking a nap with the dust mask on, using CPAP while watching TV for increasing periods of time, lying down in your bed with it on for five minutes while listening to the radio, etc. Ultimately you want to work toward 30 minutes of continuous, anxiety-free use, preferably without distraction, at which point you can begin the adaptation routine here to progress toward all-night use, starting with Stage 2 of that routine.
You should set aside up to 30 minutes every day, one session per day, for exposure. If your first step is just to have the mask and machine on for 30 seconds, then see whether you can repeat the 30-second exposures several times during the 30 minutes, using plenty of soothing and encouraging self-talk throughout. But if you do two 30-second run-throughs, and feel very satisfied with that accomplishment, be happy with your partial victory and come back the next day to do a little more (still 30 seconds at a time, but with more repetitions). Your motto can be, “A little bit is better than none at all.” You will know you’re ready to move on to the next step when the current one no longer distresses you.
Why exposure helps, and how to deal with the anxiety it raises: Psychologists used to think “counterconditioning” was the key to overcoming phobias, that if you could be deeply relaxed during exposure to phobic stimuli, the stimuli would increasingly become associated with relaxation rather than anxiety over time. But many researchers are now of the opinion that the key to recovery is being present enough to see the stimulus for what it really is, without all the imagined bogeymen that accompany those things we avoid. Deep relaxation needn’t even be a component of the treatment (in fact, some clinics use “flooding,” in which one is exposed to one’s most feared situation without benefit of a gradual hierarchy beforehand). Once we see for ourselves that the experience isn’t dangerous, and also see for ourselves that we, personally, have what it takes to handle the situation and our own anxiety about it, it ceases to be frightening. A useful analogy is the childhood fear of inoculations. It’s hard to experience the raw sensations associated with a shot, to really experience that which frightens us on its own terms, when our terror puts us into an all-out state of panic. But if at about age 12 we decide just to see what it is we’ve been phobic of all this time, and we calm ourselves enough to focus on the sensations accompanying the shot without all the distracting anxiety taking over, we see that it hurts a little, and that we can handle the pain. Thereafter we’re not anxious. So when you use exposure therapy to treat your claustrophobia with CPAP or BiPAP, work toward being as present as possible for the raw sensations associated with using the machine, and present as well for yourself, using soothing and encouraging language to comfort the person who is bravely enduring the exposure. And by all means know that the machine cannot in reality hurt you or stop you from breathing. If you have any doubts about that, pepper your physician or respiratory technician with as many questions as you need to be assured of that fact.
When you undertake exposure, it’s not realistic at the start of each stage to be free of anxiety. Freedom from anxiety is the end point of each stage, not the starting point. Anxiety is not an argument that you can’t handle what you’re doing; rather, it’s a normal reaction to a phobic stimulus, and a sign that you are rising to a challenge. But even outright panic is not a sign of danger, just of extreme anxiety. (Indeed, part of the treatment for panic disorder involves intentionally bringing on panic attacks to see that they are survivable, recede on their own, and are not dangerous.) You can achieve mastery with less suffering if you choose steps that make you uncomfortably anxious but not outright panicky, but you needn’t fear panic.
What to do if you are anxious in general: If you run anxious in general, consider learning the rudiments of meditation (best practiced regularly), self-hypnosis or bodily relaxation so that you feel some control over your own anxiety level in general, and so that you naturally come to feel more relaxed at baseline. Attending to stress in day-to-day life also really matters. Doing so can be harder when you are sleeping poorly due to untreated apnea (another reason to try to conquer the claustrophobia), but exercise, quiet time for yourself, support from those who care about you, doing things just for fun, and self-care in all its stripes are marvelous ways to lower your vulnerability to anxiety and make you more stress-hardy. And finally, learn some good tools for working with particular anxious thoughts by reading excellent books on the topic (e.g., David Burns’s When Panic Attacks or Robert Leahy’s The Worry Cure) or by seeking professional help.