Newbie started strong . . . now it's all going to hell

[BuddhaCat]

Okay, "hell" is a strong word. But things are becoming pretty craptastic sleep-wise.

After 2 weeks of CPAP use, I thought I was getting in cruise control mode: sleeping about 7 hours a night, AHI between 1-3, pressures in the 7-8 range. I was tweaking things around the edges and getting ready to start reaping the benefits of regular oxygen during sleep.

This week it all went kablooey. In 2 of the past 6 nights, I've slept 0 hours with the machine. One of the nights was 4 hours. (I realize that 4 hours is still a goal for many people. I'm not trying to rub it in, only reporting that I'd been sleeping considerably longer on CPAP, then not so much.) Right now I feel like a physical mess from lack of sleep and OSA. A migraine is hovering above my right eye.

The main issue seems to be that I'm having trouble regulating my breathing. I've been laying awake in bed feeling like I was breathing too hard and couldn't catch my breath, and would need to open my mouth to exhale. (I notice this while awake. Who knows what's going on when I'm asleep?) For the past few nights I've had this problem even at a pressure of 5. BTW, my machine normally starts at a pressure of 5, but I can ramp up from 4. (The DME set it that way.)

I do have mild asthma, but it hasn't bothered me at all since I started CPAP. I've even been going without my Symbicort because I've felt so good. My allergies are pretty darn well controlled with zyrtec, rhinocort aqua, and singular.

I'm looking for advice to prevent the self-fulfilling prophecy of thinking I can't sleep with the machine. Any ideas? Need to see any graphs?
Thanks much --

[zoocrewphoto]

Are you using ramp? What is your starting pressure?

I suspect you have gotten used to the pressure range of 7 plus, and now you are bothered by a low starting pressure of 4 or 5. You may need to disable the ramp and/or raise the minimum to at least 6.

[BuddhaCat]

Wow -- I never even considered raising the pressure . . . just assumed that if I was having trouble I needed the pressure to start lower, not higher. Interesting.

My ramp pressure starts at 4. Regular pressure starts at 5 and goes to 15. Typical average nightly pressure is around 7-8.

I wasn't using ramp until these past few nights, when I couldn't catch my breath at 5.

[Julie]

The weather's been very hot and humid too in the NE, and Cpap doesn't always work very well in those conditions, so it's possible it's not only not helping as much as usual, but the humidity may be aggravating your asthma... not everything is about the machine.

[BuddhaCat]

Good point, Julie. I'll drop the humidity level.

P.S. -- Notice the cat theme we've got going on amongst the posters on this thread?

[englandsf]

What's your prescribed pressure/range? Where on the humidity scale are you (I speak Resmed not PR sorry!)? Do you have any hose heat on at all? I agree with other posters about ramp not helping and find anything less than about 10 to make me feel starved. I also do 3-5 mouth breaths as I lay down then switch to using me P10 nose pillows only.

[BuddhaCat]

What's your prescribed pressure/range? Where on the humidity scale are you (I speak Resmed not PR sorry!)? Do you have any hose heat on at all? I agree with other posters about ramp not helping and find anything less than about 10 to make me feel starved. I also do 3-5 mouth breaths as I lay down then switch to using me P10 nose pillows only.

Hi englandsf --

My prescribed pressure is 5-15cm. I have an auto CPAP.

I've been using a "3" humidity on a scale of 1-3.

Yes, I do have a heated hose.

I don't have to use the ramp, but can choose to use it.

Do you ever have the feeling of not being able to catch a breath? Is that the same thing as feeling "starved?"

Thanks--

[BlackSpinner]

I don't have to use the ramp, but can choose to use it.

Do you ever have the feeling of not being able to catch a breath? Is that the same thing as feeling "starved?"

Thanks--

Some people feel like that at lower pressures.

You mentioned opening your mouth - you may need a full face mask when allergies kick in.

[englandsf]

Yes, I get starved feeling if pressure is below about 10. But my pressure is set at 10-20 and always stays 10-13. I have trouble with full face masks which make me claustrophobic so I use pillows with nasal rinses and run my humidity low (2.5/6.0 on ResMed scale) with zero heat (pass over I think it's called). It takes a few breaths for the dry air to push open my sinuses. I would very much suggest you turn down the humidity but not sure if I'd risk raising your pressure, just no ramp may make sense. Do you have a "turn on" routine - I sit on the end edge, turn on the machine with my mask on then take a few mouth breaths as I lie down and roll over holding my hose and settle on my pillow. Then I switch to nose breathing and slow things right down. If I get stuffy I just do a few more mouth breaths then try again...

[BuddhaCat]

I don't have to use the ramp, but can choose to use it.

Do you ever have the feeling of not being able to catch a breath? Is that the same thing as feeling "starved?"

Thanks--

Some people feel like that at lower pressures.

You mentioned opening your mouth - you may need a full face mask when allergies kick in.

Thanks BlackSpinner. The mouth-opening has happened during the last week when I'm awake and can't catch my breath. I just feel like I "have" to open my mouth in order to breathe, so I do and it equalizes the pressure or something. I know that's not sustainable in the long run.

I'll do some thinking about the ffm.

[BuddhaCat]

Yes, I get starved feeling if pressure is below about 10. But my pressure is set at 10-20 and always stays 10-13. I have trouble with full face masks which make me claustrophobic so I use pillows with nasal rinses and run my humidity low (2.5/6.0 on ResMed scale) with zero heat (pass over I think it's called). It takes a few breaths for the dry air to push open my sinuses. I would very much suggest you turn down the humidity but not sure if I'd risk raising your pressure, just no ramp may make sense. Do you have a "turn on" routine - I sit on the end edge, turn on the machine with my mask on then take a few mouth breaths as I lie down and roll over holding my hose and settle on my pillow. Then I switch to nose breathing and slow things right down. If I get stuffy I just do a few more mouth breaths then try again...

Lots of food for thought here. I think I'll talk to the DME rep about the pressure issue. I'm a bit claustrophobic too, so I use the P10. I do nasal rinses too, plus the allergy meds. I'll turn down the humidity tonight. The reason I have the heated tube on high (5) is because of the window air conditioner. Originally I tried a lower tube temp but had rainout issues.

I'll also think about the "turn on" routine. Great ideas, thanks.

[Todzo]

Okay, "hell" is a strong word. But things are becoming pretty craptastic sleep-wise.

When CPAP does not work well (becomes hard to use) it is more than frustrating, it indeed can be devastating.

After 2 weeks of CPAP use, I thought I was getting in cruise control mode: sleeping about 7 hours a night, AHI between 1-3, pressures in the 7-8 range. I was tweaking things around the edges and getting ready to start reaping the benefits of regular oxygen during sleep.

This week it all went kablooey. In 2 of the past 6 nights, I've slept 0 hours with the machine. One of the nights was 4 hours. (I realize that 4 hours is still a goal for many people. I'm not trying to rub it in, only reporting that I'd been sleeping considerably longer on CPAP, then not so much.) Right now I feel like a physical mess from lack of sleep and OSA. A migraine is hovering above my right eye.

There are so many things that can change the stress level, change how the muscles work, the level of inflammation in the body, blood circulation, the way our breathing reflexes work...

Why they do not monitor everyone who uses CPAP every night I do not know.

The main issue seems to be that I'm having trouble regulating my breathing.

This was going to be my first guess. Breathing stability issues. Issues that relate to respiratory control system gain. I believe this is the most common source of problems when using CPAP.

I've been laying awake in bed feeling like I was breathing too hard and couldn't catch my breath

Been there, done that, often. The thing that most helps me to shift out of the crazy air hunger mode is eucapnic breathing techniques. I am suspicious that Buddhist ‘Mindfulness of Breathing’ techniques would also work.

, and would need to open my mouth to exhale. (I notice this while awake. Who knows what's going on when I'm asleep?) For the past few nights I've had this problem even at a pressure of 5. BTW, my machine normally starts at a pressure of 5, but I can ramp up from 4. (The DME set it that way.)

I do have mild asthma, but it hasn't bothered me at all since I started CPAP. I've even been going without my Symbicort because I've felt so good. My allergies are pretty darn well controlled with zyrtec, rhinocort aqua, and singular.

I'm looking for advice to prevent the self-fulfilling prophecy of thinking I can't sleep with the machine. Any ideas? Need to see any graphs?
Thanks much --

Practice eucapnic or Buddhist ‘Mindfulness of Breathing’ techniques especially while starting to use the machine. Practice during the day my help as well.

Lower stress levels.

Increase circulation.

In your graphs follow minute volume average (lower is generally better) and the variance between that and the 95% and peak values (less variance better – implies more stable breathing). Your metabolic needs at night are not great and should not change a great deal so your breathing levels should follow.

[BuddhaCat]

Thanks, Todzo. I'll look into eucapnic breathing!

[HoseCrusher]

When under stress there can be a mind game going on... Clear your mind.

OK, how do you do this.

There is some "anticipation" involved with hooking a mask up to your face and relying on a machine to provide enough air to breathe. If you are having some difficulty the anxiety skyrockets and your mind can play games with your breathing and you can end up with the mask on the floor and get no quality sleep.

As you get ready for sleep, clear your mind and think of pleasant things like a walk in the park or a swim in warm water on a nice beach. Relax and just before you mask up take several deep breaths. When you lie down just relax and let natural sleep progress.

The deep breaths will over saturate your blood with oxygen and you will find the starving sensation greatly diminish. The relaxed state of mind will allow you to drift off to sleep effortlessly.

With that said 5 may be too low a starting point and you may want to increase it to 6.

[BuddhaCat]

When under stress there can be a mind game going on... Clear your mind.

OK, how do you do this.

There is some "anticipation" involved with hooking a mask up to your face and relying on a machine to provide enough air to breathe. If you are having some difficulty the anxiety skyrockets and your mind can play games with your breathing and you can end up with the mask on the floor and get no quality sleep.

As you get ready for sleep, clear your mind and think of pleasant things like a walk in the park or a swim in warm water on a nice beach. Relax and just before you mask up take several deep breaths. When you lie down just relax and let natural sleep progress.

The deep breaths will over saturate your blood with oxygen and you will find the starving sensation greatly diminish. The relaxed state of mind will allow you to drift off to sleep effortlessly.

With that said 5 may be too low a starting point and you may want to increase it to 6.

Excellent advice, HoseCrusher. You have accurately diagnosed the anxiety issue. I'll give the deep breathing a whirl.

BTW, if I do need to increase the starting pressure from 5 to 6, can I do that myself? I'd assumed only the DME could do it.