CPAP not working ....why?

Hello, New to the forum and just got my CPAP. I had a sleep study done a few years ago and elected to have the surgery then to correct which did not help. Was just feeling BLAH all the time and a cardiologist suggested a sleep study again due to unneccessary strain on my heart. I just had the new sleep study done and was woke up during the study and was asked to wear the CPAP but I could not fall back asleep so no information was gathered. The sleep study doctor suggested another sleep study or a auto cpap machine which would adjust accordingly to what my needs were while I was asleep. So I got the machine and tried it two nights and was "choking" out about two hours into it and could not fall back asleep. I called the healtcare people who in turn called the sleep doctor for permission to turn up the air pressure as I was still recording a AHI of 46??? The machine was turned up for a range of 6-20 (which is as high as it will go) tried it again for two nights and still have a high AHI (one night was 35 and the other was 33) and still unable to sleep a full night without the choking out feeling a couple of hours into it. I really would like to be able to sleep a full night and get a full nights rest but it seems like this may be impossible for me right now, should I go to another doctor and look at another surgery to correct whatever it is that is causing the air blockage? Has anyone out there experienced this and if so what was done for you to correct it.

Can you tell us what kind of corrective surgery you had? Then, perhaps others who have had the same type of surgery can share their experiences?

And what kind of cpap and mask are you using?

As it appears that you are having a problem with the autoPAP, I would suggest getting a sleep clinic titration. You may want to ask your sleep specialist to prescribe a sleeping pill or a benzodiazepine.

dreammaker wrote:... should I go to another doctor and look at another surgery to correct whatever it is that is causing the air blockage? Has anyone out there experienced this and if so what was done for you to correct it. ...

Sure. Almost everyone has problems (to some extent) adjusting to using CPAP. Who wouldn't?

Okay, I'm going to tackle this as best as I can.

First of all, you don't mention what type of surgery you had. From what I've seen (from friends and folks I know) some surgery does almost nothing. Some surgery can make it difficult to use CPAP. Again, just from my experience almost all surgery does not help.

Second, why should you get this addressed? Well, you are seeing a cardiologist !!! Need I say more? There is a VERY high correlation between sleep apnea and heart problems, hypertension, strokes, type 2 diabetes, obesity, memory problems, and excessive daytime sleepiness (which can lead to fatal accidents). Untreated sleep apnea kills.

If I say that almost all surgeries do not work, then what surgery does work? Well, tracheostomy is the one sure surgery that will eliminate problems with obstructive sleep apnea:

http://en.wikipedia.org/wiki/Tracheotomy

Don't know about you, but my answer for this option [ unless there is NO other solution ] is ... "Uhhhh... NO!"

So, what are you going to do about it? You need to face the situation. The ONLY way the sleep doctor (ANY sleep doctor) can find out what causes your poor sleep is for you to sleep at a sleep lab. They need to record a LOT of different information (several hundred pages worth of information !).

dreammaker wrote:... and still unable to sleep a full night without the choking out feeling a couple of hours into it. ...

It seems the biggest issue you complain about is the chokng feeling. It is possible that the surgery made it difficult for you to use just a nasal mask. Sometimes the surgery damages the soft palate and the airway does not properly close. You feel as if you are choking / gagging. Perhaps a full face mask (that covers the nose AND mouth) will address that problem.

But you really need to have the sleep study done. Ask your doctor why you feel that "choking" feeling. If you explain why it does not seem to be working for you and you want good sleep so want something that will work ...

But in your shoes ... with reasearch I've done in the past ... and my friends (about 10 over the years) who NEVER had success with surgery ... I would stay away from any further surgery. I wish there was a "quick fix". But there is not.

Hope that helps.

Hello and welcome. I certainly am not an authority on this, but do have some things for you to consider as you work thru all this.

First, make sure your leak rate is acceptable to better insure reliability of the AHI.

Consider what pressure the machine is (and was) reaching in the limited time you've used it. If that number is substantially higher than 6, it may be that the climb to provide a therapeutic pressure takes too long to prevent events. Whatever the highest pressure reached so far (with acceptable leaks) may be a better place to start your pressure range.

As far as the choking sensation, that is one description often used to describe waking up with an apnea event, so it may be that your residual events are causing this. Or maybe it's what you would feel if nose breathing but the seal of your tongue against the roof of the mouth breaks and air rushes out your mouth. Or it could be a sudden awareness of a pressure change. And sometimes acid reflux can cause a choking sensation. And so can vocal cord spasms. Just saying, maybe you can more clearly identify the sensation you feel and rule out some of the possible causes.

All the things I've mentioned are generic and not specific to those who have had surgery. I've read on here of issues using CPAP after some surgical procedures, so hopefully some of those folks will see this and weigh in, or someone with links to prior discussions will post them.

Best wishes.
Kathy

Autopaps respond to events the make them raise their pressure.
What pressure is your machine reaching?
What make of machine?

Sometimes surgery which trims the palate (UPPP) make autopap use impossible, because the auto simply doesn't idetify the events necessary to make it raise its pressure.

You could also be attempting to use an auto that does not suit your breathing pattern - and another type may respond better.

Please by as specific as you can, that will help us help you.

I'm wondering if the range 6-20 isn't too big of a range and maybe that range needs to be closer together. The machine may be having a hard time reaching the right pressure to prevent the apnea event. The apnea event may be causing the feeling "choking". After all when apnea occurs you stop breathing and many people snort, gasp and choke to start breathing again.

rosie

I also think your pressure range is set too wide. I've read here that those who weren't able to get a good titration during their sleep study sometimes use 10cms as a guide as that pressure can usually keep the airway open, so a range of 8-12 might be better.(-2 - +2). Just a suggestion, I'm not an expert. Do you have the software to monitor your nightly data?