New-ish User, Terrible Results Taking a Nap

[decker12]

I've bee on my CPAP machine for about 4 months and doing pretty well with it. Nighttime, averaging 100/100 scores with less than 3 AHI, no mask discomfort, no major seal issues, just doing pretty well with it.

I was up late last night and up early this morning, so today I tried to take my first nap at about 2PM and used the same mask, same machine, same bed, same pillows, same everything. It was AWFUL and I don't know why!

My myAir app showed 10.5 AHI in the 54 minutes I wore the mask. I've never seen it that high. I would say I didn't get more than 15 minutes of actual sleep and didn't feel like I took a nap at all. When I woke up from that minor dozing, my chest felt FULL, like I was an overstuffed balloon. I opened my mouth and exhaled and a huge gust of air came out. It literally felt like I was letting the air out of an over filled balloon. Even when I wake up at night to roll over, I never feel this giant inflated feeling like I did during this nap.

I closed my mouth and tried twice more with the same result. As soon as I put the nose pillows back in, it was like I was inflating. This does not happen at any time during the night when I regularly sleep. It seems clear that my machine was pushing too much air into my nose for reasons unknown because it's all set to auto, just like at night. Hours later my chest/lungs still feel like they've been through a work out when all I did was lay down in my usual sleep positions for less than an hour. I don't experience this at all when wearing it during my regular sleep time.

Really discouraged because I've tried to take a nap on the couch without the machine, and that simply didn't work, I felt like I just couldn't get enough air the entire time. Now, napping with the mask, it felt terrible as well. Any ideas what this could be?!?

[Julie]

What are your pressure settings?

[LSAT]

The problem was that you only got about 15 minutes sleep in the 54 minutes that you used the machine. If you check your data, I'm sure that you will find that most events were CAs (SWJ). You are trying to measure AHI while awake or partially awake. You breathe differently when awake vs sleep.

[lynninnj]

I've bee on my CPAP machine for about 4 months and doing pretty well with it. Nighttime, averaging 100/100 scores with less than 3 AHI, no mask discomfort, no major seal issues, just doing pretty well with it.

I was up late last night and up early this morning, so today I tried to take my first nap at about 2PM and used the same mask, same machine, same bed, same pillows, same everything. It was AWFUL and I don't know why!

My myAir app showed 10.5 AHI in the 54 minutes I wore the mask. I've never seen it that high. I would say I didn't get more than 15 minutes of actual sleep and didn't feel like I took a nap at all. When I woke up from that minor dozing, my chest felt FULL, like I was an overstuffed balloon. I opened my mouth and exhaled and a huge gust of air came out. It literally felt like I was letting the air out of an over filled balloon. Even when I wake up at night to roll over, I never feel this giant inflated feeling like I did during this nap.

I closed my mouth and tried twice more with the same result. As soon as I put the nose pillows back in, it was like I was inflating. This does not happen at any time during the night when I regularly sleep. It seems clear that my machine was pushing too much air into my nose for reasons unknown because it's all set to auto, just like at night. Hours later my chest/lungs still feel like they've been through a work out when all I did was lay down in my usual sleep positions for less than an hour. I don't experience this at all when wearing it during my regular sleep time.

Really discouraged because I've tried to take a nap on the couch without the machine, and that simply didn't work, I felt like I just couldn't get enough air the entire time. Now, napping with the mask, it felt terrible as well. Any ideas what this could be?!?

Might be easier to follow along if you stick to one thread for most stuff. I think over on your P10/P30i thread we were asking for data. Maybe post it over there so folks can follow your journey?

[robysue1]

My myAir app showed 10.5 AHI in the 54 minutes I wore the mask. I've never seen it that high. I would say I didn't get more than 15 minutes of actual sleep and didn't feel like I took a nap at all.

Sounds to me like your machine was scoring a whole lot of "events" when you were not actually asleep.

As to why that would happen: Our wake breathing is a lot more irregular than our sleep breathing is. While awake, our breathing is controlled by the part of our nervous system that controls conscious movements; while asleep, our breathing is controlled by the automatic nervous system. And while we are awake, we'll do such things as momentarily pause our breathing when we're concentrating on something, or we'll take a series of large "cleansing breaths" followed by a series of much, much smaller ones. In other words the overall breathing when we're awake is just more 'ragged' looking than our breathing is when we're asleep. Now add in the fact that you were trying to get to sleep. And sometimes the transition from wake breathing to sleep breathing is not completely smooth: It's not uncommon to have a CA or two happen as the breathing trigger (the amount of CO2 in the blood) is reset to be just a bit higher. And if you were drifting in and out of sleep more than you realize, that could also explain why where were so many events.

When I woke up from that minor dozing, my chest felt FULL, like I was an overstuffed balloon. I opened my mouth and exhaled and a huge gust of air came out. It literally felt like I was letting the air out of an over filled balloon. Even when I wake up at night to roll over, I never feel this giant inflated feeling like I did during this nap.

I suspect that the machine scored a bunch of Hs or OAs near the beginning of your "nap", and this resulted in an increase in pressure. Which may have triggered some air swallowing and/or some deep breathing just as you finally started to get your 15 minutes of dozing in, and you might not even have been aware of the change in breathing and/or the swallowing.

I closed my mouth and tried twice more with the same result. As soon as I put the nose pillows back in, it was like I was inflating. This does not happen at any time during the night when I regularly sleep.

Sleep breathing is much more shallow than wake breathing. So the tendency to "over breathe" while having the mask on is greatly reduced at night---particularly if you fall asleep reasonably quickly at night.

It seems clear that my machine was pushing too much air into my nose for reasons unknown because it's all set to auto, just like at night.

Without seeing the data from the nap, I would guess that the machine scored a bunch of OAs and Hs while you were awake and that caused the machine to increase the pressure significantly. The machine doesn't know when you are awake or when you are asleep. And so it has been programed to assume that you are asleep whenever its on and detecting a breathing pattern that fits its definition of an apnea or a hypopnea or a flow limitation.

Hours later my chest/lungs still feel like they've been through a work out when all I did was lay down in my usual sleep positions for less than an hour. I don't experience this at all when wearing it during my regular sleep time.

This is actually a somewhat common complaint that many new PAPers have, except some new PAPers experience it with their nighttime sleep as well. It takes more effort to exhale fully against the pressure, and that requires more work from the diaphragm and chest wall muscles. So, yeah, sometimes they're sore because they have been working harder than they're used to.

Really discouraged because I've tried to take a nap on the couch without the machine, and that simply didn't work, I felt like I just couldn't get enough air the entire time. Now, napping with the mask, it felt terrible as well. Any ideas what this could be?!?

So now we're also dealing with a conundrum: On the one hand, you eventually felt like your lungs were overfull because there was so much pressure, but on the other, you also felt like you "just couldn't get enough air" the entire time.

So answer these questions so that we can help you fix the problem:

1) Do you use the ramp feature? If so, what are the ramp settings?

2) Exactly what do you mean when you say you "just couldn't get enough air" the entire time? Do you mean that inhaling comfortably and deep enough was difficult because there was not enough air coming through the mask? Or do you mean you couldn't breath comfortably because it was difficult to fully exhale because there was too much air coming through the mask? Or was EPR on and you felt like the machine was "rushing" your breathing---i.e. it felt like the machine was encouraging you to start exhaling (or inhaling) before you were ready to do so?

When you say you "just couldn't get enough air", most people around here will interpret that as meaning that you feel like you cannot fully inhale comfortably. And the usual fix for that problem is more pressure. In other words, we'll tell folks to turn the ramp off and/or bump their min. pressure setting up by a cm or two.

But if the problem is is actually that you're finding it difficult to fully exhale, "more pressure" can make the problem worse, rather than better.

As always, if you posted some OSCAR data or a link to data from SleepyHQ, it would be easier for us to tell you exactly what's going on. And that would make it easier for us to help fix the problem.

[decker12]

Thanks again everyone for your input. I'm going to extract the SD card and put it through OSCAR and post my results shortly.

you also felt like you "just couldn't get enough air" the entire time.

I didn't explain this very well. When I try to take a nap WITHOUT the machine, that is when I start to feel like I can't breathe very well. It was explained to my why in the other thread I made about my back pain, so it makes sense to me now why my attempts to sleep is so miserable without the machine now.

My nap yesterday I felt like I could breathe fine, with the caveat that towards the end of my nap, I didn't feel like I was having deep quality breaths because of having that massive "feeling full" sensation. The best way to describe it is that I felt like I was drinking water with a ton of water already swishing around in my stomach.

I do use the Ramp Up feature set to Auto, with Pressure Relief set to On. I don't use the heated tube and my humidity is set to 5. I also just realized that for last night the LCD screen said my pressure ended up on a 12! That seems high for me but I'll know for sure when I pull the card out.

Anyway as stated I will post my OSCAR results shortly and looking forward to any more tips or advice. I'll also keep my journey in a single thread instead of splitting it into separate topics - I figured separate topics would split up my questions into logical blocks instead of one giant 5+ page thread.

[lynninnj]

Thanks again everyone for your input. I'm going to extract the SD card and put it through OSCAR and post my results shortly.

you also felt like you "just couldn't get enough air" the entire time.

I didn't explain this very well. When I try to take a nap WITHOUT the machine, that is when I start to feel like I can't breathe very well. It was explained to my why in the other thread I made about my back pain, so it makes sense to me now why my attempts to sleep is so miserable without the machine now.

My nap yesterday I felt like I could breathe fine, with the caveat that towards the end of my nap, I didn't feel like I was having deep quality breaths because of having that massive "feeling full" sensation. The best way to describe it is that I felt like I was drinking water with a ton of water already swishing around in my stomach.

Anyway as stated I will post my OSCAR results shortly and looking forward to any more tips or advice. I'll also keep my journey in a single thread instead of splitting it into separate topics - I figured separate topics would split up my questions into logical blocks instead of one giant 5+ page thread.

At least with 5+ pages we can all follow your journey. whichever one you land on-did you nap on your back or side?

[decker12]

I edited the above post with info about my ramp-up and pressure.

For my nap, I started on my back and tried to fall asleep for about 30 minutes. Then I turned to my side which is probably about when I actually fell asleep. It was then I woke up from that light doze feeling very full as described in my original post.

[decker12]

SleepHQ is awesome! Just uploaded my data to it, and here's the public link for the past 90 days:

https://sleephq.com/public/96eb0ef8-117 ... 420b429e15

Thank you again for any insight you may teach me from that data!

[lynninnj]

SleepHQ is awesome! Just uploaded my data to it, and here's the public link for the past 90 days:

https://sleephq.com/public/96eb0ef8-117 ... 420b429e15

Thank you again for any insight you may teach me from that data!

I like the ease of use too.

Do you recall which mask was when? Trying to look at leak data to compare.

At some point posting individual days will be more important. Also it allows us to see settings. Can you post nap day?

[decker12]

I've been using the P30i - the mask with the hose on top of the head with nose pillows - for about the past three weeks. One of those nights (forgot which) in there I switched to the N30 to test out my hurt-back theory but the next night was back on the P30i. Always using the nose pillows.

Here is nap day (yesterday):

https://sleephq.com/public/4d1759ed-9db ... 6d603a1ec9

The timing on either my SD card or Sleepyhead is off by 2 hours, because yesterday I definitely took my nap at 3PM, not at 5PM.

[lynninnj]

I've been using the P30i - the mask with the hose on top of the head with nose pillows - for about the past three weeks. One of those nights (forgot which) in there I switched to the N30 to test out my hurt-back theory but the next night was back on the P30i. Always using the nose pillows.

Here is nap day (yesterday):

https://sleephq.com/public/4d1759ed-9db ... 6d603a1ec9

The timing on either my SD card or Sleepyhead is off by 2 hours, because yesterday I definitely took my nap at 3PM, not at 5PM.

I sent PM on resetting time on charts.

I wish I knew where Robysues or pugsy or some other helpful explainer is but some things catch my eye. Some I sent in PM.

A few thoughts I had were that if it were me I would turn off autoramp and pick a time frame. Though the algorithm is good at detecting if you’re asleep I have mine on 5 min and then pressure goes from 4 to my minimum.

Then your min goes to 5 I think? The EPR can only lower it 3 and machine can’t get below 4. So you don’t get pressure relief of 3 unless pressure is at 7. You spend much of your time well above your minimum setting so it bounces up and down a lot trying to compensate. Your trend stats put your med somewhere around 8-9 but machine has to blast off between 5 and 8-9. THEN it goes higher to prevent your airway from collapsing.

That’s what I see.

HTH

[ozij]

I've been using the P30i - the mask with the hose on top of the head with nose pillows - for about the past three weeks. One of those nights (forgot which) in there I switched to the N30 to test out my hurt-back theory but the next night was back on the P30i. Always using the nose pillows.

Here is nap day (yesterday):

https://sleephq.com/public/4d1759ed-9db ... 6d603a1ec9

The timing on either my SD card or Sleepyhead is off by 2 hours, because yesterday I definitely took my nap at 3PM, not at 5PM.

SleepHQ shows each user their own time zone -- based on their computer's time zone definitions.
[edited to correct a slip which could be cofusing....]

You data supports robysue's hypothesis:

Sounds to me like your machine was scoring a whole lot of "events" when you were not actually asleep.

When you look at the flow rate, you can see that your Auto Ramp was working for all of ten minutes. And the zooming up very quickly. So: either you, or your machine don't identify your sleep period correctly. Let's assume it's the machine. We can see the same behaviour at night: a very short ramp, and a very quick upwards response.
Do you really need the ramp?
Do you need your minimum pressure to be so low?
Is technically it possible to give the Auto Ramp a minimum that's higher than 4?

If it were my data, I'd try to raise both ramp and minimum pressures, letting my comfort be my guide - and I'd check if I can tolerate starting sleep at my minimum pressure without the ramp at all I'd check those things at at time that is not bedtime, when all I want it to sleep, but rather at a time when I can be relaxed and awake enough to do some systematic trial and error.

Our aim is to set the minimum at a level that prevents events and keeps our breathing stable.

Based on this single night of data I'd aim for a minimum of 8 since whenever the pressure drops beneath it, the breathing flow gets ragged. It may take a few days of gradual raising to get there.
If you need the ramp, see how high you can tolerate it.

Although we don't, as a rule, recommend changing more than one thing at a time, in this specific case I would indeed change both the ramp minimum and the therapy minimum together.

[chunkyfrog]

I don't normally nap unless I am sick or somehow became sleep-deprived.
In any case, sleeping in the daytime often results in crappy numbers.
When I need extra sleep--and get it; I don't let anything but how I FEEL matter.
My body clock thinks it's the wrong time, but I am still getting what I need.
Not the time to judge--just do it.

[decker12]

What is a bit frustrating is that I really don't understand much of this. My sleep doctor pretty much just gave me the test, confirmed my 33 AHI, then the machine arrived a few weeks later. When I first got it I didn't even know I needed to keep my mouth closed and had to figure it all out on my own. Bad on them, but they're local and take my insurance and I didn't need to wait 9 months to get my first appointment so I went with it.

I don't know how to change the pressure on my device. I don't really know what the ramp up time is supposed to mean, or if I want it short or long. It's pretty much just using the defaults the device shipped with. I didn't choose to use the auto ramp, and I haven't slept without it, and while that is a feature I can change, I don't really know what it should be set at so it's just on Auto.

I'm open to any advice, and yes I understand nobody are doctors, but right now I'm basically just using my machine on Auto / default settings. And it sounds like I should be tweaking something, somewhere. Presumably the pressure was set at the factory based on info my sleep doctor gave them, but if it can be changed, I don't see any options in the menu to do so.

It sounds like my minimum is set at 4, but should be set to 8, because with auto-ramp enabled, I basically zoom past 4, 5, 6, 7 and quickly slam right into 8. So I should be starting at an 8. The auto ramp sounds like it is supposed to prevent 8psi of air blasting into my nose the second I turn the thing on. But it also sounds like I DO want to avoid using auto ramp for a reason I don't quite understand? Thanks again for any help.