Feeling Choke when Pressure Goes Up

[FairwayGirl]

I haven't been doing this very long, and I've been having a very difficult time adjusting. I can wear it. I just feel like I'm choking and my throat is closing the whole time I'm wearing it. I keep hitting the ramp button and I can breath for a while. But, sometimes for some reason it jumps from 4.0 to 10 and chokes me, before the ramp is over (which is 45 mins) It jumps to 10 all the time when I'm still awake and breathing perfectly fine, I don't get it. It's not like I'm having any events. I'm awake and feel fine, I just can't sleep because of the air, so I'm just laying there and it starts pushing air. I have been timing it, and the ramp does not wait the 45 mins before jumping to the max pressure of 10. Okay, on to other issues on it. My throat is sore as soon as I put it on, not just sore but it hurts. And I am currently feeling much worse every day from using it. I was tired before, that's why I went to the doctor, but this is much worse. Before I would take Provigl maybe once a week, twice on a horrible week. Now I have to take it every day. And I am actually falling asleep at my desk, I've never done that. SleepyHead is showing my average AHI is 2.5 or so, and it's always much higher when the pressure is up? I guess I can't figure out why the pressure is going up if it's causing APNEA events? I don't understand that part at all. But, there is one day I have 5.9 average, and it's all at the beginning of the night and all at 10.0 pressure. I will hope to have a chance to take screen shots, but I have no idea how to do it, so I'll see if I can follow the directions. Thank you for any help!

[Janknitz]

I can't address why the ramp would increase in pressure before the 45 minutes is up--it may be that the pressure GRADUALLY increases over the 45 minute period.

But you also said "I just feel like I'm choking and my throat is closing the whole time I'm wearing it." So let's figure a few things out.

Do you feel like you are choking immediately when you put it on? Maybe you are not getting enough air when it first starts up, I feel like I'm suffocating when the pressure is that low.

Are you keeping your mouth closed, lips sealed and tongue on the roof of your mouth? Or is air rushing into your mouth or out of your mouth, making you feel like you are choking. A nasal mask will not work unless you can keep your mouth closed, your lips sealed, and your tongue on the roof of your mouth to keep the air going in your nose and down your airway instead of filling up your mouth with air.

Is your nose clear so that you can really get air in? Do you have the right size of nasal "pillow" with your mask (I'm not sure that's what they are called on the DreamWear)? You can google "DreamWear CPAP mask" to see the fitting guide.

Have you tried wearing your mask when you are awake and not trying to sleep? That's a way to get used to it and more comfortable--while doing some quiet activity like reading or watching TV. It would be especially helpful to turn the ramp off and try to get comfortable with a pressure of 10.

Let us know if any of these suggestions help.

[FairwayGirl]

I feel great when the pressure is at 4, and I'm even okay when it's at 7. It's when it goes up that I have a problem and feel choked. I wear it for several hours each night not sleeping, I always put my mask on as soon as I get into my room, and either watch tv (rarely, about once a month) or read. But, I have to keep hitting ramp just so I can not feel like my throat is closing. And, in the last 2-3 days I have a lot of pain in my face, ears and eyes when I wake up, and when I put the mask on. It does get better during the day. I saw an ENT before I got my machine, because I had severe ear pain at my sleep study that lasted for 3 days, and that seems to be much better now! I am very hopeful this will get better too

[Julie]

Are you using a humidifier? I imagine that could make a big difference if you need one and don't use it... your throat could get quite dry and feel choked.

[FairwayGirl]

Yes, I'm sorry! I thought all that was by my name! I should have said it. I'm using a DreamStation and it has a humidifier on it and a heated hose, set at the highest temp. I have the humidifier set at 2, because when it was higher it poured water on me, oops! But, I have it down now, and the air is colder, yuck, but I'm not swimming! Before all this I couldn't even stand even a fan in the room, it always locks me up. Makes my face swell, and my ear hurt badly (I still can't have a fan!) And I freeze all night. I think the freezing from the CPAP is the hardest part! It makes me so cold! What really stinks is how good I feel when I sleep with out the mask :/ If I give up and take it off in the morning, or take a nap, I feel so much better than I do sleeping 6-7 hours with the mask on :/ I still have slept with it on every night! I took screen shots of my SleepyHead data, but cannot figure out how to post it! I haven't ever been on a forum before!

[palerider]

I still have slept with it on every night! I took screen shots of my SleepyHead data, but cannot figure out how to post it! I haven't ever been on a forum before!

shhh shhh, calm down. you get all this excited any you'll never be able to sleep.

read this page, follow it, then there's a link at the bottom to the next steps, read that page, follow it, and follow the link on the third page.

your already done screenshots are probably not optimal, most peoples aren't when they are new and don't know what to put in them.

https://sleep.tnet.com/resources/sleepyhead/shorganize

[Janknitz]

You might do better turning your CPAP to a steady pressure of 7 with maybe a 5 minute ramp. Just to get you from 4 to 7 while you are awake, so you can go to sleep knowing the pressure isn't going any higher. If you can be comfortable with that enough to sleep, that's a good start. After you are more used to it, and depending on your data, the pressure can slowly be increased to your prescribed pressure. That might be a better way for you to start than trying to get all the way to ten if it bothers you so much.

Try that for a week or so, and then you can look at the data to see how it's working for you and whether or not you really need any more pressure.

[sangreal]

Do you have smart ramp turned on? I don't have the provider manual in front of me, but from memory this feature causes it to use the apap algorithm during ramp so it might be increasing pressure to respond to a perceived event

[FairwayGirl]

You might do better turning your CPAP to a steady pressure of 7 with maybe a 5 minute ramp. Just to get you from 4 to 7 while you are awake, so you can go to sleep knowing the pressure isn't going any higher. If you can be comfortable with that enough to sleep, that's a good start. After you are more used to it, and depending on your data, the pressure can slowly be increased to your prescribed pressure. That might be a better way for you to start than trying to get all the way to ten if it bothers you so much.

Try that for a week or so, and then you can look at the data to see how it's working for you and whether or not you really need any more pressure.

I can't figure out how to change the machine. My recommended level was 8 from the study, I don't know why it keeps jumping to 10. And, like I said, it's doing it while I'm awake and breathing perfectly fine :/ I have a pulse oc thing too, and my oxygen level is 98 when it's doing it. I asked someone from apnea board to send me the manual, and I think I didn't save it? I don't know, but it's gone now so I can't figure out how to change the pressure :/

[Wulfman...]

You might do better turning your CPAP to a steady pressure of 7 with maybe a 5 minute ramp. Just to get you from 4 to 7 while you are awake, so you can go to sleep knowing the pressure isn't going any higher. If you can be comfortable with that enough to sleep, that's a good start. After you are more used to it, and depending on your data, the pressure can slowly be increased to your prescribed pressure. That might be a better way for you to start than trying to get all the way to ten if it bothers you so much.

Try that for a week or so, and then you can look at the data to see how it's working for you and whether or not you really need any more pressure.

I can't figure out how to change the machine. My recommended level was 8 from the study, I don't know why it keeps jumping to 10. And, like I said, it's doing it while I'm awake and breathing perfectly fine :/ I have a pulse oc thing too, and my oxygen level is 98 when it's doing it. I asked someone from apnea board to send me the manual, and I think I didn't save it? I don't know, but it's gone now so I can't figure out how to change the pressure :/

I had the link posted in the following thread for a day or two. You should have downloaded it while it was available.

viewtopic/t111192/viewtopic.php?f=1&t=1 ... 0#p1067300

But, if you'll PM me with your email address, I'll send it to you.


Den

.

[FairwayGirl]

Thank you! I PMed you

[Julie]

Make sure your machine (and humidifier) are on a level below you/your head, so the water will always run down to the machine and not into your mouth.

[Wulfman...]

Thank you! I PMed you

I replied to it.


Den

.

[robysue]

FairwayGirl,

You have a lot of different issues going on. Some of them are probably interrelated. But you may need to tackle solving them using several different techniques.

Let's start with the fact that you are comfortable breathing at 4-7cm of pressure, but you are not comfortable breathing at 10cm. It's a little bit unusual around here, but it sounds like you start having problems when it feels like there's too much air coming into the mask to breathe comfortably. As a newbie I had a lot trouble feeling like I could not exhale properly and that left me feeling suffocated from too much air. I suspect that something similar might be going on with you.

Unfortunately, your current "solution" of hitting the ramp all night long may be leaving you unprotected from the OSA: A certain amount of pressure is needed to splint your airway open and if the pressure is not high enough, you can still have a lot of apneas and hypopneas occurring. That's why we'd like to see what the daily data shows about how many events you are having, when they're occurring, and what else (like snores and flow limitations) might be driving the pressure increase that is causing the problems.

You also write that you are using the machine for long periods when you are awake, but in bed. In particular you write:

I keep hitting the ramp button and I can breath for a while. But, sometimes for some reason it jumps from 4.0 to 10 and chokes me, before the ramp is over (which is 45 mins) It jumps to 10 all the time when I'm still awake and breathing perfectly fine, I don't get it. It's not like I'm having any events. I'm awake and feel fine, I just can't sleep because of the air, so I'm just laying there and it starts pushing air. I have been timing it, and the ramp does not wait the 45 mins before jumping to the max pressure of 10.

Your machine cannot tell that you are awake and using it. And it turns out that normal wake breathing is much more variable than normal sleep breathing. In fact, normal wake breathing is so irregular as compared to normal sleep breathing, that the machine can be fooled into thinking that your normal wake breathing patterns represent sleep disordered breathing patterns.

Now you are using a PR DreamStation. The PR machines respond to events that are scored during the Ramp period: If the machine detects what it thinks is a sleep disordered breathing event, it increases the pressure and then continues ramping up from the new pressure. And since the machine cannot tell if you are asleep or awake, it responds to the things in your normal wake breathing patter that it thinks are sleep disordered breathing patterns by increasing the pressure during the ramp period. If enough of these "false" events are scored during the early part of the ramp period, then the pressure can reach your minimum pressure setting well before the 45 minute ramp period is over. If we look at some of your data that is recorded during a period when you know you were clearly awake and breathing normally, we'll be able to figure out what it is in your normal wake breathing patterns that is fooling the machine.

It's not easy, but the real fix for this problem is to teach yourself to fall asleep quickly enough to prevent the machine from inappropriately responding to your wake breathing patterns. In other words, you are going to have to is to teach yourself to fall asleep quickly enough so that there's not enough of these "fake events" that are part of your normal wake breathing to trigger the uncomfortable pressure increase. That is not an easy thing to do when you are very sensitive to the higher pressure. In order to figure out a way to increase your comfort during the time period when you are trying to get to sleep we need to know more about the settings on your machine.

I've been able to figure out this much: You are using the ramp. Your starting ramp pressure is 4cm. Your ramp is set to 45 minutes. And you apparently are ramping up to 10cm. What I have not been able to figure out are what the therapeutic settings are.

In particular can you get into the clinical menu and check on the following settings without changing anything?

Mode. Are you using CPAP mode or APAP mode?
If you are using CPAP mode: Your pressure is probably set to 10. Can you confirm that?
If you are using APAP mode: Your minimum pressure is set to WHAT? On this thread it appears your min setting might be 10. On the other thread you said something that indicated that your min pressure might be as low as 5cm. We need to know exactly what the settings are. Likewise, what is the max pressure setting? 10cm? Or higher than 10cm?
Flex setting: Are you using C-Flex, C-Flex+, or A-Flex? If so, what is the Flex setting?

SleepyHead is showing my average AHI is 2.5 or so, and it's always much higher when the pressure is up? I guess I can't figure out why the pressure is going up if it's causing APNEA events? I don't understand that part at all. But, there is one day I have 5.9 average, and it's all at the beginning of the night and all at 10.0 pressure.

If the events are all occurring before you get to sleep, they are not real---they would not be scored on an in-lab sleep test. But your machine doesn't know you are awake---it assumes that you are asleep since you are using it. Post the data and it will be easier to explain this to you.

And, in the last 2-3 days I have a lot of pain in my face, ears and eyes when I wake up, and when I put the mask on. It does get better during the day. I saw an ENT before I got my machine, because I had severe ear pain at my sleep study that lasted for 3 days, and that seems to be much better now! I am very hopeful this will get better too

It is possible that your ears and eyes are very sensitive to either the pressure or the air blowing around your face from the exhaust vents built into the mask. It may be possible that a slight reduction in the max pressure for your APAP may help fix this without allowing too many real OAs and Hs to get through. Or it could be that an eye mask might help prevent the eye problems.

Yes, I'm sorry! I thought all that was by my name! I should have said it. I'm using a DreamStation and it has a humidifier on it and a heated hose, set at the highest temp. I have the humidifier set at 2, because when it was higher it poured water on me, oops!

You may want to turn that humidifier back up to 3 with the heated hose and learn how to deal with the rainout.

Some tips for rainout:

Make sure the machine is below your head. If your nightstand is at or above the level of your mattress, you may want to move the machine to the floor to see if that helps with the rain out problem.

Don't overfill the humidifier tank. If the tank is overfull, that winds up increasing the chances of rainout.

Use a room humidifier so that the machine has to add less water to the air in the hose to get the humidity up where the machine wants it to be when the humidifier is set to 3.

If your bedroom is very cold, consider increasing the temperature in the bedroom by turning up the thermostat.

Run the hose under the covers and against your body.

Consider hanging the hose overhead. Just make sure that as much of the hose as possible is on the machine's side of the top point in the hanging hose.

But, I have it down now, and the air is colder, yuck, but I'm not swimming! Before all this I couldn't even stand even a fan in the room, it always locks me up. Makes my face swell, and my ear hurt badly (I still can't have a fan!) And I freeze all night. I think the freezing from the CPAP is the hardest part! It makes me so cold!

Sounds like you are a lot like I was when I was first starting out on CPAP. I too intensely dislike sleeping under a fan. And pre-CPAP, sleeping under a fan would always make me wake up with badly chapped lips and feeling hoarse and congested. And I would freeze when sleeping under a fan. It did take a very, very long time for my upper airway, sinuses, throat, and lips to adjust to sleeping with the dang machine every night because it felt just like sleeping under a fan, only worse, since I couldn't move around in the bed to get away from the air flow.

Some things that did help me:
1) I used a cloth hanky draped across my eyes for several years. I now have a proper eyemask that I use most nights. That kept the exhaust flow from bouncing off the bedcovers and back into my eyes. So the eyes no longer felt like they were sleeping under a fan.

2) I would often drape a second hanky across my lips to keep the airflow from the exhaust vents from hitting my lips and protect them from getting chapped. I also slept with a Burt's Bees chapstick in my hand for over a year: When ever I woke up, the first thing I'd do was slather more Burt's Bees on my lips. Since then, I've found Badger Balm which seems to last longer. I still use the hanky across the lips if the lips are feeling like they're getting chapped.

3) Sleeping in long sleeves. In the winter this was easy: I stole hubby's big fluffy robe and wrapped it around my chest twice. It protected my chest and arms from the exhaust flow coming from the mask. It also was emotionally comforting since it was hubby's robe so it was like getting an extra hug from him. But big fluffy robes and summer weather don't go so well together. So in the summer time I sleep in a large long sleeved poplin shirt of hubby's. Again, it's big enough for me to have a double layer on my chest and still have plenty of room to move around in. And the long sleeves protect the arms without making me too hot.

4) Learning how to get to sleep within 10-15 minutes of turning the light out. This is hands down one of the hardest things I've ever had to do. But once I finally started falling asleep quickly after masking up, that really helped more than anything else. In my case it took 3-6 months of pretty intense cognitive behavior therapy designed to address my sleep onset insomnia problem before I was really able to get to sleep with the mask on before the machine would bug me to the point where I was wide awake instead of being sleepy.

[FairwayGirl]

That's a lot of data, and what you are saying about how the fan makes me feel is spot on! My biggest defense before was water! I would wake up at night and drink water, but now I can't :/ I choke as soon as I open my mouth :/ I am forgetful! I though I listed my pressure range. The doctor had it set from 7-10 with a ramp of 4 for 45 mins. The EPR is 3. But, my therapeutic level from my study was 8, I can't figure out why it's set to 10, and my DME thought it was too much as well, but he said he had to do what was written :/ I've always had major issues with falling asleep, and average several hours before falling asleep. Then I wake up many time through out the night. (Now and before CPAP) I take gabapenten and 10mg of melatonin as well as having lavender oil on little cotton pads all to attempt to sleep. What you are saying makes me totally understand why the ramp is jumping to 10, though. I was just trying to get the machine on. If I only used it when sleeping I wouldn't have enough time for insurance. I don't know what the c flex and all those are? I know my ears are extremely sensitive to pressure because I hurt in an airplane too, I've read a couple of reports on that, and that's why I went to the ENT, but he said he can't tell unless it is during the event of something happened. He did test me for food allergies, though, just Incase they are causing sinus issues. I do have my machine even with my bed, but, if I lower it I won't be able to hit the buttons to see where it is, and the hose won't be long enough to hang from my head board. I am hurting quite a lot every day, I'm guessing it's because I can't move during the night because of the hose. So I'm having to take pain meds every day for my back and neck. I haven't had to take pain pills in years, but there have been days in the last few weeks I had to roll out of bed, and it took several tried to even do that!

As background, I also take meds for migraines and epilepsy and to stablise my heart best and blood pressure (it drops very low and I black out!) those are on top of my pills to go to sleep, and for now I'm having to take Provigl daily :/ none of the pills I normally take have a negative effect on sleep. Hopefully I answered all your questions you asked! Thank you so much for your info! It was a lot of good things to go on!