Wake up gasping while using CPAP

[dooodlebugg83]

Hi everyone,

I've been having issues where I wake up from a dream with a huge gasp. And I can't figure out why this is happening.

I've been using my CPAP for a few years now. I started having gasping events a few months ago, not frequently, though. It's been increasing and is happening multiple times a night now.

I'm always coming out of a dream when it happens. It feels like something is stuck on my nose preventing me from breathing. It varies on how violent the wake up gasp is. I usually wake up my husband too. It feels different than when I snore myself awake when I'm not wearing the CPAP. That feels more like it's in the upper throat, while this feels like my nose is blocked.

Sleeping position doesn't seem to be the issue. It might be slightly more frequent when I'm on my back, but I've been sleeping on my sides and still getting multiple events.

I'm using my CPAP at the time. Airsense 11. OSCAR data doesn't show any events or changes in flow rate right before awakening. I can't find any patterns at all. My API is always very low, with very few events overnight in general. My husband is a heavy sleeper, but he was awake in bed once when it happened and he said he didn't notice any breathing changes before it happened.

I've tried adjusting the pressure, both low and high ends. (From 8-12 low to 12-14 high) I've tried setting the pressure the same on both ends. I've tried with and without EPR on and on different settings. I don't use a ramp on start. I've tried automatic and soft settings. Soft just made me have more apnea events. I haven't noticed any changes in the gasping events when changing the settings.

I've tried changing to a new nasal cushion (N20). The fit is fine and normally leaks are low. The CPAP technician at the sleep clinic thought the fit was ok, and wasn't much help after that.

I recover quickly after I gasp. It doesn't feel like a panic attack. More like coming up for air when you're underwater then breathing normally after a big breath. But I have a start too, and I usually sit up or back at the same time, like to move away from what's causing the issue. I recognize it immediately after wakening.

I can't think of any more details to write right now. I hope someone here might have an idea for what's causing this.

Thanks,
Valerie

[ChicagoGranny]

OSCAR data doesn't show any events or changes in flow rate right before awakening.

Here is how we might be able to help you.

1. Get a free account at SleepHQ.com, upload your data card, post the link to the SleepHQ analysis in this thread.

2. The next time the gasping awakens you, turn off the machine. Then, let it AutoStart or you start it. This marks the spot of the graph just after the gasp.

3. With your link, our members can zoom in on the gasp. They might see something that you don't.

Welcome!

[dooodlebugg83]

Thanks! Many of the graph gaps are from the gasping events. Sometimes I wake up and use the washroom or something, but lately in the last couple weeks it's been mainly being woken up gasping.

https://sleephq.com/public/teams/share_ ... 7d50f39f09

[Nocibur]

Looks like they (one anyway) are occurring @termination of REM period. Pen & paper @bedside and IMMEDIATELY write down what you were dreaming about @wakeup. Dream recollection is fleeting so you got about 2 seconds to do that.

[ozij]

You're snoring almost all night through.
On a properly set up CPAP you don't snore.
Two things stand out in tha flow chart:
Your machine sticks to the highest pressure - and it can't stop your snoring. That means the high isn't high enough
Your machine tries to go lower every now and then, and can't stay there. That means it has no business being at that low pressure.

In order to be properly treated you have to stop the snoring.

Have you always been snoring on CPAP?
Have there been any changes in your health / weight accompanying your sudden awakening?
Who chose your pressure settings and what was their reasoning?

[ChicagoGranny]

If those were my charts, I would raise the minimum to 10 and the maximum to 20 (The machine will not increase the pressure higher than needed.) Check SleepHQ the next morning.

What happened on the 12th - 39m usage?

[dooodlebugg83]

Hi Everyone!

Thanks for your feedback! Turning up the pressure seems to have helped a lot, I'll probably turn the max up even more. It also may be my stress levels have changed. I'm thinking that might have something to do with it too. The only time I had a gasping event last night was at 4:10AM. And I think the night before I might not have had any.

To answer some of your questions: most of my dreams right before I wake up are of the nose piece or something on my nose either shooting backwards through my head or expanding to double its size. For the day that only had 30ish minutes of data, I think the time has shifted an hour later, maybe because of DST? So I woke up after the day changeover, and the end of my sleep that night was counted on the next day. Some days I've been sleeping later because of not great sleep, and this graph has it an hour later than that.

The sleep clinic told me to keep the pressure where it was because higher pressure was causing too many leaks, and "I didn't need to because it said the 95% value was the maximum it was set at, which means it was set right", one of the many instances of bad advice they've given me. I asked my GP to get a referral to a real doctor to talk about the results with, not just a technician. I haven't really had any health or weight changes in the last 6 months at least.

It's odd that it says I snore. My husband says he can't ever hear anything besides the normal breathing sound from the machine. Never heard any snoring.

I think it's still the same link to see the new data: https://sleephq.com/public/teams/share_ ... 7d50f39f09

Thanks!

[Nocibur]

Turning up the pressure seems to have helped a lot, I'll probably turn the max up even more.

What does "helped a lot" mean? If there's no events, FLs, and the snoring is just artifact, what's the basis for DWing (although by definition, "DWing" is just spinning the dials hoping for something good to happen).

Indeed, if you go back over the data, your breathing appears quite stable at lower pressures, but becomes very unstable once the pressure begins to rise (and I'm not seeing any good reason for the pressure to increase either):

dood.jpg (64.39 KiB) Viewed 757 times

[Nocibur]

Good:

dood1.jpg (51.32 KiB) Viewed 749 times

Bad:

dood2.jpg (51.1 KiB) Viewed 749 times

So unless you can think of a better reason, IMO unnecessarily high pressures are wrecking your sleep.

In re: "gasping", it may simply be dream content is causing increased respiratory rate and depth, and that pattern persists for a bit post-awakening.

[dooodlebugg83]

The flat times at the lowest pressure are when I'm wearing it but still awake. Sometimes if I can't fall asleep right away, I'll read or something and keep it on. I wouldn't trust anything that is flat at low pressure right after I start.

[dooodlebugg83]

Also, if you go back several days, you can see the graphs for when I have the max pressure set lower.

[Nocibur]

The flat times at the lowest pressure are when I'm wearing it but still awake.

Sleep onset should occur ~15 minutes. Given that, with those huge chunks of wake I must change my initial observation from your sleep being "wrecked" to "it's a total disaster".

The lowest pressure I see is back on October 23rd, and the pressure then is not really low (I'm talking about see what your breathing is like on like 8.0 cmH2O).

However, grossly, the waveform looks slightly more stable:

dood3.jpg (66.59 KiB) Viewed 681 times

So again, your sleep breathing should look like the above sample of what you consider wake breathing. IMO your biggest problem is sleep continuity, and DWing may (probably) be making it worse.

[ozij]

If there's no events, FLs, and the snoring is just artifact

I want to be sure I understand: flow limitations and snores should only be considered if there are events?
And this (these) from Nov. 13 are artifacts, making the machine raise pressure for the wrong reasons?



Thanks.

[edited to correct a typo]

[Nocibur]

If there's no events, FLs, and the snoring is just artifact

I want to be sure I understand: flow limitations and snores should only be considered of there are events?
And this (these) from Nov. 13 are artifacts, making the machine raise pressure for the wrong reasons?

Y'know, I thought if I put a comma after "FLs" it would avoid confusion, but OST it didn't help.

OK:

1. There are no events
2. There are (virtually) no FLs.
3. The snoring has been dismissed by the OP.

Consequently, there is no reason to be arbitrarily raising pressure.

That said, in the example you posted (which is actually the night of the 12th) there is FL which appears to be clinically significant. Specifically:

dood4.jpg (86.78 KiB) Viewed 487 times

There is FL leading to a change to normal breathing which suggests an arousal and making this a RERA (although not "officially", but these are the tools we got) and should (could) be addressed.

[Nocibur]

Then OP noted this

The flat times at the lowest pressure are when I'm wearing it but still awake.

So much for the "8.0 cmH2O might work better" idea.

But looking at the night, by any measure this is a Yossarian-level disaster.

dood5.jpg (63.83 KiB) Viewed 472 times

To me, this looks like poor sleep at its worst (or best, depending on how you look at it).

In a close-up of an area, there do appear to be some RERA here, and the snoring flags are correct in drawing attention to it:

dood6.jpg (46.47 KiB) Viewed 472 times

so while OP denies snoring, might not be enough to rattle the pictures off the wall, but it's enough to create an issue.