Smothering ... please help!

[MauiDozer]

I was diagnosed with obstructive apnea about a month ago. AHI was about 17. I live on an island so not a good team of DME people out here. Anyway when I called them after Doctor gave the prescription they wanted to charge me $1600 (after insurance - not including mask) for the machine (which was a pretty lousy machine) so I decided to get a Resmed S9 Autoset from cpap.com (my pressure setting is 7). Machine came and I set it up according to instructions and I really have no trouble getting to sleep. The problem I have is that I am waking up almost every night at about 2 or 3 a.m. feeling like I am smothering. I don't have the back covered and in fact removed the filter to see if I could get more O2. It feels like I am not getting the correct amount of oxygen! I am using a Resmed Mirage Swift II Nasal Pillow.

[GumbyCT]

I was diagnosed with obstructive apnea about a month ago. AHI was about 17. I live on an island so not a good team of DME people out here. Anyway when I called them after Doctor gave the prescription they wanted to charge me $1600 (after insurance - not including mask) for the machine (which was a pretty lousy machine) so I decided to get a Resmed S9 Autoset from cpap.com (my pressure setting is 7). Machine came and I set it up according to instructions and I really have no trouble getting to sleep. The problem I have is that I am waking up almost every night at about 2 or 3 a.m. feeling like I am smothering. I don't have the back covered and in fact removed the filter to see if I could get more O2. It feels like I am not getting the correct amount of oxygen! I am using a Resmed Mirage Swift II Nasal Pillow.

My guess without asking more questions is that maybe you are having events (apneas or hypops) which would mean your pressure is not adequate OR you are having leaks which are dropping your pressure and allowing events.

You will need to get the software to determine exactly what IS going on.

Good Luck

[Amigo]

A few thoughts:

...the vent for the CO2 you exhale could be blocked causing you to re-inhale it, and thereby reducing the amount of O2 you're getting

...your pressure setting is too low

Since I'm not familiar with either your machine or mask, I'll let those who are add their knowledge to your dilemma.

As an aside, I'm quite sure the intake filter is not the problem unless it is completely blocked, and keeping out dust, etc. will prolong the life of your device.

[BlackSpinner]

You need to get the software to see what is happening at those times. Put the filter back - the only thing you are doing right now is making your machine dirty. The amount of O2 you are getting is good.

However - according to my sleep doctor - it takes up to a month for your subconscious to trust the machine. Since you fall asleep happily the amount of air you are getting is fine - it is your brains that are mostly the problem. The best thing is to remember that and lift the mask and say to your self "See I can breathe fine" and put the mask back on. Having said the 7 is pretty low - you might experiment with raising it a small amount at the time for a few days and see how you re-act. Keep checking your figures in the lcd if you don't have the software. and make sure you are not mouth breathing.

[Julie]

Nothing (adverse) will happen if you raise your pressure to e.g. 9 rather than 7, which seems to be a standard # MD's prescribe even though almost no one ends up being able to continue on at that number (most of us are at around 10 or so). That plus consider that your mouth is open when you sleep, in which case you may need a full face mask such as a Quattro, Hybrid, UltraMirage or others.

[CollegeGirl]

I agree with the above advice. I had the same issue and it turns out my prescribed pressure (6) was far too low.

[Emilia]

The OP does say he got the S9 Autoset, but does not say he has it in auto mode. With a setting of 7, it seems unlikely it is in auto.

@ MauiDozer: Aloha! I would suggest moving over to Auto Mode with a pressure range of 6-10. I had an AHI of 16.5 (very close to yours) and use an auto with a range of 6-10. My data shows a few events in which my machine had to chase with a pressure as high as 9.7. By moving to auto you can assure yourself that you will receive the right amount of pressure for events as they occur. Once you get your software and can monitor the events, you'll know if you are hitting that ceiling of 10 and may need to nudge it up a bit more.

[OutaSync]

If you are not comfortable with raising your pressure, try turning the EPR off. You shouldn't need it at a setting of 7 and it effectively lowers your pressure to the point where it may feel as though you are not getting enough air.

[MauiDozer]

Thanks for all the great tips. I will try adjusting the pressure tonight. I am still waiting for a card reader so I cannot look at my stats yet on the computer. BTW, what does EPR and autoset actually do?

[elena88]

Thanks for all the great tips. I will try adjusting the pressure tonight. I am still waiting for a card reader so I cannot look at my stats yet on the computer. BTW, what does EPR and autoset actually do?

what everyone else said.. its not your filter..

you have an auto machine running at straight cpap it sounds like..
this is like driving an auto transmition and leaving it in first the entire time.. very restricting.

The EPR is exhalation pressure relief.. settings from one to three, three being the most relief of the pressure you breath against on
the exhale.

your pressure is very low, and you might need a bit more.. usually when you take an autoset home, they leave the pressure on a wide range
so you can see what your average is..

There is a way to easily change your autoset not to run in cpap mode, there is a clinicans manual you can ask for that here or you press the two top
buttons for five seconds together at the same time, and the clinicians menu should show up.. you can highlight what you want to change, then
press on that highlighed menu setting.. then turn the knob to change the settings..
there are settings for the t ype of mask you are wearing, cpap to autoset mode, ramp feature (how long to stay at lower pressure to get to sleep)
EPR (the exhalation relief) and the pressure settings too.. you could try 7 to 10, and put the epr on three if ten is hard for you to breath against..
If you have a doc to call to give you a little guidance and confirmation, thats is always a good idea..

[Emilia]

EPR reduces your exhalation pressure (Exhalation Pressure Relief). It makes breathing out easier for you. Autoset provides you a range of pressures, as I suggested in my other post above, so you can see what your events are requiring. If you are set at a straight cpap of 7, and you really need a 9 to meet an event, you won't get it. If you put your machine into Auto mode and set a pressure range of 6-10 you give yourself a range of pressures to meet your event needs. It is a far superior way to handle your therapy although some do prefer a set pressure.

As I said before, your study results were similar to mine... and I am using Auto with a range of 6-10 and have had wonderful results. Give it a try!

[lbw]

Check to see if the RAMP is turned on. It will decrease your air for the first 20 min or so depending on the settings. I agree that 6 is low. When I started with RAMP at 6 I felt like I could not breath. I agree try a higher setting.

[torontoCPAPguy]

I was diagnosed with obstructive apnea about a month ago. AHI was about 17. I live on an island so not a good team of DME people out here. Anyway when I called them after Doctor gave the prescription they wanted to charge me $1600 (after insurance - not including mask) for the machine (which was a pretty lousy machine) so I decided to get a Resmed S9 Autoset from cpap.com (my pressure setting is 7). Machine came and I set it up according to instructions and I really have no trouble getting to sleep. The problem I have is that I am waking up almost every night at about 2 or 3 a.m. feeling like I am smothering. I don't have the back covered and in fact removed the filter to see if I could get more O2. It feels like I am not getting the correct amount of oxygen! I am using a Resmed Mirage Swift II Nasal Pillow.

Whooooooa Nelly here!!
I am taking a cursory glance at some of the responses and your original statement and I am just shaking my head; although I am a relative newbie I have to say that there is a general misunderstanding of OSA/etc. and cause/effect of breathing issues!

Your choice of the S9 Autoset is a good one - now you must take the data and ResScan and interpret it. You really MUST learn as much and a quickly as you can about OSA/etc. and breathing disorders and how it all interacts. If you are waking up at 3 a.m. feeling that you are smothering there are a plethora of reasons that this is possible. To me, the most obvious would be that you have simply smooshed your nasal pillows and closed off the ends. Then there is the issue of hypopneas (and apnea events of course). It is NOT a simple 1+1=2 here and EVERYTHING fits into this equation. For instance, let's take hypopneas (shallow breathing)... perhaps it is simply that you are not taking in sufficient AIR (not to be confused with oxygen O2) to supply your bodily needs - suffocation. Perhaps it is that you have a vicious circle of shallow breathing or other cause creating a buildup of CO2 or CO in your body. Or how about this one? You DO NOT have an autonomic reaction to CO2 building up in your body... which regulates your breathing during REM sleep and you are simply not getting enough AIR into your body to ingest sufficient OXYGEN? Or perhaps it is simply apnea and hypopnea events causing your blood oxygen saturation to desaturate (drop), shooting your blood pressure through the roof briefly and alone or together with other factors your autonomic nervous system, as you enter REM sleep and increase the need for autonomic response... are getting the reaction from your brain "Wake up! Breathe deeply... your SaO2 has dropped and we are worried about you dying in your sleep!". Perhaps you are getting leakage in the contact between pillows and nose and correction of OSA/apneas/hypopneas is terminated due to loss of pressure/leakage? That would do it for sure if you are entering REM or L4 sleep without pressure. SaO2 drops, BP rises, brain screams "wake up". Since we don't really know all of your numbers and cannot see your graphical interpretation of same, it is very difficult to guess at what the cause is... we only have the effect to go by.

So, again, here's my example. I have played with my pressures for almost 10 months now and have been recording and interpreting my graphical results; along with using a pulse oximeter that records and presents me with a pretty accurate chart of where my blood oxygen saturation goes all night. I can DEFINITELY see a realtion between things like increased mask leakage, hypopnea events, etc., and my SaO2. And I can now, over time, link these to awakenings where I actually wake up completely. At first it was in a cold sweat; as of late I have been able to correct most all of those problems and issues and very often have an AHI of 0.0.... no apnea events, no hypopnea events, yet entering REM sleep (presumed) I awaken as my SaO2 desaturates and my autonomic nervous system does its job well. I can almost run a line between desaturations and other events (like mask leakage) and awakenings. Unfortunately, without EEG results I can only relate to awakenings when I come fully awake and can note the time on a pad by the side of my bed. Next day it is amazing to correlate the data and see exactly what I have just suggested taking place. To maintain minimal leakage I have as of late been using a full face mask unless I am just laying down on the couch to watch TV for an hour. I hope you can see where I am going with this. In fact, some of us are working on an oxygen infusion system with feedback from the pulse oximeter that will keep or attempt to keep the SaO2 in the 95% range - seems to make a difference. I am just awaiting the arrival of my oxygen concentrator here to get mine up and running. I have also invested in an O2 analyzer ($750) as the amount of O2 actually presented to your body will vary with the flow rate of your XPAP machine and the vent rate of your mask. So, to be totally scientific about it, although it is not truly needed for cause, action and effect - one wants to know exactly what amount of oxygen is being presented. And conversely, I have been thinking of measuring the amount of CO2 being vented to see if my body is processing things the way it should be, but that's a story for another day. In REM sleep it is the CO2/CO in your body that regulates the intake of oxygen/air. It gets even more complex when one begins to take this into consideration because the introduction of supplemental O2 infusion messes with this equation as well.

I would suggest that one needs to get a data recording blower first and foremost; along with a recording oximeter; one needs to watch the numbers being generated based on effectiveness of treatment (i.e. leak rate, pressure range, apnea events, hypopnea events, SaO2 desaturations and averages especially during REM sleep, etc.). Once you have a handle on getting your numbers to the best place you can possibly get them by ensuring the use of a well-sealed efficient mask and proper pressures for YOU and so on... you can then begin to address any other issues you may be having. This is not NOT an overnight cure by any means. It is going to take effort and time (especially with regards to trying to educate yourself on the affliction and the way you body works).

Heck, I had a long chat with my rehab doctors and nurses a while back and learned that simply by properly oxigenating my liver ALONE, all of the body's functions will improve, medications being taken will change in efficacy and interactions may occur that were never even thought of before. This is not a bad thing... just another thing to deal with. For instance, I am diabetic and since getting my XPAP going and to the best numbers I can get at the moment... I have had to eliminate one medication and reduce another by 50% as my liver is processing things that much better; stripping glucose from my blood hemoglobin far better than it has in ten years. My Hemoglobin A1C has dropped like a rock. And that, by the way, is another thing that I track intensively.

What I have learned from this forum and all of the wonderful folks on here is that there is a plethora of information available as well as much experience that does not appear in any medical books and which your GP 'never learned in school'. I have learned that one needs to become one's own advoacate and become as tenacious as a pit bull if one wants to get a handle on this affliction. It is possible. For most of us there will be a magic bullet out there somewhere but it takes some time and considerable effort to find it. And the magic bullet is NOT just one single thing, like turning on your blower at night.... it is a stew of information, action, cause and effect, interactions, etc. The more one learns the more one realizes that there is much to discover. So, stick with it! Work on it like a pit bull. YOUR magic bullet is out there somewhere and you WILL find it eventually. Good luck.

[Frankc111]

I am having the same smothering feeling 2 hours after I fall asleep. I wake up and it feels like the air pressure dropped. I take the mask off and let the machine do its shut down then place that mask back on and even my ramp pressure of 6 feels much stronger than my sleep setting of 9. The mask is sealed the hose is sealed its seems like its the machine is not maintaining the pressure and a reset restores the pressure the ramp up pressure of 6 feels 3 times stonger than what I woke up to.

[Xney]

I am having the same smothering feeling 2 hours after I fall asleep. I wake up and it feels like the air pressure dropped. I take the mask off and let the machine do its shut down then place that mask back on and even my ramp pressure of 6 feels much stronger than my sleep setting of 9. The mask is sealed the hose is sealed its seems like its the machine is not maintaining the pressure and a reset restores the pressure the ramp up pressure of 6 feels 3 times stonger than what I woke up to.

You get used to the higher pressure, until it feels normal. After a while, higher pressures can start to feel too low, actually. Maybe you actually want a higher pressure than 9, even though at the beginning 6 feels strong..