Getting through the night

[MOTOR815]

Hello,

I have just been prescribed a cpap machine for severe sleep apnea. I've been trying to get used to the thing or about 3 weeks now, and can't seem to make it through the night with it on. I wake up feeling like I'm suffocating, and have a panic attack, and can't get the mask off my face quick enough. Obviously not a pleasant experience that I don't enjoy repeating. The last couple of nights I said forget it, I'm not going through the trouble with it tonight. I'm using a ResMed Liberty hybrid full face mask. It seemed to be the best pick of the full face because its smaller, and I wouldn't be so claustrophobic with it on. I've already been to follow up appt with the sleep Dr, and they readjusted (lowered) the pressure to 7 (it is auto pap that will adjust from 7-16 depending on need. Just not sure how much more I can take with this thing, before I give up or good, and sell it on Craigslist.

[OutaSync]

First of all, welcome to the forum. Stick around here and you will learn so much.

The machine that you are showing is an older, discontinued model. Are you sure that is what you have? Do you know what your AHI is for the hours that you were actually sleeping?

Bev

[robysue]

MOTOR815,

Several things come to mind:

If you wake up feeling like you are suffocating and you can't rip the mask off fast enough, your pressure setting might be too LOW. Did the doctor or his assistant explain why the setting was LOWERED at your follow up appointment?

You are using a full face mask. Do you know for a fact that you are a mouth breather? Or are you just assuming that you might be a mouth breather? Have you tried any other masks? Masks are funny things and they really are in the nose (and mouth) of the beholder. What works for one person won't work for another. You might want to try at least one other type mask before the 30 period for mask swaps at the DME is up.

Have you tried some desensitizing techniques to help you get used to the feeling of the mask being on your face? Could you bring the CPAP and mask into your living room or den and put it on and read or watch tv for an hour or two with it every day for a while just so you can get used to how it feels to breath with it on? That might help the panic-y feeling you have when you wake up at night.

And finally please be aware that every night you give into your baser instincts and fear of panic and don't sleep with the mask, it makes it that much harder to actually get through the whole adjustment period and start sleeping through the entire night with the mask on. You are giving into negative reinforcement of the idea that you will never be able to adjust to CPAP, and that's the quickest way to make sure you fail to adjust to CPAP.

[Eureka]

I have a friend who had that problem and found that the ramp pressure was too low. The doctor either changed that -- or turned it off -- and she is getting along a lot better. It seems that the feeling of suffocation often comes from the pressure being too low -- not enough air. Hope you can work it out. Getting good treatment of sleep apnea is a life saver.

[MOTOR815]

I have no idea what my AHI is. All the Doc told me was that my apneas were recorded at 117 per hour. She said my oxygen satuation was down to 70%. I am having alot of trouble adjusting to the exhale, with it blowing up my nose, seems hard to breathe out. It was originally set to 10 (with ramp up to 20), and she lowered it to 7, and thought that would help with the exhalation problem I was having. She also said although high on the apnea events, mine seemed to respond well to a lower pressure.

[avi123]

Hello,

I have just been prescribed a cpap machine for severe sleep apnea. I've been trying to get used to the thing or about 3 weeks now, and can't seem to make it through the night with it on. I wake up feeling like I'm suffocating, and have a panic attack, and can't get the mask off my face quick enough. Obviously not a pleasant experience that I don't enjoy repeating. The last couple of nights I said forget it, I'm not going through the trouble with it tonight. I'm using a ResMed Liberty hybrid full face mask. It seemed to be the best pick of the full face because its smaller, and I wouldn't be so claustrophobic with it on. I've already been to follow up appt with the sleep Dr, and they readjusted (lowered) the pressure to 7 (it is auto pap that will adjust from 7-16 depending on need. Just not sure how much more I can take with this thing, before I give up or good, and sell it on Craigslist.

I would do the following:

1) Try to use it during the day for an hour or so at a time.
2) If you want to lift the mask off your face you could just push it up without unlocking the headgear. The headgear's straps are made of elastic stuff. I do that when I need to sneeze. I would mount the mask loosely on the face even if it leaks somewhat.
3) Ask your doc or provider about converting it to a standard CPAP mode with fixed inhalation pressure. My was set to 6 cm H2O according to my sleep study. But I raised it to 7 on my own to " get more air". I set the ramp to zero and the EPR to 2. As I understand, it it means that my expiration will be against a pressure of 7 cm H2O minus 2 cm H2O = 5 cm H2O . But in your machine it's done via the C-flex. See here:
https://www.cpap.com/pdf/Respironics-Br ... -Study.pdf

4) I am using two types of masks and exchange between them depending on my nose stuffiness. One is a nasal Mirage Soft Gel, but no pillows which could be squeezed shut! (this mask is over the nose but not covering the mouth. The other is a full face mask covering both nose and mouth). The full face mask is not tight on my face. It could let an expiration leak out by the seal. During inspiration it is sucked toward the face and seals. It is a Fisher Paykel FlexFit 432 with the silicone cusion mounted on foam. But the headgear lock is hard to apply shut but easy to unhook. IMO, it's still a lousy design.

[Janknitz]

I am having alot of trouble adjusting to the exhale, with it blowing up my nose, seems hard to breathe out. It was originally set to 10 (with ramp up to 20), and she lowered it to 7, and thought that would help with the exhalation problem I was having. She also said although high on the apnea events, mine seemed to respond well to a lower pressure

.

Your machine has a setting called "C-Flex". The purpose of that setting is to reduce the pressure when you breathe out, so that you don't feel that you have to breathe out against air blowing in. The settings for C-Flex are probably 0-3, with 3 giving you the most relief. THAT's what should be adjusted if your problem is exhaling.

As far as a feeling of suffocation, is the ramp set on your machine? Most ramps are set to start at 4 cm, and many of us feel like we are suffocating when the pressure is that low. If possible, turn the ramp OFF, or ask your doctor to. Most people find it to be a source of discomfort rather than comfort.

AHI is Apnea and Hypopnea Indices and it's expressed per hour. You had an AHI of 117 on your sleep study (that means you stopped breathing for at least 10 seconds 117 times per hour--do the math, that's a LOT), it should be below 5 with effective treatment from your machine. You need to learn how to check your AHI's to see if you are getting effective therapy. It will help you understand what's going on, and know when things are working or they aren't.

If you still feel like you are suffocating with the ramp turned off and the C-Flex turned to 3, then talk to your doctor about maybe rasing that lower pressure at least a little. Or see if you can try a nasal mask or nasal pillow mask--they are less confining and you don't feel like you will suffocate because you know you can always open your mouth to get air (but you shouldn't for effective therapy). And definitely work at getting comfortable with this--your life depends on it. Wear it to watch TV or listen to music to build your tolerance and comfort level. You'll be glad you did.

[Muse-Inc]

...Doc told me was that my apneas were recorded at 117 per hour.
117 is probably your AHI (apnea hynpopnea index, average number of events per hr)

oxygen satuation was down to 70%
Scary low That's oxygen-deprivation level for sure; you want that number to not drop below 90, or ideally not below 92. 88 is the % that Medicare uses to approve supplemental oxygen at night.

I am having a lot of trouble adjusting to the exhale...seems hard to breathe out.
If your machine has exhalation relief, you need to set it higher. If it doesn't, you need to start using a machine that does immediately.

It was originally set to 10 (with ramp up to 20), and she lowered it to 7, and thought that would help with the exhalation problem I was having.
Changing the initial ramp pressure isn't likely to help your exhalation problem if your pressure the rest of the night is 20...with pressure that high, you likely need a machine that delivers 2 pressures, one for inhalation and another for exhalation. They are commonly called bi-levels or biPAPs.

although high on the apnea events, mine seemed to respond well to a lower pressure.
Pressure is not directly related to the number of events (severity); the pressure number is what is required to stent open your airways and that is based on the anatomy of your airways. If you respond to lower pressure, then why is your machine ramping to 20? 20 is the highest pressure that a CPAP or APAP machine can deliver.

[robysue]

I have no idea what my AHI is. All the Doc told me was that my apneas were recorded at 117 per hour. She said my oxygen satuation was down to 70%.

Sounds to me like you need to first of all have a much clearer idea of exactly what your diagnosis figures are just for your piece of mind. Call the doctor's office and politely request that they send you a copy of the sleep report for your records. Your entitled to the information in your medical records. And you need this information to provide accurate information when you are providing medical histories to any new doctors you see in the future.

I am having alot of trouble adjusting to the exhale, with it blowing up my nose, seems hard to breathe out. It was originally set to 10 (with ramp up to 20), and she lowered it to 7, and thought that would help with the exhalation problem I was having. She also said although high on the apnea events, mine seemed to respond well to a lower pressure.

You need a much clearer understanding of what your prescribed pressure settings are. Ask the doctor's office to send you a copy of your prescription along with the sleep report. Straight CPAP machines typically can be set anywhere from 4cm to 20cm. And APAPs can run in a range that can go as low as 4cm to as high as 20cm (or anywhere in between. So it's not clear what you mean when you say that your machine was originally set at 10 with a ramp up to 20, but your doc said your events respond to lower pressure and that the machine is now set on 7.

Find out exactly what your prescribed pressure setting is and whether the pressure setting is fixed at 7cm or is a range of values.

The ramp is a comfort feature found on some CPAP/APAP machines that allows an extra low pressure (as low as 4cm, which lots of people around here find suffocating, but I don't) right at the start of the night and the machine steadily increases the pressure over a fixed time frame (typically somewhere between 5 and 45 minutes) up to the prescribed pressure level. On some machines, the user can control the time of the ramp. On others, the user can control the starting pressure of the ramp feature. If your CPAP/APAP has a ramp feature, but you can't control it (turn it on or off or adjust it), you should contact your DME and ask the tech who set the machine up to turn on patient access to the ramp controls. Or ask for advice here on how to do it yourself.

As for difficulty exhaling against the pressure. Reporting the problem to your doctor was the first step. You've already said the doc ok'd a reduction in pressure. So far, so good. Did the reduction in pressure help any? Does your machine have any form of exhalation relief? Is it turned on? (It's a patient comfort feature on some machines.) Read the owners manual that came with your machine. And talk to the DME. If your owners manual and your DME indicate that your machine does not have any kind of exhalation relief, you will need to get the doctor to prescribe a particular brand and model of CPAP/APAP that does---aim for something like a ResMed S9 AutoSet or a PR System One Auto, and make sure the doctor writes something like "dispense as prescribed" or "do not subsitute" on the prescription. If you continue to have exhalation problems with a machine that has exhalation relief at a lower pressure setting after another week or two of seriously trying to make it work, you should let your doctor know the problem has not gone away. The doc may suggest that you try an alternate mask. The doc may suggest doing a week of auto-titration to see if another pressure adjustment could be done. But after enough time and effort has been made to adjust to CPAP, if you still can't exhale, the doc may be willing to say you've "failed" CPAP and recommend a bi-level titration and a bi-level machine.

[jweeks]

You need a much clearer understanding of what your prescribed pressure settings are. Ask the doctor's office to send you a copy of your prescription along with the sleep report.

Hi,

Yes, my thought exactly. If this really is a straight CPAP machine set to start at 7 or 10 and then ramp up to 20, then I am surprised that the original poster hasn't tossed it through the window yet. That would be like trying to breathe out of the back end of a jet engine.

If this is an auto of 7 to 20, then I'd like to see where it is sitting for the 90% level.

If the poster really does need a pressure of 20, then I agree that he is probably a great candidate for a BiPAP machine.

-john-

[ChelseaChestnut]

You might try a different mask. I tried both the Liberty and the Hybrid and didn't like either one. A true full face mask might help you feel better about being able to breath. Another thing to try is just sit and watch tv or something for a few hours while using the cpap. Before you know it, you will forget you even have it on.

[MOTOR815]

I updated my profile to show the correct equipment. I had the wrong model CPAP listed before.

[cflame1]

Motor,
when they're talking 90 %... you won't know that with your machine. All it does is report the hours used.

[MOTOR815]

Just a little update. Not giving up yet. Never could get through the night with the Liberty mask. The nasal pillows were just not working for me, it was pushing too much air up my nose, and after awhile I would get a burning sensation in my nostrils from the forced air. Today I switched out my mask with a ResMed Mirage Activa nasal mask, and chin strap. It seems much more tolerable. Hopefully, this one will help alot during night and being compliant.


Could someone please explain a couple of things I am seeing from my statistics info. There is one tab called "periodic breathing"?..it shows 0%. I don't know what that is.

also 90% ?(although someone mentioned that my machine doesn't record this, apparently it does )

thanks

[xenablue]

Hello,

I have just been prescribed a cpap machine for severe sleep apnea. I've been trying to get used to the thing or about 3 weeks now, and can't seem to make it through the night with it on. I wake up feeling like I'm suffocating, and have a panic attack, and can't get the mask off my face quick enough. Obviously not a pleasant experience that I don't enjoy repeating. The last couple of nights I said forget it, I'm not going through the trouble with it tonight. I'm using a ResMed Liberty hybrid full face mask. It seemed to be the best pick of the full face because its smaller, and I wouldn't be so claustrophobic with it on. I've already been to follow up appt with the sleep Dr, and they readjusted (lowered) the pressure to 7 (it is auto pap that will adjust from 7-16 depending on need. Just not sure how much more I can take with this thing, before I give up or good, and sell it on Craigslist.

The mask in your profile is a nasal one, not a FF.