Another take on dependency, difficulty breathing

[JHZR2]

Hi again,

Im new to CPAP, but have been trying to see how my response to the airflow has been changing since I started. My first night, I couldnt stand the pressure coming out at 8cm. Used the ramp function. Nights after, got a bit more comfortable with it. Recently, Ive gotten to the point where using the ramp, I feel like there is insufficient airflow through the system - it impedes my breathing and I feel that Im suffocating. Once the cpap ramps to pressure, all is more or less well.

While I think that some of this is due to mentally focusing on it, it also seems that I have become reliant upon the presence of pressure, when Im breathing in a constrained way like through a CPAP mask. Obviously I dont have any notable issues normally during the day.

Any thoughts on this? Seems that I am more sensitive to the pressure level and being able to take full breaths as Ive been getting treatment.

Thanks!

[mowdoc]

I don't think you are dependant of the CPAP to breath.

It is commonly spoken around here that a pressure of 4 gives the feeling you can't breath. I know it really bothers me to be at that pressure. I don't even ramp anymore, I just start at my pressure of 8 and go. That is much easier for me to do.

You did not give your CPAP pressure but if you must use ramp, try setting the beginning pressure at 5 or higher to avoid the dreaded 4 pressure. I think this will help you a lot.

Good Luck

[Mary Z]

Turn off your ramp if you are more comfortable at your full pressure. The ramp is just a comfort feature for those who have trouble falling asleep at the higher pressure.
I never had any probems with bilevel at 4/8- the air pressure is just splinting open your airway and should not impact your ability to breathe. Still a lot of people complain about a pressure as low as 4, I think it's all mental, but you can't argue with what makes you feel uncomfortable. I think you have outgrown the ramp, turn it off. Congratulations.

[Linda4atc]

My husband has used a CPAP for a couple years now. He had no real problem getting used to it, and at first it made a huge difference in his sleep. He wears it faithfully. But he has started having eppisodes of feeling he can't breathe too. But it is happening well into the night I don't think it is related to the pressure ramping up. He asked the doctor and the lady at the medical supply store where he got the machine and they didn't really have anything to say about it.

He to fears that his body is becoming reliant on the machine and it is somehow causing him harm.

[NightMonkey]

Any thoughts on this? Seems that I am more sensitive to the pressure level and being able to take full breaths as Ive been getting treatment.

Thanks!

I have the same feelings and believe it is a good thing. Whether I am going to sleep or waking up in the morning the pressurized air feels healthy and it is healthy.

Maybe there is an analogy to running on a treadmill. I learned to run at steep inclines - 8 to 14%. Even while most people in my gym run at zero incline, if I run at anything below 4% it feels strange and a little clumsy. (But I run well on a flat road course.)

There is no way around the fact that people with sleep apnea will be healthier using CPAP and unhealthy sleeping without CPAP. This is assuming their CPAP process is well tuned.

[BlackSpinner]

My husband has used a CPAP for a couple years now. He had no real problem getting used to it, and at first it made a huge difference in his sleep. He wears it faithfully. But he has started having eppisodes of feeling he can't breathe too. But it is happening well into the night I don't think it is related to the pressure ramping up. He asked the doctor and the lady at the medical supply store where he got the machine and they didn't really have anything to say about it.

He to fears that his body is becoming reliant on the machine and it is somehow causing him harm.

No he is probably just getting older. Life doesn't stand still on cpap. It is one of the reasons a fully data capable machine is so important. With a fully data capable machine he would know if his AHI is changing and what the patterns of his breathing are.

Get the DME to loan him a data capable auto machine and oxymeter so it can be checked. A competent doctor would have arranged that already.

[NightMonkey]

My husband has used a CPAP for a couple years now. He had no real problem getting used to it, and at first it made a huge difference in his sleep. He wears it faithfully. But he has started having eppisodes of feeling he can't breathe too. But it is happening well into the night I don't think it is related to the pressure ramping up. He asked the doctor and the lady at the medical supply store where he got the machine and they didn't really have anything to say about it.

He to fears that his body is becoming reliant on the machine and it is somehow causing him harm.

That is a good point that BlackSpinner made. As the body changes the settings on the CPAP machine may need to be changed. Most of us here use the data from the machine and software to keep a check that the therapy continues to work properly. You can find lots of information here on machines, data, and software. Or, as BlackSpinner, says you can ask your DH's doctor or DME.

[Linda4atc]

Thank you both, I will be sure to share this with him. I know that he he takes his machine to be checked regularly, and gets all parts from the same place. Honestly I do not know much more about it myself. The only thing i have helped him with is the headgear straps when he is having problems with them.

[jules]

when was his original sleep study? has he had a follow up sleep study?

has his health / weight changed during this time? these can cause a need for a change in pressure

as others have mentioned some of us have data capable machines and keep track of how we are doing and make adjustments (some of us with permission of our physicians - some without) in pressure as we see fit -

you might need your sleep doctor on board - many GPs have no idea on what changes need to be made and the medical supply place has their hands tied on making changes in pressure without a Rx ordering it

[JHZR2]

Well to follow up on this topic, two things.

One, I feel that it has been getting worse wrt feeling like I cannot breathe when putting on the mask/machine and trying to fall asleep.

But the funny thing is that I know it was turned on last night when I went to bed, but this am, my efficacy data shows that the system wasnt on last night, which was the case I think - I must have manually turned it off last night right after turning it on and slept with my mask on.

Maybe this is the case, but I felt that I slept and breathed well, don't have any signs of co2 poisoning, etc.

So I'm a bit confused... Not sure if I got treatment last night or not, but especially if not (don't remember if I turned off the machine this am or not, so I have to trust the machine's log I guess), seems breathing difficulty is more of a synchronization with the pressure vs. restricted flow.

[jamiswolf]

JHZR2,
I feel that there are several adaptations we make being on cpap. The brain tends to shut down sensations that we have continuously. We get used to the feeling of wearing clothes...for example. I think this same thing happens with cpap. I personally don't believe it's an addiction with the reaction that we need more and more pressure to keep us satisfied. It's just that we get used to the pressure that we're at.

A similar but more rapid thing happens during the length of a single night. At least to me it does. When I mask up, I feel the pressure like I usually do, but by morning, I can hardly believe that the machine is running because I don't sense the pressure anymore.

I'm wondering if that might be related to what Linda4atc's husband might be experiencing. Toward morning, when he has these breathing issues...it could just be he's reacting to not sensing the pressure like he did at bedtime. Just a thought.

MaryZ wrote: Still a lot of people complain about a pressure as low as 4, I think it's all mental, but you can't argue with what makes you feel uncomfortable.

I have to disagree with Mary's comment about it being all mental. Certainly there are phychological adaptations with CPAP...but I don't feel breathing at 4cm pressure is one of them.

I would suggest that it could be mask related. Some masks are vented less then others, and at 4cm pressure, it's possible that there isn't enough airflow to exhaust CO2 and the end result would be CO2 re-breathing. The body would then want to breath more. This could set up a sort of feedback cycle but that's just speculation.

I do know that I have extreme difficulties at low pressures and don't start feeling comfortable until about 7cm pressure.

Cheers,
Jamis

[VVV]

I must have manually turned it off last night right after turning it on and slept with my mask on.

So you are saying the machine was off???

Does that model have an "Auto On" feature? Mine does and I like it. It solves the problem of going to sleep and failing to turn the machine on. Two or three breaths and my machine turns itself on.

[archangle]

I recommend everyone turn the ramp feature off if they can get to sleep without it. There's no good reason to use it otherwise, and several good reasons NOT to use it.

Most of us here, and in the medical community, think that you don't become more dependent on CPAP in the traditional sense, but there are reasons you may think you become dependent.

Before CPAP, you developed apnea slowly over the years. Your brain finally gave up fighting and panicking when you got strangled during the night. After using CPAP, you are no longer being strangled during the night every night. Your brain is no longer used to ignoring being strangled. If you stop CPAP, your brain reacts a lot more to apnea.

Some people have suggested that your body adapts to low oxygen by "thickening" the blood and doing other things that people at high altitudes do to adapt. If you start CPAP, you may lose this adaptation and will feel it more if your apnea comes back.

Presumably, if you stop CPAP, your adaptation to apnea will tend to come back. You might suffer more for a while, especially in terms of sleep disturbance. Don't forget that, even with adaptation, untreated apnea is probably killing you slowly.

[HoseCrusher]

I recommend everyone turn the ramp feature off if they can get to sleep without it. There's no good reason to use it otherwise, and several good reasons NOT to use it.

On the contrary. I find the ramp function, when properly set up, very comfortable to use, and that is an excellent reason to use it...