On CPAP still waking up grasping for air!

mild6 · Post by **mild6** » Mon May 29, 2006 7:10 pm

Before I scheduled my sleep study I had waken up grasping for air once in a while. It usually happened when I was deeply in sleep, where I felt suffocated badly until I finally woke up and breathed again. These episodes have made me determined to go for the sleep study, which reported that I suffer from mild OSA, 6 cm h2o prescribed by titration.

I've been on CPAP since Feb 06, assuming the suffocation would not happen again. But this morning (ard 5 a.m.) it did! I ended up grasping for air, with my nasal pillows nicely sealed and air pumping into my nose, extremely frustrated. I have noticed that every time it happens, there's mucous lingering around my throat. I suspect that this is the substance causing the blockage, but don't I get air pressure from my CPAP to prevent me from suffocating? puzzled! Any of you have this experience? Comments and suggesetions would be much appreciated!

NightHawkeye · Post by **NightHawkeye** » Mon May 29, 2006 7:50 pm

mild6 wrote: . . . but don't I get air pressure from my CPAP to prevent me from suffocating? puzzled! Any of you have this experience? Comments and suggesetions would be much appreciated!

Mild6, several things I can think of might be going on, but first, what does your Silverlining software tell you is going on? That's the first thing I'd check. Does it tell you that you are having long apnea episodes? Forget about AHI for the moment, and the way your sleep lab diagnosed you with "mild" apnea. I tend to think in terms of length of individual apnea episodes. Longer is worse. I suspect length is only loosely correlated with AHI, but haven't seen any studies showing that.

Your titration at 6 cm may only resolve 90% of your apneas. If you were using your machine in APAP mode, then the machine could reach higher pressures to help relieve those pesky residual apneas.

Also, for many folks apnea is very position dependent. Could you have been sleeping in a somewhat different position than usual?

Regards,
Bill

Darth Vader Look · Post by **Darth Vader Look** » Mon May 29, 2006 8:04 pm

Your titration level of 6 cm is likely too low for you in different positions. For example it is a well known fact that obstructions happen quite frequently if you sleep on your back. Typically the pressure required to open an obstruction in that position is between 8 and 10 cm. An APAP set up properly will under normal conditions resolve that obstruction no problem. Even a CPAP set up for that particular position will resolve it. As Bill says you should view your crunched data to see if any clues are given there.

bsil · Post by **bsil** » Mon May 29, 2006 8:22 pm

Mild6: I am new to Apap, however, I have a few ideas. Regarding the mucus in the back of your throat...I am frequently plagued with this as I have allergies/sinus issues.I have a bedtime ritual that has helped me tremendously.
I use Ocean spray (saline spray) to clean out my nasal passages as well as mucus in the back of my throat. I squirt enough Ocean into my nostrils so that I have enough to swallow.
This seems to break up the mucus in my throat and can then swallow it. Also, I use AYR nasal saline gel...apply a light coating with a q-tip inside my nares.
As far as waking up gasping, I too experienced this. I decided that I must be opening my mouth during sleep. I had read a post where someone had suggested using Poligrip strips on your lips to help keep the mouth from opening. I have tried this for the past 2 nights, and it has been a good solution for me.
I also think that switching to Apap will help you when you might require higher pressures.
Good Luck

mild6 · Post by **mild6** » Mon May 29, 2006 8:56 pm

NightHawkeye / Bill,
1) Thanks for your response! Yes, I’ll check Silverlining tonight. Hopefully it will tell me something.
2) At first I used the APAP mode, but after almost a month of using it, the data of the Silverlining showed that most of the time the machine was operating at 4cm h2o, and I was not feeling any obvious improvement, so I switched the mode to CPAP at cm 6 cm, the level I was prescribed by the doctor. After last night’s incident, I think I should switch it back to APAP mode.
3) I turn myself while sleeping, sometimes supine sometimes side. When the suffocation happened last night I was sleeping on my left side.

Darth Vader Look,
Thanks for your response! Yes, I will check the data and try switching the mode to APAP.

bsil,
Thanks for your response and suggestions! As for my mouth, I am pretty sure that it was shut when the suffocation happened.

Goofproof · Post by **Goofproof** » Mon May 29, 2006 9:02 pm

I would try APAP range 6 to 10 cm., at 4 I wouldn't be able to breath. Jim

NightHawkeye · Post by **NightHawkeye** » Mon May 29, 2006 9:08 pm

Mild6, what you just said sounds kinda familiar to me. I noticed on APAP that some nights, the machine stayed at the lowest pressure (5 cm in my case) all night long. When everything was going right, and the stars were aligned, and I slept in just a certain position with my head just right. I even had several days in a row when this happened. However, I've also had days when my machine got up over 12 cm. Not many mind you, but a few. Mostly, it would max out at 8 cm or 9 cm for the night.

Anyway, my experience is that my pressure needs vary not only during the night, but also from night to night.

Regards,
Bill

WallyGator · Post by **WallyGator** » Tue May 30, 2006 6:38 am

I first went to the sleep lab for the same problem and was prescribed a setting of 8.5cm. I still had the occasional scary suffocaton episode at home so I started slowly increasing the pressure by 0.5cm at a time until after a few months I was up to 13.5cm. That's when they finally stopped happening, and it hasn't happened for a few years now.

I've had two different sleep studies but I never could sleep deeply enough in the lab to have a suffocation event. As has been said, maybe your pressure just isn't high enough. Sometimes the lab environment can't replicate conditions at home well enough, especially if you're sleeping a bit "on edge" while there.

Guest · Post by **Guest** » Tue May 30, 2006 6:55 am

[quote="bsil"]Mild6: I am new to Apap, however, I have a few ideas.
I use Ocean spray (saline spray) to clean out my nasal passages as well as mucus in the back of my throat. I squirt enough Ocean into my nostrils so that I have enough to swallow.

NightHawkeye · Post by **NightHawkeye** » Tue May 30, 2006 8:21 am

On the subject of cleaning out your sinuses, here's what I use every night.
http://www.natlallergy.com/cgi-bin/MySQ ... eadid=1502

Regards,
Bill

mild6 · Post by **mild6** » Thu Aug 03, 2006 2:33 am

hi guys,
for sake of convenience, i'm just using this thread to record my "titration" of suffocation episodes.

august 1, 2006
APAP mode 4-20
suffocation happened on august 2, 2006

oldgearhead · Post by **oldgearhead** » Thu Aug 03, 2006 5:34 am

mild6,
I agree with Jim, your minimum pressure is way low on auto, and, I suspect, too low at 6cm/H2O CPAP to prevent the 'events'..

I require 8.5 cm/H2O when on my side, and 11cm/H2O on my back, or I have exactly the same symptoms, you have.

Offerocker · Post by **Offerocker** » Thu Aug 03, 2006 7:51 am

Mild6You've received excellent advise! I also use a Neti pot (stainless steel one) and it works wonders; I have a constricted left nasal passage and it always gets cleared. The Ayr gel (with aloe) is also a big help. I tape my mouth shut w/tape just in the center of my mouth. You can do a search on that; there are many entries.
Good luck, and I hope previous suggestions solve your problem!

roadwarrior · Post by **roadwarrior** » Thu Aug 03, 2006 10:34 am

That is interesting indeed. Now that I have an APAP I've been playing with the limits. I started at 6-12, now I'm using 8-15 as I have found having the low end set near my sleep study titration level of 9 it helps avoid any possibe episodes. However what is also just as interesting, I've observed the pressures it has settled at when I wake up. One morning it was up to 15, another morning at 12, and low and behold this morning it was at 8. Now it could very well be a leak issue where the machine ups the pressure to compensate, but then until I get the software I'll never really know.

On CPAP still waking up grasping for air!

On CPAP still waking up grasping for air!

Re: On CPAP still waking up grasping for air!