New CPAP User need help/Suffocation issues???

[Gmac76]

Hello all,

First time poster, new to the world of CPAP's...My name is Greg and I am an OSA Sufferer.

I was diagnosed with OSA back in '05 and never received a CPAP or treatment due to financial difficulties and no insurance. I finally broke down and went to obtain treatment as self paying patient.

I received a ResMed AutoSet H5i S9 series.

I have a ResMed Quatro FX medium size full face mask.

The first night I used the machine, it seemed to go well. I went to sleep around 1am and woke at 5:15 or so and took off the mask to sleep on my stomach as I was kind of groggy, I slept until 6:45am.

The set up on the machine was a ramp of 20 minutes, 80 degrees for humidity (per the reps recommendation for proper humidity production), and since it is an auto pressure self regulator (or whatever they call it.) I have no idea on the pressure settings. The next two nights I woke up with the issue of feeling like I was suffocating and my mask seemed to be preventing me from exhaling, even when I was awake. I noticed the flap in the elbow of the mask was closing as I exhaled, but not covering that exhaust spot when I was not exhaling. It felt as though the mask was lifting off of my face and popping every time I exhaled.

I went back to the reps office on Friday to have him assist me in figuring out the issue and if the mask was the problem or??
He found that the settings on the mask were on a pillow setting (I may have accidentally messed this up in my trying to figure out things, I just don't recall) He changed that to full face mask and he set the EPR to 3 as it was on 0 I believe. In the office with the machine on, it seemed to have solved the issues. However last night when I tried it again and everything was set properly and such, I had the same issues occur. I woke up before the end of the ramp time, which I set to 30 minutes in hopes of being in a deeper sleep when the pressure kicked in to possibly avoid the suffocating feeling, but I woke up and thought I was drowning/suffocating. I took the mask off as I am frustrated and somewhat angry because I just want to sleep and sleep well for the first time in roughly 17 years...

I have read some of the previous older postings, but thought I would see if there was anyone out there who might be able to assist me in figuring out what is in my head that I need to get past mentally vs. machine related settings and such that might make it easier to adjust to this new life?

Grateful for any help I can get,
Greg

[Gmac76]

I also had a study that showed 66 apneas when lying on my back and 32 when on my side/stomach.

I had been trying to go to sleep on my back and I thought that may have been the issue, but it happened the 2nd night when I was lying on my side.

Thanks.

[Pugsy]

Your machine is likely set to start out at 4 cm pressure and then increase as needed after you go to sleep.
For most people that 4 cm pressure is simply not enough air movement and they will feel like they are suffocating..especially with a full face mask because the air is even more diffused.

Even if they have the minimum pressure higher...if you are using the ramp feature it drops the pressure back down to 4 cm.
I think if you were to use maybe 6 cm starting pressure you would feel much less like you were suffocating.

You might want to check out exactly what your settings are and consider that little increase.
Here's the clinical manual for your machine and it explains how to get to the setup menu area.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

This link has similar shortened version of instructions with pictures and there is a video showing the ins and outs of your machine.
http://www.apneaboard.com/resmed-s9-cpap-setup

Also...check out the links in my signature when you have time. Get SleepyHead software installed so that we can see if maybe you are falling asleep and having a bunch of apneas that are part of the problem because pressure may be too low.

Test out starting the machine out at 6 cm...while awake at least to see if it helps your comfort level.
Typically these APAP machines are dispensed with settings 4 to 20 when no titration study has been done to try to find an optimal pressure and that 4 cm is just too low for comfort for most people.

[John from Brookston]

That little flap in the elbow is the safety valve. if the power goes out and the machine fails it's supposed to open to allow you to breathe. If it's flapping open and shut as you inhale/exhale, your pressure is really low. It should snap shut as the pressure come on and stay shut as you breathe.
And the mask will feel like it's straining at the straps, especially if you're on BiPAP and using exhale pressure relief (lower pressure on exhale). When I started, I was on straight CPAP, and could not deal with trying to exhale against 19 cm/H2O. So they put me on BiPAP and I still inhale 19, but exhale is only 13 and I don't notice it anymore after 6 months. After 2 months I stopped using ramp because I was waking up after 15 minutes gasping for more air.

[dieselgal]

Both of the above answers are good and may fix your problem but one other thing to consider is lowering your humidifier or maybe even trying it without it. If I use a humidifier on even a very low setting it sometimes gives me that drowning feeling. I used the humidifier for 2 years and for the last 3 I haven't used it at all. My pressures are lower than yours but you might try lowering your humidifier settings just to see if that helps you any.

[Gmac76]

Thank you all so much for your help, it appears that moving my start pressure to 6, EPR is at 3 and last night I slept the entire night without any issues, that is 2 nights in a row and it seems to be pretty seamless now.

The other night I slept with it on and it was on the ramp pressure, but for some reason never kicked on and actually shut down at some point while I was asleep. I woke up realized it wasn't on and clicked it once, but then it did the same thing...no idea what happened, but it sucked sleeping with that mask on and no air pressure or humidifier, I woke up feeling so terrible and dry...

I will keep all of your recommendations in mind for any future issues. I am a mouth breather with a full face mask, but it seems like I am able to swap to nose breathing with the mask, that is strange to me.

Again, thank you guys very much, a ton of help.

Greg

[Gmac76]

Oh yea and for my first sleep through the night, I had an AHI of 0.1!! I am under the impression this means I had roughly 10% of an apnea occurrence, is this correct? I know it is good either way, but getting the hang of the lingo/jargon and the terminology to understand more about what I am doing.

Thanks again!!
Greg

[Pugsy]

Oh yea and for my first sleep through the night, I had an AHI of 0.1!! I am under the impression this means I had roughly 10% of an apnea occurrence, is this correct?

No, that's not a % number. AHI is an average per hour number.
Take the total number of apnea or hyponea events over the entire sleep time and divide by number of hours of sleep time to get an hourly average.

You didn't have many events at all for the entire night if the average per hour was only 0.1. That's extremely good.
Mine last night was 1.43...and that's good too. Under 5.0 is considered acceptable but we like to get it as low as we can when we can.

When you have time you might want to read this as I think it will help explain what you are seeing.
understanding your data viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html

[Gmac76]

Thank you Pugsy, I greatly appreciate your kindness and time.

I am researching it online, because I do not believe I was given cleaning instructions for my ResMed thin ClimateLine tubing for my machine.

Since it has the power connection to the machine, I am assuming it is not safe to hand wash and submerge, however I know these days that might not be true as so many things electrical seem to be able to be washed and submerged.

Greg