Please help - is CPAP causing night panic attacks?

[maccknight]

I really need some help and advice please. I have been on APAP for seven months. Initially after a brief honeymoon period I started to feel really bad again. My machine was set at auto range 4 - 20. After advice and research on here I reduced my pressure range to 8-14 and felt a bit better. At my only review by Doc said I needed more pressure and to set it back to 10 - 18 again. I did this gradually and failed to notice I was going down hill. This last two weeks I feel like I have fallen off a cliff. Really rough in the morning dead anxious. On Sunday I turned the pressure back to 10 - 14 and felt quite a bit better. Lying in bed last night with the machine switched on I felt I could breathe properly and I had a stitch like feeling trying to breathe. I have woken up really anxious with my lips and feet tingling and been having panic attacks all day. I asked to see the Doc again but there is a three month wait and the earliest appoitment I could get was mid November. I neverf had a sleep study done just a pulse oximeter overnight and do not know what to do as I am feeling so bad and dont seem to be getting any help and assistance from the NHS and am desperate to feel some relief.

[Wulfman...]

I really need some help and advice please. I have been on APAP for seven months. Initially after a brief honeymoon period I started to feel really bad again. My machine was set at auto range 4 - 20. After advice and research on here I reduced my pressure range to 8-14 and felt a bit better. At my only review by Doc said I needed more pressure and to set it back to 10 - 18 again. I did this gradually and failed to notice I was going down hill. This last two weeks I feel like I have fallen off a cliff. Really rough in the morning dead anxious. On Sunday I turned the pressure back to 10 - 14 and felt quite a bit better. Lying in bed last night with the machine switched on I felt I could breathe properly and I had a stitch like feeling trying to breathe. I have woken up really anxious with my lips and feet tingling and been having panic attacks all day. I asked to see the Doc again but there is a three month wait and the earliest appoitment I could get was mid November. I neverf had a sleep study done just a pulse oximeter overnight and do not know what to do as I am feeling so bad and dont seem to be getting any help and assistance from the NHS and am desperate to feel some relief.

My advice is........Quit using pressure ranges!

Did you have a prescribed pressure? I would suggest trying a straight 12 or 13.


Den

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[maccknight]

No I didnt have a prescribed pressure. I only had a home oximeter test which showed fifteen events an hour. I was given a machine (set on factory defaults), a mask (no choice of size or anything) and sent on my way. A 5 minute review 4 months later when I was told to increase the max pressure AHI was 4 and to come back in six months.

I asked about all the flow limitations and was told higher pressure would sort that out.

Last night I can remember dreaming that I was struggling to breath out properly and woke up with loads of anxiety today and then had my first panic attack for months today

[ChicagoGranny]

maccknight

Are there any items on the list below that you are particularly deficient in?

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular wellness visits to confirm there are no other medical problems.

As far as CPAP causing panic attacks, as a general rule it relieves anxiety. Did you have these attacks before your started using CPAP?

You say you can't see your sleep doc for three months? What if you call his office or your GP's office and told them about the panic attacks?

[Wulfman...]

No I didnt have a prescribed pressure. I only had a home oximeter test which showed fifteen events an hour. I was given a machine (set on factory defaults), a mask (no choice of size or anything) and sent on my way. A 5 minute review 4 months later when I was told to increase the max pressure AHI was 4 and to come back in six months.

I asked about all the flow limitations and was told higher pressure would sort that out.

Last night I can remember dreaming that I was struggling to breath out properly and woke up with loads of anxiety today and then had my first panic attack for months today

I still stand by my recommendation........try straight 12 or 13.

And, there have been times I've seen pressure ranges/changes actually make the flow limitations worse. I believe the potential human reflex reaction to pressure increases can signal the machine that another flow limitation is occurring and it will keep bumping the pressures......sort of like a "runaway"......or at least enough to cause significant pressure changes without actually treating or heading off any actual "events".......but the resulting pressure increases frequently awakens the user.


Den

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[ChicagoGranny]

I still stand by my recommendation........try straight 12 or 13.

Of course. It's your shtick.

[maccknight]

Yes thats what I thought that CPAP relieves anxiety.

My Doctor is aware of this and is one of the reasons he refered me to a sleep doctor as it was something that I seemed to wake up with

My Sleep Doc doesnt have a secretary he uses an answerphone which he checks between 4 and 5 pm on a Thursday. My Doctor wrote again asking him to see me again and after an exchange of 5 letters I got the appointment in mid Nov My Doctor freely admits he knows very little about CPAP. I cannot change sleep Doctor as he is the only one in my NHS area and feel that if I complain about him I will get even worse treatment

[Wulfman...]

I still stand by my recommendation........try straight 12 or 13.

Of course. It's your shtick.

And, it works just fine in many situations.


Den

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[Wulfman...]

Yes thats what I thought that CPAP relieves anxiety.

My Doctor is aware of this and is one of the reasons he refered me to a sleep doctor as it was something that I seemed to wake up with

My Sleep Doc doesnt have a secretary he uses an answerphone which he checks between 4 and 5 pm on a Thursday. My Doctor wrote again asking him to see me again and after an exchange of 5 letters I got the appointment in mid Nov My Doctor freely admits he knows very little about CPAP. I cannot change sleep Doctor as he is the only one in my NHS area and feel that if I complain about him I will get even worse treatment

Well, even ranges of pressure in APAP mode is still "CPAP".........Auto-adjusting CPAP, but still CPAP.

But, sometimes pressure ranges are sleep disturbing for the users and straight pressure may not be, so at least should be an option to try for any number of situations.


Den

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[zoocrewphoto]

You don't seem to have a lot of events, but your pressure is going up and down like crazy. It probably is disturbing your sleep. Many people are sensitive to that. Like Den said, try a single pressure. If you feel like you are sleeping better, then you can look at the number of events and see if the straight pressure needs to be raised or not. But clearly, the wider range bothers you more. 12 or 13 looks like a good starting point. Give it a few nights and see how you feel.

[kteague]

Just some things to think about... Not sure about the duration of your events or if you desat with them. Theoretically your treatment COULD be causing you to awaken feeling panicked. Significant apnea events can be accompanied by a surge of stress hormones. Even hypopneas can cause desats.

You mentioned difficulty breathing out against higher pressure. Not familiar with your machine, but if it allows, maybe a fixed higher pressure set to lower on exhale could work for you. It appears what you're doing now isn't optimal treatment. If you choose to stay with auto mode, consider moving the lower pressure up to 11 and compare your data. I suspect it's more the lower pressure causing your problems than the higher one. A bit more on the lower end may preclude the machine seeing a need to go much higher. I could be wrong, just thinking out loud.

Just to be sure, your vent holes are remaining unobstructed all night, right?

Good luck figuring things out.

[maccknight]

Thank you everyone for your replies. I really appreciate all your help and just wish my Sleep Doc was as helpful as all you kind folk

I make sure the vent holes are clear when I go to sleep but it seems to be that I am rolling around a lot and moving a lot in the night.

I can see there are not many events apart from the Flow limitations. Indeed I woke up the other week with an AHI of 0.7 my best ever score but felt awful. It seems that the anxiety and panic are at there height when I wake up and subsides during the day and are almost gone by the time I go to bed at night. My head feels really weird and painful in the morning and when I wake up feeling really bad have a lot of diarhea.

I was beginning to wonder about all the pressure changes - I take it that the pressure is changing far too much from the suggestions of narrowing the range.

I am having terrible problems with leaks and dont know what to do about them - I have tried all sorts. I put the mask on as is shown on their video and when I roll in the night cause it too leak. I have made the straps tighter and then get a leak from just moving my face which wakes me up. I guess this is when it is too tight but not sure?

There is no exhale relief on my machine - these things were never explained to me and I was never given a choice of machine because I would definately have chosen one with it had I known about as I have never been good breathing against resistance even from when I was a kid in strong winds. I am struggling and get a stitch at 10 which was where my initial concern about the APAP causing night time panic attacks came in

I feel stuck between a rock and a hard place at the moment but have to drive 7 hours on Sunday to get home and really need a good nights sleep on Saturday night

[Julie]

Well overtightening is sure to cause more problems, so I wouldn't do that, but... how many other FFMs have you actually tried - while lying down in diff. positions, with a machine on? There are very many out there, including e.g. the Hybrid (or Liberty) that might fit you better - check on Cpap.com for the variety and info on possibilities and you should not feel stuck with one that doesn't work for you.

[Hang Fire]

But clearly, the wider range bothers you more.

lol Let's call speculation, speculation, not clarity.

I was beginning to wonder about all the pressure changes - I take it that the pressure is changing far too much from the suggestions of narrowing the range.

That many pressure changes may be (speculation) that your minimum pressure is set too low. If I had those statistics, I would change my minimum setting to 12 and the maximum to 20. (Don't worry so much about the maximum. The machine will not raise the pressure unless it senses a higher pressure is needed to keep the airway sufficiently open.)

Raising the pressure is no guarantee of anything. It is a reasonable trial to see if the pressure swings will be reduced and if you will feel better. Often, it takes several experiments to find what works best - tweaking.

[Pugsy]

Well...another reason to avoid the F & P machines...lack of exhale relief that we normally expect or might need. I think that the Sensawake feature is supposed to make up for lack of exhale relief.
Do you haven Sensawake turned on or off? If it is off you might try turning it on.
I am going to send you a private message in a little bit with links to either the Icon or Icon + manuals so you can know how to turn on Sensawake (if you don't know about it).

I don't know if the pressure variations are part of your problem or not but they might be and I agree with HangFire....if it were me I would raise that minimum pressure to at least 12 as he suggested and I would open up the range to see where it wanted to go. It won't go up unless it thinks it needs to for some reason. Often when the minimum pressure is set more optimally so that the machine does a better job of preventing the airway collapses then it doesn't have to work so hard (all those pressure swings) trying to fix something after the fact. You might get lucky and find that with a higher minimum the pressure won't need to go so high so often.
Once the minimum is set more optimally you should be able to evaluate the reports and get an idea as to a suitable fixed pressure (if you want to try fixed pressure which I think would be a good idea to try just in case those pressure changes are causing sleep disturbances).

Oh, for further report sharing..we don't need the "by pressure" graph or the AHI graph.
Losing those would enable us to see the pressure graph and leak graph larger and in more detail and would be more useful.

Using a higher minimum pressure would allow you to fit the mask for that pressure and maybe reduce some of the leak if the leak is caused by pressure changes...though to be honest I suspect normal moving around in bed to be the primary culprit. You have times at your maximum that don't have a large leak.
60 L/min total leak is the no man's land starting point for large leak on the Icons. That would be the top line in the leak graph.