.3 AHI or lower, but still wake up feeling suffocated sometimes.

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See-Papa
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.3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Thu May 14, 2020 6:18 pm

Hi, I am having a problem that I want to share with you guys. I am going to see my doc bout this, but wanted to share my experience with you guys and see if anyone can help me.

I have severe apnea with a 70 AHI recorded on sleep tests, and started treatment a few years ago. I am 100% compliant and have no issues with using my CPAP (other than the one I will explain).

I have many wonderful days where I wak up refreshed and feel great. I am trying to make those 100% of my days!

My set up is a Phillips Dream Station set at 10 CPAP. I prefer to wear the nasal mask (ResMed Airfit N20), along with a cervical colar, a Breath Right strip on my nose, and I tape my mouth shut.

When my nose is stuffy, I switch over to a full face mask (F20).

My AHI is generally around .3 to .5 each morning. I have learned how to have many nights with 0 apneas of any kind or any hypopneas too. None recorded in OSCAR.

HOWEVER, even with no apneas or hyponeas recorded, I can still wake up in the middle of the night feeling suffocated and having a racing heart. On those days I don't feel great the whole next day. On days when that doesn't happen I can feel great!

So what is going on with me? Be assured I will asking my doc.

But here is what I can see in OSCAR. When I wake from one of these suffocations, I note the time on my clock. What I see in OSCAR is that leading up to that time (1/2 hour before perhaps) my breathing becomes less. The air volume is lower, and my respiration goes up (into the 20's). The minute vent has very low spikes (in the 1's and 2's). Then I wake up and the data all resets instantly to normal breathing. The machine does not flag anything at that time even though I woke up gasping.

It is like I am slowly running out of air, the machine registers no AHI or H, but then I startle and wake up gasping! Next day I feel like crap even though I have registered a 0 AHI.

During these times of low breathing I see waveforms that are much shallower on the expiration.Like the waveform goes up normally, curves down towards zero, but then does not go negative by much, and is flat on the negative side. No negative dip. like normal, or when I feel good.

I feel bad when this happens and would like to address it. It still feels like suffocation, just a slow reduction in breathing that the machine doesn't seem to flag.

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Julie
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by Julie » Thu May 14, 2020 6:42 pm

Is there a reason you apparently are on plain Cpap even though your machine is listed as an Auto?

See-Papa
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Thu May 14, 2020 7:33 pm

Julie wrote:
Thu May 14, 2020 6:42 pm
Is there a reason you apparently are on plain Cpap even though your machine is listed as an Auto?
That is my prescription. But doc is Ok with me making tweaks.

My experience with APAP has been that I have to set the bottom number at 10 and then move the top number up to 13 when I have a cold. The 90% number will drift up during the cold, then come back down when the cold is gone. But when I don't have a cold it just stays near 10 anyway.

I don't have a cold now.

The high pressure spikes that happen as APAP changes pressure sometimes cause me mask leaks. So I would prefer to avoid that.

The machine seems to 'experiment' in APAP mode and will raise the pressure, then drop it back down. That leads to mask leaks, so I prefer to avoid the spikes if they are just going to cause me leaks.

Hope that makes sense.

See-Papa
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Fri May 15, 2020 6:34 am

Last night I used APAP with a setting of 10 min and 14 max.

OSCAR shows the machine staying at 10, but ramping up and then going back down in a sawtooth pattern. But always going back to 10.

Here is the OSCAR from this night. I didn't feel like suffocating this night, or remember waking up gasping. That didn't happen this time. Feel OK.
But OSCAR is showing some OSAs.
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palerider
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by palerider » Fri May 15, 2020 8:23 am

See-Papa wrote:
Fri May 15, 2020 6:34 am
Last night I used APAP with a setting of 10 min and 14 max.

OSCAR shows the machine staying at 10, but ramping up and then going back down in a sawtooth pattern. But always going back to 10.

Here is the OSCAR from this night. I didn't feel like suffocating this night, or remember waking up gasping. That didn't happen this time. Feel OK.
But OSCAR is showing some OSAs.

OSCAR1.pngOSCAR2.pngOSCAR3.png
Please review the instructions on how to post images, it will save you, and us, time: http://cpaptalk.com/wiki/index.php/Oscar:organize the sawtooth pressure changes you describe are 'pressure probes', they're a dumb part of the respironics algorithm, whenever the machine thinks that you sleep is really good and even, it starts messing about with the pressure, but when your sleep is uneven, it does nothing. Ergo, the more of those sawteeth, the better.
Get OSCAR and come chat on IRC: #cpaptalk on irc.libera.chat

Accounts to put on the foe list: mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They're often post misleading, timewasting stuff.

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zonker
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by zonker » Fri May 15, 2020 9:59 am

See-Papa wrote:
Fri May 15, 2020 6:34 am
Last night I used APAP with a setting of 10 min and 14 max.
as palerider says, pls reorder your charts, like this-

Suggested Support Order for your charts
Event Flags
Flow Rate
Pressure
Leak Rate
Flow Limit (Only for Resmed machines, not on Respironics)
By replacing your morning coffee with green tea, you can lose up to 87% of what little joy you have left in your life.

See-Papa
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Fri May 15, 2020 9:59 pm

OK. Please ignore my first data post then. It wasn't the data for my posted problem anyway. I read the wiki on how to format data.

So here is the data for my posted problem.

At 4:15 am in the morning (according to my bedside clock) I woke up gasping for air and had a pounding heart. But that event does not register in OSCAR.

What I see is that I was having leaks before that time and respiration rate went up, and spikes lower in minute vent. Like 0 right before I woke up.

That is exactly what it felt like. Waking up from holding your breadth. Like drowning.

I feel this is happening to me even though the machine registers no OA or H.
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See-Papa
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Location: Maryland, USA

Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Fri May 15, 2020 10:12 pm

Here is the whole night.
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See-Papa
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Mon May 18, 2020 9:29 am

Update

I made some simple tweaks to my setup and seem to have eliminated these suffocation events, at least for the last few days.

I noticed that the events coincide with when the leak rate goes up. That is usually associated with mouth leaks. Mouth leaks usually mean I have a stuffy nose.

Sometimes a 'stuffy nose' for me is just enough that it causes mouth breathing. Doesn't have to be a cold.


So, I started doing Neti pot each night which clears out mucous from deeper in the nose. I also always use Flonase daily.

But perhaps most important, I shower in the pm to wash off pollen. Pollen on the pillow case gives me allergies which lead to a stuffy nose.

And I slept on my side. (I have a way to make myself sleep on my side).


Put all that together, and I get this data.

I do wonder what it meas when Total Leak goes to 0 and Flow Rate goes up for 15 minutes.?

But I am feeling great here.
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Miss Emerita
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by Miss Emerita » Mon May 18, 2020 10:04 am

I'm glad to hear you figured out the "suffocation" problem, and thanks for posting about it -- you never know when your observations will help someone else.

Your machine's data when displayed by Oscar will show an intentional leak rate (basically, the venting) as well as leakage above that. So it is surprising to me that you had that interval at close to zero. Any chance your sleep position resulted in your partially blocking the vent??
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See-Papa
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Location: Maryland, USA

Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Tue May 19, 2020 10:12 am

Miss Emerita wrote:
Mon May 18, 2020 10:04 am
Any chance your sleep position resulted in your partially blocking the vent??
I think you are on to something there. I am using a new sleep position and pillow (with success). The nasal mask has the vent at the mask, so it can be blocked if I go face down into the pillow.

The good news is that it appears that when that happens, I am also in a position where I have no apneas. So I cruise through it. I probably am breathing all through the mouth then.

I am really learning that the geometry of my tongue is my problem. My ENT says "your tounge falls back into your throat". So if I sleep on my side or stomach, it doesn't fall as much.

Sleeping on my back makes for serious blockage by the tongue. I have been plagued by this my whole life. Good to finally be figuring it out.

It really doesn't matter for me if I have one suffocation or more than one. My next day is ruined either way. I need that to be ZERO.

This slow suffocations don't register as an OSA or H on the machine, so you need to watch out for this.


I have removed the tape. The doc told me to go with tape or no tape as I need.

I had another good night, and I kept doing the neti pot, and showering off pollen to keep my nose open, and sleeping on my side.

Getting less mouth leaks even though I am not using mouth tape. I think it really is about keeping the nose clear and a good passage for air so that your body doesn't try to switch to mouth breathing.

No suffocations again.
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ronragus
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by ronragus » Tue May 19, 2020 2:24 pm

See-Papa wrote:
Mon May 18, 2020 9:29 am
Update

I made some simple tweaks to my setup and seem to have eliminated these suffocation events, at least for the last few days.

I noticed that the events coincide with when the leak rate goes up. That is usually associated with mouth leaks. Mouth leaks usually mean I have a stuffy nose.

Sometimes a 'stuffy nose' for me is just enough that it causes mouth breathing. Doesn't have to be a cold.


So, I started doing Neti pot each night which clears out mucous from deeper in the nose. I also always use Flonase daily.

But perhaps most important, I shower in the pm to wash off pollen. Pollen on the pillow case gives me allergies which lead to a stuffy nose.

And I slept on my side. (I have a way to make myself sleep on my side).


Put all that together, and I get this data.

I do wonder what it meas when Total Leak goes to 0 and Flow Rate goes up for 15 minutes.?

But I am feeling great here.
Hello sir- wanted to ask how you get adjusted to sleeping on the side? thanks

See-Papa
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Location: Maryland, USA

Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by See-Papa » Tue May 19, 2020 3:54 pm

ronragus wrote:
Tue May 19, 2020 2:24 pm
Hello sir- wanted to ask how you get adjusted to sleeping on the side? thanks
I fall asleep on my side.

I have a memory foam pillow that has contours. I go right to the edge of it so my mask hangs off the edge. My head is in the nook and my neck is supported.
I turn the pillow at a 45 degree angle. This makes resistance to rolling over since my head would have to go 'up hill'. If I fall asleep there, I don't change position.

Rather than punishing yourself for sleeping on your back (tennis ball, negative reinforcement), make side sleeping more comfortable (positive reinforcement) so your sleepy self wants to stay there.

But switch sides to relieve your back and shoulders. When I switch sides, I re-orient the pillow 45 degrees the other way.

Try to keep your airway straight and not kinked. That means the height of the pillow can't be too high. My pillow is pretty flat with the contour to support the neck.

I suppose everyone's shape is different so you have to find the pillow that keeps your airway open when on your side. This is probably not going to be a very high pillow.

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Miss Emerita
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Re: .3 AHI or lower, but still wake up feeling suffocated sometimes.

Post by Miss Emerita » Tue May 19, 2020 8:46 pm

Those are some ingenious ideas about how to stay sleeping on your sides! One thing I do want to mention, though: you need that vent to be clear, because it's what allows your exhaled CO2 to escape. When the vent is blocked, the CO2 builds up, causes your desire to breath to become desperate, with the results you know so well.
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Oscar software is available at https://www.sleepfiles.com/OSCAR/