Suddenly struggling 6 months in

[BREES1971]

Hi everyone, thanks for reading... In the beginning my wife prodded me to talk to my family doctor as I snored loudly and unevenly with lots of pauses. Had a sleep study and they diagnosed sleep apnea with an average of 16 AHIs per hour. Went back for the 2nd study and they started me with a full face mask but ended up on a nasal which worked nicely. Sleep doc determined CPAP with a pressure of 8 plus daily steroid nasal spray. I started with a demo AirSense 10 AutoSet 'for Her' with EPR level 3 and Airfit N20 nasal mask. From day one I had no problems falling asleep and generally sleeping 11pm to 6:30am. I had some stops and starts trying a few different masks hoping to solve comfort and dry mouth but kept resorting back to the N20 nasal mask. In the beginning I was scoring an average of 8 AHIs a night but after a few weeks I decided to slow tweak-up my pressure which led me to land on 9.4 which got me to an average of 4 AHIs. I was feeling the results of good sleep, no urges to nap, better memory and mood, and my wife says my snoring completely stopped.

Fast-forward six months into my therapy and suddenly one night I wake-up at 1:45am and have a panic attack and anxiety fighting to breath through the mask. I take the mask off and calm down, try again and can't get started. I focus on controlling each breath- in and out, in and out, in and out. I'm unable to turn off my controlling each breath and my brain won't just 'take over'. I take the mask off and tell myself I'll try again in a few more minutes but end up falling asleep immediately and wake up my wife with my snoring, stumble downstairs to the couch and fall asleep (without CPAP). The next night I get ready for bed, put on the mask and immediately have a fearful thoughts of fighting to breath. I fight through it, breathing against the machine and manage to fall asleep but suddenly am awake again at 1:45am. I try again to put the mask back on, controlling every breath- breathe-breathe-breathe-breathe, give up and sleep on the couch. This routine has been happening for about 2 weeks now- I've reasonably worked through the anxiety of falling asleep with the mask but every single night I wake up somewhere between 12:30am and 2am and can't get restarted.

Over the past 2 weeks I've experimented with lowering my pressure back to the original recommendation of 8, increasing the humidity, and trying the auto pressure setting with the range of 8 to 14. I tried wearing the mask daytime and working at the computer for a few hours. Almost the whole time my brain wouldn't 'take over' and I was still controlling each breath.

Any advice? I'm thinking that I can fall asleep as I'm relatively calm even though I'm controlling each breath. But when I wake up after midnight I'm anxious of getting restarted and I'm much more awake. But why am I waking up anyways? I'm wondering if there's anything in my charts to indicate a problem with my setup or breathing that's happening every night between 12:30 and 2am.

I'm including a chart below with an example night of waking up shortly after midnight.

Thanks for everyone's thoughts and input.

[Julie]

First, why do you say you have an auto machine, when your results say a fixed pressure? You do know I hope that an auto can do plain cpap, but not the other way around?

Second - lose the calendars and some of the graphs - please read instructions re what to post and what not to - it matters a lot to helping you here. Hate to ask, but...

Thirdly - could you ask your MD for e.g. 1-2 Ambien or very low dose melatonin (1-3 mg) to try before bed for a couple of nights to get back into a routine, and if that doesn't work, possibly a quick session with a CBT therapist might help.

Something, whatever it was (probably long gone) woke you the first time, and somehow it's taken hold even if it's not Cpap related... so you have to find a way to calm down again unless we do see some drastic thing going on out of nowhere in the new charts (post a couple after trying some of the above ideas). Sometimes just a one-time glitch can occur and wakes you, but it doesn't mean it's some dramatic Cpap problem.

[kteague]

Hopefully someone will come along soon with suggestions to better optimize your settings, as it appears to these little-trained eyes your machine is not set up to best help you. Good luck with things.

[khauser]

First, why do you say you have an auto machine, when your results say a fixed pressure? You do know I hope that an auto can do plain cpap, but not the other way around?

OP has an Autoset For Her, as reported on the chart, but it's running in CPAP mode. So I'll alter your first question to "why CPAP mode instead of auto?"

[LSAT]

In my opinion all the settings are screwed up...Fixed pressure of 9.4 with an EPR of 3......30 minute ramp starting at 5 which is where most of the CAs are occurring. I think he was awake during that period.....sleep/awake junk.

[Pugsy]

ResMed machines don't flag anything during the ramp period.

The central apneas flagged after the end of the 30 minute ramp period....probably are SWJ if the person was still awake at the end of the ramp period.

[nicholasjh1]

For me I used to sleep through all my apneas. Once I was actually rested enough I experienced my first gasping wake up from an apnea. Likely pressures just need to be tweaked which these guys are better at helping with.

[nicholasjh1]

Also I would say most doctors are way to careful about CA's. I had some at the start of my therapy and they simply went away after about 6 months. haven't had any in 2 years. My brain simply needed to heal. Unless any CA's are both real (not during a wakefullness period that was caused by OSA with too low pressure) and if they aren't severe in my opinion they should be disregarded as the brain damage caused by severe untreated apnea is likely part of the cause of the CSA's. I would say as long as they are under 5 or during a wakeful period CSA's should be completely ignored. And yes I would open up the auto to max 20. You haven't died from OSA for years. The very limited possibility of a csa response doesn't seem worth the trouble and having it on auto can greatly increase your sleep outcomes. Resmed in particular seems to have improved their auto algorithms recently as well.

[Revived1]

I'm wondering if there's anything in my charts to indicate a problem with my setup or breathing that's happening every night between 12:30 and 2am.

I'm no expert on Oscar, but I don't think there's any data in those graphs that comes from between 12.30 and 2am. The "Events" graph, at the top, has been compressed in some way, and the rest show that the data was from between 10.35 and 11.50pm. The info. on the left of the bottom graph also says that the session went for 1 hour and 16 minutes. If you want to have another go at posting data, and be sure that it shows from 12.30 to 2am, someone might be able to see something that helps explain what's waking you at that time.
As others have said, though, it might be something unrelated to CPAP that's waking you as well. Maybe a dog barking in the neighbourhood or something like that. Could be anything.
Good luck.