Signs of Therapy Intolerance/Incorrect Settings

[Baron57]

Hey everyone. First off I'll preface my post by saying I *do* in fact have an appointment scheduled with a sleep specialist, but I'm curious if anyone else has ever had the experience I've had after using a BiPAP machine for the past 18ish months.

I've started exhaling very hard as I'm drifting off to sleep. It's enough to wake me up every time, and it happens consistently. I'm actually on a prescription sleep aid right now to help me fall asleep because of it. It happens automatically without me even trying, like someone is pressing really hard on my diaphragm. During the day, I've started noticing that it feels like I'm not breathing shallow enough, like my resting breathing is just at the top of my lungs. The sharp exhale happens even when I'm not using the machine, though I've never not used my machine for more than a night...just to test it out.

Is this something that could have actually been caused by positive airway pressure therapy, and is it reversible? Just wondering if anyone else has had this experience. I'm hoping this is just a side effect being caused by my machine and an adjustment will stop this from happening over time.

I can't find any information about this online except for cases of parasomnias where people let out a groaning noise while they're sleeping, but this doesn't seem related to that.

[Julie]

Depending on your machine, you likely have a feature that provides exhalation relief (EPR, C- or Aflex, etc) so what machine model do you have?

[chunkyfrog]

. . .
The sharp exhale happens even when I'm not using the machine,
. . .

See your doctor.
Your machine has nothing to do with it.

[zonker]

Depending on your machine, you likely have a feature that provides exhalation relief (EPR, C- or Aflex, etc) so what machine model do you have?

he's using bipap. totally different from apap or cpap and has it's own ways of dealing with exhalation.

mind you, *I* don't know what that is , so will have to wait until the bipap users come by.

[Pugsy]

Depending on your machine, you likely have a feature that provides exhalation relief (EPR, C- or Aflex, etc) so what machine model do you have?

he's using bipap. totally different from apap or cpap and has it's own ways of dealing with exhalation.

mind you, *I* don't know what that is , so will have to wait until the bipap users come by.

When someone uses any form of exhale relief (no matter what it is called or brand) they are essentially using bilevel pressures.
2 distinct pressure....one for inhale and one for exhale.

Pressure support (difference between inhale and exhale and a term used on bipaps/bilevel machines) is nothing more than a fancy name for exhale relief.
To complicate things a big more though...Respironics bilevel machine do also offer the BiFlex exhale relief on top of pressure support.
Resmed doesn't do this.

The fact that OP has perceived issues breathing even when not using the machine....he needs to see his doctor.
If the perceived issues happened only when using the machine....remote chance that someone is dealing with central apneas for some reason but still needs to see the doctor.
Highly unlikely that cpap caused this problem. Remember to fix a problem we first have to figure out what the problem is....and even then it isn't always an easy fix.
Anytime someone has issues breathing while awake...they need to see their doctor first and foremost.

[zonker]

The fact that OP has perceived issues breathing even when not using the machine....he needs to see his doctor.

AH! so just another of those coincidences happening, then.

[Miss Emerita]

It's good you're seeing the doctor. Sleep transition is a complicated neurochemical/mechanical process, and disruptions of respiration during the transition are not uncommon. I haven't heard of this one before, so that's just a general comment.

I wasn't sure from your description whether it's the same thing during the day and when you're falling asleep, or a different thing. It'd be good to have a super-clear way to describe your experiences to your doctor.

Let us know what the doctor says, would you?

Also, if you ever start using Oscar and want to post a chart, we might be able to spot something to contribute to understanding what's going on.

[ChicagoGranny]

I'm actually on a prescription sleep aid right now

It helps to know which one. Our members have experience with a wide variety of sleep aids.

[Baron57]

Sorry for the delay in my reply.

A few updates/context:

• This is still happening nightly, and the only thing that seems to help is Lunesta. I can tell my body is trying to fall asleep within 15-20 minutes, but I'm having these 'sleep-start' like events where I'm aroused by a forceful exhale during transition from being awake to being asleep.

• My at home sleep study revealed mild sleep apnea 6 AHI/16 RDI. An in-lab study is pending.

• This started happening after 3ish months of me not using my BiPAP last summer/fall.

• After a few years of shortness of breath episodes, my doctor said I have pre atrial contractions and am probably caffeine/alcohol sensitive. For this reason I don't have any caffeine within 12 hours of bed.
  
  I've spoken with two sleep specialists. One suggests the forceful exhale is a manifestation of sleep apnea, while another suggests it's anxiety related.
  
  I use a Phillips Respironics BiPAP AutoSV System One, and an AirFit F20 full mask. I ramped for 45 minutes on this night:
  
  Entire Night View
  More data that was cut off
  Closeup of these sudden exhales
  
  Suggestions are all welcome. I'll update when there's something to update on.