Wake/Sleep Transition CA

[mdunk100]

Hi all,

I'm not really worried about this, but it is something I experience most nights. As I start to transition into sleep I stop breathing. I have read this isn't uncommon, but its something that keeps me from going to sleep comfortably. I am aware of this when it happens, I gasp and it wakes me back up to an alert state. This happens 3 or 4 times before I go on to sleep. Before cpap this would happen periodically, maybe 2 weeks then seem to go away. It started again when I started cpap 3 weeks ago. I've tried different pressures as I go to sleep but hasn't helped so I assume it's more like a central event. It may have something to do with anxiety, I had anxiety at first but have adjusted well to cpap. As I said, I know there's transition "junk" when you start off to sleep, but is being awaken to it common? After I go to sleep I don't think I have a real CA problem. I will list my oscar numbers below. I plan on creating a image link to oscar. One more note, I can see this happen on oscar but a lot of the time its not tagged.
APAP 8-15 - Full Face F30i
EPR Off
AHI 4.13
LL Mask 0.17%
CA 2.76
OA 0.61
H 0.61

Thank you for your help! Mike

[lazarus]

As a general rule, a sleep-initiation pause in breathing, in and of itself, shouldn't wake you up or make you gasp, because it is a simple matter of your body 'stepping on the clutch' as it 'switches gears' from wake-breathing to sleep-breathing.

However, when someone begins his PAP-therapy journey, the brain can become a bit touchy and twitchy for a while at sleep initiation, because falling asleep just plain feels different from how it felt before PAP. The brain may simply need to get used to falling asleep with PAP. The brain will figure it out with time.

On the other hand, if gasping or any feeling of closure occurs at sleep initiation with PAP, then (1) turning off ramp or even (2) increasing start pressure minimum on an APAP may be worth trying. That is because, for some, any slight pause in breathing allows the airway to start to narrow or close so that the otherwise-harmless so-called "central" morphs into an obstructive event very quickly. That can cause enough discomfort to startle someone out of the falling-asleep process, enough to negate any of the comfort that others may get from ramp or from a low minimum pressure.

The above statements are based primarily on my own personal experience and from reading some posts about what some others have experienced.

[mdunk100]

Thank you for your response. I do have a 10 min ramp from 6. I do like a settling time to relax and get ready to sleep, but I think that may be a bit long, I will reduce it to 5 min. My sleep study and my clinician set my pressures at 4-20. This was horrible, The first few nights my AHI never dropped below 15. I thought something had to give. So I took Jason's advise from Youtube to "own your therapy" After tweaking pressures, I now rarely go above AHI of 5. It's just this transition time that is giving me issues. I feel like it's delaying my good sleep by 15-30 min because when I wake up my heart rate is up and I have to settle again.

Thank's for your advise and I will adjust my ramp time down and also raise my bottom pressure a bit and see how that works.

Mike

[lazarus]

I believe in keeping my min within 1 or 2 cm of what is needed to prevent apneas all night. I do not limit max. And I do not use ramp at all, since I have learned to find the pressure to be comforting and relaxing. Your experience may differ.

[chunkyfrog]

. . .
my clinician set my pressures at 4-20.
. . .

NO. THEY DIDN'T "SET" A DAMNED THING.
4-20 is the DEFAULT.
You did right to reset it to more workable pressures.