Day 3 with CPAP and having a problem

[markpmaui]

I was diagnosed as severe and have my REMstarPlus - M Series cranked up to "16".
It seems like plenty of air, but I still stop breathing as I fall asleep, awaken startled I gasp and can't get enough air.

I think I have Central Sleep Apnea and the doctor doesn't know that yet. I just stop breathing. That is what I am perceiving. It isn't about air pressure, it is that I just do not breath.

Any comments or observations?

Thank you

[TWW]

Did you have a sleep study?

(If no, find yourself a doctor first)
(If yes, continue)

Was it a "two part" study, including a hookup to a CPAP machine?

(If no, wait for the other half of your sleep study, which is necessary for choosing and setting up CPAP machine.)
(If yes, continue)

Perhaps it's an equipment problem (such as an inappropriate mask). Can you edit your profile and include info about not only your machine, but also your mask? The more info, the better.

[DreamOn]

Welcome to the forum, markpmaui! From what you are saying, I get the impression that there weren't any centrals found on your sleep study. You should get a copy of your complete sleep study and find that out for sure.

What you are experiencing MAY be perfectly normal, as it isn't uncommon to have central apneas as we are falling asleep. I occasionally have sleep-onset centrals too, yet there were none in my sleep study.

This explanation of the sleep-onset centrals, from the book "Sleep Apnea: The Phantom of the Night" by T. Scott Johnson, M.D, et al., may be helpful:

"Small numbers of central apneas are seen in virtually every normal and abnormal patient that is studied in the sleep lab and are usually a normal part of the transition to sleep.
....
"We have an automatic breathing control system that maintains the carbon dioxide in our blood at a stable level. This system helps to control the rate at which we breathe....During the day when we are constantly overriding our automatic breathing, most people maintain their carbon dioxide level at a fairly low level. With the onset of sleep, however, the sensor mechanism that detects levels of carbon dioxide in the blood becomes slightly less sensitive and accepts higher levels of carbon dioxide....This change in sensitivity occurs quite suddenly as we drop off to sleep from a normal awake breathing state, and we suddenly do not have enough carbon dioxide in our blood to drive regular breathing during sleep. For this reason, at sleep onset and after arousals there is often a pause in the effort to breathe that may last as long as 10 to 15 seconds. These events may be normal."

This is something you may want to discuss with your sleep doctor, just to make sure there isn't more to it. I hope that your therapy is going well.

Best wishes,

DreamOn

[markpmaui]

Thank you for your responses. I will consult my doctor.

Aloha

[JohnBFisher]

I was diagnosed as severe and have my REMstarPlus - M Series cranked up to "16".
It seems like plenty of air, but I still stop breathing as I fall asleep, awaken startled I gasp and can't get enough air.

I think I have Central Sleep Apnea and the doctor doesn't know that yet. I just stop breathing. That is what I am perceiving. It isn't about air pressure, it is that I just do not breath.

Any comments or observations?

Thank you

Greetings and welcome to the forum.

First, you might want to fill in the equipment profile for yourself. This will let us know what type of equipment you have. Click on the User Control Panel hyperlink in the upper left corner. You will find it off the second tab.

Second, sure it is possible you encounter central apneas as you fall asleep. This is actually very normal. Most people do have some. If it is a serious problem, you might want to talk with your sleep specialist about this. You can use medication to help you sleep. Medications such as Sonata, Lunesta, Ambian all help you fall asleep faster. You would NOT want to use a central nervous system depressant (such as alcohol or benadryll or an opoid / pain killer). If the central apneas continue into sleep and are extensive enough, you sleep specialist should help you manage them such as via an ASV (Auto Servo Ventilator) unit.

[Jay K]

When I first went on an APAP about four months ago, the same thing happened to me when I was falling asleep. It did induce some panic. Then I read on this board that this is fairly common and not something to worry about.

More recently, it seems these occurrences of panic have diminished substantially, or disappeared altogether, perhaps because I have become more acclimated to being on an APAP.

The one thing I am still a bit puzzled about is why if these central apneas while getting ready to doze are so common we only become aware of them when we begin CPAP treatment. I suspect the answer lies in the fact when we begin treatment we are not used to breathing against the level of air pressure we receive from our machines, and something about that makes us more aware when we have momentarily stopped breathing. However, this is just a guess, and if someone else can confirm this or provide a better answer, it would be appreciated.

[JohnBFisher]

... The one thing I am still a bit puzzled about is why if these central apneas while getting ready to doze are so common we only become aware of them when we begin CPAP treatment. I suspect the answer lies in the fact when we begin treatment we are not used to breathing against the level of air pressure we receive from our machines, and something about that makes us more aware when we have momentarily stopped breathing. However, this is just a guess, and if someone else can confirm this or provide a better answer, it would be appreciated.

It's a good guess. I have two other guesses (and from my reading all three might be accurate).

First, due to better sleep, you might not be as desparately sleepy. Thus you might not fall asleep as quickly. So you might notice those whereas before you would have just fallen asleep. I know on my own sleep studies, if I am not sleeping well, my "sleep latency" (that is, the time before I fall asleep) is MUCH shorter.

Second, the fact that your airway is now splinted open will change how well you exchange CO2 and O2. So, that in itself can mess with the respiratory cycle. It might take a while (after therapy) for your body to adjust to the new norm.

But I also like your idea. You are right. When I change machines or masks, it takes me a little longer to fall asleep for a while - just because it is not "normal". So, once you become accustomeed to it we might fall asleep faster.

[DreamOn]

I had noticed the occasional sleep-onset centrals even before starting CPAP myself. And there are none in my sleep report, which I mentioned earlier. So in my case, I think they're perfectly normal.

First, due to better sleep, you might not be as desparately sleepy. Thus you might not fall asleep as quickly. So you might notice those whereas before you would have just fallen asleep. I know on my own sleep studies, if I am not sleeping well, my "sleep latency" (that is, the time before I fall asleep) is MUCH shorter.

Second, the fact that your airway is now splinted open will change how well you exchange CO2 and O2. So, that in itself can mess with the respiratory cycle. It might take a while (after therapy) for your body to adjust to the new norm.

I've also thought that the sleep-onset centrals may be more prevalent when CPAP is first started because we sometimes breathe a bit "abnormally" when we first begin therapy. I know in my case, I think I was mildly hyperventilating at times. Sometimes I felt like I was breathing in longer (and deeper) than I was exhaling, so my guess is that I wasn't expelling as much CO2 as I needed to, throwing off the CO2 balance. Does that theory make any sense, John?

~ DreamOn

[markpmaui]

I am really appreciative and impressed with the responses i have so quickly received. I believe that most of what i am experiencing is just part of getting used to the CPAP.

Again. Many thank!

[DreamOn]

I am really appreciative and impressed with the responses i have so quickly received. I believe that most of what i am experiencing is just part of getting used to the CPAP.

Again. Many thank!

I think you'll find the people on this forum to be very helpful if you ever have any questions. There is a lot of information that can be learned here about sleep apnea, the various machines, how to monitor your therapy with a full-data capable machine, and tips & tricks to make CPAP more comfortable. Search the forum and check out the CPAP Wiki (at the top of the screen) when you have some time.

I hope everything goes well for you! Please let us know how you're doing with your therapy. I hope you're feeling better during the daytime -- if not already, then very soon!

~ DreamOn

[terrydk]

I had noticed the occasional sleep-onset centrals even before starting CPAP myself. And there are none in my sleep report, which I mentioned earlier. So in my case, I think they're perfectly normal.

First, due to better sleep, you might not be as desparately sleepy. Thus you might not fall asleep as quickly. So you might notice those whereas before you would have just fallen asleep. I know on my own sleep studies, if I am not sleeping well, my "sleep latency" (that is, the time before I fall asleep) is MUCH shorter.

Second, the fact that your airway is now splinted open will change how well you exchange CO2 and O2. So, that in itself can mess with the respiratory cycle. It might take a while (after therapy) for your body to adjust to the new norm.

I've also thought that the sleep-onset centrals may be more prevalent when CPAP is first started because we sometimes breathe a bit "abnormally" when we first begin therapy. I know in my case, I think I was mildly hyperventilating at times. Sometimes I felt like I was breathing in longer (and deeper) than I was exhaling, so my guess is that I wasn't expelling as much CO2 as I needed to, throwing off the CO2 balance. Does that theory make any sense, John?

~ DreamOn

DreamOn, thanks for pointing me to this thread. What you and others are saying here makes a lot of sense. I was really surprised when the first couple of nights went very well but the last three have been pretty bad. But the last couple of nights I noticed that just as I was falling asleep I would wake right back up and after thinking about it this morning while trying to get over a splitting headache I related it to the 10cm of pressure that I was breathing with/against. I like you find myself 'over' breathing or inhaling and exhaling longer than normal than if I didn't have the mask on. In other words I am thinking about my breathing too much instead of just relaxing and breathing normally, if there is such a thing as breathing normally with the CPAP mask on.

[flylow]

You may want to see if you can get a different machine that has dtailed data capability. With a pressure of 16, you probably could get good benefit with a auto (I recommend the resmed S8 autoset II). By virtue of posting here, you are sufficiently involved and motivated to get good therapy. You need detailed data to be able to tweak all aspects of your therapy. Without it is like a blind person trying to drive a car.

[DoriC]

Just another thought, do you know if your machine is set up with the ramp feature? If it's set at too low a pressure you may be having apneas as you fall asleep. It takes time to get it all sorted out. Good luck.

[JohnBFisher]

... I've also thought that the sleep-onset centrals may be more prevalent when CPAP is first started because we sometimes breathe a bit "abnormally" when we first begin therapy. I know in my case, I think I was mildly hyperventilating at times. Sometimes I felt like I was breathing in longer (and deeper) than I was exhaling, so my guess is that I wasn't expelling as much CO2 as I needed to, throwing off the CO2 balance. Does that theory make any sense, John? ...

Yup. You would essentially breathe out less than you should. Your body would then overcompensate by hyperventilating. And that could drive your O2 levels up high enough that the need to breathe is surpressed. You would the fail to breathe until the CO2 builds up, triggers a deep breath and away we go again. I guess it may take a few days or weeks before your body fully adjusts to breathing against the pressure.