Apneas when semi-awake with the mask on?

[frh]

follow-up to viewtopic/t51141/Snoring-In-Full-Face-Mask.html

Yesterday (after 2nd night with full face mask), I had problems with esophagus discomfort coming back. (I have scarring in the espohagus caused by stomach acid at night.) I ran out of energy in the late afternoon and wanted to take a nap. In spite of the moleskin, my nose is so sore I can hardly wear my glasses.

This morning about 4 am as I lay in bed semi-awake, contemplating getting-up to use the restroom I had a strange experience. I began to notice I wasn't breathing for a few (or 6, or 8, or 10?) seconds, then I would resume with a big inhale through my mouth. About 6:30 am (when the dogs wake me up) I noticed it was happening again. My wife confirmed I snore for a while, then stop for a few seconds, then start snoring again. Just like I did before the CPAP machine.

I don't remember anything like this happening with the Swift LE nasal mask.

Fortunately, this morning the DME Provider returned my call to let me know they will let me have the Swift FX they special ordered for me.

[granti55]

Hi I experience the same thing. I have a comfort gel nasal mask. when I download my card it shows a whole bunch of apneas in that great period where you are
half awake, contemplating getting up.

Grant

[JohnBFisher]

If you find that you stop breathing as you fall asleep (as you describe), please realize this is a perfectly normal situation. The following paper describes it in detail. It's normal for there to be unstable breathing during when you are in this "semi-awake" stage.

Ventilation is unstable during drowsiness before sleep onset
http://jap.physiology.org/cgi/reprint/99/5/2036

So, unless there is some other issue, just know that it's normal. Once you are fully asleep a normal breathing pattern settles into place and those apneas go away.

[WindFlyer]

So, there are apneas that are normal and okay? I'm not so sure. My sleep doc always tells me if the machine is doing it's job you won't snore at all. I was thinking maybe your pressure was too low. I know when I switched from nose mask to full mask that I had to bump my pressure up quite a bit to get back to "no snoring" mode.

[dave21]

So, there are apneas that are normal and okay? I'm not so sure.

Yes you can have apneas when awake, e.g. you can have central apneas where your brain doesn't send the signal to your muscles to breathe. This can happen when asleep or awake.

My sleep doc always tells me if the machine is doing it's job you won't snore at all. I was thinking maybe your pressure was too low. I know when I switched from nose mask to full mask that I had to bump my pressure up quite a bit to get back to "no snoring" mode.

Definitely the pressure can be too low, and that could cause snoring. Basically snoring is caused when the soft palate (the back of the roof of the mouth) and other tissue in the mouth, nose and throat vibrates. It doesn't have to necessarily be because the upper airway is blocked, there are other reasons that you might snore including excess Alcohol, Sleeping Pills, Smoking, Allergies, Nasal Stuffiness, breathing through your mouth, tongue falling to the back of your mouth and many other reasons. So if the snoring is being caused by say your tongue falling to the back of your mouth or your upper airway being reduced then it would suggest the pressure is too low to keep the upper airway from collapsing.

I similarly have noticed that whilst I'm in the falling asleep stage that sometimes I do stop breathing or breathing becomes abnormal, same as when awaking. This can also be seen on the flow graphs when looking at machine data. You can also sometimes have Apneas or Hypopneas wrongly diagnosed in these times too.

Thanks
Dave

[Kickthefog]

If you find that you stop breathing as you fall asleep (as you describe), please realize this is a perfectly normal situation. The following paper describes it in detail. It's normal for there to be unstable breathing during when you are in this "semi-awake" stage.

Ventilation is unstable during drowsiness before sleep onset
http://jap.physiology.org/cgi/reprint/99/5/2036

So, unless there is some other issue, just know that it's normal. Once you are fully asleep a normal breathing pattern settles into place and those apneas go away.

Hi John!
Your old buddy kickthe dog er i mean frog, i mean... FOG here!
So when you say completely "normal" you mean normal for people with Sleep Apnea or normal even for "normal" people?
Sorry, i should read the pdf you linked to first before asking this but i figure you know already and well... i'm lazy and too busy kicking frogs.... i mean fog.
Pat

[JohnBFisher]

... So, there are apneas that are normal and okay? I'm not so sure. ...

The difference is that while falling asleep we all go through a change in how our bodies regulate breathing. This leads to this ventilation instability. Once fully asleep, apneas should NOT occur. But during the transition phase, apneas ARE normal. They should just not be so profound that it disturbs the process of falling asleep.

This is one reason some units have a "settle" time to allow you to fall asleep.

[JohnBFisher]

... So when you say completely "normal" you mean normal for people with Sleep Apnea or normal even for "normal" people? ...

From what I've read, normal means everyone (with or without obstructive or central sleep apnea) experiences this. As I just noted, apnea during this transition to sleep will occur, but should clear once someone is fully asleep.

Sometimes during this transition the apnea is so profound that it disturbs the transition to sleep. In that case, it does need to be addressed. Based on the experiences of those on this forum this problem tends to accompany central sleep apnea. But for most people, once you fall asleep this apnea is perfectly normal. Lasts only a few minutes and clears up once you are fully asleep.

Again, as always, I caution this is only my understanding as a fellow sojourner along this particular path. I can be (and often am) wrong. But my own experience and that of others here seems to bear out my observation. Combine that with the article I reference, and as I note... When you are falling asleep some apneas are both normal and not an issue.

[Ms.Snuffleupagus]

JohnBFisher
The difference is that while falling asleep we all go through a change in how our bodies regulate breathing. This leads to this ventilation instability. Once fully asleep, apneas should NOT occur. But during the transition phase, apneas ARE normal. They should just not be so profound that it disturbs the process of falling asleep.
This is one reason some units have a "settle" time to allow you to fall asleep.

John, this would explain why when I first wake up my AHI might be 2 point something. But if I hit the snooze button repeatedly and drift off into a light sleep, it can rise to 3 or 4 point something. To try to get a more accurate reading, I sometimes hit the settling button on my machine when I first awaken if I don't plan on getting out of bed right away.

[wjp]

Try paying attention sometime when just driving down the road. You'll find your breathing is not that regular when you are awake.

I have the some problem. I frequently wake up around 4am and never really get back to sleep. My AHI's are near zero when I'm asleep but when mostly awake the AHI's go through the roof, and can not be controlled even with my APAP.

The software in the machine is counting HI's and AHI's based on changes in your breathing patterm. When awake these are not as regular, and are counted by the machine as events.

[Ms.Snuffleupagus]

Wjp, exactly! This added to the S8's supposed overestimation of HI's can lead to an overall high AHI score and lead one to think they are not getting good enough therapy, when in fact they may be. I wonder if the same problem exists on the S9 and other machines.
Since I started using the settling feature again on my machine, my AHI's are now lower and fall within the "normal" range. Yeah... whatever it takes to get those lower numbers on my machine...