Feeling suffocated through night

[sleepyUK]

Hi guys (and gals).
I'm a user from England. I have had the machine 7 nights and I'm experiencing two major problems. The machine is a ResMed Air10 and I use Autoramp settings, but don't have humidifier. I'm really keen to use the machine, and the results in terms of the apnea seem great. My initial AHI was 77.7 and is now down to 0.5 - 2!! I'm not feeling any better though, or even worse with the machine. I didn't feel sleepy during the day before the machine but would wake with dull headaches which sometimes lasted all day. I am now feeling sleepy with the machine (today fell asleep 5 times). My problems are:
1. I get severe dry mouth with wakes me about every 50 mins. I did get this before, but could have a drink of water and fall back to sleep quickly. Now I wake up fully eaxh time because I have to take the mask off and then back on and have to do this with a light on to sort the mask straps out. I have read some of the dry mouth posts and was going to try Biotene gel tonight.
2, This problem is worse. I really can't stand the warm air feeling around my mouth when I breathe out. I wear a full mask because I breathe through my mouth. I can just about cope when I first wear the mask and I'm going to sleep, but later on when I'm going back to sleep and only partly awake the sensation is terrible and almost feels like I'm suffocating and I just get a panic attack and end up ripping the mask off. I don't know if this is a common problem. I cannot stand any sensation of warm air in my face when I'm going to sleep/asleep. I have to turn away from a partner when I "share a bed". I was abused as a child and I think this could be related to that (don't want to go into a lot of details here) but I often had a hand placed over my mouth and I think this could be why the sensation is so terrifying. I really don't want to give up on the treatment, but also because of the above I feel the humidifier may make things worse as there would be warm air in front of my mouth all the time.
I'd like to know if anyone else has problems with the warm air sensation without any other history and how I can get used to it.

[Pugsy]

Auto Ramp starts the pressure at 4 cm and then moves up to whatever your pressure setting is.

With a full face mask and that 4 cm starting point (and maybe even the ending point if it isn't very high) you are exhaling into the mask and your breath is warm and there's not a lot of air moving around in there to exit out the vent holes. I think that maybe using something higher than that 4 cm starting point might help with the warm air sensation you don't like. Move that exhaled warm air out a little faster so you are breathing in slightly cooler air.
Also remember that even without the humidifier being on that if your ambient bedroom air temp is very warm that's the starting point for the hose air temp.

Welcome to the forum.

Do you know how to get into the clinical setup menu are so you can see exactly what all the settings are?
If you don't this manual explains how.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Write down all that you see for settings...mode, pressure (might see a minimum and a maximum), and what it says about ramp.
Come back here and tell us those settings and we can then offer better ideas.

[quiltybe]

In regards to your dry mouth— you said you have a Quattro Air full face mask.. I also use a Quattro Air ffm and get dry mouth. I keep a drink cup with a lid and straw on my night stand — I unhook my hose at the elbow ( without removing the mask) and take a quick drink thru the hole in the mask... good luck, it really does get better.. the people here are a wealth of info...
Bev (^..^)

[sleepyUK]

Thanks, for the positive comments and suggestions, I didn't expect any replies so quickly. I will try and check settings, the hospital set up my machine, but I've got the manual and should be able to work round that. I do feel better when the pressure starts to increase and don't mind the cool air sensation then. It has been unusually warm and humid over here these last few weeks, so that may not be helping as you suggest. I will try the straw method for the drink, sounds easier than removing whole mask. Thanks

[chunkyfrog]

There are TWO manuals:
One is the user manual, given to patients.
The other is the CLINICIAN'S manual--the one you really need.

[rick blaine]

Hi sleepyUK,

You don't say which part of the UK you're posting from, and you don't say whether you're being treated within the NHS or whether you are being treated privately. Both of those can make a difference as to what advice is most suitable for you.

Also at the general level: the best way forward with the several-faceted patient-report that you offer - both in this thread, and in the other one - is to identify and separate out problems, and then deal with them one at a time. And that's what I aim to do for you.

1. The first thing is: it can easily take three months to get used to using an APAP machine. The fancy name for it is 'the process of habituation', and it's a variable – everybody's different. Some adapt and habituate quickly, some take a bit longer.

But however long it takes, you have to persist for habituation to take place. Even if you have no pre-existing psychological condition, you need to complete that period of adjustment.

2. The second thing - you mention dry mouth - you also say (in the text): "The machine is a ResMed Air10 and I use Autoramp settings, but don't have humidifier."

Then, at the bottom of each post - in the space for machine and mask and so on - you have chosen the option that says you do have a humidifier.

Which is it?

If you're being treated by the NHS, and the staff at the sleep-medicine department haven't issued you with a humidifier, then you need to go back and ask for one.

And if the policy in your area, or for that foundation trust hospital's sleep-medicine department, is not to issue a humidifier - then you might think about buying one of your own.

ResMed Uk will sell you one for about £150 (and no VAT). Dialling from within the UK, they are: 0800 907 7071

You do not need a prescription to buy an add-on humidifier direct from them – although you do if you buy a machine-plus-humidifier from them.

(When you call, the first question they may ask you is if you are calling professionally or from some part of the NHS. You say, no, you're a patient. You'll then get put through to the right department.)

3. If on the other hand, you do have a humidifier, then use it. In the long term, it does more than just make for more comfort. It reduces the risk of sore throats and infections.

And yes, I do understand you have a problem with warm air .... So:

4. You say: "Any warm air sensation in front of my mouth sets off a panic attack." And you describe it as "PTSD" And you add that you're having counselling for it.

Is that within the NHS? Or is it outside the system? And if I might ask, what type of counselling it is it?

Whatever kind of therapy it is, what I'm about to suggest may be better - and quicker.

The kind of thing you describe is proving very amenable to a newer form of therapy called Havening. So far it has proved very effective in reducing and removing adverse responses to the kind of trigger you describe - and in only one or two sessions.

It is not available within the NHS; people have to pay for it. Practioners vary in what they charge, but you might expect something in the order of £75 per session.

If you call a Tony Burgess on 07989 469 570, I'm told he's the best person to find you a Havening practitioner in your area.

[Pugsy]

Then, at the bottom of each post - in the space for machine and mask and so on - you have chosen the option that says you do have a humidifier.

Which is it?

The only option in the equipment menu choices for the ResMed AirSense 10 AutoSet is the choice that mentions humidifier...that's because the humidifier is built in to the machine. They all come with a humidifier. Now whether someone actually uses it is a different matter and there's no way to address that fact in the menu choices for the AirSense/AirCurve machines.

Instead people might mention it in the comments section which the OP did but he actually says the humidifier wasn't supplied...that's an error really. What is more accurate to say is that the water chamber wasn't supplied. All the AirSense machines come with the ability to add humidification but the water chamber is needed to be able to turn it on.
There is an end plate available which can be stuck in the space where the water chamber would go and that effectively will allow the machine to be used without the water chamber.
What would have been more correct for the OP to say is ....not using a humidifier because no water chamber was supplied.

With the AirSense 10 and AirCurve 10 models...there is no longer a separate humidifier device like there is with the older ResMed models or the Respironics models. It's built in to the body of the unit. The water chamber is the key to having the ability to turn it or or not.

[Pugsy]

Here's what that side plate or end cover looks like
https://www.cpap.com/productpage/resmed ... cover.html

To make use of the humidifier all a person needs to do is remove it (and it's easy to do as I have done it) and insert the water chamber.
https://www.cpap.com/productpage/resmed ... amber.html

[rick blaine]

Got it. I was thinking of the ResMed S9. I am now better informed.

[rick blaine]

Hi Pugsy,

If this is the component that you mean, then it's available direct from ResMed UK for £75.

https://mysleep.resmed.com/GB/en/CPAP-M ... 0?plp=true

Tx.

[Pugsy]

Hi Pugsy,

If this is the component that you mean, then it's available direct from ResMed UK for £75.

https://mysleep.resmed.com/GB/en/CPAP-M ... 0?plp=true

Tx.

Yep, that's it.

Ouch on the price. Is that equal to US $99 or did I mess up the conversion rate?

If that's right...maybe I need to start buying up some and selling them to the UK users. I bet I could make a few bucks even with mailing costs and save people some money.
Might be worth it to see how much international shipping would be for this one. Amazon will do international shipping on some items.
https://www.amazon.com/ResMed-Standard- ... er+chamber

[Pugsy]

Hey Rick...I was chatting over on Jason's board with a guy in the UK (maybe 6 weeks ago) who was in the same boat as the OP here...no water chamber. His equipment supplier told him it would cost him around 300 pounds to add a humidifier to his AirSense 10 machine.
Can you believe that crap? Man was he P O'd when I explained the AirSense and that it already had a humidifier and his equipment seller was putting the screws to him.

He finally found one some place in the UK or Europe that the price was just about the equivalent to him as our price is here in the US. I don't remember where, or if he said, he found it. Only that he thanked me for saving him a bunch of money.
If he hadn't found a decently priced chamber he was going to let me send him one and just pay me.

[sleepyUK]

Hi.
Many thanks again for the really detailed help. Apologies if I've not given enough info., it's a bit difficult to judge what info is needed, as it's all quite new. I think Pugsy cleared up the confusion with the humidifier/water tank - thanks!. Good news is that the NHS Sleep Clinic in Leeds is supplying a water tank by mail, so it should arrive sometime this week. As with a lot of the NHS the department is very understaffed; they have one Physiologist to serve the main hospitals in Leeds. He mentioned that equates to over 5,000 patients currently on CPAP whom he is responsible for. The advice from this forum is really useful as I don't have to check every little detail with him first. The NHS in my area don't routinely supply the water tank and use the blanking plate to save money (you worked out the cost for one!). The machines are "loaned" free of charge, so cannot grumble too much.
It's a bit late now so I can't answer all the points raised. As for therapy, I am receiving private psycho-therapy for the traumas. This has mainly focused on the effects of the flashbacks and night terrors. I also suffer from chronic spinal pain, and I have had mindfulness technique training to help with this. I have been trying to apply the mindfulness techniques to the suffocating feelings and discomfort I've had with the machine, but often this sensation wakes me from sleep in a panic.
I don't think it's the raise in pressure after the ramp starts to increase the pressure (sorry if get the terms wrong). I have noticed that sometimes the warm air feels worse than others. Some of the time I can feel a burst of cold air as I start to breathe in, which helps clear the warm humid air from the mask. However, sometimes this doesn't seem to happen and I feel like I'm just re-breathing the warm air which builds up inside the mask until I have to remove it. This morning after I had replaced the mask and restarted the machine it seemed to have the cool air as I breathed in for about five minutes then that seemed to stop and more and more warm air built up inside the mask. I'm not sure if this is a fault in the auto-ramp function of just that I am less tolerant when I'm less conscious. Apologies again if that is a bit complicated and rambling but it can be quite difficult finding the right words to describe what happens. The sensation is very unpleasant and disturbing.
I will ask my therapist about the technique you mentioned, she is very amenable to referring people to alternative therapies and usually is quite conversant in many new techniques, even if she doesn't practise them herself. I will also get in touch with your contact for names of local practitioners.
Anyways, I'll head off to try and get some z's. If there any points I've missed I'll go through them laster, and try and get more of the machine's set up details. I do know the auto-ramp is set for 4-20 which I believe is standard. When I've checked the therapy pressure shown on the machine is usually 9-10cm. My initial AHI was 77.7(!) and the highest on treatment has been 4 with average less than 1.5 (many below 1). I was quite impressed with that. I do tolerate the treatment pressure well (except dry mouth) and sometimes I've woken up and thought I'f take n the mask off it seemed so comfortable. The trouble occurs most when I try and drift back to sleep.
Thanks for the support, I really appreciate everyone's time and advice.

[rick blaine]

Hi Pugsy,

Yes, at today's rates £75 = US $99.52.

And on the way to getting the ResMedUK price on the net, I found re-sellers in the UK charging even higher prices - there was one at £90, and another at £105. But that £300 offer you mention – that takes the biscuit.

The reason I recommended the OP going to ResMedUK is that there are certain legal protections which buying direct from the OM provides. Since the NHS does not give the machine to the patient, but instead makes a long-term loan of it (and thus it remains their property), the NHS 'has an interest' in what is done with it.

But any arguments or objections disappear if the patient can say to whoever - "I used 100 pc OM parts."

That said, your 'export business' could be on a winner with those whose treatment isn't from the NHS. The guys at ResMed tell me they have quite a sizeable list of customers and users who are outside the NHS system. People who prefer to buy outright and who want service today – professional sports people – professional business people whose employer buys them UK private medical insurance – and people like my family lawyer who, if she needs an operation, doesn't want the delay and hassle of an NHS waiting list.

You could call it 'Tubs R Us'.

[Pugsy]

But any arguments or objections disappear if the patient can say to whoever - "I used 100 pc OM parts."

You could call it 'Tubs R Us'.

Actually those on Amazon (like the one I linked to) is a real name brand ResMed product. In fact I have never seen an aftermarket water chamber for any of these machines. I don't think there is enough money to be made to make it worthwhile to counterfeit or generically produce the chambers. So if anyone ever does get anything from me...it's going to be name brand and they can still say "100 % original parts"

I don't really want to go into the business...too much work and I always feel bad to charge someone more than I paid for something.
Anytime I do send out stuff it's always at my cost and postage reimbursement. Every time I send out something my husband always asks (he's joking of course) "did you make any money this time" and I just roll my eyes at him.
Besides...if I started a for profit side business then I have my own legal and tax issues to worry about. No thank you. Not worth it.
Now I am happy to send a friend in the UK (or wherever) a "gift" and they just pay for "postage/shipping and handling" which amounts to about my cost for the "gift" and mailing it. That "handling" part usually covers the cost of the whatever.

Besides...it's not like I don't have enough on my plate to do as it is now. I don't want more to do.

The guy on the other forum who was quoted such a high price. He wasn't NHS...he was private and the supplier trying to hoodwink him was some sort of private supplier. They told him to bring the machine in and give them 2 or 3 days and I think it was around the 300 pounds...and they would add a humidifier to his machine. Somehow or other I doubt they will ever get one dime's worth of business from that guy again. He was really pissed. Can't imagine why.