Suffocating Feeling First Night

[JP11283]

I was recently diagnosed with severe sleep apnea with an AHI of 85 and got set up with a Phillips DreamStation APAP yesterday. I have chronic nasal congestion and tend to breathe out of my mouth quite a bit so the respiratory therapist set me up with a full-face AirFit F20 mask. I'm currently using the medium size, which seems comfortable. The prescription is for 8-20 cm H20 and the ramp was set to start out at 5 and ramp up to 8 in 10 minutes.

The problem I'm having, besides just getting used to the entire experience, is that I keep feeling like I'm suffocating, especially when I feel like I'm just starting to fall asleep. I'll get jarred awake and feel like I have to take a really deep breath. I've tried both with and without the ramp feature and still feel like I'm not getting enough air, which makes it hard to relax and fall asleep, especially after the few times I've come close to falling asleep just to be jarred awake. I used the machine for around three and a half hours, then took the mask off for the next several hours. Later in the night I did some reading and increased the minimum pressure to 10 and used it for another two hours. Increasing the pressure to 10 made it a little easier to breathe but still didn't completely take away the suffocating feeling.

My OSCAR data is posted below, although I'm not sure how helpful it is after only one night and around five to six hours of use. I appreciate all help, as the first night was much rougher than I was expecting it to be.

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[Pugsy]

First nights are indeed rough. Lots of new stuff to get adjusted to.
Keep the minimum at 10 cm and try again. Use the machine while awake when you can.
Things will get better but it will take a bit of time.

[joeack1]

I know personally I really struggled with that feeling when first starting w/CPAP. I'd echo Pugsy's recommendation in that for me I wore it quite a bit during waking hours to desensitize to it. It can take a little while, but stick with it and keep reminding yourself you will be much better off when you finally get adjusted to it. I know also for myself initially I was very focused on "feeling" the air in the mask and that triggered feelings of suffocation. I got over this by using the "Calm App" and listening to bedtime stories etc to distract my mind. Personally I am just about to reach my 1 yr mark w/CPAP and if I think back to those early days never would have thought it was possible to get this comfortable with it. So stick w/it and wear it during the evening watching tv or reading a book etc to get comfortable.

[jbgilm]

I have sinus problems and find that it doesn't wok as well when I'm congested. If it's hard to breathe without the machine, it will behard to breathe with it. Nasal strips can help keep your breathing open. Also decongestant spray can help, but not too often.

[Miss Emerita]

Hello, JP. Isn't it nice that you'll never again have to have a first night with PAP!

I'm impressed that you read up on your options and took charge of your therapy right off the bat. Plus you're using Oscar! With this attitude, I think you will do very well.

Your instinct to raise the starting pressure was a good one. I'm not sure, but it looks as though you may also have turned off the ramp; if so, another good move.

Were you asleep during the segment from around 5 to 7? It looks as though you settled into some good sleep after the first little bit. That would be promising.

Please post more charts in the coming days. I'm certain people here can help you sleep better and drop your AHI further.

[JP11283]

Thanks for all the replies. Last night was rough as well, with around the same amount of time on it as the first night. I was still feeling like I wasn't getting enough air at 10 so I bumped it up to 12 and upped the humidity slightly, which seems more comfortable. I did turn off the ramp too, which I think is also helping, as well as using it while I'm sitting at the computer to help acclimate. I think my chronic nasal congestion is causing a lot of the issues; I use Flonase and Sudafed but they don't always seem to work well enough. I've avoided Afrin as I don't want to risk rebound congestion. I have a lot of post nasal drip as well and it seems to throw things off when I clear my throat, which is often.

The clock on my machine wasn't set right the first night so the times on the charts are incorrect. I'm honestly not sure if I was asleep during what's showing as the 5-7 time-frame, I feel like never actually fallen asleep while using it but maybe I have? I'm going to try to resist the urge to take the mask off overnight and try to get a full night in and then post the charts to see if I'm headed in the right direction.

On a lighter note, my six-year old seems to think the site of me with the mask on is hilarious. I had it on while I was checking email before taking her to school this morning and she came in and about died laughing when she saw me.

[JP11283]

What a roller coaster this first 10 days has been. I've only averaged around two to three hours each night before ripping off the facemask. Emotions have ranged from "Wow, I actually feel better, even with only three hours of use," to "I'm about to toss this thing out of the the window!" All depending on how the night went.

I tweaked settings but never really had improvement. Then, after reading post after post of people with chronic nasal congestion who successfully use nasal pillows, I decided to give them a try and ordered the P10 nasal pillows. Last night was the first night using them but wow, what a difference. None of the confining feeling like I had with the full-face mask and no problems breathing just through my nose, even with my congestion. I did drop the minimum pressure back down to eight, as it felt like I was drinking from a firehouse, so to speak, on the higher setting I was using with the full-face. Below are my results from Oscar. This was the longest usage I've had so far. While my first Oscar post showed over five hours use, much of that was while awake to acclimate, while all of last night was sleeping.

I have to say, last night was encouraging and just what I needed to keep from giving up.

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[mper!?]

Hi,
_ it appears you are doing well....you went on any systematic titration, either lab or not?

_ Maybe I could suggest you take a look at this Resmed titration guide: https://www.resmed.com/us/dam/documents ... pdf....you might think, at some point, be worth starting all over again, pressures wise. I used to change my presssures a lot before I knew this very useful guide...things went quickly on more well defined tracks.

_ also, you might want to consider your Expiration/Inspiration ratio < 1.0 (exertioned respiration, maybe), rather than around 2.0. Take a close look at your FR to see whether confirme or not this ratio. Thins anomalous ratio appears pretty much always occur with APAP machines.

good luck

[Miss Emerita]

It's very good to hear things are starting to go better. Also, that you're keeping your daughter amused!

Three quick questions: what accounted for the breaks during the night? What is your usual sleep position: back, sides, stomach? And what do you have in the way of pillows: fat/low, soft/firm?

[JP11283]

It's very good to hear things are starting to go better. Also, that you're keeping your daughter amused!

Three quick questions: what accounted for the breaks during the night? What is your usual sleep position: back, sides, stomach? And what do you have in the way of pillows: fat/low, soft/firm?

I tend to fall asleep for a couple hours, then I'm awake for several hours, then I go back to bed and sleep until morning. Can't seem to shake that schedule, I've tried going to bed later, OTC sleep aids, etc. I primarily sleep on my sides and use two medium firmness pillows. I have herniated discs in my next so my pillow set up keeps my neck happy.

[Miss Emerita]

Ah! You're a first-sleep/second-sleep person. If that's OK with you, then don't fight it, but DO get more sleep in total. Four to five hours is not enough.

I have a little bit of a suspicion that you are tucking your chin off and on during the night, causing the little clusters of events. When the chin is tucked down toward the chest, it can slightly constrict the airway, making various kinds of obstructive events more likely to occur.

It's important to keep your neck comfortable. How do you think you'd do using a soft cervical collar? If you think you could tolerate it, that'd be a good experiment to try.