Having periodic issues exhaling

[ccrandall77]

Hi all. I'm a noob here. Just recently got my CPAP (back in early May) and I've been playing around with a few masks and stuff to get the right set up for me. I have a Resperonics System One REMStar with heated humidifier. I started with a mask that covers both my mouth and nose, but being a bit claustrophobic, I switched to a mask that just fits over my nose with a support resting against my forehead. Then my father told me about the Sleep Weaver cloth mask which is what I'm primarily using now.

The doctor instructed my CPAP provider to set it to 4 - 15 cm with ramp up. I started off ok, but once it hit 12-15 cm, my mask would start leaking badly (all of them, no matter how loose or tight) and I was having problems exhaling (the main reason I'm posting... more on that in a bit). After meeting with my doctor again, he actually insisted that the setting be turned up even higher to 4 - 17 cm. I ignored this, because I know better!!! Anyway, I went and turned it down to a max of 12 cm. That helped some, but I was still having issues. So, I lowered it to 11 and then 10 cm.

Well, things got a lot better. My Zeo sleep monitor showed I was increasing from about 2.5 hours of sleep a night to 4-5.5 hours. However, I'm still having problems exhaling occasionally. What I mean by this is, when I exhale the pressure from the CPAP is making it hard for my throat and tongue to open up the right way to breath out of my nose. It's worse when I take a deeper breath, so shorter breaths are better. But eventually I get winded and need to take a deep breath.

I notice this even when I first put my mask on and it happens with every mask. It happens even when I'm sitting upright. When it is happening, I can see and feel my mask move when I exhale. With the cloth mask, it balloons up. Whereas when I'm breathing easily, the mask barely moves when I exhale.

This is really causing me a lot of problems when I sleep. I think I've got the pressure where I need it (10 - 11 cm at max), I've got a memory foam wedge which has me on sleeping on my back, and now I have to get over this last hurdle. If anyone has a clue what I'm doing wrong, please respond.

Thank you!
Curt

[Pugsy]

When you first start the night your minimum pressure is only 4 cm...is that what it is now? That is very low and a lot of people would find that low rather stifling..almost like they were suffocating. Your machine won't go any lower.
To experience problems exhaling against 4 cm pressure would be rather unusual. Now if you told me this happened in the middle of the night when pressures are maybe increased...then that would be more common.

Is it possible that you are experiencing feelings of slight suffocation causing apprehension and the change in respiration?

[Julie]

If your machine has a feature called either c-flex, a-flex or EPR, see if you can turn it on - it's specifically to help you exhale against the pressure.

[ccrandall77]

@Pugsy - Yes, 4 cm is my starting pressure and it ramps up to 10, 11, 15... whatever I have the max set to on that given night (experimenting with the right pressure for me). Last night I put the Sleep Weaver on and right away I could see the thing balloon up when I was exhaling. I do not believe my exhaling problem is due to being apprehensive at all. I'm pretty used to having the mask on and this issue happens one night, then the next it's fine, and the next it's back again. On the night's it's not happening, I really enjoy my CPAP since for the first time in years I'm getting real sleep!

When I'm having the problem, it feels like my airway is collapsing in the throat and my tongue is moved back and blocking the air from exiting my nose. Sometimes, this same issue also makes it difficult to swallow. So, I have to open my mouth and clear my throat.

It's also not happening on every exhale too. I'm trying to breath in and out steadily and calmly, but even that doesn't always seem to work.

I'm going in tomorrow to talk to my CPAP provider and ask them if maybe there's something wrong with the machine. It just seems weird that it's so intermittent even when I stick with the same mask (leaving it tightened in the same position) and keeping my CPAP settings constant.

@Julie - I believe the A-Flex is on. I will double check.

Thank you!
Curt

[Pugsy]

I am out of ideas and the one I had was pretty pitiful. So sorry. I cannot grasp what you are describing because I cannot duplicate it. I sat here and tried and can't put my tongue in any position that blocks me from exhaling through my nose.

You might play around with the AFlex settings though. Sure wouldn't hurt.

[LSAT]

If your uit was set at 4-15 and you were hitting the max (15), then your doctor was right...the max should be higher. The CPAP will not go to the max unless it is trying to stop an apnea from occuring. I would set the unit at 6 min and 20 max. Have you determined what your 95% pressure is?

[Pugsy]

Forgot to mention software. Check out SleepyHead in my signature line. It will work with your machine and you can see if the maximum is being reached during the night. If it is spending a lot of time maxed out and your AHI isn't quite optimal then you may be experiencing unwanted apnea events. Use the software to see what is going on.

[jweeks]

If your uit was set at 4-15 and you were hitting the max (15), then your doctor was right...the max should be higher. The CPAP will not go to the max unless it is trying to stop an apnea from occuring. I would set the unit at 6 min and 20 max. Have you determined what your 95% pressure is?

Hi,

This was my first thought, too. Since I didn't see AHI mentioned, I suspect that the original poster isn't watching their data. Since CPAP does not work on a sliding scale (the pressure is all or nothing as far as treatment goes), not running at the prescribed pressures is giving very little treatment value, and might not be worth the aggravation of using the machine at all.

I suspect that ccrandall77 could benefit greatly from a BiPAP machine. On BiPAP, you can run with the higher pressure on inhale and get the full treatment value, yet have a much lower exhale pressure to make it easy and comfortable to exhale. Insurance plans will sometimes not allow a patient to have a BiPAP until they fail on CPAP. If this were me, I'd complain repeatedly about the pressure until I was declared to be a failure, and then get the BiPAP machine.

-john-

[Julie]

I also think some people believe they have to breathe a certain way, to a certain rhythm, etc., and don't understand that they should not be concentrating at all on breathing (just keep it normal as you would without cpap), and let the machine do it's thing, rather than trying to regulate what happens themselves.

[ccrandall77]

To answer some of the questions here, my AHI was diagnosed as 87 in my sleep study. Initially on the CPAP, I got it down to about 12.6. After switching masks, I see my 7 day average shot up to 36 and my 30 day average is now 26. I think a large part of that is when I was at an AHI of 12, I was only getting a little bit of sleep, so statistically it may not have had long enough to get a good reading.

I don't have a 95% pressure stat, only a 90% and it was around 12.5 cm before I lowered the pressure to 10-11 cm. The reason I did that was because no matter how tight I was getting my mask (that covered my mouth and nose), it was leaking bad and making a bad sound in the middle of the night that woke my wife and I. Also, when it'd hit its peak, that's when I'd start to have problems exhaling.

When I lowered it to 11, I finally got my first night with 5+ hours of sleep (out of 9 hours in bed) and hit 53 on my Zeo sleep score. My previous high was 41 and I was averaging 22. And while maybe my AHI went up, I found I wasn't ripping my mask off at night and I was feeling much better in the morning. So, maybe it wasn't what the doctor ordered, but it seemed to work.

I did increase my A-Flex from 2 to 3 and I was better last night in terms of the exhaling. However, I got very poor sleep... but I think it's because I'm adjusting to the memory foam wedge that's forcing me to sleep on my back. I have boxing class tonight, so maybe I'll be so tired that I'll just fall straight to sleep tonight and that won't be a problem.

I did talk to the technician at my CPAP provider and he hasn't heard of anyone else having my complaint. To describe again, when this issue arises I feel resistance trying to exhale. This is causing the back of my tongue to collapse backwards into the throat and upwards against the soft palate. It's similar to the position the tongue would go in if you were trying to snort like a pig. Usually the deeper the breath, the harder it is to exhale when this issue arises. Then I'll have to eventually open my mouth to exhale and then cough or clear my throat so I can swallow and exhale again.

To answer a previous comment about feeling the need to breath a certain way, I'm not really doing anything differently than normal UNTIL I have the exhalation issue. Then I try to take slow, controlled breaths.

Maybe I do need a BiPAP. I'm going to give it another 2 weeks as I've only been on the CPAP for maybe a month or a little longer. And I'm also messing around with the foam wedge and stuff. I was just hoping someone here might've experienced a similar issue and have a resolution to it.

Thanks
Curt

[jweeks]

However, I got very poor sleep... but I think it's because I'm adjusting to the memory foam wedge that's forcing me to sleep on my back.

Curt,

This is interesting. Note that there is a type of disorder called "positional apnea". That is where your OSA gets much worse depending on exactly how you are sleeping. For most people with this positional disorder, it is much worse when you are on your back. In my case, I was considered to be untreatable when I sleep on my back (a pressure of 30 was not enough), but I am easily treatable when I sleep on my side. I was given the wedge during my first two sleep studies. In my third study, we came up with a way for me to sleep on my side with a pillow placed under my shoulder, then another pillow on top of that to support my head. This got me on my side, and elevated my upper body just a little. That made a huge difference for me. I wedge a memory foam pillow up against my back to keep me from rolling off of my side.

I cannot give you any medical advice, but if this were me, I'd consider trying to sleep one night on one side, and another night on the other side, and see if you do any better. If so, you might be one of the folks that are position sensitive.

-john-

[ccrandall77]

I think you might be right. When I lay on my side, my problem exhaling is better. However, I think this whole probably is better overall now. I guess I'm still adjusting to the CPAP since I've only been using it for 6 weeks or so. I had the pressure increased to 17 cm max, but it's still starting at 4 cm. That seems to be helping. The last 3 nights I've been asleep 75%-80% of the time while in bed according to my Zeo. I also got more than 5.5 hours of sleep at hit a score of 62 which is by far my best. Before my CPAP, I was averaging 11 on the Zeo.

While I probably breath a little easier on my side, since I sleep more soundly I end up killing me hip joint by laying on it so long. So, I'm just going to force myself to sleep on my back with my memory foam wedge. It's better for my back as long as I don't try rolling on my side at some point in the night.

Now I have 2 remaining issues. First, some nights my Sleep Weaver mask hisses and other nights it doesn't. I'm keeping the straps tightened the same way and I adjust the position on my face per the instructions. So, I'm not sure why some nights it still hisses. It's a bit bothersome because it'll chap my upper lip and dry out my eyes a bit. It also bothers my wife. Which is the other problem... my wife is bothered by the CPAP sounds. So, I'm sleeping better and she's sleeping worse. Hopefully we both adjust.

Thanks
Curt

[n0hardmask]

... It's better for my back as long as I don't try rolling on my side at some point in the night.

Now I have 2 remaining issues. First, some nights my Sleep Weaver mask hisses and other nights it doesn't. I'm keeping the straps tightened the same way and I adjust the position on my face per the instructions. So, I'm not sure why some nights it still hisses. It's a bit bothersome because it'll chap my upper lip and dry out my eyes a bit. It also bothers my wife. Which is the other problem... my wife is bothered by the CPAP sounds. So, I'm sleeping better and she's sleeping worse. Hopefully we both adjust.

Thanks
Curt

Curt,
The leaks can be a big deal for both parties. Since you say you'll try to stay on your back, how about trying to suspend your hose so it doesn't pull the SW off to one side? I love the SW, but it is likely to leak when rolling over. I think that's why Circadiance came up with the lightweight tube, to attempt to reduce the tugging on the cloth mask.
Make sure your face is pretty well cleaned, and unfortunately shaved where it hits. I have a short beard; hate to shave, but do keep it shaved and clean at the mask seal.
Do you use a humidifier? I use mine in pasover mode- no heat, but enough humidity to help with the sealing. Good Luck!

[ccrandall77]

I am suspending the hose and I do make sure to thoroughly wash my face before bed every night. I do, however, have facial hair so that might explain the leak above my lip. I may just clip something to the top of my nose to stop the leak spraying into my eyes.

Thanks
Curt

[Cereal Killer]

Yes, 4 cm is my starting pressure and it ramps up to 10, 11, 15... whatever I have the max set to on that given night (experimenting with the right pressure for me)

There is a lot going back and forth here and I don't see that any of the parties actually understand what pressure settings you are using.

1. When you say 4 cm, is that the starting ramp pressure or is it the minimum pressure? There is a difference.

2. Are you using auto CPAP settings? If so, what is the min pressure setting?

3. Or maybe you are using straight CPAP with 4 cm starting ramp?