How do I get past the suffocation feeling?

[iggyb]

Hi, I am VERYnew to this CPAP thing. How does one get past the suffocation feeling prior to falling asleep? I've tried a nasal mask and am now trying the Swift FX. I would really like to try the Phillips Respironics Wisp. Any opinions would help!

[Pugsy]

What pressure are you using?
Are you using the ramp feature? If so at what pressure is it starting out at?
What size nasal pillow?

Also could you please take the time to add your equipment to your profile like I have mine at the bottom of this post.
Here's how if you don't know how.
wiki/index.php/Registering_Equipment_in_User_Profile

Welcome to the forum. Once we know a little more information we can probably come up with some ideas to make you more comfortable.

[SleepWellCPAP]

Hello Iggyb!

Let me be the first to welcome you to the world of CPAP and CPAPtalk. Though I have only been registered for a few short weeks, I have found that there is an encyclopedia of knowledge right here at your finger tips. Especially, Pugsy, I have read many of her posts and she could easily be, if she's not already, a private consultant using this equipment.

Regarding the feeling of suffocation, it comes from a part of our brain that detects minute changes in our pH balance. Without adequate respiration, our CO2 level builds up in our blood making it slightly acidic. My guess is that you have a minor leak coming from the nasal pillow and you're not getting enough airflow. The pressure, ramp setting and pillow size, as Pugsy points out, are very important variables in this equation as is EPR of Flex if you're using it. Those features, exhale pressure relief for instance, reduce pressure making it more comfortable on exhale. If it's turned on, it could be too much relief. Turning that setting down, in this case would be appropriate.

Since you're new to the CPAP world, you will find there are a few books on the subject that provide a good foundation of what you should know.

Good luck, be sure to keep posting how you're doing!

Jim

[quietmorning]

I did away with using the ramp feature the second or third night and go straight into my pressure. I found that to be most helpful getting rid of that feeling that I was suffocating.

There are other things that can cause that feeling though, so Pugsy's questions will lead you to MUCH better results if you will answer them.

[iggyb]

Hi Pugsy,
Thanks for your reply. I am still in the trial stage of this whole thing. I was given a Phillips Restonic System1? The first mask I tried was a Zest nasal? The last two nights I've tried the Swift FX (which is so much nicer - but hard to get used too) with the small nasal pillow, and tonight I will try the medium (because of the large holes), just to see. I like the nasal mask, but find it too cumbersome (although I like tha fact that nothing is up your nostrils), and the head gear slides back as I sleep. I believe the setting is at 5-20 for now, and yes I have been using the ramp feature. I go in for my first return visit (to see if I qualify for a free machine, on April 18th). So far I find it hard to fall asleep - very suffocating, and I am only keeping it on till 4am each night. I do feel more energy, but I'm not at 100% yet. I was waiting to post what equipment I am using until after my "trial" period. I am looking at the F&P Icon, and I'd really like to try the Wisp mask. Sorry for my ignorance, I don't even know what all the abbreviations mean. Thanks for your help!!!!

[Pugsy]

Ramp starts at 4 cm and works its way up to minimum pressure 5 cm since you say your pressures are 5 to 20...APAP machine with pretty much wide open settings. Are they trying to figure out a suitable setting or range?
Depending on how long the ramp is...you are likely spending a lot of time a 4 cm and a lot of people simply feel like that setting or even 5 cm makes them feel like they are suffocating. While we won't ...it sure feels like it. Simply not enough air movement is felt.
You can turn ramp off in the clinical setup menu
http://www.apneaboard.com/pr-system-one ... structions

First thing I would do is turn off ramp...see if that helps...if it doesn't help enough...maybe think about getting the minimum set to 6 cm which will be more comfortable for you.

Check out my signature line for PR S1 software options...will give you an idea what software reports look like for your machine.

[Xney]

You can feel "suffocation" from either "too much air" or "too little air" - which is it?

Pugsy describes the "too little air" thing, usually due to ramp. More air is sometimes needed when the pressures are low, and the ramp can start out that way.

[Todzo]

Hi, I am VERYnew to this CPAP thing. How does one get past the suffocation feeling prior to falling asleep? I've tried a nasal mask and am now trying the Swift FX. I would really like to try the Phillips Respironics Wisp. Any opinions would help!

Hi iggyb!

A CPAP machine is designed to supply air volumes many times greater than the expected need. It is not a matter of you getting enough air rather it is much more likely that due to the added pressure you are breathing too much air which has created a breathing control problem making you desire more air in spite of the fact that you are already breathing too much.

I have felt this many times and every time reducing breathing volume solves it.

Part of this is stress related as one of the “breath more” signals is the current level of stress hormones. It is time to calm down.

Controlling your breathing is your best path to this. As one author puts it “breathing is your one direct link to your nervous system. It is the means by which you can control the fight-or-flight response of your sympathetic nervous system and activate your parasympathetic nervous system to respond with what has been called both the “feed-and-breed response” and the “rest-and-digest response”[1]. Indeed breathing a more appropriate volume of air will move your blood gases back to a point where circulation can resume, metabolism can proceed, and the breathing control system can become more stable.

I would recommend practice of gentile breathing with the machine during the day. Time of quiet listening to music for example. And perhaps some doing other things. Stay away from violent TV. Your breathing control system (breathing reflexes) are getting used to the pressure.

As I go to bed at night I make a point to quiet my breathing with the machine. I also warm my back side and hips with my constantly warm hands and arms. In days past they used to take pans with warm rocks to pre-warm the to be used bed.

I do hope you have very restful nights!

Todzo



[1]: “Heal Yourself with Qigong” by Suzanne Friedman - Page 19

Search terms for Google Scholar and PubMed: “sleep apnea ventilatory instability” “sleep apnea co2 reserve” “sleep apnea carotid body”

[SleepWellCPAP]

Hello Todzo,

I have and do recommend patients practice with their equipment during the day if they are having difficulty. Your post however, put an entirely new light on that concept.

Thanks very much for posting!

[hyperlexis]

What model number is your machine? If you have a newer version of the System One auto machine, your machine may have the OptiStart feature in the special clinician's menu (the one you have to hack into to change pressure settings etc.) The OptiStart feature is probably the best thing about the PR1 machine and I sing its praises all the time.... Basically it allows the machine to tailor your start pressure to what the machine detects you need. So if you need more than you Rx of 4, it will 'learn' that and over time, your start pressure will go up. That alone could help reduce the suffocation feeling you are having. So make sure OptiStart is turned on, and after 30 hours of use, it will kick in.

Plus, over time you will get used to cpap anyway, so the suffocation feeling should diminish with experience.

Good luck!

[Todzo]

Hello Todzo,

I have and do recommend patients practice with their equipment during the day if they are having difficulty. Your post however, put an entirely new light on that concept.

Thanks very much for posting!

Hello SleepWellCPAP!

The breathing control and carbon dioxide maintenance issues which are brought into the picture by Obstructive Sleep Apnea (OSA) and considerably exacerbated by the positive pressure of xPAP therapy are little known.

This is an area of very active research. Please do spend some quality time with the Google Scholar and PubMed search terms[1].

I think it is a bit easier to understand if you begin with the effects in the brain[2].

Please study hard and communicate with your piers!!

Todzo

[1]: Search terms for Google Scholar and PubMed: “sleep apnea ventilatory instability” “sleep apnea co2 reserve” “sleep apnea carotid body” “complex sleep apnea” “central sleep apnea” “sleep apnea carbon dioxide maintenance” “obstructive sleep apnea brain damage”

[2]: Philip N. Ainslie and James Duffin, Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation Published online before print February 11, 2009, doi: 10.​1152/​ajpregu.​91008.​2008 AJP - Regu Physiol May 2009 vol. 296 no. 5 R1473-R1495
Link: http://ajpregu.physiology.org/content/296/5/R1473.long

[johnthomasmacdonald]

For me it required going over to a bilevel machine in order to stop feeling that i was suffocating. My straight pressure was around 11-14 which i found too high to exhale against. With each breath i felt i was falling more and more behind in keeping up with exhaling enough to get rid of carbon dioxide. I switched over to a bilevel where my exhalation pressure is 7-8 and my inhalation is 11-14 and now I have no problem breathing with it. It still doesn't drop my ahi numbers much and i don't feel any more rested after 8 months on it but at least i'm not suffocating - i actually don't mind it at all).

[Xney]

If you have high pressures (14 or 15 or higher, generally) you can really feel like you can't breathe because you can't breathe out.

If you have lower pressures (it depends, but 7 or lower, perhaps) you feel smothered, like you can't get enough air.

It's important to know which is the problem before thinking about how to fix it.

too high pressure: use EPR or C-flex, or a bi-level/VPAP machine

too low pressure: turn off ramp, and raise pressure if still not enough.

[Todzo]

The thing about xPAP pressure is that it is always positive. Always above atmospheric. Even leaks twice vent rate are within the ability of the machine to compensate.

So I guess I will believe that the person is "not getting enough air" when a person shows me an awake segment where the person shows low air volume being actually used otherwise I think the breathing control system is to blame and responsible for the feeling of suffocation.

It is easy to breath more air when it is being rammed down the pipe!

I do think that ramp can allow the person to fall asleep and experience apnea or hypopnea, have his central nervous system activated, and be breathing more air because of that.

It still comes back to breathing control and the related carbon dioxide maintenance issues.

From my own experience I am well aware that stress is the major factor in my tendency to use too much air.

[DEXSUZ]

Hey Iggy:

Glad you're helping yourself by getting CPAPed and coming on here for advice.

I developed my own six-step program to get over that feeling of being smothered.

1) I found veteran CPAP users and they acted as mentors every step of the way. I knew I could ALWAYS go to them when I got frustrated or had questions.
2) Before I began using my system to sleep nights I'd sit around with the machine on and listen to it, occasionally slipping the mask over my coconut to become familiarized, comfortable, and getting my mind right.
3) Next came early afternoon naps (an hour at most)with the mask on, all systems go, the phone off the hook, and nobody home.
4) After the machine and I became fast afternoon friends, I'd have everything set at night but go to sleep without it. When I inevitably woke up at 12:30 or 1 a.m., groggy as heck, I would then throw the mask on and fall back to sleep in an almost exhausted way before my mind could be alerted and start fretting about this contraption on my face.
5) Over two weeks or so I almost looked forward to when I'd wake up and put the mask on because I was getting better and better night's rests. Thus, I set a definitie date for myself on which I'd go to bed WITH mask on an everything powered up.
6) Sunday night March 3-4 was my night and 24 of 27 sleeps since then have been of high quality.

It's astonishing to me how I've come so far in seven weeks. Be patient. See your CPAP gear as your friends. Keep reporting back to CPAPtalk. Sleep tight my friend!