Newbie Suffocating but Good AHI

[bunnyslippers]

Hi,
Last night was my first night using a machine. My Dr couldn't get me in for 2 1/2 weeks to set the pressures so I got my RX and set them myself. I purchased my machine from Secondwind.
So RX was for 5/15 so I tried that and felt suffocated. I bumped it up to 6.0 and went to sleep. I woke up a few times feeling hot and suffocated. I then bumped it up to 7.0. I had an AHI of 0 so that was pretty cool, unless it was wrong? Where should I go next with this tonight? The suffocated feeling was not good, especially combined with the hot.
I'm not sure if this is the info you need but I'm struggling to get a screen shot.
Thanks for any help anyone can provide.

SleepyHead v0.9.2

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CPAP Statistics as of Tuesday, April 02, 2013
1 day of CPAP Data, on 4/2/2013.
Details Most Recent Last 7 Days Last 30 Days Last 6 months Last Year
AHI 0.00 0.00 0.00 0.00 0.00
Hours per Night 10:19 10:19 10:19 10:19 10:19
Average Pressure 7.46 7.46 7.46 7.46 7.46
95% Pressure 9.72 9.72 9.72 9.72 9.72
Average Leaks 0.76 0.76 0.76 0.76 0.76
95% Leaks 13.20 13.20 13.20 13.20 13.20

Changes to Prescription Settings
First Last Days AHI Machine Mode Pr. Rel. Min Pres. Max Pres.
4/2/2013 4/2/2013 1 0.00 ResMed Auto EPR x2 7.00 15.00
The above has a threshold which excludes day counts less than 5 from the best/worst highlighting

Machine Information
Brand Model Serial First Use Last Use
ResMed S9 AutoSet 22111016439 4/2/2013 4/2/2013

[Todzo]

Getting used to the pressure can be hard[1].

I wrote this for another thread but I think it may be useful to you at this point.

Others will guide you better than I on monitoring and all.

Have a great week!

Todzo

[1]: by Todzo on Sun Mar 31, 2013 2:31 pm
I think that the education we found to be “Job One” last week should include all such things as options, setting up constant monitoring, bi-weekly feedback, mask fit, hose management...

“Job Two” is getting used to the pressure!!

Notes:

Getting familiar with the machine during the day should be “standard practice”. Some time in bed both learning to fit the mask, move around in the mask with pressure, laying calm in all the positions, moving too all positions, and learning to breath quietly. With the lights on and with your full awareness problems are likely to be sorted out much more quickly than seeing leaks in the data and trying to figure out why.

Then time reading a book, watching non-violent TV, listening to music or the radio, or browsing the Internet. With the involvement of the full resources of consciousness the development of the necessary new “breathing with the machine” reflexes are likely to be much more quickly made.

Reflexes do not come quickly. So lets plan on doing this for an hour a day for a month.

Then some special time learning to breath with the machine with special emphasis on breathing volume and gentle breathing.

At rest (awake in a chair apparently) we average about six liters per minute of air. At twelve breaths per minute that is using about two cups of air per breath while breathing once every five seconds. I would suppose you should use a bit less resting in bed. But the machine makes it very easy to breath in more air. This tends to upset the amount of air we need to exhale and we need to breath all this extra air out against pressure. So a little war begins with each breath of all that extra air too easy in and not so much fun getting out – frustrating – and so our breathing rate tends to increase as well. If you added only 6.4 ounces of air per breath and breathed each breath in 3.6 seconds (16.8 BPM) instead of processing six liters of air per minute you would be processing almost twelve liters of air per minute. It is easy to breath too much air while using an xPAP machine!

The changes in blood chemistry which happen if you do breath too much air tend to hyper stimulate some of the breathing control sensors. When the “frustration” signal is added to this breathing tends to take off (become unstable). The urge to breath actually increases. If events occur the added activation of the central nervous system is added to all of this as well – each time – so this all tends to ratchet up as the night proceeds. I really do believe that this is why we hear so many telling about how they rip the mask off at night and then have a lot of trouble getting back to the mask. They started a little war against the pressure and ended up getting stomped.

In my case this is all exacerbated by Post Traumatic Stress (PTS) from severe trauma in years past. During the time of year near the anniversary of the event I find myself needing to use enhanced expiratory rebreathing space (EERS)[1]. We may well see better therapies for this in the future[2].

For what ever reasons during the first few minutes with the mask I tend to find it hard to get my breathing to volumes appropriate for being at rest in my bed. I have found it helpful to count while thinking about breathing small breaths. Breath in for two counts – then – out for three counts – then pause for one count – – then do it again slower and with a bit less volume. I know I am doing it right when my feet become warm (likely due to the increased circulation) and it becomes very easy to breath. gently. Perhaps a set of techniques should be developed to help people learn to go to bed with their machines.

I believe that stress reduction is likely to help a lot with xPAP therapy.

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

[cosmo]

How bad is the suffocation? You have good numbers, maybe keep the same settings for a few more days for more data then make adjustments?

[Todzo]

Most people do a "screen capture" of the data displayed on the screen they have SleepyHead on which yeilds a picture.

Next they put the picture up on such as http://photobucket.com/ so that the picture now has it's own address on the web.

In my case I do not do this often so I will go to a thread where data is displayed and on one of the posts which disply the data I will hit the "Quote" button as if I were going to reply. That way I can see "how they did it. and even copy/paste one of the segments for one of thier images - change the address section to show my picture - and put the modified segment in my message to display the picture of my data within the message.

HTH

Todzo

[cosmo]

This site is another good one for images....http://imageshack.us/

[sleepstar]

Are you getting this feeling when you first put your mask on and start the machine? Or is it that you're waking up and feeling like you can't breathe?
Are you finding it hard to breathe out?

If you're getting this feeling when you're awake and have just put the mask on - I'd bump the minimum pressure up further. I would think the suffocating feeling would be because you feel like you aren't getting enough air. If you bump the pressure up, you'll be getting more air and it should alleviate that.

[cobra4x4]

Another thing to look into ....

Is the ramp feature turned on, It starts the pressure low (usually around 4cm) then slowly ramps the pressure up. This is supposed to help people fall asleep but for most people it causes a claustrophobic feeling.

Try turning Ramp off, this way you start at your minimum pressure right away.

[123.Shawn T.W.]

Or you have the option of raising the ramp start preasure up to say 6 or 7 ... For 5 minutes ...

Too low a preasure was my wife's problem ... We just kept bumping it up to where she was comfortable, and it caused no other problems ... She is always less than AHI 1 ... Most of the time 0.00!

I wish it was like that for me ... I still rarely get below 8!

[khauser]

You're doing really well for a start!

If you feel suffocated at the start, options are to reduce or eliminate ramp, raise the starting pressure, or try to get used to it (I would never push that). I think you raised the pressure, which is a good way to go.
For waking up hit, if you have a heated tube system I would suggest lowering it. If not but you do have a humidifier you could try lowering the humidity.

But I think you said you WOKE UP feeling hot and suffocated which makes me wonder if you are under treated.

You lost the 95 percent pressure as 9.72 so I am going to suggest you raise the minimum to 8 or 9 next.

Let us know how it goes, and do post graphical data next time please.

[zoocrewphoto]

Do you have the climateline hose? If so, you can adjust the temperature of the air coming out. The default may be too warm for you.

[dlanbro]

I noticed that you have a nasal mask only. If you breathe through your mouth at all that might be part of the problem. When I got my mask fitting they had me try a nasal mask and I knew immediately there was no way that I'd be able to use it. I got what I call "vapor lock". Just a thought.

[bunnyslippers]

I have no problems with it when I put it on, it feels fine. I haven't been using the ramp feature. I wake up and feel like my face is hot and I'm suffocating, like I just can't get enough air. Second night was similar, but with 3 events. 2 clear airway and 1 hypopnea for a .47 AHI, I had lowered the pressure back to 5/15 and raised the humidity. I will raise the pressure up to 7.5 or 8 tonight and see what happens.

I raised the humidity last night just in case that was not helping and of course, since my heated hose hadn't arrived yet, I got rain out. I got my heated hose today.
Is there a humidity setting on this machine that is not warm air? I need some humidity since I'm prone to nosebleeds.

I don't breath through my mouth so not sure that would have anything to do with it?

Thank-you so much for all of the help. I would have been concerned about upping the pressure so much without it. I also know these numbers are my Dr's guess because we didn't do a titration.
Hopefully tonight is better. My head is clear and I'm less tired than before, so that is good.

[dlanbro]

[quote="bunnyslippers"]
I don't breath through my mouth so not sure that would have anything to do with it?

quote]
It was just a thought. Not everyone does. I have a deviated septum and a small airway so breathing through my nose seems to be not an option.

[Pugsy]

Is there a humidity setting on this machine that is not warm air? I need some humidity since I'm prone to nosebleeds.

Use the Climateline hose and set it to automatic humidity delivery. Then you can change the temperature of the air but the humidity level is a constant 80% no matter what the temperature. You you don't have to sacrifice moisture to have cooler air.

[bunnyslippers]

Oh, good! Thank-you Pugsy.
I will do that tonight.
I don't know what I'd do without this group. I'd probably be stuck with a brick and have given up.