New to CPAP, woke up choking

[dave0076]

Hello,

Looking for some help. I started CPAP about 5 weeks ago. I use nasal pillows and sometimes will open my mouth and wake up to air coming out of my mouth. I started taping my mouth shut and that has helped. Last night I dreamed I was in a tornado and could not breath. I woke up from this and it felt like I really was choking in my sleep and could not breath for a while. My hands felt numb after waking up. When I woke up I was breathing through my nose and the tape was in place.

When I looked at the sleepyhead data the flow rate looked very strange. at 00:44:15 there is a lot of high frequency noise which looks strange but only lasts for about 10s. I have recently been having some insomnia and this event made it difficult for me to fall back asleep.

I'm thinking my nose might have become congested and made it hard to breath with the tape over my mouth and a congested nose. But after I woke up I was breathing through my nose so I'm not quite sure. After this I am not going to tape anymore. If my hands were not numb I would have thought this could be just a bad dream and some anxiety.

Before bed I took 500mg tylenol and 25mg Benedryl (diphenhydramine)

I had some initial good nights with CPAP but have struggled lately and this has resulted in higher anxiety and worse sleep. The frequent wake ups and rough nights are taking a toll on me.

Thanks for any feedback.

[Pugsy]

Welcome to the forum.

That "noise" is just an increase in respiration most likely from an arousal from something. No way to know what might have caused it if you don't see anything preceding that time frame. If you zoom and and make that time more at the end of the graph instead of at the left side beginning of the graph you might or might not spot something.

Arousals or awakenings don't always gives us what caused them. Wish they did because then we could try to maybe prevent them but without knowing a cause for a problem it's hard to fix the problem.

When the insomnia monster comes for a visit we don't always know what calls him and/or why he wants to hand round and annoy is.
He does create stress though because then we start clock watching and worrying about waking up and going back to sleep which of course feeds the insomnia monster and he stays even longer.

Do you have trouble falling asleep initially at the beginning of the night (sleep onset insomnia) or is it mainly staying asleep (sleep maintenance insomnia)?

Do you take any medications of any kind...if so, what?

If Benadryl helps..you can take more than 25 mg and see if that helps you stay asleep longer.

Congestion....will definitely cause wake ups even if the congestion is relatively minor in the grand scheme of things. I once tried a mask that the pressure of that mask on my nose caused congestion. I would wake up congested...remove the mask briefly off my nose and the congestion would clear up immediately and I would then put the mask down and go back to sleep but only to wake up again in a short time with the congestion again. I lasted 90 minutes with that mask. I thought for sure that those gazillion wake ups from congestion meant I lasted almost all night with the mask before I took it off and switched masks but the reports showed I changed masks at 90 minutes into the night.
If we can't breathe comfortable we can't sleep well.

[Pugsy]

Some hints about dealing with the insomnia monster can be found in RobySue's blog....she experienced it first hand.
http://adventures-in-hosehead-land.blog ... er_19.html

Take a hard honest look at your sleep hygiene...see if anything in it is maybe calling up the insomnia monster or feeding him.

[dave0076]

Thank you Pugsy,

I have posted a screenshot with data earlier. There was one 10s hypopnea about 1 minute before.

I seem to have more trouble staying asleep.

I am taking prilosec twice a day to treat a small ulcer, a multivitamin, and fish oil daily.
I take tylenol, benedryl, melatonin as needed

I will read through the link you provided thanks.

I am trying to get good sleep habits (no alcohol, no caffeine after noon, shower/read/bed, start/stop same time, deep breathing, get out of bed 30min if not asleep, etc). Trying to keep anxiety under control but not sleeping makes that difficult.

Thank you,

[Pugsy]

IMHO it's highly doubtful that the one little hyponea several minutes before the wake up was the cause of the wake up.
Remember there are spontaneous arousals (no known cause we can blame) and there are breathing related arousals.

Anxiety or worrying about the awakenings is the number one feeder of the insomnia monster and it is so hard to not do.

I assume you aren't experiencing any other causes that might make the awakenings be more of an annoyance...pain, mask fit, mask comfort, bed comfort, pain, other health issues??? Have to ask because we never know what might be a hidden factor.
I asked about meds because medication side effects often cause insomnia and we don't realize it. Even meds that come with a "may cause drowsiness" sticker can do it. I have that situation myself. I take a pain medication for my arthritis back/pelvic pain but despite it having a "may cause drowsiness" sticker on it for me I happen to be one of a very small percentage of people where it sort of wires them up and causes insomnia. I have a choice..sleep maintenance insomnia from the pain if I don't take something or sleep maintenance insomnia from the meds and less pain. Helluva choice huh? So I take a different pain med at bedtime that doesn't wire me up so much.
Even then it doesn't last all night but I at least don't wake up 2 or 3 dozen times with pain and having to change position.

We do know about the congestion which can of course cause arousals. You can try various things to reduce that annoyance.

I know telling you to try to not worry about the awakenings is much easier said than done. You already know how much anxiety feeds the insomnia monster but not worrying about it is much easier said than done.

You are taping your mouth....is that correct? Just how much leak problem out the mouth would you have if you didn't tape?
I am wondering if you didn't tape your mouth and just let you mouth breath a little when the nose gets congested if it would be a suitable compromise. Not all mouth breathing equals massive loss of therapy pressure out the mouth. I have proof of that myself where I did some known mouth breathing just to see what it did to the leak line. It didn't do much.

Try 50 mg of Benadryl...might have a bit of a Benadryl hangover in the AM but maybe that hangover would be less than the hangover from too many awakenings and poor sleep in general hangover.

[chunkyfrog]

Instead of regular tape on your mouth, try chin up strips.
They allow you to open your mouth if needed, but make it awkward to do so.
Sometimes, hilariously so.