Please help me understand what happened

I've been doing really good since I got the new cpap. My AHI has been between 0.3-0.7 since getting and then suddenly last night was a horrible night. I didn't do anything different and I'm trying to figure out what went wrong. I woke up several time literally gasping for air. I think it was when I was having centrals because when I woke I didn't have the sensation of feeling like my airway was blocked. It simply felt like I was not breathing.

My first thought was mouth breathing caused this but when I set the charts to show data 30 seconds at a time it did not look like mouth breathing triggered these events. At the beginning of most of the events my leak line was flat and within the first 10 seconds of the event it wold start to go up (sometimes way up which is when I would wake up gasping).

Here's part of what I'm talking about. I really don't have the data all figured out yet so any opinions are welcome. I woke up with a massive headache today and my whole body felt like I had been hit by a truck. I'm hoping that there is something I can do to prevent this happening again.

Looking at your leak line, the first thing I notice is the large leaks. Notice how it's approaching the red line in the leaks graph.
This is probably the first time you've felt comfortable sleeping - actually sleeping - with the mask.
Since it's a nasal mask, I'm going to assume you're leaking from your mouth.
It's pretty common, but in your case, maybe you notice it immediately.
Many people try mouth taping or denture strips to paste the mouth closed, but that wouldn't work for me.
You may need to go to a full-face mask.
You don't have to breathe through your mouth with a full face mask. It just helps keep your air from leaking from your mouth as you breathe through your nose.

The most popular full face masks are the ultra mirage full face and the quattro. It's usually one or the other that will fit, depending on the shape of your face. Either of these is usually successful at stopping large leaks with those who begin mouth leaking with nasal masks.

There may be other circumstances. Are you sure nothing has changed? Any life-circumstances that are different? Change in habits?

I agree, it almost sounds like mouth leaking. With the air rushing out of your mouth, a feeling of suffocating is not uncommon. A central apnea would not really cause leaking, anyway, unless you started pulling the mask off. Anyway it's easy to test for the mouth leaking, either tape for a night or two, or get a FFM. As DD said you're probably now getting used to the CPAP, your body is relaxing more, your jaw falls open and bam mouth leaking. I'd eliminate the mouth leaking as a culprit first, before you start chasing CA's.

Thanks for the feedback. I had another bad night and I bet that you're right about just now getting adjusted to therapy. That makes sense. I had a bad night last night too and the only connection I've noticed between the two night is that I was dreaming more and sleeping more on my back. Before cpap I never slept on my back at all so that is odd. I wasn't dreaming much until the last couple nights which I think is due to not sleeping deeply because having the mask on was bugging me and keeping me awake.

I think I have a bad combination of REM sleep, supine position and probably some mouth leaking going on. When I zoomed in on the graphs the initial leaks looked like they started seconds after the apnea event started, but once the apneas get going then the leaks get out of control.

My AHI last night was higher then the night before. I will have to give taping a try or find some other way to keep my mouth shut because I just got this mask a month ago so I can't get another one for 5 months.

oscar98 wrote: My AHI last night was higher then the night before. I will have to give taping a try or find some other way to keep my mouth shut because I just got this mask a month ago so I can't get another one for 5 months.

I assume you mean your insurance won't cover another mask for 5 months. If you find you do need another mask, you can get one at cpapauction.com. Much lower prices, though you will need to send them a copy of your prescription.

KatieW wrote:
I assume you mean your insurance won't cover another mask for 5 months. If you find you do need another mask, you can get one at cpapauction.com. Much lower prices, though you will need to send them a copy of your prescription.

That is correct. My RT is dropping off a chin strap on her way home tonight so hopefully that will help. I would like to try one of those hybrid masks if the chin strap doesn't work. I might be able to convince them to get me a mask early but that would mean waiting a looooong time before getting another one.

The auction site is a good idea but I'm having trouble getting a copy of my prescription.

oscar, any doctor can write you a prescription. your GP / PCP can write you one, so can a psychiatrist or any other licensed MD. (not sayin' you're a basket case or anything )

There is an explanation of the Rx & some examples on this Wiki page: wiki/index.php/Working_with_Physicians_ ... .2FScripts

My "prescription" was actually a letter from my sleep doctor where the following info was stated:
"On the hospital letter: Current Date. Declaration: Ms Echo, date of birth, address. Ms. Echo suffers from Obstructive Sleep Apnea. Therefore she/he needs life-long therapy with a CPAP device during the night. The device doesn't contain any pressurized gas and can be safely carried on board of an airplane. Doctor's signature"
and the reason she gave it to me was in case I would travel with the CPAP on a plane, then I could show the airline the medical necessity for a CPAP. Cpap.com accepted it as a "prescription" as it had all the required info & terminology. You can also have your doctor add "patient should have mask of choice" and your pressure setting. See the examples at the above link.

So, hopefully you can easily get a prescription like this!

Oh and in case you hadn't seen this yet:
All the info you could ever want about mouth taping, denture strips, and other fancy ways of keeping our traps shut at night:
Links to: Mouth leaks - Air Leaks - Tape - DIY Guard

Thanks echo. I like the way your doctor worded your letter. I will ask my doctor to do that.

The problem I'm running in to is that we renctenly changed doctors and DME's. My old DME is refusing to fax my and my husbands records and order for the cpap to the new DME and I went to the doctor who prescribed it and he also refused to give us a copy. He claims he doesn't have it and I need to ask the DME for it. I'm getting the run around.

I will make an apt with the new doctor tomorrow and ask him to take care of it for us.

Sheesh how annoying! I edited my post so that it more accurately reflects the original letter.
Good luck!!! Get the horns out get that letter!!

I would try to eliminate air leak first. I am not a mouth breather, but with the machine I can sleep better and very relax, I have several nights with my mouth open. I woke up with dry mouth. I tried painter tape as some people suggested, however, don't like the smell of the tape. I am now using the cheapest bandage I can found and just take my mouth vertically, just enough to prevent my mouth open at night. If I need to release excess air in the mouth, I just press the corner of my mouth and let the air out. Got 0 air leaks, 0 AHI several nights straight .

Hope you don't need to use the full mask. Good luck.

The problem I'm running in to is that we renctenly changed doctors and DME's. My old DME is refusing to fax my and my husbands records and order for the cpap to the new DME and I went to the doctor who prescribed it and he also refused to give us a copy. He claims he doesn't have it and I need to ask the DME for it. I'm getting the run around.

EXCUSE ME?????

Your former doctor and the DME both need a swift kick in the pants. Your records and your prescription are YOUR property--your former doctor should have a record of the prescription and write out a new one for you if he didn't keep a copy. Likewise, the old DME (which is probably miffed because they are losing your business) should send it upon your request.

I'd start with a quick complaint to the medical licensing board in your state, or a letter cc'd to that agency cc'd to the physician--I bet you'll get results THEN. Don't let either of them get away with this treatment!

Janknitz wrote:

The problem I'm running in to is that we renctenly changed doctors and DME's. My old DME is refusing to fax my and my husbands records and order for the cpap to the new DME and I went to the doctor who prescribed it and he also refused to give us a copy. He claims he doesn't have it and I need to ask the DME for it. I'm getting the run around.

EXCUSE ME?????

Your former doctor and the DME both need a swift kick in the pants. Your records and your prescription are YOUR property--your former doctor should have a record of the prescription and write out a new one for you if he didn't keep a copy. Likewise, the old DME (which is probably miffed because they are losing your business) should send it upon your request.

I'd start with a quick complaint to the medical licensing board in your state, or a letter cc'd to that agency cc'd to the physician--I bet you'll get results THEN. Don't let either of them get away with this treatment!

Excellent idea!!! I know the DME was miffed, they really gave me attitude when I took them their crappy Escape back after begging them for a better machine for 2 weeks. I guess old doctor is too but I don't really give a hoot what them man thinks, he's an egotistical quack.

On another note my RT showed up with a chin strap and I fail to see how this thing is going to help one lick. I put it on as tight as it will go and can still open my mouth as much as I like. Maybe I have a small head.

I like the bandage idea from above. That might actually work since I'm not opening all the way up.