Trouble falling asleep with APAP

I did a search on this, but couldn't find anyone addressing what I'm experiencing specifically with my APAP.

I just started therapy this week. I realize it's difficult to adjust for some people. So last night I took an antihistamine which will knock me out usually.

I was able to drift off to sleep. It's just as soon as I do I awaken with a giant inhale - almost like a gasp.

I'm also having the sensation that I have exhaled and I'm just staying exhaled or breathing very shallowly as I drift off into sleep.

I'm on a Resmed s8 Vantage. Range 4-18. Swift mask that is working well so far. During the 30 minutes I tried to fall asleep last night (before I gave up) my machine recorded no apneas and 3 hypopneas and a 95% pressure of 6.

Any ideas? Jenny

Try not to pay attention to your breathing, Jenny. I too noticed a "giant inhale" when falling asleep, but treated it as an idicator of "oh, I'm falling asleep, how nice", turned over, and slept..

There's a lot of strange things in this therapy - the way the mask feels on your face, the way the hose tugs, the way the air comes in and goes out, the way your breathing sounds, the noise the motor makes - you have to gradually relax and let all those strange sounds and sensations become a signal the pretty soon you'll sleep great.

It isnt' easy for those of us who notice every little sound, but it's achievable, and worth it.

Back when I started, Littlebaddow had a moto saying: "Note to self: remember to sleep and breathe at same time". I was thinking of it on one of those first sleepless nights, smiling, and it dawned on me that funny as it was, it also said something about my own responsibility to make this therapy work.

The noises and sesations didn't go away. I told myself that, as a matter of fact, they're here to stay, and I'm going to learn to sleep with them.

And I did.

It's not easy, but an important part of it depends on you .
Good luck!
O.

Did you read your numbers off the Vantage this morning?

With the Vantage, you don't get the exhale relief unless you are in the cpap mode - which I know you can't do because you are titrating.

Probably last night your fell asleep and either mouth breathed, or had an apnea. Therefore, your pressure shot up high and you had trouble breathing against it.

You need to tape, or use poligrip strips to hold your mouth shut. Either that or get a full face mask. You must guard against mouth leaks, or your numbers will be a mess and it will be difficult to tell what your titrated pressure truly will be.

Don'y fret Jenny, it WILL work out.

Now, the most obvious explanation for what you are experiencing is the low minimum pressure that your S8 is set to (4 cmH2O). For MANY of us, presures that low just result in insufficient flow of air and we feel like the air is stuffy at best, and many will feel air-starved. That's probably why you're waking up with the deep breath and feeling the gasp. The obvious solution would be to increase youir minimum pressure, but you ought to discuss this with your sleepdoc. Most of us have found 6 or 7 cmH2O to be the lowest where we feel comfortable with the air flow. Its also the reason why I won't use the ramp function at all.

Now, your S8 Vantage is a GREAT machine. Do you have the settling time set? If you do, your S8 will stay at your minimum pressure for whatever time you have set as the settling time, before it begins to adjust pressures to what you require to treat events that its detecting. So, many of us set the settling time to "OFF" to enable the S8 to begin applying the pressure that it determines that you need, from the very beginning every night.

Third, many say that ResMed machines have a tendency to over-detect hypopneas and some feel that the machine will over-titrate (increase pressure) based on hypopneas that its detecting while you're awake. I know mine sure does. I can sit there while I'm awake and watch my HIs and AHIs increase while I'm reading a book breathing normally. It somehow, detects hypops though. These may therefore, be artifacts, and so I wouldn't be too concerned about what you're seeing in your data while your awake. The machine is designed to detect and treat obstructive SLEEP apnea.

Finally, the range on your S8 is pretty broad. Most recommend at range of +/- 3 cmH2O from your titrated pressure. If you had a sleep study and were titrated to 10 cmH2O for example, a range of 7-13 cmH2O would be advisable. Yours is pretty wide, and I'd talk with my sleepdoc about that, if I was you. Narrowing the range allows the machine to track your breathing and pressure needs more rapidly.

Most of all, hang in there, cause you have the right attitude and great equipment to help you, and all the support that you'll need right here.

Cheers!

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, Ramp

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, Ramp

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, Ramp

O. - ah so you know what I'm talking about. It did frustrate me that the gasping/deep inhale was happening. I'm going to try implementing a more laid back attitude and the motto you suggested. I am definitely one of those people that hear and see everything little thing.

Linda - I will try taping my mouth tonight to see if it's mouth breathing that is causing me trouble. I know I don't breath through my mouth, but my lips do fall open when I'm sleeping. So air could escape this way I imagine.

Chuck - interesting idea about the lowest pressure setting. Last night I did turn the settling down to 5 minutes. So the gasping was occuring after the settling time was over. I do feel like the air I'm getting through the pillows is insufficient. Even awake.

I was going to lengthen the settling time tonight for the reason Linda suggested. That maybe an increase in pressure was 'startling' me or something. So if I let myself get in a deeper sleep the pressure increase maybe wouldn't bother me.

Well it seems there are lots of possibilities and I have to do some experimenting. No settling time, increased settling time, tape mouth, instruct self to breathe, talk to doc about raising the pressure.

It's so funny, I did mega research about the swift before I started therapy b/c I figured that is where my problems would be, being a side sleeper. But the mask has been just fine so far.

Thanks, Jenny

I do agree with Chuck that you probably should raise the minimum up from 4. In your case, since this is your titration, the doctor probably should do that.

Yes, if your lips open a little, air is escaping. Air escaping causes your pressure to rise. And rising pressure opens the lips more. A continuous cycle that totally screws up your numbers.