Can't sleep with pressure - suffocation feeling

I'm new to CPAP - I have a machine now but I haven't been able to fall asleep with it on. As I try to fall asleep, I always end up with the feeling that I’m suffocating so I have to take off the mask. It feels like I wouldn’t get the suffocation reaction if there was zero resistance to breathing out. Maybe it would also help if there was no air pressure until I start to breathe in. As training, I did the treatment while sitting at my desk and also while lying on the sofa. I was able to do it in those situations, but not in bed trying to sleep.

Who’s had this problem and how did you overcome it? Do I perhaps need BiPAP? (Is VPAP the same as BiPAP?)

I’m trying any setting just to be able to fall asleep with the mask on. EPR off? EPR at 1 or 2, not 3? pressure at 4? Use straight CPAP vs using APAP? Turn off ramping?

My sleep study recommended 6 cm. Masks I have:
ResMed quatro fx large and medium
ResMed “active cell” “shallow” (Activa?)
ResMed air fit P10
F&P Pilario Q
Phillips DreamWear large frame and medium frame
Phillips Wisp

For me a feeling of suffocation means that the pressure is too low and I'm not getting enough air to breathe.

I'd set the EPR to 3. I'm not sure what pressure you're on, but I know I can't stand any form of ramp, and have to start on the normal pressure, which for me is 10. If it's anything below about 8, I start getting anxious as I can't breathe freely.

I'm like the newest person in the world to CPAP (well, almost) - but, after 5 weeks, I totally see what Colin is saying.
For me, I feel like when the mask is on, I need the blower on - and mine comes on at a 6. The 6, after five weeks, feels like nothing - as the lab tec. said to me - "babies are set with a 6".
When the blower is on - the last thing is suffocation. In fact, I can bury myself in pillows and still breath perfectly normal!
Like I say, I am the most least qualified person in the world - but a suggested setting of 6 I think is quite low - which means they are thinking you don't need too much pressure through the night (at least until the auto thing has a crack and see where it goes).
I was the same - I start at a 6 - on average it gets to 8 - if I have had a few beers, it has been known to get up to 14, but I think average about 8-9 -which is nothing.
Give that a go and let us know how you get on

To start with can you tell us which machine you are using? There are lots of Resmed machines. And you mention both CPAP and APAP which mode are you using? If in APAP and the minimum pressure is 6 what is the maximum pressure? If in CPAP mode 6 is low and the machine will only lower to 4 so even if you set the machine to EPR of 3 it will only give you a 2 decrease. If you are in APAP mode and your pressure rises it will give you the 3cm decrease but not till the pressure goes above 6.
We need to begin with what machine and what pressures?

phopap wrote:As I try to fall asleep, I always end up with the feeling that I’m suffocating so I have to take off the mask. It feels like I wouldn’t get the suffocation reaction if there was zero resistance to breathing out.

People use the phrase "I feel like I am suffocating" to mean two very different things with two very different fixes.

Do you mean:

1) There is not enough air coming in through the mask to comfortably inhale as deeply as you want/need to.

OR

2) There is too much air coming in through the mask to comfortably exhale as fully as you want/need to.

If the problem is more #1, then increasing the pressure setting by 1-2 cm is the usual suggested fix.

If the problem is more #2, then appropriately using the ramp feature and making sure that your machine's exhalation relief system is turned on and set at its maximum is the first thing to try.

[I don’t know why my machine isn’t displayed - it’s the ResMed S9 AutoSet.] My sleep study recommended 6cm pressure.

The incoming pressure prevents me from exhaling completely, unless I conciously push the rest of the air out (which is no good when I’m trying to sleep and my breathing is becoming lighter), even when I set EPR to 3. I get enough air when inhaling, I just want to be able to exhale completely without fighting the incoming pressure (because that’s when the suffocation response kicks in). The machine seems to want to make me inhale before I’m finished exhaling.

I’ve tried the EPR set to 3, and also 2, and I’ve tried turning EPR off. I’ve tried both CPAP mode and APAP mode. I’ve tried 6cm CPAP, 9cm CPAP, 4cm minimum/6max APAP, and 6minimum/10max APAP.

phopap wrote:[I don’t know why my machine isn’t displayed - it’s the ResMed S9 AutoSet.] My sleep study recommended 6cm pressure.

put it in the comments section, and fill in your mask.

phopap wrote:[I don’t know why my machine isn’t displayed - it’s the ResMed S9 AutoSet.] My sleep study recommended 6cm pressure.

What was your diagnostic AHI? And did you feel like you had difficulty exhaling on the titration study?

The incoming pressure prevents me from exhaling completely, unless I conciously push the rest of the air out (which is no good when I’m trying to sleep and my breathing is becoming lighter), even when I set EPR to 3.

I understand what you are talking about; I suffered horribly from this problem during my own newbie days. It's not as common of a problem as the "I feel like I can't inhale fully" problem.

I get enough air when inhaling, I just want to be able to exhale completely without fighting the incoming pressure (because that’s when the suffocation response kicks in). The machine seems to want to make me inhale before I’m finished exhaling.

I also understand all too well the feeling that the machine was trying to make me inhale before I was done exhaling.

Although most people around here will say that EPR will not increase the pressure until you actually start to inhale, that is not how it felt to me back when I was a newbie using a Resmed S9 AutoSet of my own. To my (oversensitive) throat it felt as though the S9 was subtly starting to increase the pressure just before my exhalation really ended and the resulting "tickle in my throat" feeling really irritated me no end. After I was switched to a PR BiPAP, I no longer experienced that sensation that the machine was trying to force me to inhale before I was done exhaling. It's a very old thread, but you might want to read through the the posts starting at viewtopic.php?f=1&t=58773&p=555506#p555399 for an interesting discussion about EPR vs the PR BiPAP between me and -SWS, who no longer seems to be around these days. Unfortunately all the links to the important figures are now broken, so it may be a bit difficult to follow what's being said.

I’ve tried the EPR set to 3, and also 2, and I’ve tried turning EPR off. I’ve tried both CPAP mode and APAP mode. I’ve tried 6cm CPAP, 9cm CPAP, 4cm minimum/6max APAP, and 6minimum/10max APAP.

Several questions and observations about what kinds of things you might try:

1) At 6cm of pressure EPR = 2 and EPR = 3 are both going to do exactly the same thing because your machine will not decrease the pressure below 4cm. Once the pressure is 7cm or greater, EPR = 3 will reduce the pressure by 3cm and EPR = 2 will reduce the pressure by 2cm.

2) How often have you been changing the settings on your machine? Every 2-3 days? Every week or so? Every 2-3 weeks?

3) I know that you say nothing seems to be working, but of all the settings combinations you've tried, are any clearly WORSE than others in terms of your comfort when trying to get to sleep?

4) What are your CURRENT settings? How long have you been using them? And what is your single biggest issue in terms of comfort with your current settings?

5) When you tried APAP with a range of 4-6, did the AHI go up? If so by how much? Did your comfort in breathing out against the pressure improve at all?

6) Have you considered using the ramp with a starting pressure of 4cm?

7) Are you using a ClimateLine Hose and/or the heated humidifier? If so, what are the settings? And have you tried turning the humidity (or temperature) both up and down to see if either of those things helps your discomfort in exhaling fully?

I should have mentioned that I use the heated humidifier with a ClimateLine Hose.

I have no data on my sleep because I can’t sleep with the treatment. So I have no AHI to report. My study said “AHI/RDI at Final Pressre: 0.0/4.2. My current settings are whatever new combination I can think of. When I try a different combination of settings, I only remember that they’ve all failed, not if some were a little better than the others.

I don’t know why I was able to sleep during the study. I remember wondering if I could stand the mask being on my face, but I stayed with it and I went to sleep. My health took a definite turn for the worse since the study, so that may be affecting my current intolerance for the suffocation feeling.

I admit I hadn’t thought of changing humidity and/or temperature.

What do you think of the Respironics BiPAP Pro 2? System One? BiPAP Auto M Series? I’m looking for a very cheap used unit so I can see if bilevel solves the suffocation feeling.

phopap wrote:I should have mentioned that I use the heated humidifier with a ClimateLine Hose.

What are the settings for the ClimateLine hose? And does the warm, moist air coming through the hose add to your problems?

I have no data on my sleep because I can’t sleep with the treatment. So I have no AHI to report.

Even if you don't think you've been able to sleep with the machine, the data could be useful in a number of other ways.

How long do you wear the mask before ripping it off and just going to sleep without the mask? How sleepy are you when you put the mask on at the beginning of the night? And how quickly does it seem like the mask keys you up to the point where you feel wide awake (and mad at the mask)?

My study said “AHI/RDI at Final Pressre: 0.0/4.2.

What was your untreated AHI on the diagnostic study or on the diagnostic part of your study if it was a split study where they came in to your room in the middle of the night to put the mask on you?

My current settings are whatever new combination I can think of. When I try a different combination of settings, I only remember that they’ve all failed, not if some were a little better than the others.

I would suggest that you start keeping a log of the settings and why they seem to fail.

I also suspect that you may be changing the settings so frequently that your body doesn't have a chance to adjust. You may also be changing too many things all at once. You need to change only one or two things at a time. And you need to try to use the new settings for at least 3 or 4 days before making another change.

So lets start here: What are your CURRENT settings? And what is the biggest problem with them?

I don’t know why I was able to sleep during the study. I remember wondering if I could stand the mask being on my face, but I stayed with it and I went to sleep. My health took a definite turn for the worse since the study, so that may be affecting my current intolerance for the suffocation feeling.

Did you take a sleeping pill the night of the titration study? Did you abstain from all caffeine for 24 hours before the study? And how much caffeine are you using?

I admit I hadn’t thought of changing humidity and/or temperature.

Until you tell us some settings AND some additional information about what is bothering you beyond feeling like you can't exhale properly, it's hard to say whether changing these settings may be of use. Still it's one more variable of things to try.

Question: Do you typically find it easier or harder to breathe when you take a hot steamy shower?

What do you think of the Respironics BiPAP Pro 2? System One? BiPAP Auto M Series? I’m looking for a very cheap used unit so I can see if bilevel solves the suffocation feeling.

The BiPAP Pro 2 is an ancient machine. I don't know if it records any efficacy data, and if it does, it would use a proprietary card and card reader that would be hard to find. And it's a pretty large[/b] machine by today's standards.

The BiPAP Auto M Series is 3 generations old. While it records efficacy data (except for flow rate), it uses a proprietary card and card reader, both of which can still be bought from cpap.com. However, the M-Series is not compatible with SleepyHead, so you also need to use Encore, which can be downloaded from apneaboard.com. You would not have the flow rate data, which can be useful in trouble shooting.

The Philips Respironics System One BiPAP Pro and BiPAP Auto machines are nice machines that record full data and are completely compatible with Sleepy Head. They write the data to an ordinary SD card, and the Series 60 machines (model numbers 660 and 760) have the option of a heated hose; but that option requires a heavy duty power brick and a properly configured humidifier. If you are really wanting to try a bilevel for a relatively cheap price, I would strongly suggest that you look for a Philips Respirionics System One BiPAP Pro or BiPAP Auto. Doesn't matter too much if the machine's model number is 650, 750, 660, or 760. But you give up the heated hose option on the 650/750 Series 50 machines.

In my opinion, you are going to need data to figure out what's going on. So I personally would not recommend either the Respironics BiPAP Pro 2 or BiPAP Auto M Series. But I do think the System One BiPAPs are a very good choice if you find a used one in your price range.

My mother taught me a trick.

After i have the mask on and am laying down, I use my thump to raise the bottom of the mask up some so I get a rush of air, I keep it that way for a minute or two and it lets me relax and go to sleep.

phopap wrote:[I don’t know why my machine isn’t displayed - it’s the ResMed S9 AutoSet.] My sleep study recommended 6cm pressure.

The incoming pressure prevents me from exhaling completely, unless I conciously push the rest of the air out (which is no good when I’m trying to sleep and my breathing is becoming lighter), even when I set EPR to 3. I get enough air when inhaling, I just want to be able to exhale completely without fighting the incoming pressure (because that’s when the suffocation response kicks in). The machine seems to want to make me inhale before I’m finished exhaling.

I’ve tried the EPR set to 3, and also 2, and I’ve tried turning EPR off. I’ve tried both CPAP mode and APAP mode. I’ve tried 6cm CPAP, 9cm CPAP, 4cm minimum/6max APAP, and 6minimum/10max APAP.

If you have a Resmed S9 Autoset like I do then the 6 min/10max APAP and EPR=3 should not have given you those problems. Did you also enter the correct mask type into the machine? If it does giving you the problem of forcing you to inhale before you complete exhaling then there is something wrong with the machine. I tried with my Auto CPAP to not start the inhaling cycle for almost one minute and the machine waited until I started it. An ASV machine could force me to follow its sequence.

Thanks robysue for the in-depth response. Terms: “ASV” means what?

Should I pickup a BiPAP Auto M Series for $45 (its heater doesn’t work) to see if a bi-level machine would eliminate my end-of-exhalation-suffocation response? I know I’ll probably want better data capability in the future, but for so cheap, wouldn’t it tell me if a bi-level would solve the primary, major problem, which is suffocation?

OR, is it such an old model that it doesn’t have the fancy pressure curve options that might be the solution, so failing on this old bi-level model would tell me nothing useful?

The Respironics Bipap M Auto for $45 would give you an idea if bilevel settings would help or not.
If you need help with it...I am familiar with the M series machines and can help.
Only problem with the M series is the default PS of 2 in auto mode...and for that reason I would suggest that you not try auto bilevel mode and instead try a fixed bilevel mode to see if increasing PS would help or not.

Long story but the M series default PS minimum is 2 when in auto bilevel mode and there's no way to make it higher in auto mode. With the newer bilevel Respironics machines we can make it higher than 2 but not with the M series.
If EPR of 3 isn't enough....2 cm bilevel PS won't be enough...but maybe 4 or 5 will be.
We can do PS of 4 or 5 in fixed bilevel mode on the M series.

While the M series Bipap doesn't offer the data details of the newer machines...there's enough to get us an idea what is going on.
You will want to erase any old data on it though so as to not mix with your data. I can help you do that too if you decide to get it.
We can get an AHI average and leak average on the machine LCD screen...we can get you close in terms of some data without having to spend more money on the card reader or smart card.

avi123 wrote:

phopap wrote:[I don’t know why my machine isn’t displayed - it’s the ResMed S9 AutoSet.] My sleep study recommended 6cm pressure.

The incoming pressure prevents me from exhaling completely, unless I conciously push the rest of the air out (which is no good when I’m trying to sleep and my breathing is becoming lighter), even when I set EPR to 3. I get enough air when inhaling, I just want to be able to exhale completely without fighting the incoming pressure (because that’s when the suffocation response kicks in). The machine seems to want to make me inhale before I’m finished exhaling.

I’ve tried the EPR set to 3, and also 2, and I’ve tried turning EPR off. I’ve tried both CPAP mode and APAP mode. I’ve tried 6cm CPAP, 9cm CPAP, 4cm minimum/6max APAP, and 6minimum/10max APAP.

If you have a Resmed S9 Autoset like I do then the 6 min/10max APAP and EPR=3 should not have given you those problems. Did you also enter the correct mask type into the machine? If it does giving you the problem of forcing you to inhale before you complete exhaling then there is something wrong with the machine. I tried with my Auto CPAP to not start the inhaling cycle for almost one minute and the machine waited until I started it. An ASV machine could force me to follow its sequence.

Avi, back when I was starting I had a Resmed S9 AutoSet. First two weeks I could hardly exhale at 9cm in CPAP mode with EPR = 3. Next 2 months, I could only sort of exhale comfortably and still had severe aerophagia and still felt like the machine was trying to suffocate me by not allowing me to exhale fully even though my settings were APAP 4-8cm with EPR = 3.

Some people have a lot of trouble exhaling at even pretty low pressures.