Making Sense of My First Night on the CPAP

I'm a healthy 38 year old male, who was recently diagnosed with moderate sleep apnea, AHI 21. I obtained a Philips Dreamstation Auto CPAP from my father in law who gave up on it.

On 4/18, I setup the device with the settings to match my prescription: AutoCPAP, Min pressure: 4.00 cmH2O, Max Pressure: 20.00 cmH2O,
Other settings I changed: A-Flex 3 (this felt better as far as exhale relief), Smart Ramp on 20 mins.

I put the full face mask on and went to sleep no problem for about 4.5 hours. I woke up around 4:23 am, disconnected the hose from my face mask and went to the bathroom. Within a minute or so, there was something like an adrenaline rush that came over my body and my heart started pounding, about 130-140 bpm. I felt EXTREMELY anxious so I waited a few minutes and it did not stop. I took my blood pressure and it was 208/109 @ 117 bpm. I had my wife call 911, and they said it wasn't a heart attack based off my symptoms and was a hypertensive crisis. They had me calm down and take my blood pressure within 30 mins and if it didn't go down to call back. It slowly started to go down after 30 mins and within an hour or so I started feeling a little better. I admit the whole thing was very traumatic. The following week I met with Primary care doctor and he reviewed my blood pressure. Everything was looking good and that I should try the CPAP again.

I did some research and was thinking this experience could *possibly* be related to the FLEX settings I had on the machine. I guess a small percentage of people react negatively to the pressure relief. Also, the starting pressure of 4 seemed like it was hard to get used to. Does anyone have other ideas as to what went wrong? I'd like to get this figured out before I try the CPAP again. Thanks!

I suggest raising your min. pressure to 6-7 for a few nights and see how things go... let us know (and please stay with this thread = thanks).

Nothing about PAP therapy (for someone without a heart-related problem or serious comorbidity) causes high BP or panic attacks directly. But it can takes a while for your nervous system to figure out what's going on.

My body had been cranking out buckets of panic juice to jar me out of apnea to keep me alive before PAP. So when I started out on PAP, I dealt with a lot of anxiety and panic during waking hours as my body looked for any excuse during the day to release and burn burn off the juice it no longer needed to use during sleep.

Increasing my level of physical activity helped, but it still took a while for my body to adapt to the positive effects of PAP.

Julie wrote: ↑

Wed May 27, 2020 1:45 pm

I suggest raising your min. pressure to 6-7 for a few nights and see how things go... let us know (and please stay with this thread = thanks).

4-20 is NOT a prescription; it is the default range.
You need to take charge of your therapy--your provider is lazy and useless.

That spurt in BP and heart rate must have been disconcerting, to put it mildly! It's good you got yourself checked out via 911 and then your doctor.

It's a good sign for the future that you actually slept for over 4 hours on your first night. And if you raise your minimum pressure as Julie has suggested, I think you'll like the difference in the experience. This may also head off some of the hypopneas and maybe even OAs. You have a good machine there -- and the price was right -- but it is designed not to change pressures very rapidly. So a higher minimum may be just what you need.

It's also a good sign for the future that you're already using Oscar and coming to this forum for advice. I'll be curious to see another chart after you've gone to 7 min.

jnk... wrote: ↑

Wed May 27, 2020 2:37 pm

My body had been cranking out buckets of panic juice to jar me out of apnea to keep me alive before PAP. So when I started out on PAP, I dealt with a lot of anxiety and panic during waking hours as my body looked for any excuse during the day to release and burn burn off the juice it no longer needed to use during sleep.

Increasing my level of physical activity helped, but it still took a while for my body to adapt to the positive effects of PAP.

I can relate so much and beyond... I'm a young adult male but veryy ravaged .. of course my sh!t goes beyond central apnea but still your post is very true for a lot of people. The body and mind and its ways is a hell of a thing.