Does CPAP tickle the back of ANYBODY else's throat?

I apologize in advance for the rant and the length of this post. I got up on the wrong side of the bed (again) this morning. *sigh* This post started as a response to post in another thread, but I realized that it really wasn't about that thread's topic, so I decided to not post it there, but start a new thread with a more appropriate title. And, at the same time, to try to edit out as much of the ranting and whining as I can. And because I realized that I have a genuine question about trying to address a way of making MY therapy possibly actually work (i.e. be more tolerable) for ME. [I'm really feeling sorry for myself today.]

I have now been using CPAP, APAP, and BiPAP for three solid months with 100% compliance. And I'm still feeling much worse WITH CPAP than I did BEFORE CPAP. It is to the point where CPAP/APAP/BiPAP is proving to more of an inference with my family's everyday life than my apnea ever was. And that is a real issue that needs to be dealt with. I need to get back to functioning in the daytime folks. And simply asking my family for more time and more time and more time is not fair to them: They are already picking up more slack for me than they should should.

And to me, my sleep feels more disrupted now from CPAP-related arousals than it did with respiratory disturbances before starting CPAP. It's mostly likely because these CPAP-related arousals result in full awakenings that I remember and that it often takes me as 10--15 minutes (or more) to fall back asleep after one of these CPAP-related awakenings. And these CPAP-related arousals are not usually related to me wanting to turn over or me waking up due to a mask leak or me waking up with my mouth open. No, more often than not, I don't rightly know what's waking me up---except that it's not the mask (no leaks) and it's not my mouth (it's closed when I wake up).

Rather: I am waking up aware that I'm hearing the noise of the machine and aware that I'm feeling the pressurized air being shoved down my throat. But the most annoying thing is that the back of my throat is being tickled in a way that feels torturous to me because I'm on the verge of gagging. And I feel the air blowing around in the very back of my mouth with no where to go---and my mouth is most DEFINITELY closed because I'm fully conscious at this point---and it continues to tickle the back of my throat and irritate it and makes me feel like I'm on the verge of gagging. I wake up hoarse more often than not in the mornings as well. Turning the humidifier up simply makes me feel like I'm trying to fall asleep in a swamp because the air coming through the hose is then so HOT and DAMP and it still tickles the back of my throat---not comfortable at all.

Now, I know that I've always had a very sensitive back of throat and well-developed gag reflex: My family and friends kid me about taking bites out of grapes, cherries, and potato chips. I routinely get 4 or 5 bites out of a standard Oreo cookie. Strep tests have always been difficult to for me: I routinely have had to tell nurses that I must have my head against a wall for a strep test or I will manage to pull my head back far enough to avoid the swab stick. And recently I had an ENT do an in-office nasal endoscopy, which involved a topical anesthetic spray applied to the back of my throat. While I didn't have any discomfort while he was threading the fibre-optic through my nose and down my throat, the doctor did comment that I had and really extra sensitive back of throat and over-developed gag reflex. And through the years, dentists (and my orthodontist some 35 years ago) have also commented on my over-developed gag-reflex.

So I now ask the folks on the forum: Anybody else out there have an over sensitive back of throat? Anybody else find that CPAP tickles the back of their throat in an UNCOMFORTABLE fashion that makes you think you're going to gag at times? Anybody else find that this kind of tickling/irritation wakes them up at night?

As to how the fact that I now keep waking up numerous times at night because the CPAP/BiPAP is tickling the back of my throat is effecting my body's health compares to the effect of the average of 23 apnea and hypopneas per hour I was having before I started CPAP/BiPAP, I won't speculate. But I don't believe these CPAP-related arousals/awakenings are entirely benign even if they are significantly less damaging than the apneas and hypopneas I was having before starting CPAP.

Note: I did not desaturate during my diagnostic sleep study, but I do believe that the arousals caused by the much more numerous events scored as "hypopneas with arousal" are a significant health factor/risk that must addressed in the treatment of my particular apnea. So please don't answer this post with responses filled with information about why I need treatment---I already know I need treatment. What I need in now is information about how to address this particular issue---CPAP/BiPAP pressure tickling the back of my throat, which is then causing me to wake up at night---that is interfering with making CPAP/BiPAP work for me.

Respironics uses 2cm pressure pulses to detect central apneas (CAs). The 2cm pressure pulses by Respironics seem to bother only a small minority of our sensitive posters.
search.php?keywords=respironics+central ... mit=Search

Considering your reported hypersensitivity, Robysue, I'm not surprised to hear the Respironics 2cm pulses bother you. SleepingUgly, for instance, reported being bothered by the 2cm Respironics pressure probes, but not noticing the lower-amplitude Resmed CA detection probes.

-SWS wrote:Respironics uses 2cm pressure pulses to detect central apneas. The 2cm pressure pulses by Respironics seems to bother only a small minority of our sensitive posters.
search.php?keywords=respironics+central ... mit=Search

Considering your reported hypersensitivity, Robysue, I'm not surprised to hear the Respironics 2cm pulses bother you.

But would it be doing this when I'm breathing NORMALY trying to get to sleep?

And I also had this problem with the ResMed S9. It most certainly did not start with the switch to the PR S1.

*sigh*

Will I ever have a complete, full night's sleep without a conscious awakening again? I need one so bad right now. It's might most deepest desire: To fall asleep at 11:30 pm and not be conscious of waking up until 7:30AM the next morning for just one single night.

robysue wrote: But would it be doing this when I'm breathing NORMALY trying to get to sleep?

Yes, if you happen to present sleep onset central breathing irregularities---which is not at all uncommon, BTW. That somewhat common wake-to-sleep phenomenon would be based on CO2 homeostasis adjustments.

But the definitive answer should be in your Encore Viewer data, Robysue. I believe the graphs tell you when the pulses were administered.... So take a peek at that.

robysue wrote: And I also had this problem with the ResMed S9. It most certainly did not start with the switch to the PR S1.

I recall reading one post in which the user found the Resmed test pulses more disturbing than Resmed's. Your Resmed data shows their test pulses as well----as very low-amplitude sinusoid waves superimposed on the flat patient-flow line...

If it turns out central-apnea test pulses ARE disturbing you, then you just might sleep better with a brand/model of BiLevel machine that doesn't administer CA test pulses---the Puritan-Bennett or even previous-generation Resmeds or Respironics, for instance.

-SWS wrote: But the definitive answer should be in your Encore Viewer data, Robysue. I believe the graphs tell you when the pulses were administered.... So take a peek at that.

What in Encore Viewer should I be looking for in the data. I'm running in straight BiPAP mode (not BiPAP Auto) and I see the Ramp but no little mountain peaks I've seen in others' posted pressure data. I'll try to post some Encore data shortly.

robysue wrote:

-SWS wrote: But the definitive answer should be in your Encore Viewer data, Robysue. I believe the graphs tell you when the pulses were administered.... So take a peek at that.

What in Encore Viewer should I be looking for in the data. I'm running in straight BiPAP mode (not BiPAP Auto) and I see the Ramp but no little mountain peaks I've seen in others' posted pressure data. I'll try to post some Encore data shortly.

Look in the detailed flow waveforms. At the top you'll see a legend that says something like:

PP = Pressure Pulse

Those corresponding little red rectangles are the central-apnea pressure pulses that just MIGHT be bothering you...

My mistake, Robysue. I think that detailed information is only available in Encore Pro versus the simpler Encore Viewer. Here's a blurry example for the Encore Pro flow graph I was referring to:

http://lh4.ggpht.com/_Z8tlXCub0hM/TQmOn ... 0%2007.jpg

-SWS wrote:

robysue wrote: And I also had this problem with the ResMed S9. It most certainly did not start with the switch to the PR S1.

I recall reading one post in which the user found the Resmed test pulses more disturbing than Resmed's. Your Resmed data shows their test pulses as well----as very low-amplitude sinusoid waves superimposed on the flat patient-flow line...

Ok, I've seen these numerous times in ResScan with the S9. I know exactly what they look like. Don't know if they really woke me up or not. Although I do know I would feel them occasionally when I was drifting in and out of stage 1 sleep early in the night or while lying in bed before getting up in the morning. I guess while I'm on break I can go back through the data and start staring much more intensely at the recovery stuff and see if there's evidence of me waking up after this. I know that I had problems with the tickly feeling on nights with almost no apneas as well as on nights with 20 plus apneas. Certainly, *if* I'm having problems with the CPAP tickling the throat anyway and it decides it must start varying the pressure to see if the reason I'm not breathing is a central or obstructive apnea, then clearly, then that oscillation is likely to likely to bother me.

But, on 12-25 (Christmas night), this is what the detailed data looked like:

Those three times I clearly turned my machine off are only three of six times that I know I was clearly and consciously awake during that night for extended periods. I kept track of them by pen and paper with "tick marks"---I absolutely refused to look at the clock for fear of getting myself into even more of a tense "can't fall asleep" "can't stay asleep" cycle.

Now before anybody jumps in with comments about the leak graph for this night I want to make the following comments:

I use a Swift FX for Her. At my pressures, the intentional leakage rate (from the user guide) is listed as 25 L/min (at 6cm) and 29 L/min (at 8cm) so even my largest leaks in the time shortly before t=1 and t=2.5 are hardly excessively large. Moreover during much of this time, I was fighting my cat who kept hopping on my face and pulling at my mask. And during this period, my husband came back to bed from a trip to the bathroom and literally laid down on the hose and pulled it off my nose; I screamed at him before pulling it back onto my face. Under the circumstances I don't understand why the leaks aren't larger. I am trying to get my husband to understand why I want to ban the cat from the bedroom, but Mr. T (the cat) sleeps on my hubby's feet (when he--the cat--behaves and keeps his--my hubby's--feet warm). Banning my husband from the bedroom seems excessive: He's only sat on the hose once at this point.

The point of the above comments is that between the time I turned the machine back on at roughly t=0.5 to t=2.5, I was more or less fully awake the whole time and fighting the cat, fighting the covers, fighting the hubby (when he sat on the hose), fighting the pillows (both the bed pillows and the nasal pillows) and fighting desperately FOR sleep: But I was NOT asleep during this time. And none of the other five "awakenings" that I'm aware of for this night occurred during those two hours. So mask leaks are not what were causing me to wake up on this night, although they no doubt contributed to the misery of that two hour period when I was more or less wide awake.

And the point of this thread is to try to address whether the CPAP pressure tickling the back of my throat might be triggering my waking up or arousing and what if anything can be done to desensitize the back of my throat to this new irritant so that I can get to sleep and STAY asleep all night long.

-SWS wrote:My mistake, Robysue. I think that detailed information is only available in Encore Pro versus the simpler Encore Viewer.

Still waiting on getting my husband to tackle the Encore Pro project. I found a copy of Encore Pro on disc on E-bay and won it. But have not yet received it. Once it comes, hubby will tackle getting the MySqueal Server stuff installed and then work on the Encore Pro.

I have done some playing around with looking at wave forms after copying the data to a directory on my Mac in Audacity. But I'm blind on getting any actual meaning out of them event though I can make pretty pictures and can identify enough (having looked at the flow data in ResScan so much) to tell when it looks like I was likely troubles breathing. But I can't get a time scale on the x-axis and I can't get the volume scale on the y-axis so it's really not that meaningful. And so I'm not sure I'd recognize the pulses in the wave form even if I did see them. Still it's kind of neat to see the waves.

Robysue, is there any chance the OTC sore throat sprays that temporarily numb the throat could give you some blocks of time to sleep without feeling the sensations? Have you talked to an ENT and asked what products might desensitize your throat a bit? Maybe there's a prescription product that's stronger than the OTC sprays.

kteague wrote:Robysue, is there any chance the OTC sore throat sprays that temporarily numb the throat could give you some blocks of time to sleep without feeling the sensations? Have you talked to an ENT and asked what products might desensitize your throat a bit? Maybe there's a prescription product that's stronger than the OTC sprays.

That's an idea that I HAVEN'T thought about! Sore throats have never been much a problem for me (in spite of my super senstive throat) so I've never used those sprays. Thanks for suggesting this---it's an easy thing to try and it might just work! I'll try buying some of the OTC stuff tomorrow when I'm out and about and giving that a shot tomorrow night. Couldn't hurt could it? And if it seems promising, then talking with an ENT or my PCP might just be the next step.

The Encore report shows you snoring.

I noticed some tickling when I was coming down with an upper respiratory infection.
I also notice tickling when I get that gush of clear very salty drainage from my sinuses that precedes a cold sore outbreak.
It seems to be more noticeable with CPAP.
Horrible feeling--Good luck getting it taken care of. Sleep well.
I take valacyclovir to nip that in the bud.

ozij wrote:The Encore report shows you snoring.

Yes, it does. I'm currently dealing with a pretty bad head cold. With the S9 snoring has been more of a problem with head colds and allergies, so I'm hoping that these snores will go away when the current head cold gets better. The CPAP tickling the back of throat problem, on the other hand, has been with me right from the start even when I've been both allergy-free and head cold free.

Re snoring though: Pre-CPAP my husband was bothered by my snoring---indeed that was the main reason he insisted I be tested for apnea. It was occasionally loud enough to wake him up. But more often when I was snoring "badly" however, it was the absence of noise that would wake him up: he would wake up when I'd quit snoring because of an apnea or a hypopnea, and he'd poke at me to make me start breathing again. But I don't ever recall waking up consciously because of my own snoring. (My husband's snoring has occasionally woken me up though.) Since starting the BiPAP, my husband says he is aware of the noise the machine is making, but he is not aware of me snoring. When I was using the S9, there were a few nights that he told me that I was snoring even with the mask on, but they were very, very rare. The snore data graphs also showed some "middle level" snoring on about 1/3 to 1/2 the nights if I recall correctly.

Oddly enough, on Christmas night (the night for the posted data), I listened to my husband snoring much of the night. (He doesn't snore that loud---it's kind of like the purring of a cat----and it was more pleasant to listen to than the PR S1.) And I was sleeping on top of his chest for much of the night---when I managed to actually be asleep after t=2.5. I've read here on the forum that the PR S1 can register hose rubs against a headboard as "vibratory snores." Any chance it could pick up my hubby's snore's as mine?

During the long extended time I know I was awake fighting cat, hubby, hose, pillows, and other things, there's only one snore tick---which could easily either have occurred during a short-lived transition into stage 1 sleep or even when I was awake because I know I "snore" when I'm struggling with nasal congestion when I'm awake at times as part of trying to clear my sinuses. [It's hard to describe exactly what I mean.]