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I found that when I feel suffocated, I put my hand in front of the mask and feel the air blowing out into my hand. This gives me a calming effect, which relaxes me and the suffocating feeling goes away.

If you feel like you're suffocating, the most likely reason is that the setting of 5 is too low. The next time it happens, look at the display and see what the pressure is. Unfortuately, you'll need a flashlight or something to see it, since the backlight goes out and won't come back on unless you turn the machine off.

Don't use the ramp.

Play with the machine with the lights on and figure out how to make it adjust to a higher pressure. What works best for me is to fake snoring by snorting my nose like I'm trying to suck the stuff out of a runny nose. You'll see the pressure numbers go up.

Ignore the comments about carbon dioxide and hypocapnea. They're mostly nonsense. Especially since you're feeling it before you fall asleep.

Do you feel like you're not getting enough air when you inhale, or is it difficult to exhale?

Do NOT switch to the F&P ICON. Hang on to your PRS1 Auto if you can. It's light years ahead of the Icon in terms of being able to manage your therapy due to the data it collects. Check the "useful links" in my signature for more info on what machine to get, which ones to avoid, and how to fight for them.

Good luck.

I have just completed my fourth week of therapy. During that journey I faced this feeling of suffocation at different times. At first, I just wrote it off as something I had to adapt to. I quickly realized that most of the feeling could be eliminated with proper mask adjustment; getting the nasal pillows seated with the correct tension made a world of difference.

My next adjustment was to bump up my pressure from a minimum of 5cm to 7cm. I did this for therapy reasons, but quickly realized I was able to breath better at the higher setting.

Finally, and just on a whim, I switched from a small pillow size to a medium pillow size. Evidently small wasn't ideal; it worked, but medium is better. There is much more freedom of adjustment with the larger pillow (I see less leaks in my report, for example) and I no longer get that irritating whistling from my left nare. It seems like I am getting more air; at least it feels more comfortable.

One other observation I have noted...I sleep on the second floor and almost always climb the steps right before going to bed. Seeing as how I am not in the best of shape this leads to a little heavier-than-normal breathing. This alone can cause one to feel some suffocating during those first few moments with the mask on. I try to take some deep breaths now before masking up and that helps.