Abdulfakih - Therapy Thread

[Abdulfakih]

Hey guys,

Yesterday I was committed to continue with the CPAP, however as soon as it reached the evening my headache was so strong that I had to take another paracetamol to calm it down.

I told myself that if I had another day like the previous two, I was going to colapse from the fatigue so I decided not to use CPAP, and my deep sleep immediately doubled from 20 minutes to almost 50.

I dont know why, but I can 100% say that the CPAP is currently affecting my deepsleep. I am confused because this has not happened before.

[Jay51]

Thank you for posting that.  I did some research on deep sleep.  The highlights were:  the greater the concentration of oxygen in the air a person is breathing, usually the deeper sleep a person reaches; listening to binaural beats could possibly train the brain to enter deep sleep more quickly; and using pink noise for background noise (I have a white noise machine).  

I, like you, had 0.00 % deep sleep on my polysomnography.  It was such a new experience for me, I think that was the reason (1st time ever using pap).  I got a smartwatch and it shows I am getting some deep sleep at night, but less than normal.  And then, the validity of smart watches comes into question (how accurate are they really?  Most likely not 100%).  

You may be very sensitive to air pressures and you may have a more sympathetic nervous system tone (more wired and more alert and more sensitive).  People who can get into parasympathetic mode easily ("rest and digest") can usually tolerate pap better and enter deep sleep more quickly and spend more time in deep sleep.  It may take some training (adapting to pap therapy over time) to convert.  You might even try lowering your pressures a bit so you can more easily adapt to them.  And later increase them as your tolerance to them increases.  

Just some food for thought.

[Abdulfakih]

The Resmed Aircurve and Airsense devices all work on spontaneous breathing to trigger IPAP or cycle to EPAP. They are controlled by and follow your own breathing initiatives. What you describe is impossible and the answer to what actually happened can likely be visualized by looking closely at the flow rate (respiration) and mask pressure (device pressure) charts and seeing what happened. Most cases of what you describe have resulted from anxiety resulting from a positional apnea, and can be resolved by calmly realizing you can breathe and reset  yourself and the device with a purposeful breath.  This will result in an arousal, but the feeling of being choked is due to an adrenaline rush or a panic reaction.  Keep in mind that 10 cm-H2O is only 0.14 psi. That cannot stop your breathing or choke you.  For perspective, the atmospheric pressure at sea level is  14.696 psi (760 mm Hg).

Hey guys,

Yesterday I was committed to continue with the CPAP, however as soon as it reached the evening my headache was so strong that I had to take another paracetamol to calm it down.

I told myself that if I had another day like the previous two, I was going to colapse from the fatigue so I decided not to use CPAP, and my deep sleep immediately doubled from 20 minutes to almost 50.

I dont know why, but I can 100% say that the CPAP is currently affecting my deepsleep. I am confused because this has not happened before.

Thank you for posting that.  I did some research on deep sleep.  The highlights were:  the greater the concentration of oxygen in the air a person is breathing, usually the deeper sleep a person reaches; listening to binaural beats could possibly train the brain to enter deep sleep more quickly; and using pink noise for background noise (I have a white noise machine).  

I, like you, had 0.00 % deep sleep on my polysomnography.  It was such a new experience for me, I think that was the reason (1st time ever using pap).  I got a smartwatch and it shows I am getting some deep sleep at night, but less than normal.  And then, the validity of smart watches comes into question (how accurate are they really?  Most likely not 100%).  

You may be very sensitive to air pressures and you may have a more sympathetic nervous system tone (more wired and more alert and more sensitive).  People who can get into parasympathetic mode easily ("rest and digest") can usually tolerate pap better and enter deep sleep more quickly and spend more time in deep sleep.  It may take some training (adapting to pap therapy over time) to convert.  You might even try lowering your pressures a bit so you can more easily adapt to them.  And later increase them as your tolerance to them increases.  

Just some food for thought.

Hi, Jay thank you for the message. I am a bit slow so please correct me if I am wrong;

1) Please correct me if I am wrong but, are you suggesting that cpap could give me deeper sleep by increasing the concentration of oxygen?. 

2) I do recognize that during the polysomnography i did not have deep sleep, but I am aware that it was because i was not confortable, i was very anxious and this is not a "normal" for me. Regarding the sleep monitors like apple watch, i think they are not 100% correct. However, I have noticed that even if they arent 100% accurate, I do feel better when the number is higher on deep sleep, so maybe we can use it as a reference?.

3) regarding the sensitivity to air pressures... I think so. What I have noticed is that I personally have a very uneaven respiratory rate. I dont know how to explain this but even when I am awake, i tend to breathe slowly and with lots of pauses in my breathing. Idk why, but specially when I am focused I stop breathing for a bit. Now what I think might be happening is that the CPAP might be forcing me to breathe in a pattern or circumstances that "arent my normal" breathing. Forcing me to stay awake.

All in all, I personally have no problem with keeping the use of the cpap at the current pressure. However I cant explain how awful i felt the last 2 days, to the point where I felt my head was going to explode. I was forced to stop it today. With my current settings, what pressure/ setting do you recommend me to adjust so I can slowly build tolerance to it?

[Jay51]

1.  The higher the concentration of oxygen in the air a person breathes, the more relaxed and more parasympathetic and more easily reach deep sleep if they tried.  

Room air oxygen percentage is around 21%. Cpap air is probably around 21% or so also - since the air coming through the intake is room air.   So, if the air you breathed was mixed with an oxygen concentrator for example, the percentage of oxygen in the air would increase.  If you traveled to a place of high altitude, the air there usually has a lower percentage of oxygen than at sea level or below.  

2.  It was a very novel experience for me as well.  You can keep the data from your watch to show to your Dr. in the future if you ever need to do so. 

3. It took me a long time to get used to pap/vent therapy.  I feel your pain.  


You can lower your pressures a little bit.  Lower your epap max and ipap max by 1.0 or so.  You can even lower them both by 2 if that doesn't work.  Keep going until you can sleep with it.  Your OSCAR may look horrible, but you may get used to it so you can increase pressures later. 

Sleeprider would have had you optimized very quickly already if you could have tolerated your therapy.

[Abdulfakih]

The Resmed Aircurve and Airsense devices all work on spontaneous breathing to trigger IPAP or cycle to EPAP. They are controlled by and follow your own breathing initiatives. What you describe is impossible and the answer to what actually happened can likely be visualized by looking closely at the flow rate (respiration) and mask pressure (device pressure) charts and seeing what happened. Most cases of what you describe have resulted from anxiety resulting from a positional apnea, and can be resolved by calmly realizing you can breathe and reset  yourself and the device with a purposeful breath.  This will result in an arousal, but the feeling of being choked is due to an adrenaline rush or a panic reaction.  Keep in mind that 10 cm-H2O is only 0.14 psi. That cannot stop your breathing or choke you.  For perspective, the atmospheric pressure at sea level is  14.696 psi (760 mm Hg).

1.  The higher the concentration of oxygen in the air a person breathes, the more relaxed and more parasympathetic and more easily reach deep sleep if they tried.  

Room air oxygen percentage is around 21%. Cpap air is probably around 21% or so also - since the air coming through the intake is room air.   So, if the air you breathed was mixed with an oxygen concentrator for example, the percentage of oxygen in the air would increase.  If you traveled to a place of high altitude, the air there usually has a lower percentage of oxygen than at sea level or below.  

2.  It was a very novel experience for me as well.  You can keep the data from your watch to show to your Dr. in the future if you ever need to do so. 

3. It took me a long time to get used to pap/vent therapy.  I feel your pain.  


You can lower your pressures a little bit.  Lower your epap max and ipap max by 1.0 or so.  You can even lower them both by 2 if that doesn't work.  Keep going until you can sleep with it.  Your OSCAR may look horrible, but you may get used to it so you can increase pressures later. 

Sleeprider would have had you optimized very quickly already if you could have tolerated your therapy.

1) interesting since I live in the 15th floor.

2) unfortunately, i dont have a doctor anymore... After visiting many doctors i reached the conclusion that none of them are helping at all. You and Sleep rider are the only thing separating me from an early death hahah

3) okay will try to reduce the pressure tonight and report back tomorrow

[Jay51]

Since you said that at times you feel out of sync and out of rhythm with your machine, the VAuto has a "trigger" setting that may help reduce that.  

It you feel like the machine is trying to get you to breathe too quickly, you can reduce the trigger (from high to medium for example).  Or very high down to high ect.  

If you feel like the machine is too slow for your breathing and you can't get enough air and feel like you are suffocating, then increase the "trigger" setting (from medium to high) or high to very high, etc.

And of course try the techniques to reduce "positional apnea" that have been suggested several times (soft cervical collar for example).

[Abdulfakih]

The Resmed Aircurve and Airsense devices all work on spontaneous breathing to trigger IPAP or cycle to EPAP. They are controlled by and follow your own breathing initiatives. What you describe is impossible and the answer to what actually happened can likely be visualized by looking closely at the flow rate (respiration) and mask pressure (device pressure) charts and seeing what happened. Most cases of what you describe have resulted from anxiety resulting from a positional apnea, and can be resolved by calmly realizing you can breathe and reset  yourself and the device with a purposeful breath.  This will result in an arousal, but the feeling of being choked is due to an adrenaline rush or a panic reaction.  Keep in mind that 10 cm-H2O is only 0.14 psi. That cannot stop your breathing or choke you.  For perspective, the atmospheric pressure at sea level is  14.696 psi (760 mm Hg).

Since you said that at times you feel out of sync and out of rhythm with your machine, the VAuto has a "trigger" setting that may help reduce that.  

It you feel like the machine is trying to get you to breathe too quickly, you can reduce the trigger (from high to medium for example).  Or very high down to high ect.  

If you feel like the machine is too slow for your breathing and you can't get enough air and feel like you are suffocating, then increase the "trigger" setting (from medium to high) or high to very high, etc.

What if I feel both situations

[Jay51]

Collar + suggested changes.

[Abdulfakih]

The Resmed Aircurve and Airsense devices all work on spontaneous breathing to trigger IPAP or cycle to EPAP. They are controlled by and follow your own breathing initiatives. What you describe is impossible and the answer to what actually happened can likely be visualized by looking closely at the flow rate (respiration) and mask pressure (device pressure) charts and seeing what happened. Most cases of what you describe have resulted from anxiety resulting from a positional apnea, and can be resolved by calmly realizing you can breathe and reset  yourself and the device with a purposeful breath.  This will result in an arousal, but the feeling of being choked is due to an adrenaline rush or a panic reaction.  Keep in mind that 10 cm-H2O is only 0.14 psi. That cannot stop your breathing or choke you.  For perspective, the atmospheric pressure at sea level is  14.696 psi (760 mm Hg).

Collar + suggested changes.

Sorry I meant to say, what if I feel both suffocation and that the machine is making me breath too fast. Since both things change with trigger, I am confused as to what to set the trigger as

[Jay51]

Ok then just keep the trigger at the same setting (you can experiment up or down if you want just to see if it helps or makes things worse). 

Big picture:  

• 5.3Positional Apnea