[CPAP] Waking up after 2 hours of CPAP

[radioboy104]

Hi all. My first post so please go gentle on me! I have had sleep apnea for 20 years, after having jaw surgery to move the top jaw in and the bottom jaw out.

I have a Resmed Air Sense 10 Elite my father gave me after he had no relief when using it. I have used it for 3 nights - night 1 had AHI of around 30 and took the Resmed FFM off (without realising) within around 3 hours. Night 1, AHI of 0 which I find very hard to believe (though seemed less tired) mask was taken off without realising after 2-3 hours. Last night AHI of around 14.5, CA around 2. and I woke up and voluntarily took the mask off as I found it very difficult to breathe with the mask on. Set to start at pressure of 5 and ramp over 20 minutes to 8.5.

I have a few questions I hope can be answered here:

1) Why do I always seem to wake up (enough to take mask off even if not realising I am doing this) within 2-3 hours?
2) Why would I be asleep for 2 -3 hours (last night) and wake up unable to breathe properly?
3) What pressure would be suggested based on last nights AHI of around 14.8, given I was asleep for 2.38 hours according to SleepyHead and the AHI actually ranged from 0 - 40 in the last 30 minutes, 0 before that and snoring started at the same time the AHI's started to register. Exact = 0, 15 minutes later AHI 25, 15 more minutes it was 40? This is when I woke up and took the mask off.
4) Night 1 I had hyponea of 3.55 (AHI 30) and the next two nights hyponea of 0 (AHI night 2 = 0, night 3 = 14.8), how can I have two nights with moderate AHI, yet in the middle of those nights, had an AHI of 0?

Sorry for all the questions but as I get older, I am more worried about health risks given I have a young son and don't want him having a tired (or dead) father anytime soon.

Thanks in advance.

[DeepBreathing]

G'day RadioBoy, welcome to Apnea Board.

You haven't said that you had any kind of sleep test, so I guess you're surmising you've got aponea based on symptoms like snoring and daytime sleepiness? If you did have a test then it would be useful to see he results.

Taking your questions one by one:

1. It's really common when starting out with CPAP therapy. I'm sure most of us went through a stage of taking the mask off after a few hours, until we get accustomed to sleeping with it. I still do it occasionally after nearly four years on the hose. In general, you'll find it gets better with experience.

2. My guess is that you entered a different stage of sleep or moved into a different position which brought on obstructive apneas the machine didn't handle properly. It's better to sleep on your side - sleeping on your back is more likely to promote obstruction as your tongue falls back and blocks the airway.

3. It's really hard to guess a pressure without seeing detailed data. You have SleepyHead, so please post some screenshots from those nights and we will get a better idea of exactly what's happening.

4. See above - it's really hard to know without seeing some detailed data. The fact that you had pretty short mask sessions might have skewed the results - apneas tend to come and go in phases through the night, and if you only had the hose on for a couple of hours you might just have recorded a time without too many events.

[Sleeprider]

You have had results ranging from excellent to unacceptable using fixed pressure. That's not so unusual, and several factors could be at play. The fact that you had snores associated with increased obstructive apnea is a pretty clear indication of either pressure too low, or you changed position in a wa that your airway became obstructed. The fact you removed the mask both nights, suggests to me the place to start is with the pressure setting. A CPAP pressure of 10 should not be a problem, and might avoid the increased apnea after 2-3 hours. This should be more comfortable. Most of the time, mask removal is just a reaction to perception of discomfort (lack of air, irritation, other). Figuring out that trigger is a challenge only you can solve.

You're certainly not alone in having to overcome the problem of removing the mask after 2-3 hours of sleep. This is a habit you don't want to start. Until you break it, you might want to turn off the AutoStart function. The rushing air may wake you up enough to remember to put the mask back on. As far as timing, that is just about right to have completed a first REM stage sleep, and it could be you're removing the mask while in a lighter stage of sleep. REM is often associated with higher pressure needs and increased AHI, so that might be part of what is triggering you to remove the mask. Without auto-CPAP you have to set the pressure for your highest (90% +) need, rather than average. Without a titration study or prior CPAP experience, it may take a while to figure out what that pressure should be.

[trish6hundred]

Hi radioboy104,
WELCOME! to the forum.!
Good luck with CPAP therapy, hang in there for more responses to your post.

[Sleepster]

If you don't need the ramp, turn it off or shorten its duration. You will eventually get used to sleeping with the mask on, it just takes time. The human body is remarkable at adapting, but it does so at its own pace.

[radioboy104]

Thanks everyone for your responses. It's been almost a month now and trial and error continues. I'm now running things at 14 with ramp starting at 8. It sounds weird I know but I actually find the noise of the air blowing through relaxing, perfect for sleep!

This week:
Monday 5.26 (13.2 pressure)
Tues 0.87 (13.8 pressure)
Wed 1.54 (14.0 pressure)
Thurs 1.51 (14.0 pressure)

Should I crank the pressure up higher to aim for 0 or be satisfied with anything under 5? The AHI generally peaks between 2-8 for around a 90 minute period in the middle of the night. I have noted that the difference between setting the CPAP machine to 11 pressure to 14 has not really made any difference, so not sure what to interpret from that.

[Gideon]

As stated above, it is hard to give more than general advice without seeing data.  Please post some nightly charts so we can provide you with much better advice.  Do you prefer advice based on guesses (educated guesses) or facts.


Fred

[Texans2024]

I am having same issues too 
I went to my sleep doctor and he just told me I need to get used to the MASK

I keep waking up 2.5 hours into sleep,  no more than 3 hours. in. 
This probably has been happening for near 4 weeks. I've been on apap therapy for 3 months and the last 4 weeks, have been hell. I keep waking up.  I brought up the potential "too much pressure" waking me up, to my doctor.. He said the highest that it hits is 16? And that I am a bigger guy that knows more pressure to keep airway open. 

Idk.. I dread going to sleep because I KNOW I won't sleep well. 
The first 2 months, aside from the adjustment period, I have been doing well, not great but well.. Now, I can't even get past 4 hours of sleep per night with machine.