CPAP making me feel very tense while I'm asleep

[jlpool]

Hello everybody,

I've been having a lot of minor trouble with my CPAP for a while now despite trying several different masks and constantly experimenting with the settings [mainly the two pressure ones on my BiPap].

My biggest issue is that a lot of the time, after I fall asleep I'll be able to tell that I've been straining my muscles and tense all night, and often wake up early with a bit of a panicked feeling. It feels like I'm suffocating a bit with the mask on. For a while my first instinct was that it was a rebreathing problem, but I've been told by multiple people [including doctors] that CO2 retention isn't really a problem with most masks. It's not anxiety either - I usually go to bed fine and this problem seems to pop up no matter how I'm feeling or what's going on in my life, and it feels physical. I've been on CPAP for about 2 years.

I end up turning my pressure settings higher in order to try and counter this often, but having it higher makes me very uncomfortable, especially when breathing out where I feel like I have to force it out. I've had a lot of trouble with mask fitting in the past too, since most masks have ended up straining my neck when I tighten them enough to stop leaking. (I did post a few months ago and got some helpful advice, but I still struggle with it and constnatly feel like I need to adjust it). The most reliable mask over time has probably been the Dreamwear that just goes over my nose, but that one actually gave me this "not enough air" tension feeling the worst of them all, so now I've been using the F30i after getting a mask size that fits my face better. The Quatra mask seems to have this problem the least, but that mask is such a pain to ever get fitting right without leaking or hurting my neck from the tightness that I don't bother unless I'm desperate.

I'm not really sure what to do here, or even sure exactly what the problem was. I've also worried about the machine making me breathe too fast, but I just downloaded OSCAR and looking at that, it doesn't seem my breathing rate looks off from what I can tell.

The main problem I've had, aside from just waking up feeling like I've been tense and contorting all night, is I keep waking up after about 6-7 hours [naturally I'd sleep close to 9] and then being way too uncomfortable to go back to bed - presumably because my body remembers what was just happening to it and thinks 6-7 hours is good enough to avoid having to go through more of that. My body tends to feel like "thank God I'm awake and done with that" and doesn't want to go back to bed. Despite this, I still feel decently rested during the day - I don't feel like I did before I was using the machine during the day, which makes sense since my AHI is near 0. I can sleep longer more reliably using sleeping pills which seem to make my body ignore this problem, but that's not very healthy to rely on. I do want to reiterate I don't think it's an anxiety problem though, since it seems to change with the masks I use and I never had any problem like this before CPAP.

Anyways, I'll attach the OSCAR data from the last three nights. On the 16th and 15th I woke up early feeling very tense and uncomfortable, but I also attached the 12th which was the only day this week where I actually got 9 hours of sleep instead of 6-7 thanks to a sleeping pill (It takes me a while to fall asleep sometime so the hours listed tend to be 15-60m longer than I actually slept). It looks like the leak rate might be a problem here, though if so I'm not sure how to fix that without strapping this thing to my skull. I'm going to try messing with raising the pressure again, and maybe go back to the Dreamwear pillows to see what those look like in OSCAR, but any advice would be greatly appreciated (and thank you for reading all my ramblings )

[Jay51]

Thank you for posting all of that.  The 1st thing seems to be leaks.  Most good therapy is close to zero or low single digit leaks.  Yours are around 90%!

Hopefully some tips in this will help you:     Mask Primer

[jlpool]

Yeah, I was surprised to see that since it didn't feel like it was leaking very much (and sometimes in the past letting it intentionally leak actually helped me at higher pressures). That's part of why I'm curious how it'll look when I switch over to the nasal pillow tonight since that one doesn't leak easy.

[TechieHippie]

I don't know if you can believe that AHI, I suspect the machine can't tell what's what.

Could the anxiety be air hunger because your pressures are too low? I know you've tried higher pressure, have you tried a larger PS/ difference? Your PS is only 1.8 which would explain the difficulty with exhale.

Do you seat the mask at pressure?

You may also need mouth tape when you go to nasal mask, you could start with a small amount in the middle if it increases anxiety.

[jlpool]

I suspect the feeling is air hunger of some kind, though I don't feel like it's a case of not breathing in enough since I feel it even when I'm laying in bed awake with it on and when I have apneas then I can notice it - in the past I always worried I might not be breathing *out* enough which is a big part of why I don't like increasing the pressure. That being said, I did notice when I had the PS higher I felt better, so tonight I'll try raising the IPAP only to see how that feels.

What do you mean by "seat" the mask?

Also, I've never caught myself mouth-breathing with the nasal mask so I don't think that should be an issue (plus this problem remains whether it's nasal or not).

Thank you for the response and all the questions, by the way, I really appreciate it.


And for a slight update, I did use the nasal mask last night and was able to get 9 hours of sleep, but I still felt super tense by the time I woke up. I forgot to put the SD card in the machine while I was sleeping so I can't pull up the chart in OSCAR, though the machine itself did put a red frown face for "mask seal" so apparently there must've been some leaking there too. I'll see how it goes tonight.

[TechieHippie]

One thing I learned recently here is that my mask fits better if I let it pressurize with air and then put it on to my face to see how it fits. Sometimes this means loosening it even, over tightening can cause leaks also oddly enough. I have to adjust the straps just right. A little bit tight on one side can be a problem, too tight, too loose, or just matters of degree. And side to side the elastics might not look even, I have to go by feel. When I adjust an elastic I usually put a finger where it reached the previous time so that I can adjust in quarter inch increments. I might go back and forth a couple times.

If your machine has a mask fit function, you might be able to change the pressure that the mask fit operates at to be what you think is what you will hit at pressure. But still, even if the straps are all correct, I put the mask halfway on, turn on the machine, and then pull the mask away from my face and let it inflate and then check the fit. I might do this two or three times to get the nasal nubs lined up just right. I end up doing this a few times a night.

Keep us updated.

Lisa

[SarcasticDave94]

After you figure out the high leak rate cause, maybe VAuto mode would be a better choice with a bit higher EPAP, IPAP, and possibly 3 PS.

Right now, it's extremely difficult to determine if this event report is accurate due to the very high leaks, median of 64.8, large leak almost 95%. It looks like it's leaking badly from the start, and only had a few dips on occasion. If it's a full face, it's either the mask is fit very poorly, or a bad humidifier or hose or these connections.

[Deborah K.]

One cannot always tell when there is air leaking out of one's mouth.  I never noticed it.  If I were you I would buy some good mouth tape, tape your mouth for the night, and see if your numbers aren't very much improved.  Your mask could be leaking too, but not generally at numbers as high as yours.

[jlpool]

Lisa - I usually just will have the mask on when I'm laying in bed about to fall asleep, and then if it's leaking I'll adjust it bit by bit until it stops. Next time I'm messing with it, I'll try pulling the whole thing off and then letting it inflate towards my face like you mentioned though, since that sounds like a better idea.

Dave - I can try the VAuto mode - I experimented with it about a month ago though and found it would switch to such a low pressure setting sometimes that I could feel myself going into apneas before I even properly fell asleep though - since it made me gasp for air I wasn't too excited to keep messing with it. Maybe I set up some of the secondary settings wrong to make that happen though (I think I recall a minimum pressure setting?). Those reports were on a full face mask, but it never felt like it was leaking all that much to me, and I haven't noticed air coming out of the hose either, though I might have to check more carefully now that I know this is a problem.

Deborah - I didn't even know that was a possibility, that's kind of creepy haha. Those reports were done on a full face mask though, so mouth leak wasn't a possibility for that.

Thank you all for the input!



General update: I tried raising the pressure to increase the difference between IPAP and EPAP and switched to the Dreamwear nasal mask. I woke up about 5 hours later still feeling uncomfortable, but not as much as the last week, and couldn't fall back asleep because it seems like when I have a rough night, my body automatically remembers how it felt even if I was unconscious and it gets activated when it knows I'm about to go back into that state. That's just a theory but it is how it feels. But anyways, I got up for a little and went back to sleep and that felt a lot better - I think I might've been more on my back compared to my side, which always tends to help in my case, but I have a hard time ever falling asleep on my back so I usually don't. 

You can see in the OSCAR that my leak rate was a lot lower than the other mask (but still above the red line 33% of the time), and especially in the second half of sleep it was quite good (Maybe a little too good - my alarm didn't work and I overslept!). I think the increased difference in the pressure helped while I was falling asleep as well, though I did have to keep the EPAP low since especially in the nasal mask an EPAP above 5.2 makes me feel like I'm not even able to breathe out enough air. I suppose it'd be more scientific to have only changed one thing at a time, but it looks like I need to keep looking into where the leaking is coming from. I might try to find another full face mask too soon that actually fits, since I'd really like to have one of those that fits me well. The current one I was using before feels decent, but if it's leaking *that* much then maybe not.

[TechieHippie]

...couldn't fall back asleep because it seems like when I have a rough night, my body automatically remembers how it felt even if I was unconscious and it gets activated when it knows I'm about to go back into that state. That's just a theory but it is how it feels. 

That sounds familiar. I used to have that but I think now my body ignores or doesn't pump out the adrenaline as much.  Next time that happens, trying focusing on even, slow deep breathing into the bottom of the lungs, see if you can reset that activation. Basically meditate and try to convince the machine (in auto mode especially) and your brain that you are ready to sleep. The body takes a while to stabilize oxygen after a series of drops and it could be oxygen running low.

I'm also figuring out for myself that once my breathing has been compromised, my airway will be restricted for a while. I think I'm reacting to endogenous VOCs.. if I never get into a position that restricts my breathing I don't have clusters of drops after. But I think that's pretty unusual. I have a tiny airway to start with so it's very sensitive.

If you were getting air hunger in Vauto mode, yes, raise the pressures, not my area of expertise but there are lots of threads around explaining to others that you can draw from too. But also, remember the machine takes it's cues from you in adjustments within the range. When you relax the breath the algorithm probably will follow. If it feels like it's fighting you, don't fight back, if that makes sense.