New CPAP user. Still occasionally waking up with "panic attacks".

[Tcp84]

Hey guys first time poster here, hoping someone here could help me figure out what's going on with me. About a year ago, I started having what felt like panic attacks in the middle of the night. Almost every night at 3 a.m., I'd wake up to a racing heart and/or adrenaline surge that would last anywhere from a couple of minutes to 20 minutes. Sometimes gasping for breath too. Given I had a history of anxiety, I kind of ignored them and chalked it up to "just panic attacks". After months went by of the same thing happening almost every night, it started to feel like there was something more going on. I googled the symptoms and noticed "sleep apnea" kept popping up. So I decided to get a sleep study done. I went with Lofta, knowing I'd never actually fall asleep at a clinical sleep study. Sure enough, the study showed I think a 5.8 AHI and o2 in the high 80's, low 90's. Bought myself an Airsense 10 and after a few crappy weeks, I'm finally falling asleep with it. 
  So far AHI has been looking great. Never breaking .50. But the problem is, I'm still having those "panic attacks" on random nights. I know its sleep related because I never have them during the day. I'll wake up feeling my heart rate feels a little "off" then as soon as I sit up, my HR will start to ramp up. Though I get them WAY less frequently now, they're no less disturbing. Weird thing is, i'll get them on night where I have 0 AHI. So there's no explanation for them! I'll post the last two nights pics. Hopefully you guys can make some sense of what's going on. The 0 AHI pic is the one where the panic attack happened. You'll see where I too off the mask in the graphs. If you all need any more info, ask away!
  
Settings: Max pressure - 8.4
             Min pressure - 7.5
             Ramp - off
             EPR - off
             Climate CTRL - manual
             Humidity 2

I settled with these settings after trial and error. Could finally fall asleep with these settings. Doc just lazily prescribed 4-20 pressure and everything else auto.

[Gideon]

Welcome to the forum.
While starting at 4-20 may be OK to start, as you discovered it rarely results in an optimized pressure for anyone.
Your Flow limits are high and could easily be a part of your issue though that is nowhere near a guarantee.
Try this
Mode = Auto
Min Pressure = 7, the min for full functionality from EPR.
Max Pressure = 12, to provide some room for the Auto algorithm to work
EPR=3, Fulltime, To actually treat those flow limitations

Then post your charts so we can see how it did, and always post, as you did above, how you feel, "I feel fine" means that you have no issues and no longer need adjustments so do be critical.

[Tcp84]

Ok ill definitely try those settings out tonight. I never touched EPR after reading that in some people, it could cause central apnea. Also apparently it can cause your brain to "forget" how to breathe properly. I definitely dont feel fine after that episode last night. Feel completely drained. HR was at 160-170 for what felt like 10 min. I fell asleep afterwards but still feel exhausted. I had an EKG about a month ago and everything was good. What could be causing those attacks if my AHI is at 0? Thanks!

[Gideon]

Without question, we will be watching for Centrals, but because we are watching for them means that they are nothing to be concerned about.
If that is truly a concern then no one should ever even try a CPAP because that could and does, cause the same thing.

What happens is (simplified version) that too much CO2 gets flushed from your system resulting in the lack of drive to breathe as the CO2 levels go below your apneic threshold.

[Tcp84]

Gotcha, ok I'll report back tomorrow with results from new settings. Thanks!

[Tcp84]

Well I tried to sleep with those settings last night with no success. Guess I'm really sensitive to  any changes in my sleep. Having the EPR set to 3 just felt weird. I reverted the settings to what I had them originally so I could get some sleep, as I was already exhausted from last night's event and I have a 12 hr work day today. Could I try gradually changing my settings to what was advised? Maybe starting with EPR at 1? I'll post last night's chart anyway. Thanks!

[Gideon]

Well the EPR=3 did a lot to clean up your flow limitations. Among other things that means it is not positional.
Would you mind trying a fixed pressure at 7.
Set Min Pressure = Max Pressure =7
EPR = 3, if that doesn't work try EPR=1

[Tcp84]

Yeah I didn't even notice that until you pointed it out. There's a notable difference in the flow limit graph where I was using EPR and where I wasn't. Nice. I'll def try those settings tonight and post results tomorrow. It's strange. I don't feel this amazing difference other people have reported once they started using CPAP. I definitely feel better, but still find myself yawning alot and sometimes a little sleepy.

[Tcp84]

Well the EPR=3 did a lot to clean up your flow limitations.  Among other things that means it is not positional.
Would you mind trying a fixed pressure at 7.
Set Min Pressure = Max Pressure =7
EPR = 3, if that doesn't work try EPR=1

Good morning. I tried the settings you suggested, though with EPR at 1, and I slept pretty good. I did, however, have another panic attack in the early A.M.. You'll see the gap in the graph where I took off the mask. Besides that, those settings felt pretty comfy. Feel like any pressure lower than 7 would get start to get uncomfortable though. I've noticed the machine will rarely register an actual obstructive apnea or hyponea. starting to wonder if I still even have apnea or if the machine is just working THAT well. I attached last night's chart below. Thanks!

[DaveCar]

There appears to be five gaps, and four in the original post screenshot.
Click and drag the mouse from just inside a gap towards the left for 10 minutes or so, to make a zoomed display of time just before you take the mask off. 
Then hit F12 to make a nice screenshot, and attach it.