Waking up feeling short of breath

[geauxdbl]

First, thanks for the wealth of information that is this board.  I've found it very helpful since I'm managing my care on my own.  

Brief history: I was prescribed a Resmed Airsense 10 Autoset 4 years ago and used it for about 3 months before my weight loss from a very rigorous diet and exercise plan made it unnecessary.

I gained the weight back.  Resisted opening up the box of CPAP stuff in my attic until a bout with tonsilitis and walking pneumonia in September forced my hand.  Swollen tonsils = no breathing at night = no sleepy for me.  Not fun.

Here's my test info:

PSG 2015 Wt 253 lb: AHI 23/hr, supine AHI 60/hr, non supine AHI 17.7/hr, oxygen nadir 85%
PSG 2016 Wt 198 lb: AHI 7/hr, supine AHI 10/hr, non supine AHI 7/hr, oxygen nadir 90%
HST 4/ 2019 : Wt 274 lb AHI 17/hr, supine AHI 41/hr, non supine AHI 8/hr, oxygen nadir 85% . Sats < 88% for 0.8 minutes

Currently: APAP, Min pressure of 7.4 and max of 14, EPR off.  Going back and forth between a Resmed Airfit F10 FFM and a Dreamwear FFM.  Each has its difficulties.  The F10 irritates my eyes, and frequently when I use the Dreamwear I wake up around 1 or 2 am feeling short of breath and I have to take the mask off.  I have good nights and bad (and enough good nights that I see the benefit of the therapy), but the difficult nights are driving me crazy.  On the bad nights, the side effects of using the machine leave me more tired and irritable during the day than I would have been using no therapy at all.

That happened again last night, and I have a bunch of screenshots.  

The first half of the night I was wearing the Dreamwear FFM.  I woke up where you see at the second gap at 3:30, unable to catch my breath, and feeling generally like you would if you were breathing under the covers for too long.  Took the mask off and took several breaths of deep relief.  I then switched to the F10 for the rest of the night.  It doesn't have that specific problem, but it leaks a lot and generally bothers me.

I have a mask fit appointment this week with my old DME from back in the day, hoping I can find one that works. 

Thoughts?  Hoping one of you will see something obvious that I'm missing.  

   
   
   
   

[WillSleep]

The first half of the night I was wearing the Dreamwear FFM.  I woke up where you see at the second gap at 3:30, unable to catch my breath, and feeling generally like you would if you were breathing under the covers for too long.  Took the mask off and took several breaths of deep relief.  I then switched to the F10 for the rest of the night.  It doesn't have that specific problem, but it leaks a lot and generally bothers me.

Hi. 

Your Tidal Volume and Minute Ventilation Medians both look pretty good which means it looks like you moving air well.

Your pressure could go up a wee bit to help reduce those flow limitations. 

"like you would if you were breathing under the covers for too long" 
If your getting more CO2 than your body likes set EPR to 2 which will make it easier for your body to exhale.  

In short I would try increasing your Pressure Min 1.4 cmH20 and change EPR to 2.  If that does not do and no new information surfaces I would increase Pressure Min another .4 or .6 cmH20.
 

WillSleep

[geauxdbl]

Here are a few detailed view screenshots:

   
   

[WillSleep]

The first chart shows a Flow Limitation which calls for an increase in Pressure Min.   In the second chart I would not worry about the OA yet because the OAs are rare and a leak just ended.  

So this is still what I would do.  

"In short I would try increasing your Pressure Min 1.4 cmH20 and change EPR to 2.  If that does not do it and no new information surfaces I would increase Pressure Min another .4 or .6 cmH20."

WillSleep

[geauxdbl]

Thanks WillSleep - I’ll try it tonight.

[geauxdbl]

Slept through the night (mostly) and felt objectively better this morning.  Much easier to breathe.  AHI went up a bit, but some of that is definitely sleep/wake junk at the beginning of the night.  

Was surprised to see a CA event pop up.  What do you think, should I take the pressure up another 0.6 or does the appearance of a CA event suggest that I not do that?

   
   

[WillSleep]

Slept through the night (mostly) and felt objectively better this morning.  Much easier to breathe.  AHI went up a bit, but some of that is definitely sleep/wake junk at the beginning of the night.  

Was surprised to see a CA event pop up.  What do you think, should I take the pressure up another 0.6 or does the appearance of a CA event suggest that I not do that?

"Slept through the night (mostly) and felt objectively better this morning.  Much easier to breathe."

Great! 

In my non-professional opinion:

• This was only one night so will want to see more nights pass to firm up or disrupt the conclusions below. 
   
  
• I think feeling better during sleep and this morning  came mostly from setting ERP to 2.  This lowered the pressure required for you to exhale.  Your Exp. Time went from 1.88 to 2.08 while Insp. Time did not change.  So you spent more time and created more volume of air on the exhale.
   
  
• Raising Pressure 1.4 quite significantly knocked down your Flow Limitations which should lead to a more restful sleep and increase oxygenation a little bit as well.
   
  
• You saw 1 CA which is not a surprise at all when enabling EPR.  A few CAs a night after enabling EPR is not unusual at all and the number of CAs tends to drop as your body adjusts to EPR.   A few treatment induced CAs are usually not a concern unless 1) they are very long running, 2) the Pulse-Ox you wear all night to track your level of oxygenation (SpO2) tells you that you desaturated at that time or 3) your Minute Ventilation chart shows a big lasting desaturation at that time.    We rarely see these three results from EPR/treatment induced CAs but for sure watch to look out for them.  
   
  
• The increase in AHI is not yet significant.  Sometimes beating down AHI along is the answer.  Sometimes once AHI is under 3-4 tuning other attributes yields a better night sleep.      
   
  
• So in conclusion, I would leave these settings just as they are and continue to post a screenshot each day so we can monitor progress and see if additional changes are required.    
  

For the next screenshot it would help if you could try and squeeze these charts in this order.  If Snore is nothing or very little it is not important.  

• Event Flags
  
• Flow Rate
  
• Pressure
  
• Flow Limit
  
• Resp. Rate
  
• Leak Rate
  
• Snore
  

"Slept through the night (mostly)"
Is there any detail / breakdown on this "mostly" that you want us to know so we can better help?

Congrats on the great night!

WillSleep

[geauxdbl]

Quick update: Have not encountered any more CA events and have enjoyed several nights of sleeping well and waking up feeling refreshed.  I've even had two nights of 0.0 AHI.  Here's last night:

   

Thanks WillSleep!

[WillSleep]

That is excellent news!  

Congrats on the AHI = 0.0 and even more so on waking up refreshed!

WillSleep

[subyroo]

I have had 2 x nights recently where I have been woken up to a feeling that I was suffocating and just tore the mask off so I could get a breath.
Would this be a similar thing to what the OP experienced?