Felt like I was suffocating last night! Changed too many Clinical Settings at once.

[JoshuaApneaProblems]

I’m new to CPAP, five days in. I discovered clinical settings yesterday, and probably made too many changes right out of the gate. I struggled to fall asleep last night and had an incredibly high AHI. I have SO many questions!

First of all, the changes I made yesterday:
- I realized I had had the machine set for “nasal,” even though using pillows. I changed it to “pillows.” Not sure how this affects the pressure.
- I changed the Response from “standard” to “soft,” which uses the “for her“ algorithm so that an event at night doesn’t cause such an intense increase in pressure 
- I put EPR on, which reduces pressure for every exhalation. I set it to full-time, not just at ramp, and I said it at level 1 out of 3 cmH2O.

Trying to go to bed last night, I found myself struggling to get enough air. Every took I took a deep breath, the machine would increase the pressure. Sometimes, I’d have to breathe through my mouth to get enough air, and the machine would jack up the pressure even higher.

After a half hour, I was getting slammed with a pressure of 20, and could no longer exhale. 

I quickly started the session over, but this time, set the max pressure to 16, the min pressure to 6, the EPR to 3 cmH2O, and turned the ramp off. I hoped this would give me more air to breath up front, and make it easier to breathe throughout the night.

It looks like I still struggled after that with leaks and CA’s for another half hour before I started to fall asleep, and then continued to have events throughout the night. 

I woke two times during the night, and noted the time: at 3:32 and 5:18. But I don’t see anything unique on the chart at those moments.

Then, strangely, when I woke up, I found barely any pressure at all. It looks like it was running around 7 to 8 most of the night. But in the morning, it felt like just breathing normally, no therapy. — Is this normal? 

My AHI was terrible last night: 19.24! Mostly due to my struggles in the first hour.

I’m attaching a screenshot of my Oscar report for last night, and one for my third night on the machine last week, when my AHI went down to 1.28.

Thank you for any suggestions you fine people can offer.
   
   

[PeaceLoveAndPizza]

I would discard that night as a lesson learned. Let it go…

Let’s get back to basics. 

Min pressure 7
Max pressure 15
EPR 2
No ramp
Response Standard
Set mask type to the setting matching your mask

Give that a go and we can take it from there.

[BoxcarPete]

The answer to your last question is: yes! It should feel like you are just breathing normally. I am pretty convinced that the whole "I can't breathe out against the pressure" thing is mostly mental. Can you fill a glass of water 20cm (8 in) tall, take a straw, and blow bubbles through it? If so, you are able to breathe out against the maximum pressure the machine is able to deliver.

But as you found out, once you relax and breathe normally (which you were able to do unconsciously as you slept) the air within your airway is pressurised to the same level as the air in the hose, so it should feel like breathing normally. There were some mornings where I was surprised to suddenly have a leaf blower in my face because I thought I had shut the machine off already, but I was still breathing at 8cm or more of pressure.

The other way to think about it is altitude. Water weighs about 800x more than air, so every cm of H2O is equivalent to 80m of altitude. You wouldn't think twice about going down 600m (2000 ft) closer to sea level, equivalent to 7.5cm H2O, and having trouble exhaling, so why worry about it being delivered by machine?

Best thing you can do is relax.

[Muggzy]

"But in the morning, it felt like just breathing normally, no therapy. — Is this normal?"

I sure hope so, lol. It's normal for me anyways, and my min pressure is significantly higher than yours