Comment by wincy

Reddit is pretty great for cpap related help and hints.

I just did 3 nights with mine and conclusion: it's all about the type of mask + settings.

First 2 nights was terrible (and painful on the face) due to wrong masks and wrong settings. 3rd night was best I've slept in a longgggg time.

I can't tell you which masks or settings (it will be completely different per person), but reddit is pretty great at providing hints.

My case: disaster with nasal mask and full face mask size L and high pressure settings (lots of central apnea). Almost perfect with 4 to 10 pressure setting and face mask size M (which should be too small for me according to the manufacturer).

I use a Resmed Airsense 11, soon getting a heated tube so I can crank up the moisture setting without getting condensation and noises in the tube. Will try more different full face masks as well.

I’ve been using a CPAP for 15 years. A few items I had to adjust when getting that suffocating feeling a few times:

1. When getting a new CPAP I had to reduce the pressure from 15 to 14 or 13 to mitigate the suffocating feeling. I still get my normal 0.5 events per hour while I’m use. I also got a different type of mouth and nose mask which may have contributed to needing to adjust the pressure.

2. I was trying to mitigate the colder air being distracting by enabling the humidifier and tube heater. With the humidifier level too high at 5 I got a suffocating feeling, reduced it down to 2 or 3 and the air was warmer while not feeling suffocating. 3. I also turned off the dynamic pressure on breathe out as the timing felt off and would cause a hitch in breathing, so I have just plain constant pressure.

The name of the game is tweaking and experimenting.

Followup sucks in most part of the world, unfortunately, which leads to awful compliance.

Best thing to do is install Oscar [1], take screenshots of your data, and post it to Apnea Board [2]. The folks there will likely be able to offer some solid advice.

Without knowing anything about you or your data, all of this speculation, but: APAP sucks, it is always too slow to respond, it won't know to increase the pressure until after you needed more pressure. This is especially true for wide ranges which are often the default (like 5-20cm). If you need 15cm, it will take forever to get there, because you'll start at 5, start to drift off, get an apnea, the machine will increase the pressure, you'll wake up ever so slightly from the apnea, the machine will decrease the pressure because now you're breathing fine, and the cycle will continue.

[1] https://www.sleepfiles.com/OSCAR/ [2] https://www.apneaboard.com/forums/

Things that have helped me:

- nose mask rather than full face mask

- nasal spray if my nose feels congested

- upping the pressure. In theory a professional is supposed to set your pressure but I do tweak mine. If the setting is not visible it's probably in a hidden menu - Google for how to enable it for your machine.

- sleeping pills

I hope you find a solution. Sleep apnea is terrible.

> as soon as I try to go to sleep I feel like I’m being smothered and my heart starts racing

You may need your pressure adjusted. You are awake so whatever pressure the machine is using is fine. Then you start falling asleep and that's when your apnea kicks in.

If you are using the standard autoset 4-20 setting it may not be enough. Ideally this would be done by a medical professional and yada yada - insert standard disclaimer here. I would suggest increasing the lower pressure (say, to 7) to see if it helps you. I was using the default for years and, while it did help me, apparently it wasn't enough. After increasing, it's been night and day.

It _could_ be an issue with your mask but given what you described, probably not.

Sounds like you aren't getting enough pressure. Also sounds like there could be some mechanical reasons like gerd, allergies or inflammation that cause your apnea, especially if you start fine.

I went through the same thing.

- #1 - switch to Nasal pillows.

- I had to learn to breathe through my nose

- I had to learn to sleep on my back with a pillow that cradled my head without raising it

- I had to make sure the level of distilled water in the humidifier was not too high.

- make sure the tubes are not higher than your nose (otherwise condensation water drips into your nose)

Did you try different types of masks? I found that I felt like that during the initial phases of the titration study (where they determine the right settings for you) but once they dialed in the pressure, that feeling went away and now I actually quite enjoy it, since it makes it easier to breathe through my nose. I use a nose pillow.

This is a common and difficult problem. Has your sleep doctor helped you with it? You might also find an online Sleep Apnea forum has ideas for you. I learned a lot from https://www.apneaboard.com/

I was prescribed a CPAP (well, APAP as you mention) and the first week was miserable. I think I got 3 hours of sleep total that week, and obviously felt like crap. I talked to my primary doctor and she's like "well then go back to the specialist". That's what I'm doing.

My plan is to get a prescription I can use to buy a bunch of different masks (I don't care about the cost), and get a few days of sleep aids. That should sort it out.

The few hours I did sleep with a CPAP were crazy. I forgot that I stopped having dreams. I had so many dreams while I could breathe at night.

Your pressure is too low and you are suffocating. While awake you are manually breathing deeper which is why you are okay.

Set the minimum pressure to something higher, like at least 10, possibly more. If it’s an auto machine then it will adapt to you anyway. At the minute it’s probably set to something like 4 which isn’t any air at all.

Have you tried playing around with the humidity? If I have it set too low, that definitely makes a big difference. There are also other treatments for sleep apnea that you could look into which might work better.

That feeling of being "smothered" might simply be that you need a higher pressure setting. The pressure that feels comfortable while awake might not be sufficient when your body is asleep.

Have you looked into "elastic mandibular device"? You can get a mouth guard that keeps your jaw from falling away from alignment. It was enough for me to avoid a machine entirely.

EASE and/or MMA

https://sleepapneasurgery.com/about-dr-kasey-li/

Do you have a slow ramp up of pressure? I have to start on low pressure when I first put the mask on each evening.

Your sleep doc/clinic may be able to help.

That sounds like a huge problem! Which masks have you tried? There are many different mask options that you may respond differently to

Honestly? Find a new doc. I went to one for sorta similar issues and their advice was basically "oh well that sucks" and then years later went to another who said "okay let's try this instead"

Now I'm on a bipap and tolerate it through the night.

> I can breathe through the CPAP exclusively for hours but then as soon as I try to go to sleep I feel like I’m being smothered and my heart starts racing

I felt the same way when I was prescribed a CPAP about 20 years ago. I'd be set to go, get panicky, take the mask off and not feel like trying again for longer periods of time until I gave up. Then about 2 years ago I decided to get a doctor again, talk about my sleep apnea, get a new set of sleep studies done, try to get a machine (it took forever!). I got prescribed a similar machine called an ASV.

For me, the thing that works is a breathing technique the technician at the sleep study told me, which was breath in manually, but then just relax to breathe out rather than forcefully breathing out. Currently I do that by breathing in manually, and then relaxing while counting to three as I let it out. I don't know if it's just a mental way to relax or what, but it works for me. Also, when I was taking the sleep study, I was determined to complete the test, so taking it off wasn't an option, even if I got anxious. So I did the breathing thing, and they were able to get enough data to proceed.

I go to sleep when I'm very tired; that might help. As far as I remember, I fall asleep very quickly. If I wake up in the morning, I can't really get back to sleep since I just notice the mask too much while not falling asleep; I guess I'm not tired enough any more at that point. 7 hours is good for me, but often I'll get 5-6 hours.

Edit: oh yeah, my number of sleep events (when you stop breathing) went from 120 to ~1 per hour. For comparison, >5 is mild, >15 is moderate, >30 is severe.