My wife has heard me choking/gasping after one year of usage

[luke1081]

Hi there. I've been using my CPAP for just over a year. In the last few weeks, my wife has heard me choking/gasping for breath while sleeping. She nudges me to wake me up. It was the same sound that encouraged me to first go to the doctor's in the first place (and then get diagnosed with sleep apnea). It's only occurring when I am supine/sleeping on my back. I am a 38 year old male, not overweight, non-smoker/drinker, who exercises regularly.

I have a recessed lower jaw and deviated septum (which I presume is the reason for my CPAP therapy), and during my sleep test scored 19 AHI. I suffer from allergic rhinitis permanently and use nasal strips and Ayr Nasal Gel before sleeping.

No ramp time. Humidity Level 4. Tube Temp Off. Full face mask.
Mode: AutoSet
Max Pressure: 20.0
Min Pressure: 6.0

Though the AHI is (and always is) under around 2/3, I am obviously worried I am still choking! Here is my chart from last night (when my wife informs me she woke me after hearing gasping):

[rick blaine]

Hi luke1981,

Hmm. The question was raised – might you have sleep apnea. You were tested – you don't say whether that was with the NHS or privately. But you were diagnosed. You were issued with a machine and mask. Your numbers on treatment look good.

What's the issue?

The thing about CPAP treatment is – from time to time, you may still have apneas. Getting to an average AHI below 2 is good. The staff at your sleep apnea clinic – if you are in the NHS system – may be working to 5. I can't see any clinician being alarmed by these numbers.

By the way, deviated septum isn't necessarily the 'reason' for sleep apnea – especially if you have the kind of rhinitis you describe AND you use a full-face mask. Much more common is 'tongue position in throat' or 'tongue falling back in throat'.

And a so-called 'full-face mask' could better be called 'nasal passages so blocked or diminished that patient has to breathe thru the mouth' mask.

[luke1081]

Hi, thanks for your reply. It was NHS, yes. And I agree, the numbers are always good, but my concern is the literal choking that still seems to occur- and that leads my wife to have to rattle me awake. I think maybe I was under the impression that the CPAP would prevent the apneas reaching a stage where I was still lying there fighting for breath - which it doesn't seem to do if I am choking/gagging/gasping still? Is that still normal then? Like I say, it only happens on my back.

[rick blaine]

The tongue is more likely to fall back when the patient is lying on their back. Which is why patients are advised to avoid sleeping in that position if they can.

Some estimates say that back-sleeping can add as much as 5 to the AHI. A good reason to avoid doing it.

[luke1081]

Hi luke1981,


By the way, deviated septum isn't necessarily the 'reason' for sleep apnea – especially if you have the kind of rhinitis you describe AND you use a full-face mask. Much more common is 'tongue position in throat' or 'tongue falling back in throat'.

And a so-called 'full-face mask' could better be called 'nasal passages so blocked or diminished that patient has to breathe thru the mouth' mask.

Thanks, Rick. That's all very interesting. The NHS/ENT clinic have never offered any reason for my sleep apnea (Just "You got it, you're not overweight, but here's a machine, good luck."), so it's all been a bit of a journey of self-discovery to find out why I have it exactly.
As I say, not overweight at all, in my late 30s, non-smoker. Not denying I have it, the results speaks for themselves, just wish I knew whether it was deviated septum, allergic rhinitis, physiological makeup with recessed jaw, tongue etc etc, or all of the above!

[rick blaine]

To luke1081,

The amount you get told varies around the UK. Some FTH clinics have a very big caseload, and don't really have the time. Other clinics aren't quite so busy, and still offer 30-minute appointments so there's time to better brief the patients.

Either way, this is as good an information video as you'll find:

https://www.youtube.com/watch?v=-gie2dhqP2c

[kteague]

You might have more than one thing contributing to you having sleep apnea. In previous discussions on here about having an inset lower jaw, It was said that the lower jaw is not smaller, it is set back farther thus making the airway smaller. Prime situation for apnea as there is less room for laxity in the tissues. At any rate, a few thoughts about your current treatment. Most of us just live with those few breakthrough events when side effects from high pressure would be more problematic than the events. However, with events severe or prolonged enough to cause the symptoms you describe, trying to resolve them sounds prudent. If you are not having issues with your pressure (like air in the belly, excessive mask leaks, etc) increasing your pressure to try to stop them is one option. It may be if you increase your lower pressure your machine may be able to keep those events from breaking through. Another option is to take steps to stay off your back for a few nights and check your data. Wearing a book bag/backpack with something in it to keep you from rolling onto your back might work. You can then decide which approach (or both if needed) will be least disruptive to you and your spouse's sleep.

[Rob K]

Kteague laid out a nice action plan for you.

Apnea is worse when on our backs.

The first thing I notice looking at your Oscar data is quite a few leaks. Ideally you don't have any LL(large leaks) Reducing leaks should improve things some. Things that cause leaks are poor fitting mask, improperly adjusted mask, moving around in your sleep, and probably more I'm not thinking of. Are you waking a lot through the night and find yourself temporarily taking the mask off or adjusting a lot? It could be you have your mask adjusted to seal well for low pressure, but when the pressure automatically ramps up then you are getting leaks. Not always the case, but it looks like it happens several times through the night.

Your maximum pressure is set plenty high enough since the pressure is not maxing out. The low setting seems like it could be a little higher since the pressure is ramping up a fair amount through the night.

I would probably start by getting a good mask fit and see what the data looks like. It could be that the machine is increasing the pressure fairly often to compensate for all the leaking.

[nicholasjh1]

I find that even when my AHI is low I sometimes have "bad" nights. I think I have enough rest that I wake up and "prevent" longer than 10 second apneas (even if I don't remember "waking up") so even though your numbers are low you might benefit from a higher minimum to prevent sleep disruption from incipient apneas. My AHI is the same if my minimum is 6 or if it is 12, but I feel much better at 12.