Woke Up Gasping

Hi All, First post for me. Need some help with a wake-up last night urgently pulling off my F20 and gasping. I tape my mouth so was breathing heavily through my nose and was able to recover without removing the tape. I spent about a minute catching my normal breathing before replacing the mask and going back to sleep. I did fine the rest of the night. Can anyone tell me what the "squiggles" are in my breathing pattern (I'm guessing micro apneas) and how to manage around them. Thanks for any help!
I added an attachment as I could not figure out how to insert an image.

Airyhead;
The best way to get some help is post the OSCAR chart for the problem night
and a chart for a different night .. That will give something to compare ..
Good luck ..

Airyhead wrote: ↑

Mon May 06, 2024 8:37 am

Hi All, First post for me. Need some help with a wake-up last night urgently pulling off my F20 and gasping. I tape my mouth so was breathing heavily through my nose and was able to recover without removing the tape. I spent about a minute catching my normal breathing before replacing the mask and going back to sleep. I did fine the rest of the night. Can anyone tell me what the "squiggles" are in my breathing pattern (I'm guessing micro apneas) and how to manage around them. Thanks for any help!
I added an attachment as I could not figure out how to insert an image.

I agree with Sauerkraut... post a full Oscar or SleepHQ graph. You probably had a big O2 desat... are you using O2Ring? Were you flat on your back? Did you accidentally cover your exhaust ports?

Normally the machine will see those squigglies and count them as Snoring... this will make the machine angry, and if on APAP it will drive the pressures way up. Your full Oscar graph would have a Snore graph on it, you should see indications there. Looks like your waveforms got expiratory flow limitations (EFL's)... EPR might help you there. Again, we don't have the full graph so we don't know your settings. If you do turn on EPR (Resmed?) then raise the pressure 1cm for each cm EPR.

Thanks everyone for the help. I've attached the Full Oscar page zoomed in on the events in question. I did not get a SpO2 reading for this particular night. I have EPR set to 2 on CPAP mode and pretty sure I was on my back. I don't think the exhaust ports were blocked but I guess I could have been on my side. I checked the balance of the night and I had similar "squiggles" in other segments but they didn't bother my sleep. I'm thinking I might bump my pressure up to 11cm and keep the EPR of 2 to try to overcome any resistance that may manifest. Appreciate the help!

Frickin' website ate my pearls of wisdom! I'd been putting it all on Clipboard before posting... forgot to... oops. POS.

Summary... you had a bad desat related to OSA. Your pressure needs to go up. Lowering your EPR will effectively do that too. I prefer SleepHQ because we get to see the whole night, not just a zoomed-in piece. You might try APAP 10-14cm and see where it takes you. We did not get to see the Snore graph, I assume it registered. Ctrl-a ctrl-c dammit!

Thanks vandownbytheriver and sorry for the frustration. I'm a bit new to the the forum. Very much appreciate the help. I determined Ctrl-A isn't working on my PC for some reason and as I have SleepHQ I thought I'd attach the link here: https://sleephq.com/public/1aae1727-cfa ... ea808c6561 The period in question ends around 09:05:15. I checked the Snore graph and don't see anything around that time. I've got my Resmed 11 set to CPAP after spending several nights with APAP and looking at ranges and maximum needed pressures. Level 10 was at the 99.5% range. And following Lefty Lanky's advice I put the unit into CPAP mode to preclude the lagging response issues he talks about. I'll try a pressure level at 11/ EPR 2 and see how that works. My other issue is a waxing/waning issue throughout the night so I am very cautious about using EPR. I have an older Resmed 10 BiPap that's seen better days so I may go back to it to see if I can manage the waxing/waning issues any better. Thanks again.

Airyhead wrote: ↑

Wed May 08, 2024 8:26 am

Thanks vandownbytheriver and sorry for the frustration. I'm a bit new to the the forum. Very much appreciate the help. I determined Ctrl-A isn't working on my PC for some reason

The Ctrl commands were meant for me. And it happened again... getting very frustrating using this website.

and as I have SleepHQ I thought I'd attach the link here: https://sleephq.com/public/1aae1727-cfa ... ea808c6561 The period in question ends around 09:05:15. I checked the Snore graph and don't see anything around that time.

You're right... no snore detected. See how your expirations go away right before you panic? Expiratory Flow Limitation... EFL. You need more support and less EPR at that time. Any disciple of Jahsohn should disdain EPR. I take it the gap in the graph is the AutoStop/Start working.

I've got my Resmed 11 set to CPAP after spending several nights with APAP and looking at ranges and maximum needed pressures. Level 10 was at the 99.5% range. And following Lefty Lanky's advice I put the unit into CPAP mode to preclude the lagging response issues he talks about. I'll try a pressure level at 11/ EPR 2 and see how that works. My other issue is a waxing/waning issue throughout the night so I am very cautious about using EPR.

Waxing and waning *what*?

I have an older Resmed 10 BiPap that's seen better days so I may go back to it to see if I can manage the waxing/waning issues any better. Thanks again.

Mind blown... you've moved from an Aircurve 10 (best thing since sliced bread) to an Airsense 11 Autoset (questionable at best)? What change in your treatment allowed you to make this move?

Yes, the gap is when I took off the mask to catch my breath. Not a great feeling for sure. The move to a Resmed 11 APAP from the 10 BiPap is the outcome with yet another sleep study, new Doc and her insistence that I needed an Auto machine and could not justify a Bi-Pap cost because the study showed no evidence of a need (and to answer the obvious question in advance, the Doc had no financial interest in the DME). She genuinely thought I did not need a BiPap.

As a Jason fan, I know his distain for EPR and understand and buy-in to his position. My motivation for trying EPR was a effort to stay with the 11 and try the "poor mans" Bi-Pap. Looks like it may not work for me. My reason for trying to stay with the 11 is two fold: 1) The 10 is pretty beat up with lots of hours and 2) the Doc is monitoring my 11 and I'd like to honor her position until we can agree my therapy is not optimal. If I can't get there, I'll move to plan "B".

The waxing/waning (aka periodic breathing) is persistent across my day-to-day waveforms. While it looks a lot like periodic breathing, I don't fit the profile for one who might present with this feature. Jason's recent videos around UARS seems to describe my situation well - yet another reason to move to a Bi-Pap machine. My Doc is a highly experienced sleep Doc with years in the specialty, with great bedside manner and a desire to help. Rare these days so again I would like to continue with her. But as I, like most on this site and others, live, breath ( ) and dig into each breathe we take, the Docs like mine (though well meaning) don't have the luxury of time to treat the outliers like me. My wife, from day 1 took to her CPAP and for 20 years sleeps great with a AHI of zero every night. Thankful for that.

Probably back to the BiBap soon at a CPAP level 11 and pressure support.

Thanks for the help vandownbytheriver! I'll post for a follow-up if I make the move.

Airyhead wrote: ↑

Thu May 09, 2024 8:28 am

Yes, the gap is when I took off the mask to catch my breath. Not a great feeling for sure. The move to a Resmed 11 APAP from the 10 BiPap is the outcome with yet another sleep study, new Doc and her insistence that I needed an Auto machine and could not justify a Bi-Pap cost because the study showed no evidence of a need (and to answer the obvious question in advance, the Doc had no financial interest in the DME). She genuinely thought I did not need a BiPap.

You're also aware of Jason's disdain for AutoSet... there are folks around here that prefer it, if you're highly positional and can deal with the swings then whatever... but I find the best therapy and sleep for me is at a steady (bi-level) setting. They make auto bi-level machines, your Aircurve 10 might even be a vAuto. Even if it's an S I'd prefer it to the alternative. It's the same damn hardware, I've proven that to myself many times... the good firmware costs double. Do you happen to know your Aircurve settings? CM and PS?

As a Jason fan, I know his distain for EPR and understand and buy-in to his position. My motivation for trying EPR was a effort to stay with the 11 and try the "poor mans" Bi-Pap. Looks like it may not work for me. My reason for trying to stay with the 11 is two fold: 1) The 10 is pretty beat up with lots of hours and 2) the Doc is monitoring my 11 and I'd like to honor her position until we can agree my therapy is not optimal. If I can't get there, I'll move to plan "B".

You get the 'motor life' message at 22,000 hours... I have an Autoset with almost 23,000 hours and a new motor, ready to go for another seven years. Motors are cheap, 130USD on Amazon/Baidu.

The waxing/waning (aka periodic breathing) is persistent across my day-to-day waveforms. While it looks a lot like periodic breathing, I don't fit the profile for one who might present with this feature. Jason's recent videos around UARS seems to describe my situation well - yet another reason to move to a Bi-Pap machine. My Doc is a highly experienced sleep Doc with years in the specialty, with great bedside manner and a desire to help. Rare these days so again I would like to continue with her. But as I, like most on this site and others, live, breath ( ) and dig into each breathe we take, the Docs like mine (though well meaning) don't have the luxury of time to treat the outliers like me. My wife, from day 1 took to her CPAP and for 20 years sleeps great with a AHI of zero every night. Thankful for that.

Probably back to the BiBap soon at a CPAP level 11 and pressure support.

Thanks for the help vandownbytheriver! I'll post for a follow-up if I make the move.

So wax/wane is CA... IMO these are mostly caused by CO2 stripping... using EPR is one of my bugbears... as Jason has noted it just tends to string the cycles out longer. As the pressure rises at some point it becomes superfluous... probably around 17cm... and going on up you *need* a pressure differential to help dump your blood CO2. You're running 10cm CPAP at EPR 2... and experiencing CA's. Lose the EPR, go down to 8cm if you have to, and see what happens. I'd be real interested to know your old bi-level settings, guessing it was an Aircurve 10 S? You're hinting you had 11cm with some PS? That would be equivalent to say 13cm EPR2 (or whatever your PS was) for Autoset.

Airyhead, it’s possible you had a brief period of palatial prolapse. If it keeps happening, talk with your sleep doctor. She might then want to refer you to an ENT.

Miss Emerita wrote: ↑

Fri May 10, 2024 7:20 am

Airyhead, it’s possible you had a brief period of palatial prolapse. If it keeps happening, talk with your sleep doctor. She might then want to refer you to an ENT.

Exactly.
Those last breaths before you ripped the mask off, see how you exhale (below the 0 line) is a suddenly pointy and narrow?

Referencing the chart in your original post,
What I find to be significant is that your expiratory volume is significantly less than your inhalation volume. If the flow curves are correct, air was accumulating over many breaths (11).

Thanks all, The old unit is the Aircurve 10s with last best settings of CM=11 PS=9. Good to know concerning rehabbing the old unit with a new motor.

I've been down a rabbit hole today on the topic of palatial prolapse. Thanks all for the observations. Fascinating in my case and seems to fit the balance of my breathing patterns, at least with my current equipment and settings. Seems like the Bi-Pap may address this issue a bit better so will try that with settings of CM=11 and PS=9, review exhalation curves and make adjustments from there.

Dataq1, would you be so kind as to expand on your comment of accumulating volumes over many breaths.

Sure.
Unless there is a significant leak, the volume of air inspired should be close to that of the volume expired.
In your beginning three breaths of your original post the volume of air exchanged between 21:04:36 and 21:04:40 is fairly equal between Inspiration and expiration.
( the area under the curve represnts the volume of air)
for example:

Where red is the inhalation volume and blue is the exhalation volume.

Compare those three breaths at the start of your posting with the next 11 breaths, where the volume being exhaled is significantly less than the volume that had just been inhaled.

dataq1 wrote: ↑

Fri May 10, 2024 2:17 pm

Sure.
Unless there is a significant leak, the volume of air inspired should be close to that of the volume expired.
In your beginning three breaths of your original post the volume of air exchanged between 21:04:36 and 21:04:40 is fairly equal between Inspiration and expiration.
( the area under the curve represnts the volume of air)
for example:

Where red is the inhalation volume and blue is the exhalation volume.

Compare those three breaths at the start of your posting with the next 11 breaths, where the volume being exhaled is significantly less than the volume that had just been inhaled.

Thanks dataq1.....I see that now. And it then begs the question, what goes in must come out and leaks register as good. As I tape my mouth that question is a bit of a mystery.