Wake up feeling like I'm suffocating

I've had 3 nights on CPAP - I'm gradually overcoming problems (no rain-out now, found info on the LCD...) but I still wake up after about 5 or 6 hours of sleep and feel like I can't breathe (in or out). I adjust the pillows but it is a scary feeling and I end up taking it off so I can go back to sleep. When I put the machine on at night the breathing feels "forced" but I can handle it - why do I feel so panicy when I wake up? Is this a common thing or are these little pillows actually closing up (it's what I feel like has happened). I'm using the Small pillows - may try medium and see if that helps. My pressure is 6 but I haven't yet figured out how to see at what number the EPR is set. I feel like I can't inhale or exhale. Actually, I'm thinking I'll trade to a different type mask. I also am confused about the results data on the LCD but will try to research that - the "hours used" was not the number of hours I had it on. Also the AHI was higher than my combined apneas and hypopneas although I thought it was supposed to be the "daily" number. My, my - so much to learn!

btesterman wrote:I've had 3 nights on CPAP - I'm gradually overcoming problems (no rain-out now, found info on the LCD...) but I still wake up after about 5 or 6 hours of sleep and feel like I can't breathe (in or out). I adjust the pillows but it is a scary feeling and I end up taking it off so I can go back to sleep. When I put the machine on at night the breathing feels "forced" but I can handle it - why do I feel so panicy when I wake up? !

I had that too with my full face mask after the first week. Try to just take off the mask, breath a few times and put it back on. You have to train your mind to accept this new stuff. It worked hard for years keeping you alive by waking you up when you couldn't breathe It isn't fully convinced this stuff works yet.

Hello! I remember you from before Thanksgiving. It has taken you a while to get started! Good to hear that you have your machine now.

There are several settings that may make things more comfortable. One is EPR. I found that too much EPR wasn't comfortable for me, as it almost felt like the machine was forcing my breath. I have it set to "1" right now, and I'll probably turn it off soon. Another is Inhale, which can be set to either Fast or Medium. I find Medium to be more comfortable, but everyone's different. If you have Ramp set, you may want to turn that off. Your set pressure, at 6, is very low. Many people find it more difficult to breathe between 4 and 6. But I think there's also an adjustment period, as you get used to the machine and learn to trust it. You may be hyperventilating a bit. I know that I was in the beginning, as I was trying to figure out how the machine worked. Try not to concentrate on your breathing. I use "nature" CDs to distract myself as I'm falling asleep.

You may need a different size of nasal pillows, like you said. Or a different style of mask. You may want to try various humidity settings too. Everyone's different, but I find it more difficult to breathe when the humidity's higher because the air feels "heavier". I usually keep my humidity at 1.5 or 2.0. But I don't heat my home and room conditions/climate are different everywhere.

As far as reading the machine's LCD information, if you want to see the results from the night before, then you have to access the information before noon. You are correct -- the AHI should be AI + HI.

There is a lot to learn, but you're catching on quickly. You'll do great. I hope you're feeling better during the daytime. Hopefully, you'll feel up to cooking a big Easter dinner this year!

~ DreamOn

btesterman wrote:I've had 3 nights on CPAP - I'm gradually overcoming problems (no rain-out now, found info on the LCD...) but I still wake up after about 5 or 6 hours of sleep and feel like I can't breathe (in or out). I adjust the pillows but it is a scary feeling and I end up taking it off so I can go back to sleep. When I put the machine on at night the breathing feels "forced" but I can handle it - why do I feel so panicy when I wake up? Is this a common thing or are these little pillows actually closing up (it's what I feel like has happened). I'm using the Small pillows - may try medium and see if that helps. My pressure is 6 but I haven't yet figured out how to see at what number the EPR is set. I feel like I can't inhale or exhale. Actually, I'm thinking I'll trade to a different type mask. I also am confused about the results data on the LCD but will try to research that - the "hours used" was not the number of hours I had it on. Also the AHI was higher than my combined apneas and hypopneas although I thought it was supposed to be the "daily" number. My, my - so much to learn!

I just finished my 9th night on CPAP, so I understand your new found issues. My CPAP pressure is 11, and I start at 6 with my ramp, so for me 6 is quite nice and comfortable, if I try 11 to start, it feels like what you are talking about, suffocating.

One thing I've found that helps me is to train my mind is telling myself "this mask will HELP me", and it does help. I used to wake up with headaches, and major sinus pain. The other day I almost felt as if I didn't need my prescribed sinus medicine (took it anyway, it's good to keep everything on a regular schedule). My PCP told me that I may get off of my recently (1 yr) blood pressure medicine if this treatment continues (yea!).

I'm fighting a sore nose myself, a blister has formed, and burst, just below the bridge of the nose, and although it doesn't hurt, and hasn't interfered with my CPAP usage, it looks ugly. I'm going to go with a bandaid tonight to see if I can't get it healed.

Keep with it, it will only get better and easier with each night. Don't forget to use it when you take a nap as well.

Wishing you the best!

You're already getting good advice from the three people who've already posted here. I'll add this -- a discussion you've already seen, but might be part of your problem:

Re: MIRAGE SWIFT LT QUALITY POLL--THE RESMED CHARADE??? -- poll started by plr66
viewtopic.php?p=425631#p425631

On page 12, tattooyu's DME talks to a ResMed rep:
viewtopic.php?p=411916#p411916

"I wanted to chime in here and mention that I brought it up to my DME, who is a great guy and very interested in my feedback and my therapy. He spoke with a rep. at ResMed (I don't know what department) and he brought it up to them. According to him, they know about this quality control issue on the nasal pillows but don't want to change anything because, "Patients are allowed new nasal pillows every month anyway."

You mentioned you were thinking about switching from the small pillows to the medium. I think that would be a good thing to try.

A pressure of 6 is quite low. I'm not saying that's not the correct pressure to keep your airway open, but if you do have EPR turned on FULLTIME (that means throughout the night, not just while using RAMP) whatever the EPR setting is (1, 2, or 3) that will be how many cms the pressure will drop each time you exhale.

In other words, since your therapeutic pressure is set at 6, if you turn on EPR "2" (for a 2 cm drop each time you breathe out) the pressure will be only 4 cm to hold your airway open while you exhale. AND...(here's the problem, imho)... the pressure will REMAIN down at 4 cm during any pause you might have before you start to inhale again. If your airway collapses in an apnea during that pause at the end of breathing out, you can't START to inhale again.

Starting to inhale again is what triggers EPR to let the "regular" pressure back in. If you can't get an inhalation started, EPR will just sit there at that lower pressure, until EPR times out (a built in safety measure) and finally lets the regular pressure back in even though you've not been able to start the new breath yourself. But those seconds ticking by, not being able to get a new breath started, could be happening over and over again during the night.

If I use EPR, I personally want to raise the prescribed pressure by the same number of cm's as what I set EPR at, to be sure my airway is being kept well and truly open during every exhalation, and more importantly, during any pause before I start to breathe in again. But I'm not a doctor...that's just what I do.

rested gal,

You explain things so clearly! Especially for those of us who have low set pressures, it's very important to understand how ResMed's EPR works. Most people do feel like they're suffocating at a pressure of 4 or 5, which is essentially what you're getting on exhale when using EPR with a low set pressure. I wonder if that's even enough pressure to clear out all the carbon dioxide in the mask sometimes. And knowing that the EPR pressure stays low during any pause after the exhale, before inhaling again, is something many don't realize. I'm so glad you mentioned that!

I have wondered, too, if I can handle the "difficulty" breathing when I first put the mask on because I'm mentally prepared for it. When you wake up you're still sort of out of it and it may seem more "serious." I'll try taking it off, taking deep breaths and then resuming with the mask. I can't keep stopping CPAP at 3 or 4 AM every night!

I think I got the numbers wrong this morning. I really MUST have my coffee before I go check my results!!!! I'll also take the time to read more in the clinical manual.

I'd read about the pressure settings with Resmed on your posts before and it makes sense but have hesitated to change that quite yet. I'm sure my DME will flip out when they just find out I get into the clinical menu. Heaven forbid I should have any control of my own therapy!

I can get two new pillows every two weeks - doesn't speak well for their durability!!

I will change the pillows tonight and see how that works. I know this is all part of the process of correcting things and adapting..... I shall persevere!!!

Oh and yes, my first sleep study was in October - waited 15 days for results and to schedule next study. Another 15 days until they finished doing results of that one just to have me make an appt. to discuss the results. That was over Christmas so it was another 2 weeks until I could get in for the appointment. Then I had to work around my work schedule to see the DME, then went back to Doc. to change the script, back to DME...... Good thing I didn't expire in the meantime!!!

btesterman wrote:I'd read about the pressure settings with Resmed on your posts before and it makes sense but have hesitated to change that quite yet.

Well, that's up to you....

btesterman wrote: I'm sure my DME will flip out when they just find out I get into the clinical menu.

Let 'em. Your treatment is about YOU, not about them.

btesterman wrote: Heaven forbid I should have any control of my own therapy!

heheh...yeah.

DreamOn, your post was excellent, as always. I keep forgetting about the "Medium" and "Fast" adjustment settings for EPR -- glad you mentioned that!

Tielman, sounds like you are doing a good job on getting the puzzle pieces in place. The most important piece of all is the mask. Gotta have a mask that will let you sleep comfortably, plus the good attitude you have about wearing a mask. I like your mantra:

Tielman wrote:One thing I've found that helps me is to train my mind is telling myself "this mask will HELP me"

That's the way to think, but of course having the right mask for you helps make it possible to wear the mask without it causing sores. If a bandaid fix doesn't get the job done (and it very well could) you might want to go back to your DME and try some other masks. Any DME worth their salt should be willing to let you swap masks at least once (preferably more times) during your first month until you find one that doesn't chew your nose to pieces. Many masks feel fine during a mask fitting. But the real test for any mask is wearing it several nights at home in your normal sleeping positions. Good luck!!

Well DRAT - I went to get the medium pillow to switch out and the DME had given me a second small and an extra small - no medium. Well, I'll still try taking a couple deep breaths and try to assure myself that I am not going to lie there and suffocate. The DME did say I could trade out masks in the first 30 days - now I'll need to research other masks. Sounds like others have problems with nasal or full face rubbing sores on their nose. Couldn't you put a bandade or some such thing on BEFORE it rubs you raw? I used a Comfort Gel for titration (granted only one night) and it was fine. It was an older model. I take it you can use Respironics masks with ResMed units????

btesterman wrote:I used a Comfort Gel for titration (granted only one night) and it was fine. It was an older model.

One short titration night is one thing -- trying to use the same mask all night several nights in a row might be a completely different ballgame, so I wouldn't necessarily request a Comfort Gel mask. There are other masks I'd want to try rather than that one.

btesterman wrote: I take it you can use Respironics masks with ResMed units????

Yes, with your ResMed Elite II, anyway. There is a ResMed machine (Adapt SV) that's picker and where mask selection is limited and crucial, but you can use any brand of mask with your Elite II CPAP.

Before I spent one more night at suffocating pressure, I'd want to do a little testing while I was awake in the daytime, to see if increasing the prescribed pressure of 6, up to 7 AND to 8 felt better. I'd give each of those pressures at least ten minutes of relaxed, wide awake breathing while watching TV or something.

I'd also turn on EPR fulltime, set it for 2, and a "medium" rate, before I raised the prescribed pressure.

Back here, I wrote to someone else...
viewtopic.php?p=226375#226375

To access the therapy setup menu (clinical menu) in your machine, hold these two buttons down together until you see "Welcome clinical" and then keep holding them down a few more seconds:

"Down" arrow button and right button

If you do decide to go into the setup menu, I'd suggest you have paper and pen handy. I wouldn't make any changes at all the first time you go through the clinical menu. I'd simply go all the way through it, writing down everything you see about each setting...every word, every symbol, every number. That way you'll have a record of all your original settings if you make changes later and find you want to go back to the way it was.

When going through the menu, you'll see the word "Change" in many of the settings windows. It's ok to press the left button under the word "Change" and to toggle (with the up/down arrow button) through the parameters, just to see what changes could be made.

The only way you can make a "Change" stick (automatically be saved) is if you press the left button under the word "Apply." If you don't want to make a change to a setting you've been poking around in, just be sure NOT to press the left button when the word "Apply" is sitting over the button.

In other words, pressing "Change" will not actually MAKE a change. It just lets you see what changes you could make if you wanted to. Pressing "Apply" is what makes a setting you're looking at actually be saved.

If you do explore the clinical menu, you can use the right button under the word "Exit" at any time to back out of whatever menu item you happen to be looking at. Exit works like a browser back arrow button while you're in the clinical menu. If you get lost in the menu tree and just want out of the whole thing, hitting the Exit button 4 times will let you be sure you've exited completely out of the clinical menu.


I understand that you don't want to mess with things right now. Just sayin' what I'd do.

I'm glad someone brought up some of these points. I have been wondering about the EPR setting on my machine and what it does exactly until now. I have also experience the suffocating feeling some nights and almost feel overwhelmed.....I wind up taking that mask off as fast as possible and at least once have fallen back to sleep without it for an hour or so. It does not happen every night and I noticed it happens with both the Comfort Gel nasal mask I initially got and now the Swift LT. Thanks for the info, everyone! I'm so glad I found this forum and the DME's have a lot of improving to do.

Geminidream wrote:I'm glad someone brought up some of these points. I have been wondering about the EPR setting on my machine and what it does exactly until now. I have also experience the suffocating feeling some nights and almost feel overwhelmed.....I wind up taking that mask off as fast as possible and at least once have fallen back to sleep without it for an hour or so. It does not happen every night and I noticed it happens with both the Comfort Gel nasal mask I initially got and now the Swift LT. Thanks for the info, everyone! I'm so glad I found this forum and the DME's have a lot of improving to do.

Interesting - and I thought it was just my mask. I was afraid to change the pressure from 6 to 7 but found I could do 6.6. (I didn't know you could do that - or did I mess something up?)I also cut back on the ramp time and raised it from starting at 4 to 5 but that isn't when I feel I can't breathe - I'm still a bit afraid to mess with the EPR but another night of this and I may be willing!!!! It is not a fun feeling! I also wonder if I wake up and feel that way or I wake up BECAUSE I feel that way.

btesterman wrote:I'm still a bit afraid to mess with the EPR but another night of this and I may be willing!!!!

What is the EPR setting on your machine currently? And, is EPR set to "Fulltime" or "Ramp Only"?

DreamOn wrote:

btesterman wrote:I'm still a bit afraid to mess with the EPR but another night of this and I may be willing!!!!

What is the EPR setting on your machine currently? And, is EPR set to "Fulltime" or "Ramp Only"?

The EPR is set to Fulltime and at 3.

btesterman wrote:

DreamOn wrote:

btesterman wrote:I'm still a bit afraid to mess with the EPR but another night of this and I may be willing!!!!

What is the EPR setting on your machine currently? And, is EPR set to "Fulltime" or "Ramp Only"?

The EPR is set to Fulltime and at 3.

I think that may be a big part of your difficulty with breathing. At a pressure of either 6.0 or 6.6, with an EPR of 3, you are exhaling at 4 (the lowest the machine goes). And EPR of 2 is really no different, as it's exhaling at your set pressure minus 2 (which is 4 at set pressure of 6.0). Most people have a difficult time breathing at that low level. You can try your new setting of 6.6 and see how it goes, but when you feel comfortable changing it, you may want to consider an EPR of 1 and see how that feels. And you may want to check the Inhale setting too. I think most people prefer Medium, rather than Fast.

I think when you're starting out it takes a week or two just get used to the machine. I had the same problem you're having (my pressure was also 6 to start, with EPR of 2). No hurry to change things right away, but at least you have some ideas to explore.

~ DreamOn