Choking on CPAP ,snorring without it

[nabilx]

I have been using Resmed 10 Airsense for around 20 months, I experienced great improvement for that period, and my events recorded by the machine per hour has been below 1.
However, for the past few months, i have been waking up grasping for air , but the system did not flag this unknown event as apnea as its simply choking.
I attached below a sample of my normal breathing that changed suddenly into such a strange event.
Now , i stoped using CPAP because it has become worse than the apnea and snoring which I experience without CPAP.

I doubted that my machine is faulty so I sent it for maintenance where they said the machine is ok.
Very confusing , any ideas ??

WhatsApp Image 2024-10-09 at 11.20.26_0cbe7bce.jpg (62.38 KiB) Viewed 2327 times

[robysue1]

The breathing that you've circled is an arousal, and arousals are not typically flagged by a CPAP machine.

Now the thing about arousals is that some of them are spontaneous---i.e. they're not related to any problem with the respiration. In a spontaneous arousal, you just arouse or wake for no apparent reason. Even people with perfectly normal sleep patterns have a few arousals every night and they're not considered problematic by themselves unless there are lots and lots of them indicating plain old "bad sleep". Two common causes of spontaneous arousals are the need to turn over in bed or the end a a REM cycle.

But some arousals are respiratory related---i.e. they are caused by an airway that either has collapsed (after an OA or H) or is threatening to collapse (sometimes called a RERA---respiratory effort related arousal). Some machines attempt to flag RERA, but RERA flagging can be hit-or-miss if your flow limitations have a shape the machine isn't quite sure about or if your arousal breathing doesn't match the machine's algorithm for a "recovery breath".

It can be fairly difficult to decide whether a particular arousal might be respiratory related, particularly if the machine didn't flag a RERA but there is some minor activity in the flow limitation graph, and you didn't show us what was going on in that graph.

In the snippet you've shown there is some evidence of a potential flow limitation right before that arousal. If you look at the inspiration part of the flow rate graph immediately prior to the arousal, you will notice that the inspirations have flattish tops or angular tops. That can be (but not always is) a sign of a flow limitation. Flow limitations can occur for several reasons, two of the more common ones are (1) plain old nasal congestion (i.e. not related to OSA) and (2) an unstable airway that is at risk of collapsing enough to cause a hypopnea or an obstructive apnea, but the airway has not yet collapsed to the point of causing an obstructive event. This second kind of flow limitation is definitely related to OSA and it is possible that this particular arousal was caused by the flow limitation.

Now to figure out whether your machine decided there was a flow limitation here and whether it was a significant flag that your airway might be in danger of collapsing, you need to look at the flow limitationgraph and the pressure graph if you are running in Auto mode as well as the flow rate graph.

If the bit of breathing before the arousal you circled is indeed distorted enough to be classified as a flow limitation, there should be evidence in the flow limitation graph AND if you are running in AUTO mode, you should see a corresponding increase in pressure.

If you often see arousal breathing right after flow limited breaths, then bumping up the minimum pressure by 1 cm may be a good idea. The idea is to find a minimum pressure setting that smooths out the inspirations and limits activity in the flow limitation graph.

I'll also add this: The grey background at the end of this snippet indicates that at that point your leak rate was in Large Leak territory---i.e. your excess leak rate was above 24 L/min. It is possible that you had a leak that was steadily growing just before that arousal and that the leak caused the arousal and the breathing in that grey area occurred while you were awake and trying to fix the leak. We can't tell if this is what was going on because you didn't give us the leak graph.

In general, when there is funky behavior in the flow rate graph and you want someone to tell you what might be going on, it's useful to include all the following graphs:

1) The flow rate graph
2) The pressure graph
3) The leak graph
4) The flow limitation graph

We need the information in all of these graphs to tease out whether an arousal was spontaneous, was potentially caused by a leak, or had a high chance of being respiratory related. Without those other graphs, all we can do is take a good educated guess based on the shape of the inspirations that precede the arousal breathing.

[robysue1]

However, for the past few months, i have been waking up grasping for air , but the system did not flag this unknown event as apnea as its simply choking.
I attached below a sample of my normal breathing that changed suddenly into such a strange event.
Now , i stoped using CPAP because it has become worse than the apnea and snoring which I experience without CPAP.

If you want help figuring out how to get back to using your CPAP without waking up "grasping for air", we are going to need a lot more information than just one snippet of what you think is funky breathing.

Some questions for you to answer in order for us to help:

How bad is your untreated apnea? What were the symptoms that led you to get a sleep test?

How often were you waking up grasping for air? Every night? Multiple times each night? Or only occasionally?

When you say you were "grasping for air", do you mean you could not inhale fully and completely? Or do you mean you could not exhale fully and completely?

Do you use a nasal mask or a full face mask? Have leaks been an issue? Do you mouth breathe during the day?

Do you use a heated humidifier? Do you wake up to gurgling noises in the hose or with a sensation of water up your nose causing the choking feeling?

[Janknitz]

Waking up "choking" is a classic sign of reflux. Stomach acid is getting into your airway, causing the choking sensation.
That's NOT the same as an obstructed airway, although the two often go hand in hand. The struggle to breathe during an apnea event can cause a pressure gradient that pulls stomach acid into the airway. BUT, reflux can also come first, then it inflames and swells the airway tissues, increasing the apnea.

You need to see a doctor. Ideally you should have an endoscopy, but the more conservative approach is to be put on reflux meds to see if they help. If you're already taking them, and you have for a long time, it's important to understand the issue isn't too much stomach acid, it's stomach acid in the wrong place. We NEED stomach acid, and when we suppress stomach acid long term with medications, then an important pH signal to tighten the upper stomach sphincters to prevent acid reflux no longer function. There are dietary approaches (that do NOT include low acid diets) that may help.

Many people have a trifecta of OSA, reflux, and asthma. And it's important to address all three to see improvement.