New user: feeling of drowning/suffocation?

All,

Just recently diagnosed with OSA following a hospital sleep study with the VA, I was very surprised by this (young, healthy). I got my machine 2-3 weeks ago (auto PAP) and haven't been able to sleep a full night with it, though I am still trying. My issue is not so much noise or the sensation of having the mask on my face, but a sensation of drowning or suffocating. I am committed to acclimating to the machine and I know many of my complaints are similar to what folks here have already dealt with. I'm interested in what specific techniques other people might have used to successfully cope with these issues.

Here are my stats and equipment:

Basics... Male, 29, pretty healthy otherwise (20% body fat, 190lb, I run, lift weights, etc), never fallen asleep on the road or at work, no excessive napping, just tired all the time, low libido, hazy.
Resmed Airsense 10 Autoset
Using nasal pillows (Phillips), also have tried a nose mask and full face mask. I have a full beard.
Have had great sleep hygiene during the workweek to cope with chronic fatigue (not too successfully due to OSA!)... go to bed same time every night, dark room, same routine. I stopped drinking alcohol after 6pm after my diagnosis, and I reduced my caffeine intake to almost nothing (like 1 cup a week now).
I'm also doing mouth/tongue/throat exercises online. I'm not under the pretense that this will supplant the need for CPAP, this is something I'm doing in parallel with CPAP.

My machine settings:
5-20 pressure (set by the lab, I know this is probably not ideal)
I set the humidifier to 4, range is 0-8
I am using a ramp time of 45min

I wear it while playing video games, watching TV/movies, doing homework, or just using the computer. So my target is like 10+ hours/week of awake time to help me acclimate to the mask/machine.

While doing an activity during the day, I am totally fine with the machine and breath very naturally while I'm engaged in said activity.

While in bed at night, I seem to "overthink" breathing, and I consciously take control of the breathing process. I believe this is due to a fear and a feeling of suffocating or drowning (which by the way I don't have outside of the machine. Not afraid of water, swimming, holding my breath, etc). I'm not truly afraid for my life or anything, for me it's a innate feeling of discomfort. This prevents me from fulling relaxing and slipping into sleep. I have napped for about 1 hr on three occasions during the past 2 weeks, so I know it is possible, but I'm not there yet. When I am able to relax and allow myself to breath unconsciously (without active control of inhalation/exhalation) I can fall asleep.

I have found this relaxation impossible to "systematize" to date. I try to think about food, vacations, bright sunny days, etc, in an attempt to relax, but I don't have a working system yet.

When I do fall asleep, I wake up about an hour later, which is very frustrating since I am basically starting back at "square one" with respect to falling asleep. On all occasions I have taken the mask off at this point, because I have to sleep before I go into work.

Anyway, I realize this is a lot of detail, sorry for the length. As I said, I know a lot of this requires time and effort, and I'll continue to put forth on those fronts. A few questions:

(1) Does anyone have any "relaxation" techniques they use while in bed to take their conscious mind off the breathing process?

(2) Should I be changing my pressure range? My clinic doesn't answer their phone so it's not easy to get informal advice from them. I will be sending my SD card to them in a few weeks for their analysis. Not sure what the next steps are from there, didn't discuss that with them.

(3) Any other thoughts?

Thank you very much for your time,
Eric

Hi - turn off the ramp (it's preventing full therapy til it reaches the very low setting of 5), and turn up that low to 6 for a few nights and see how you feel. Also, do you actually need all that humidity where you live right now? It can cause congestion if not.

Two things that helped me with that sensation:
- Starting the ramp at 7 instead of 5 (my therapy is at a set pressure of 10)
- Putting a couple drops of essential oil on a cotton ball and setting it right next to the air intake

I use an exercise where u tighten then relax every muscle in your body, starting at your toes and workyour way up your body. You can find guided exercises on YouTube.
However,your ramp may be too long as well,so it stays at a low presure for a longer time so it might not feel like enough air.
It's worth downloading sleepyhead to look at your data, and probably then narrow your pressure range and raise the starting level too.

Hopeful50 wrote:feeling of drowning/suffocation?

Most likely your ramp and minimum pressure are too low. Anything below 7.0 will cause me to get a feeling of suffocation. Many others report something similar.

Guest wrote:Does anyone have any "relaxation" techniques they use while in bed to take their conscious mind off the breathing process?

For me it is simple, just think about lounging on a warm beach in a light breeze listening to the gentle surf with no one around.

Do you practice good sleep hygiene measures? Here is my checklist -

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Optimize emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.

CG

Guest wrote:Should I be changing my pressure range

All the regulars on the forum monitor their own therapy and set the pressures accordingly. I don't allow anyone to touch my CPAP.

You need to register and fill out your equipment profile. Later you will understand what the value of this is to you.

All,

Thank you so much for your suggestions! By the way, "guest" was me. Forgot to login to my new account.

I will try the relaxation technique you suggested Diamondminek, thank you!

Hopeful and Julie, I know now that I need to tweak my pressure settings. I'm not sure if my medical folks are counting on a constant pressure range during my first "acclimation period"... perhaps I will try to leave them a voicemail prior to altering that.

I'll go ahead and fill out my equipment profile too.

Thank you all!
Eric

I will add that I had a very hard time adjusting to CPAP. Gave me panic attacks and the same feelings you described. I can honestly say that if you just stick with it, you will get beyond the issues.

The relaxation tips help as well. I even purchased some self hypnosis audio and would listen to it with earbuds when I went to bed. It really did help.

Hang in there.

If you can relax a bit while your lying in bed you'll notice your breathing normalizes. I also did better without the ramp.

You got this!

For a couple weeks in, you are doing well. I agree that you should raise your minimum pressure to something that doesn't feel like it's limiting your air. I would try 8 or 10, and back it down if it feels like too much, but give yourself a chance to get used to the higher starting pressure. The ramp, if you use it at all, should be short, maybe just a few minutes. My starting pressure is 11.5 I think, and no ramp at all, but I chose that to try to minimize my AHI.

Try using the machine while watching TV to get your mind off your breathing and help you get used to it.

Jim

All,

Last night wasn't too bad using a minimum 8 pressure and no ramp. I also bumped humidity down to 2/8, no issues. I think I slept maybe 45m-1hr on the machine before tearing it off . I will definitely continue to work on relaxation and comfort though.

I found the same issue of suffocation and not being able to catch my breath. I am also on a low pressure setting and am sure a little higher might help but I found the Pillows mask I had was the issue. I switched to a nasal masked and no longer have that feeling.