[CPAP] First days of CPAP/APAP, not feeling better.

[asm44]

Just woke up from a dream, where in the dream I was having a hard time breathing.

Am I correctly seeing this as a fllow limitation -- the amplitude is relatively small. Why doesn't the pressure increase? After waking up I took off my mask because I couldn't breathe. My throat is very sore.


An hour before this, I had woken up, also feeling very uncomfortable and immediately turned the machine off to get some relief:

[asm44]

I am beginning to suspect that I have some type of obstruction that is not treatabable by CPAP -- i.e. Expiratory palatal obstruction or floppy epiglottis

I have never experienced this type of choking event before.

[Sleeprider]

Palatal prolapse looks much different, and usually shows up in the charts as a normal inspiratory wave with a sharp-cutoff on the expiration when the palate slams shut and air is shunted to the mouth. The chart above where you had a dream of breathing difficulty is high flow limitation from 05:10 to 0:12 ending with arousal, and shows you will want to move your SoftPAP expiratory pressure relief setting to 3. As you approach the arousal, we can see the cycle time, especially inspiration getting longer, and volume higher as effort increases and air becomes more restricted. Your softPAP feature should help this. I'd like to get a look at the full night, but we might want to allow pressure to increase for events like this. I think we should probably restore your maximum pressure of 12.0. As I recall, this puts you at minimum 9.0, maximum 12.0 and SoftPAP 3.

[Sleeprider]

On this chart of flow limitation from the wiki,  your flow limitation morphology looks most like inspiratory flow limitation with normal expiratory flow morphology (chart 4), also shown as Class III in the second chart.  Palatal prolapse normally presents as the second to last chart showing expiratory mouth breathing.

[asm44]

Thanks for the help, Sleeprider.

Here is the whole night, let me know if I should zoom in on anything you're interested in.




Regarding EPO -- I think you're right. I don't have that.

But I think there is a good chance it could be floppy epiglottis. Here are some flow rates associated with the condition (see more here: https://erj.ersjournals.com/content/50/3/1700345):


Any thoughts? I do have some inspiratory peak jaggegness, and in my previous nights there were a number of times where my breathing just stopped as above.

I went back to the sleep doctor today, and unfortunately he didn't seem too interested in looking at my APAP data or settings. Instead he looked at my throat, said it looks really bad, and prescribed high dose PPIs (pantoprazole 40mg) to be taken 2x daily. I urged him to schedule a drug induced sleep endoscpy to have a look at what's happening, and he said we will eventually but it's hard right now because of COVID. He also prescribed Pregablin 85mg to help me sleep with the APAP, and told me to sleep on an incline. Frankly, after my choking experiences, I have anxiety about using the APAP.

I don't know what to do. I am contemplating seeking out a US specialist who will agree to do a sleep endoscopy ASAP. I'm a software engineer and the company I work for said that I can temporarily or permanently relocate to the US if I so desire, so it is possible. I'm a US citizen of course.

Here is another moment in the night where a RERA was detected, and the flow rate looks like the floppy epigloittal problem above:

[asm44]

...and here is the previous night, same setup, no choking:

[asm44]

Small update:

I stopped using the APAP. I got a semi-custom MAD device that I conformed to my teeth at home. First night did not wake up with burning throat throughout the night. I'm hopeful this experience continues and it's the solution.

[Dormeo]

Thanks for the update, and the very best of luck to you.

[asm44]

Thank you, Dormeo.

I had been sleeping pretty well with the MAD, but it doesn't fit perfectly and was giving me a lot of mouth pain. I decided to try APAP again after waking up with a hurting mouth and had another bad experience. I don't understand what happened -- can anyone give any insight?

I only tried for roughly an hour. I don't know if I slept; if anything I was falling asleep and quickly waking up. I felt anxious the entire time, but just tried to focus on my breathe and fall asleep. Eventually, it felt too much to bare, I looked at the machine, saw it was at the max set pressure, and immediately stopped it. I took the mask off and it still felt a little hard to breathe and I felt very anxious.

Here's the hour:



More zoomed in:


Is it really possible to have all these obstructions while drifting in and out of sleep? Could it be a mask issue? It seems to be working fine. My nose is also not congested.

Aside, I did have a consultation with Dr. Barry Krakow, and he said that I probably cannot tolerate APAP due to having UARS and chronic anxiety. I don't know what to do. I brought up bilevel/ASV to my sleep doctor and he dismissed it saying it's only for very ill patients who neurological conditions, and my sleep study showed no periods of where my chest or sotmach stopped moving.

[Dormeo]

Yes, if you were drifting in and out of sleep, you may have had obstructive events during the sleep intervals.

As I'm sure you know, Dr. Krakow is a pioneer in the field of treating UARS. Did he bring up the possibility of using a bilevel or ASV machine? Did he confirm that he thinks you have UARS?

Your doctor is wrong about the range of uses for bilevel and ASV machines, but even with a better informed doctor, you might have trouble getting a prescription for a more expensive machine.

I also wonder whether you would be able to use a bilevel or ASV machine, given your difficulties with a CPAP machine. What are your thoughts about that?

This may have come up earlier in the thread, but -- are you being treated for anxiety?