[Equipment] Waking up in middle of night terror can't breathe

[rylan]

I have been on bipap machines for 15 years plus. With my new machine (s9 vapap auto) I have on occasion woken up with the machine off and myself gasping for air. Never had this with any other machine. The first few times I easily caught my breath reset the machine and went back to sleep. Last week this happened, I was so out of air by the time I woke up I couldn't catch my breath. Just writing about this is uncomfortable, like it could happen again right now. I was in full panic mode. I was gulping air but still wasn't getting any oxygen. I was doing everything I could (gulping) but it was not helping. Imagine having plastic pressed over your face and not being able to get air and also knowing you could never remove the plastic no matter what you did. The only thing that helped resolve this was doing something a nurse once told me. Breath in normally but blow out gently like you were trying to cool down a cup of hot coffee. After a few moments I began feeling more in control. The panic seemed to last forever.

My resp. therapist recommended a full face mask and changed the settings on my machine so an alarm (not very loud) would go off when it sensed no breathing instead of shutting down the machine when it sensed no breathing. (Why in the world would someone design a breathing machine, that was suppose to help you breath when you stopped, to stop when you stopped breathing????) (I am paying for a machine that wants to kill me!)

The full face mask didn't help. When strapped into it, it is hard to get out of quickly. Believe me, when you are panicing because of no air, even a second or two is a life time. Also, my pressure is so high the mask makes farting sounds when leaking unless you pull the straps so tight you face deforms. Which again makes the mask just that much harder to get out of. So now I am back with my old stand by nose pillows.
Has anyone else had a problem like this? If so, what has helped for you???? Thanks Rylan

[quiescence at last]

You need to know your settings and could gain tremendous insight if you used the free software. please do so. you know you have VAPAP for a specific reason. It is a forced ventilator model. It is meant to make you breath when you don't. It has a totally different feeling than all your BiPAP machines of the past.sorry I got that wrong! I agree with later poster. thx.

You are absolutely correct that a machine intended to make you breathe should not turn off when it senses that you are not breathing. Is it possible you actually did turn it off instead of reset it, or turn it off as you were awakening, but still were in a trace?

Your machine should have an AUTO - ON feature, and that works well with pillows.

QAL

[trish6hundred]

Hi rylan,
WELCOME! to the forum.!
I'm sorry you are having such a rough time with your therapy; If you feel better, less panicky, with pillows, just stick with them.
Hang in therre for more suggestions and much success to you in getting your CPAP therapy finetuned.

[DeepBreathing]

G'day Rylan, welcome to Apnea Board. From the Resmed site: http://www.resmed.com/us/en/commercial-p...-auto.html The S9 VPAP Auto is an auto-adjusting bilevel model that delivers comfortable therapy to treat OSA patients who may need higher pressure support. Based on the enhanced AutoSet™, the VAuto algorithm adjusts to the baseline pressure so breathing feels natural and comfortable.

So it's not a ventilator or ASV machine, but a xPAP with a much higher maximum pressure and a wider adjustable range between inhale and exhale (probably similar to the bipaps you've used previously).These machines do have a number of adjustments which should help you adjust better, including (obviously) the max and min pressures and pressure support, and the timing (TiControl) which manage the switchover from inhale to exhale and reverse. These might need tweaking.

The auto-on ("SmartStart") feature uses the flow sensor to detect when you start breathing, and starts the compressor going. Its converse is the auto-off which is supposed to sense when you've taken the mask off, and turns the compressor off. There is also a leak alert which detects a prolonged large leak and sounds an alarm. From my experience, these "features" are a bit erratic, give false alarms and aren't reliable. I turned them all off. I suspect you had the auto-off enabled and that's what shut your machine down. I think your therapist has enabled the leak alarm - as far as I know the VPAP Auto doesn't have a "stopped breathing" alarm (though some of the hospital grade Resmed machines do).

Something to consider is that your mask is vented so that even if the machine shuts down, you can still breathe, though it may feel a bit obstructed. Knowing this fact might help alleviate your panic symptoms.

You might also like to check the troubleshooting guide to see if there's anything else in your setup that might be causing problems: http://www.resmed.com/us/dam/documents/p...er_eng.pdf

[rylan]

I down loaded the software but haven't used it yet. I don't think I turned the machine off. Possibly.

I might not have been wearing my chin strap the night I had my panic attack, if that might have anything to do with it.

[archangle]

Are you using autostart? If you put the mask on, does the machine start automatically, or do you have to push the button.

It's possible that you're opening your mouth or otherwise having a large leak and the machine is shutting off because it thinks you've taken the mask off.

Unfortunately, ResMed doesn't allow you to turn on the Autostart feature without turning off the Autostop feature.

Wakeup and fix this, ResMed!!!!

If you install sleepyhead, you will be able to see if there's period of time of large leak before it shuts down.

If it happens again, try opening your mouth and breathing that way. Once you catch your wits, put your hand over the air vents, and see if you can feel the air flow like you can when the machine is on. That will tell you whether the machine has turned off for some reason. You may also feel air flow once you open your mouth, if the machine is running.

You should be able to breathe fairly normally with the FFM (full face mask,) even if the machine is turned off. The FFM will have an anti-asphyxia valve that lets you breathe outside air, even if there is no CPAP pressure.

[Jim Bronson]

I can breathe pretty well with the machine turned off, not quite as well as with the mask off, but well enough that I think I could sleep through a power failure. If I felt panic coming on, I could always simply start breathing through my mouth. I've never tried a FFM, but I would think it would be loose enough that you could just pull it away from your face until you are able to take it off by disconnecting the straps.

[Sleeprider]

Jim, have you been evaluated for central apnea? If you're not breathing long enough for the machine to shut down, you need an adaptive servo ventilator (ASV) with timed breaths to ventilate you when you don't initiate a breath. Otherwise, I would recommend going into the therapy settings and turning auto off to 0. You do not want the machine to automatically stop. Some of us can use that setting to allow us to take of the mask and the machine will shut down. In your case, this seems like a bad idea.

If your situation is what I described earlier, contact your medical professional. You may need ventilation support for central apnea.

[retired_guy]

Rylan, it sounds like you were not able to exhale as much as you inhaled. So in your "panic attack," it's not that you couldn't breath in, you were not able to completely breath out allowing for room to breath in. That's also known as "hyperventilating." That's why the breathing technique offered by your RT worked. Another modification to that is to do what is called "pursed breathing." That's where you put your lips together and exhale in puffs of air, like a choo-choo....

Revisit all your pressure settings and the differences between inhale pressure and exhale pressure. Also be aware that going from the pillows mask on your old machine to ffm on you new machine could have created some "breathing confusion" as well.

I would stay with the pillows mask if that has served you well in the past. If you need the chinstrap then use it as well. It sounds like you are well aware of how to make that sort of mask and chinstrap work for you, so there really isn't any compelling reason I have seen you mention why that should change.

Turn off the "auto on, auto off" stuff as suggested.

[Jim Bronson]

Jim, have you been evaluated for central apnea? If you're not breathing long enough for the machine to shut down, you need an adaptive servo ventilator (ASV) with timed breaths to ventilate you when you don't initiate a breath. Otherwise, I would recommend going into the therapy settings and turning auto off to 0. You do not want the machine to automatically stop. Some of us can use that setting to allow us to take of the mask and the machine will shut down. In your case, this seems like a bad idea.

If your situation is what I described earlier, contact your medical professional. You may need ventilation support for central apnea.

Sleeprider, sorry I wasn't more clear in my reply. My machine never shuts down, but I intentionally turned it off and tried to breathe in an effort to give feedback the OP. I had never tried it before and I was wondering whether I would awaken during a power failure. I don't think I would awaken unless I had an OA event or started snoring badly. Again, sorry for the confusion.