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Onetime Apnea like event 20 to 30 minutes into sleep every night even with CPAP

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shaji +0 points · about 2 months ago Original Poster

I am 40 years old ( 5' 10'' with 96 KG weight ) . It began when I started waking up from sleep with choking sensation every night in the first 30 minutes of my sleep. After the apnea like event happens once, I am able to sleep the entire night without further awakening. But the choking sensation itself was scary and my doctor suggested sleep study. I was diagnosed with moderate obstructive sleep apnea in 2019 ( 14 AHI ). Initially they suggested the oral appliance and I gave it a try. It did not solve my problem. I still choked and the first thing that I do on waking up with the sensation was to throw the appliance away. After 5 t o 6 months of unsuccessful trial and 2000 dollars later, I went for another sleep study. This time I had 15 AHI and opted for CPAP therapy. I intended to buy Dreamstation Auto CPAP as I found it quite cheap in Amazon. During the 1 month machine trial( December 2020), I didn't had any issues for the first 10 days, but after that I started having the choking sensation ( in the fist 30 minutes of sleep ). My sleep specialist told that it will go away after some time. I decided not to go with the sleep clinic's 2500 dollar Dreamstation and bought my own dreamstation for 45 dollars( Canadian). With the Dreamstation my AHI had come down to 2 by June 2021, but I still had the choking sensation 30 minutes into sleep. I tried pressure settings of 4 to 7 minimum to 11 to 20 max . I have also seen that my AHI shot up when I increased the minimum pressure to 6 or 7. After Dreamstation got recalled, I bought Fisher and Paykel sleepstyle Auto and it is currently showing my AHI as 0.7 ( 9 hours of sleep with a pressure range of 4 to 15 cm H2O). But I still have the one time choking sensation 30 minutes into sleep. Did anyone else had such an experience? I am starting to think that I may have some other medical condition causing it.

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Sierra +0 points · about 2 months ago Sleep Patron

About all I can suggest is using OSCAR to look at the detailed data. I am not sure if the F&P Sleepstyle is supported by OSCAR. The preceding SleepyHead did not. But, the Dreamstation did. If you still have the SD card from the Dreamstation there may be useful information on the card.

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shaji +0 points · about 2 months ago Original Poster

Yes I have the Dreamstation SD card. Even though I uploaded the screenshot here, I don't see it anymore. So uploading again.

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shaji +0 points · about 2 months ago Original Poster

Yes, I have the Dreamstation SD card.

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shaji +0 points · about 2 months ago Original Poster

Thank you for your reply. I had posted my Oscar report as your reply. But can't see it here. Please let me know which particular figure in the Oscar report should I concentrate on?

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Sierra +0 points · about 2 months ago Sleep Patron

Use the Daily Report tab for one of the days when you had an event like this. Make sure to start with the orange Write a Reply button in the bottom left of the screen. That will allow a fuller view of the graphic.

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shaji +0 points · about 2 months ago Original Poster

Hi Sierra, Please see the screen shots for January 10.

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Sierra +0 points · about 2 months ago Sleep Patron

About all I can 30 minutes into the sleep is an interruption in the CPAP operation. I am assuming you took the mask off? No events seem to be associated with it. Minute ventilation seems to rise up right before it. You may see more if you zoom in on the time right before the interruption.

In general I see most of your events are hypopnea. At least on a ResMed the EPR can be effective in some cases in reducing the incidence of hypopnea. I believe the F&P has a similar function. I now use EPR at 2 cm and it seems to have made a big reduction in hypopnea.

The other thing I see is a very low minimum pressure. I find pressures down at 4 cm to be almost suffocating. I normally suggest a minimum pressure of 7 cm unless there is some reason to keep it lower. Personally I use a ramp start pressure of 7 cm, and then when I go to sleep the machine goes to a fixed 11 cm. I have issues with CA events and find a fixed pressure works better than an automatic changing pressure.

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shaji +0 points · about 2 months ago Original Poster

Hi Sierra, Thank you very much for the reply. Yes, I had removed the mask because I had the choking sensation. I don't know whether that sensation is real or mental. I will increase the minimum pressure and see how that works.

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Sierra +0 points · about 2 months ago Sleep Patron

If you do a search here I think you will find some posts on an issue sometimes described as sleep onset apnea. I don't recall an "aha" moment where there has been a clear solution. I have experienced nothing like it, and have no idea if it is real or imagined. The only solution that I have been able to come up with is to ensure the pressure is as high as is reasonable at the time of sleep onset. That is why I suggested the minimum pressure increase.

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shaji +0 points · about 2 months ago Original Poster

I still have my 6 month old Philips Respironics auto CPAP with me, cleaned and neatly packed for the re-call.

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Sierra +0 points · about 2 months ago Sleep Patron

Assuming they replace or rebuild the DreamStation I think I would go back to using it when you get it back. I have about 2 weeks experience with the F&P SleepStyle as that is the machine I was given on trial. I had a couple of concerns with it. First, at least at the time, it was not compatible with SleepyHead (now OSCAR). Second after my own research on it, I don't believe it can tell the difference between obstructive and central apnea events. It treats them both the same and increases pressure to both types. That is good for obstructive events, but exactly the opposite to what you want to do in response to a central event. Most often central events are made worse with higher pressure. The DreamStation is a good machine and identifies and treats CA events properly. The only thing I don't like about it is that it keeps trying to reduce the pressure and then spike it up again on a timed basis. The pressure tends to spike up and down all night. The response can be controlled by increasing the minimum pressure so it does not keep reducing it and spiking it back up again.

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shaji +0 points · about 2 months ago Original Poster

Hi Sierra.. Thank you for introducing me to the term "Sleep onset Apnea". I read some posts about that and it indeed describes my issue. I am eagerly waiting to re-use the dreamstation with Oscar once the foam issue is settled. F&P Sleepstyle do flag some events as Central Apnea, it could be that they have improved their app recently. I have also felt that F&P sleepstyle is more comfortable to use than the dreamstation, perhaps due to their Senseawake feature.

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Sierra +0 points · about 2 months ago Sleep Patron

Yes, the F&P SenseAwake feature is something that ResMed and DreamStation do not have. Seems like a good idea. To do the same thing with ResMed you have to shut the machine off and turn it back on again. That is a little less convenient. However what I find is that with a fixed pressure of 11 cm that is quite comfortable without going back to the 9 cm ramp pressure.

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