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Problems about middle of sleep time

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Varmit +0 points · almost 3 years ago Original Poster

Am quite new to using a CPAP device -- ResMed AirSense 10 AutoSet with full mask -- and not sure whether my experiences are due to newness or there is a difficulty with the unit. Have 2 issues: 1.About 4 hours into usage, sleeping on my back as normal, I'm awakened by air leaks squawks, squeaks, etc, especially around the lower jar area. Any attempt at minor adjustments makes the situation worse enough to shut all down, remove mask and start all over. If this doesn't work, I've just stopped use for the night -- not ideal. Otherwise, I've lain nearly awake, trying to keep the mask sealed, until a reasonable hour to get up. Is this a normal problem caused by gravity/muscle relaxation?

  1. As an alternative or combined with the leaks, my jaws and cheeks are forced outward, breathing must be done through my mouth whether I want to or not and the pressure is such I feel overwhelmed and find breathing to be at very fast rate. (No, I do not have panic attacks, nor am I anxious at this point, just annoyed.) Is it possible, the AirSense has jumped it's setting of 12 or that the setting is inappropriate?

Yes, I've called our Medical Supply office where I received both the equipment and basic instructions. All suggestions are welcome.

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wiredgeorge +0 points · almost 3 years ago Sleep Enthusiast

My suggestion is that your mask is the issue. Yes, your face totally relaxes, your jaw goes slack and LEAKS happen. Find a mask that will work under these conditions. The opinion of your DME office doesn't help since everyone is totally different in this regard. I started with a full face Simplus mask and it LEAKED. I tried a smaller cushion and it really helped but the air would escape and get into my eyes and this was annoying although it didn't effect therapy since the leak was relatively small. I found mask cushions... pieces of tee shirt cotton cut into the shape of the mask cushion and these stopped the small leaks into my eyes. I found when my jaw sagged through relaxation, the bottom of the mask ended up in my mouth and this created TOTAL leakage. I found boil and bite mouth guards and this stopped the jaw sag and all was pretty good. I tried a nasal mask and about drowned from the moisture that collected and could not exhaust enough air. I then tried the Amara View mask and then had to go down one size on the cushion and now seldom get any leaks and no mask pads. It works for me, FOR NOW. I may have to switch tactics at some point if the mask gets in the way of therapy but I did this all on my own as the DME can't really drive this part of therapy. Try a different mask; what I use may not be right for you. Your pressure may dictate which type mask you use so do some research and experiment till you find the right mask.

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Varmit +0 points · almost 3 years ago Original Poster

Thanks a lot. I'll see what's available to try around here. See if this will help.

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Tonawanda +0 points · almost 3 years ago

Your description of the four hour usage issue is exactly the same as the one I have. After about four hours of sleep with no leaks, the full mask is blowing off my face with leaks galore. It doesn't matter how tight it is, or what kind of mask I try to use. In my case, I don't think it has anything to do with the mask. I believe what's happening is, that for some reason I start waking up and unconsciously try to start breathing at my own rate out of sync with the machine, and the pressure is too high to accommodate my normal breathing. I had a long discussion with my doctor about this issue and he suggested several alternatives to try to mitigate the problem. Initially he lowered the pressure from 16 to 14. I slept much better with no mask issues at all, but my AHI numbers went up significantly (20 to 25). After a week, I contacted him through the patient portal, and asked him if he could have the pressure increased in small increments to see if I could reduce the AHI and still tolerate the pressure. He had the pressure increased to 14.6 and the AHI has gone down to an average of about 10 per night, and I'm still sleeping great with no mask issues. It's only been a week, but obviously still too high. In the next couple of days I will ask him to increase it again. Hopefully I can end up with a lower pressure that allows me a AHI of below 5 and a comfortable nights sleep. If the problem reoccurs as the pressure increases, he said he may also change the back up rate to see if that will help. I can't tell you how great it is to have a doctor who listens to, and is willing to work with his patient! Good luck, I'd love to know how you do resolving the problem.

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Varmit +0 points · almost 3 years ago Original Poster

Re-read the following and realized I kept talking of myself and my concerns. Please excuse this rudeness. First thank you both for replying to my writing; makes one feel that isolation is not the name of the game and there's thoughtful commentary around us. Secondly, I hope your experience with this therapy is working better and better as time goes by. The difference before and after seems to have potential for serious increase in quality of life. Good sleep and breathing.

Sorry for the delay in response, but life is... and it's given me some time to try out a couple of ideas. Bottom line is that at some point beyond initial few hours of sleep, I'm waking up with lots of pressure and no way to relieve it short of turning the unit off and restarting with a 20 to 25 minute delay. This way, I can relax into some pressure and therapy and fall asleep for a longer period of time. However, waking up is still filled with too much pressure, being unable to rhythmically breathe and finding my belly bloated and aching from the effects---though to a lesser degree than earlier. Yesterday, was able to walk well for 2 miles without too much discomfort and a fairly sufficient breathing pattern. The bloating/cramping seems to push up into the diaphragm/lungs so it's not possible to breathe fully.

AHI seems to be quite variable. However, over the last 20 nights it hasn't risen above 9/hr, with an average of 7.78 and am sleeping more hours, more consistently. Waiting to talk with my dr, though am not sure he really knows specifics about this process. When I saw him last, he nodded and said getting used to the process took a couple months, etc, etc. Then the tech at the medical supply place (who was to work with me that morning) slid me off onto the next month I saw the dr. 00.00 assistance --- GRRRRRRRR.

One thing that stays with me is the possibility that the machine is actually malfunctioning. Earlier, at a different location on this site, another patient detailed similar difficulties and she found that her machine (another ResMed) was malfunctioning and received a replacement. As a result, I'm emboldened to push past this laissez-faire attitude and find out if my equipment is operating abnormally. When I do have a good and lengthy sleep, my day is so much improved. One morning I actually felt like my old self. I want to get entire the system working well to have that kind of waking-up and day more often.

Quick additional question: 1. Does your unit get warm to hot during the night, even with plenty of water? When I put the mask and tube back to work after a 2-3 o'clock break, the pressure is warm. In the morning the water container is noticeably warm, working on hot.

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wiredgeorge +0 points · almost 3 years ago Sleep Enthusiast

What would happen if you asked your doc to contact the DME and request a machine swap out? If you are insisting the machine may be malfunctioning, the doc will likely have his staff push the DME. I can't imagine why a machine would get hot although I never use heat for my water reservoir or hose so am not an expert here. Your apnea numbers, while better are still not where they should be and it could be that the machine is malfunctioning and causing this; dunno but I would look at getting rid of that machine for another. If that fixes things, good and if not, perhaps your prescription isn't optimal for keeping your airway open OR is causing central apneas. I believe the sleep doc CAN look at OSA vs central apneas if they want to so that info might also be a good tool to figure out what is happening.

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Varmit +0 points · almost 3 years ago Original Poster

I'm new enough to need a glossary: What is DME, central apneas? I'm sure it's not anything to do with injection molding and such.
Will speak to the Dr when possible -- he is not a specialist in sleep difficulties, but a really good Cardiologist. I'll push him and see what can be done.

I do not use heat per se, it's just the machine getting hot. It may be where located -- on the lower shelf of the night stand in a corner next to me. May not have enough air flow.

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wiredgeorge +0 points · almost 3 years ago Sleep Enthusiast

DME = durable medical equipment

These are the folks who hand out PAP machines and supplies as well as wheel chairs and hospital beds in many cases.

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Tonawanda +0 points · almost 3 years ago

First, I wouldn't be overly concerned about expressing your own concerns and issues. I find that I am able to learn and benefit from other member experiences. My machine is in the open and also warm to very warm at times. Yes, having your machine in an open area should reduce the heat building up around it.

DME is your durable medical equipment/provider.

This link titled Aerophagia Causes and Resolutions is information related to stomach bloating. https://www.sleepapnea.org/treat/cpap-therapy/troubleshooting-guide-for-cpap-problems/aerophagia-causes-and-resolutions/

Sleep Disorders Dictionary https://www.webmd.com/sleep-disorders/sleep-disorders-glossary#2 Don't get overwhelmed by all these terms. I would use it for reference only for the terms you need.

Your doctor and equipment provider should be able to help you with your issues. Keep up the good work. You will get better!

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sleeptech +0 points · almost 3 years ago Sleep Enthusiast

The humidifier chamber, especially the bottom of it, can get quite warm (bordering on hot as you say) during operation. I can't a lot of detail specifically about the AirSense 10 just at the moment because we don't use them very often. Check that your filter is clean. It is behind a small, hinged flap on the left side of your machine as you look at it from the front.

When you stop breathing in sleep, it is classified as either a central apnoea or an obstructive apnoea. Obstructive is by far the more common. It means that the muscles which should hold your airway open are relaxing too much in sleep and allowing your airway to collapse, thus obstructing airflow into your lungs. A CPAP machine fixes this by using positive pressure to inflate your airway and prevent the collapse. A central apnoea is very different from an obstructive one. A central apnoea occurs when the muscles which should be pushing the air in and out of your lungs stop. The difference is important because CPAP is rarely effective in treating central apnoeas. It doesn't matter how much your air way is opened up if your muscles aren't pushing the air in and out. It is still treatable with a very similar machine to a CPAP called a BiPAP (amongst other things).

This is all rather a simplification, but I hope it helps you get a grasp of the concepts.

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Varmit +0 points · almost 3 years ago Original Poster

Again, thanks so much for all the replies and information. I'll check out the Dictionary and other sites to come up to speed. Have been reading a number of other folks questions and difficulties. Seems I'm by no means alone with this problem. Interestingly it seems always to be with a Res Med. If you all are browsing around the entire site, note the variations in commentaries about swallowing air during high pressure events. I think spreading the link would be worthwhile to a number of people.

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theMezz +0 points · almost 3 years ago

I have same issue. I sleep some then get leaks and struggle with leaks for hours So I take it off Very frustating

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Varmit +0 points · almost 3 years ago Original Poster

How often each night does this happen? I'm trying something: as soon as it happens I turn off the machine, maybe walk a bit, then restart AFTER getting comfortable and with a ramp of about 20-25 minutes. During that time, I concentrate on slowly, deep breathing and day dream about something I enjoy -- often reliving a story I'm reading. I suppose it sounds like imitation yoga or ??, but so far I'm having better experiences each night. Even got 7 hrs of sleep last night, waking only twice. I've also added a mild otc muscle relaxant (called 303), but have reduced the amount and taken it only once last night. Am hoping to continue similar nights, but we'll see.

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