Airsense 10 issues? Waking up gasping

I started CPAP therapy over 8 years ago and used a Phillips Respironics Remstar Pro C-Flex + System one. In May last year I got a Airsense 10. It took some time to get the settings right on that. When I don’t use a cpap, I can’t sleep. It’s not my possible. My body jolts me awake as soon as I start to fall asleep, presumably when I stop breathing. With the AirSense 10, no matter what the settings are (EPR, no EPR, autoset, cpap, lowering ramp, etc) I have nights (not every night) where my body does that. As I’m falling asleep I’ll jolt awake, heart racing. If I’m lucky it will happen once or twice that I’m aware of. I’ve had nights where it will last hours or in a couple of instances, all night. Im at a total loss. I can’t go back to the Phillips because of the recall. My results on my air score is always 100. It says I have 1.5 - 3 AHI per hour.

I never had anything like this in the 7 years I was using the system one. My sleep doc just kind of shrugs and says the reports look fine.

It might be useful to get another data point by checking your O2 levels while sleeping to determine whether you are desaturating. If so, you are likely experiencing apneas. You can do that yourself using an overnight recording oximeter. They are available online, and communicate via bluetooth with your smart phone.

If you aren’t having apneas, could you be experiencing hypnogogic jerks? And if you ARE having apneas, are they obstructives or centrals?

My suggestion would be to download OSCAR. It is a freeware program that will display your minute to minute data from the AirSense 10 SD card. Then you should be able to identify the type of event that is waking you up. OSCAR requires a SD card reader and PC or Mac.

Sounds like you're not getting enough airflow, you might want to up your settings. Sleepyhead software is very useful in looking at your sleep data, it helped me figure out my problems with pressure and flow. Good Luck!

Here is an example of what an OSCAR (SleepyHead) looks like. This is one where I had an event shortly after going to sleep. If you left click repeatedly in the area of interest you can expand out the horizontal time scale. Where the green line is located is when the A10 decided I was asleep (ramp set to Auto for time) and then there is a ramp up in pressure. Very shortly after that I had a obstructive (OA) event, followed by one that did not last the 10 seconds to be flagged. This was a few days ago, and I have no recollection of waking up. But, it obviously disrupted my breathing pattern.

Yes, that is a helpful chart. I find it easiest to just press the F12 key (on a PC) to save the screenshot. Watch the bottom right of the screen to see where it gets saved. Then you just use File Explorer to left click and drag the image file to a post. It is best to start a new full width window for the post by using the orange Write a Reply button in the bottom left. Otherwise it gets too small to read.

Have you tried the AutoSet mode instead of the fixed pressure CPAP mode? It seems like the fixed pressure you have is not high enough to prevent most of the obstructive apnea. I also like to set the "Ramp Time" to Auto, and then set the "Start Pressure" higher. I would suggest a minimum of 7 cm, but I use 9 cm. Using the Auto for time the machine will hold at that Start Pressure value until it senses you have gone to sleep. That may help avoid apnea events that could be occurring during the ramp period. The machine does not report events until after the ramp is over.

Those would be my initial thoughts. But, if you have some other days to post with the pressure set higher or in the AutoSet Mode. All your previous nights should be saved on the SD card.

Based on this one night you do not seem to be hitting the max of 18 cm, so that max setting should be fine in AutoSet mode. Minimum pressure could be increased to 14 or 15. There is a rule of thumb that says if you want to go from auto mode to fixed CPAP mode the initial pressure setting should be the 95% pressure. So for you, based on one night that would suggest 15.8 cm. However, you may want to collect more data in Auto before you make that switch. Moving the start ramp up to 13 is good. If you move your minimum up I would also move the Ramp Start up too if you find it comfortable. I don't believe you can set the ramp start higher than the minimum though. But that said, I have not tried it. In any case it is not a good idea as you don't want the pressure to drop at the end of the ramp.

The idea of moving the ramp start pressure up is to prevent apnea events during the ramp period. The idea of moving the minimum pressure up is to prevent apnea events when the auto function ramps it down during the night. It also avoids the initial events needed to ramp up the pressure early in the night.

I see there are some CA or central events. It is hard to read the graphs accurately, but this may be due to the higher pressures. Once you get more data in Auto one possible advantage of switching to fixed CPAP mode is that it can limit the maximum pressure and possibly avoid some of the CA events.

I hope that helps some. l suggest you post more daily reports as you gain experience with the AutoSet mode. There is nothing totally consistent about CPAP treatment. It can be very misleading to make setting changes based on one night only. It is better to get a few and average them.

I'm looking at my results from last night and the night before and if I'm reading this right, looking at how much time my pressure goes above 13. I'm kind of perplexed why my doctor had my CPAP originally set at 13 and then with the new machine have a range of 4 - 14. I know my apnea could have gotten worse over the last 8+ years, I've definitely gained weight, but this seems like a big difference.

Sometimes you can get away with a lower pressure when it is fixed instead of in Auto. I think you would be better to leave it in Auto for a while to collect some more data before trying to go back to a fixed pressure. From what I can see you had the EPR in Ramp Only mode for your previous report, and now it is full time. In some people having the ramp on full time can increase the frequency of apnea events, and force the pressure to go higher. Because the pressure is reduced on exhale you can be getting an apnea event on exhale. Unless you are having a high frequency of hypopnea events I would switch your EPR back to Ramp Only to see if that reduces the pressure needed. I also see that your ramp time is set at 5 minutes. You may get better results with the ramp time set to "Auto". And it may also be of benefit to increase both the minimum pressure to 14, and the Ramp Start pressure to 14 cm as well.

That would be my thoughts for now.

Comments:

April 27, top screen shot: In the time before it appears the machine was shut off, there are no significant apnea events. However, I think I can see some flat spots on the top of the inhale peak flow. That can indicate a flow restriction, and I see there is an indication of Flow Limitation but it is not all that high. After the machine is back on again, I do see a significant no flow period and it looks long enough that it should have been flagged as an apena event. Although the left panel says the Ramp is off, I wonder if it really is. Sometimes SleepyHead did not report the status correctly. I don't know if that has been fixed in OSCAR.

April 25: The pressure chart is showing a slight ramp, but it is not much. I see an event is flagged about 2 minutes in about 22:44:30. There is no obvious apnea event before the machine is shut off at 23:09. There is a RERA and some Flow Limitations displayed though. You would have to expand that area out some to see if there were any flow stoppages. EPR is on in this chart. It may be advantageous to turn it off. Having EPR on could help with flow limitations, but it may make the frequency of OA events worse. With EPR you need to try it both ways to see if it helps or hurts.

There is nothing jumping out at me that the machine is not working properly. It all looks reasonable what it is doing.

Last night I know when I experienced the waking up 'jolt', heart racing, etc. I turned off my machine so I could take a look today if there was anything out of the ordinary but now looking I can't see when I turned off the machine so that I can see what happened just before. Am I missing something? I know it was within the first 15 - 30 min of turning the machine on.

I had the racing heart issue on occasion for the last five years when I started using CPAP. It happened more several months back. For about three months I have been taping my mouth and that alone stopped the racing heart. My sleep is also better, not perfect, but a lot better than what I was having. I wear a full mask and for years prior, I was always a mouth breather. I started off slow with the taping. Patches are sold online. I also place the white tape over it so it does not fall off.