Major weight loss and high pressure issues

[Soonerdude11]

Greetings,

I am new to this forum and I'm really struggling. I was originally diagnosed with sleep apnea in 2014. I think I was around 270 pounds and was put on a fixed pressure of 11 and face mask. Fast forward to December 2017. I had a second study done due to weight gain. I was around 315 pounds at the time. I was changed to a Resmed Airsense 10 APAP with a pressure of 11-13 and a Resmed N20 Nasal mask. My EPR was set at 3. I took to nasal and had no issues with mouth dropping open. I started my weight loss journey October of 2019 I was around 340 and am now currently around 220 pounds. I started having mouth leaking and severe dry mouth as I have gotten lower. I am currently using a chin strap and also went down a size in my nasal mask and have reduced leaking. I have also just recently dropped my pressure to 10-13 which is what my sleep study actually indicated as optimal pressure at the time. It seems lowering my pressure and helped with leaking some and also reduced my sore stomach and aerophagia but I'm having issues with central apneas. I felt awful at 11-13 and feel awful at 10-13. Is my next step to turn down or turn off EPR? or lower pressure to 9? I noticed when I had played with the pressures and lowered to 9 that my central apneas seemed to be more so I went back up to 11 and now have gone back to 10 and think its better than 11 but I still feel sick due to central apneas I get towards the last few hours of sleep in clusters. I don't know if EPR is causing issues or that I need to lower to 9. I'm lost and confused and feeling ill every morning and sick to my stomach and not rested.I haven't adjusted EPR at all so far since changing my bottom number.

[zonker]

Greetings,

welcome to the zoo! sorry you're having such a dreadful time of it. don't know if it makes you feel any better, but we've all pretty much been down that road. clearly, your machine isn't adjusted properly.

tell you what. look at the links in my signature. you'll find the free software program, oscar. note: you'll need a computer. this doesn't run on a phone. windows,ios or ubuntu (or similar).

also there is a link for newbies. this includes a "how to" for oscar. follow it carefully and capture some images of the data generated. post those here, right HERE, for the experts to look over and advise.

we are all of us just that much different that it's hard to give meaningful advice without seeing the data. so once you've got that uploaded, you'll be ready to get your therapy optimized.

good luck.

you can do this.

we can help.

[Julie]

Yes - please post Oscar results - we can tell loads from those, but only guesses without it.

[Soonerdude11]

The last three nights. Tried changing EPR each time to help. I know thats probably not great. This is at the pressure I have been trying. 11-13 is my normal range before weight loss. So I have been trying 10-13. I was around 270 when I had my first sleep study and put on a fixed pressure of 11. My second sleep study put me on APAP with a pressure of 11-13. I was also 315 pounds when I had it my second study in December 2017. I had been around 340 pounds before I started weight loss efforts in October of 2019. My leaks got worse and worse as I lost weight. I ended up adding a chin strap and then using a smaller nasal mask. That seemed to reduce leaks somewhat. I have been having a lot of aerophagia and dry mouth. I'm currently 220 pounds and miserable with this machine.

[zonker]

The last three nights.

good job. i can't answer the questions directly. but i can make one small suggestion for the next time you post. you've got flow rate in there but have missed flow LIMIT. this may be important because your machine is showing you with more centrals than anything else.

i'm not good at advising about centrals. so i'll shut up and let those who know speak up.

good luck!

[Soonerdude11]

Thank you for the advice. I hope this works ok.

[Okie bipap]

You do not have enough centrals to even think about a different machine. I would be willing to bet many of them are sleep/wake junk (SWJ). It looks like you hit the top level of you pressure range one time. If you do not bump up against the upper limit every night, there is not much to be gained by raising you upper limit. Even if you set to the maximum of 20, it is doubtful it would ever go much over 13. Normally, we recommend an upper setting of 20 and let the machine decide where it wants to go. The only time we recommend less than 20 is if you are having trouble with aerophagia.

[Soonerdude11]

Well that’s good as far as not needing a new machine. I can tell you for sure that I feel ill. It’s the starting pressure that has me concerned. My 11-13 isn’t cutting it and maybe 10 is better but I don’t know anymore. Trying to figure out what’s causing the centrals. Is it because I lowered pressure? Do I need to lower further? Is it the EPR? Pretty much weight loss has thrown me out of whack on pressures and I’ve gone up and down with that minimum number and it’s not helping. Aerophagia was never an issue for me before. Dry mouth has been going on since February I think. I didn’t start feeling really bad until late August. I wake up sick, tired, no energy and just miserable like before I had been treated. I just want to know what my weight loss means for my pressure. I shouldn’t feel this bad for how many apnea’s I’m having.

[palerider]

Well that’s good as far as not needing a new machine. I can tell you for sure that I feel ill. It’s the starting pressure that has me concerned. My 11-13 isn’t cutting it and maybe 10 is better but I don’t know anymore.

Then change it, set your min to 12, and max to 20.

Trying to figure out what’s causing the centrals.

ignore the centrals, they are insignificant, unimportant, just a distractor. More likely they are a result of your not sleeping well, not the cause of it.

I shouldn’t feel this bad for how many apnea’s I’m having.

There's more to bad sleep than just apnea's.

If you have dry mouth, try either taping your lips shut, or a dual sided boil and bite mouth guard that doesn't have a vent hole in the middle, chin straps absolutely won't prevent mouth breathing, because teeth aren't airtight.

[Soonerdude11]

Here are my screen shots from the last two nights. This is at a pressure of 9-13. So far dropping two cm of pressure from my base seems to be the most helpful. How long should I stay at this pressure before attempting to lower to 8-13? My dry mouth is much better and leak seems to be a little better and stomach pain has lowered but not completely gone when I wake up. I am still having some aerophagia and a little tired but better. I never had issues with aerophagia until I lost a lot of weight. Please advise on my next steps.

[Pugsy]

I would lower the minimum right now.
You can't expect to sleep your best or feel your best while having aerophagia issues messing with how you feel.

[cathyf]

Just a random thing to throw out there as another person who has lost a lot of weight. (I went from 270 to 140). I kept getting hit with what felt like terrible gas, mostly focused on the right side under the bottom of my ribs. I took all sorts of evasive action for aerophagia with adjustments in my settings, and it didn't help much. I finally ended up seeing a gastro and looking at gall bladder problems.

Ok, in my case it turns out that my gall bladder is just fine, but one of the things I learned is that the process of big weight loss causes gall bladder problems in lots of people, and so it's something that should always be considered and ruled out. Another thing I learned is that the way that the nervous system works is that your body isn't always very good at telling you exactly WHERE any particular pain is coming from! Your gall bladder can mimic tendonitis in your shoulder, or lower back pain, for example. Your torso is all sorts of systems all packed in pretty tightly -- lungs, stomach, intestines, reproductive organs, etc -- so it's not at all obvious what has the problem with just where the pain is coming from, and if your brain doesn't even know the right spot it makes it even harder!

I know that this doesn't help with the hypochondria (been there done that got the t shirt!) but you have to be careful that you are thinking broadly enough and that you aren't limiting yourself to the wrong places entirely for answers.

[Soonerdude11]

Can some explain this to me? So I tried setting the machine for 8-13 and sometime in that 20 minute window I felt myself choke and wake up. You can see where the OA registered. What I want to know is why does it say 3.33 and why does it say (10) OA? Like its only showing one to me.The AHI ends right there where it shows for that time I had the machine on. I figured out really quick I guess that was too low of pressure so I turned it back up to 9 after this event. I had a little bit of a headache in that short time window.

[Soonerdude11]

Here is the same night but after I turned it back to 9-13 for the night. I woke up feeling pretty good honestly. Still a little bit of a sore stomach but not very much and a little burping on my walk this morning but can I get any closer than this? Should I try something else to help with the aerophagia? It's greatly diminished, but I'm just wondering if its something else also contributing. Honestly I'm just happy that I'm starting to feel better rested at this new pressure range compared to my others. I was feeling awful before even though my numbers weren't showing it in a major way on paper. I can tell dropping my base number 2 cm of pressure has improved my quality of sleep these past three nights.

[Pugsy]

Time period of usage 18 minutes.
The 10 in parentheses is duration of the event in seconds and to be honest...looks like SWJ sleep/wake/junk post arousal to me.
Since your time of usage was so short and they had to extrapolate what that would equal in an hourly average/index they came up with AHI of 3.33.
18 minutes is roughly a little less than 1/3 of an hour. Actually 1/3 would be 20 minutes.
So the machine made a best guess that you would have another couple of OAs if you had used the machine for a full 60 minutes.
It's how the machine calculates things when it has less than an hour to come up with an hourly average.

Weird math. We both know you may or may not have had another 2 1/3 events if you had used the machine another 48 minutes but the machine had to come up with something in terms of AHI.
The machine extrapolated a bit so it could come up with an hourly average.

Ignore it.