Need advice - is lower setting better than not using at all

[peljbl@yahoo.com]

Hi - been using BiPap 3 yrs now - Resmed VPAP III - at yearly checkup I mentioned that I was waking up during the night - pulmonologist sent me for titration test at sleep lab - prev sleep study 5 yrs earlier. After first sleep study - was put on CPap - couldn't tolerate - too much air in stomach and chest and head so she ordered the VPAP. I loved it - setting was 10/5 - I did well with it and then after this study was told that the setting would need to be changed to 16/10. I stated that after the sleep study - I had air in my stomach and chest and could we start out gradually upping the pressure so I would not have such discomfort. No she said - it will be okay - she had the DME to change it - after 4 nights I was miserable during the day - hurting - burping, bloated and miserable til bedtime - I did sleep a little better though. Called pulmonologist back - told her how miserable I was - could we lower it - she said only to 14/9 - that's when I posted on here for help to change it myself and thank goodness someone responded with the clinician's manual and I changed it back to 10/5. No more air in gut.

Sorry for the long post - now here is my question - I have only missed 2 days on the machine in the last 3 yrs - feel like I could die in my sleep if I don't use it - but if I use it at the tolerable level 10/5 - is it better than not using it or since it is not at the correct level - is it useless? I am going to try raising it slowly to see if I can tolerate a higher level - should I start with going 11/5 or 10/6 - not sure which causes the air in the gut. Any advice would be appreciated and I'm so glad to have found this forum. Thanks.

[peljbl@yahoo.com]

I forgot to add - yes - I do use a chin strap.

[ozij]

Using it is much better than not using.
I would raise it gradually - and I would make the change at the same time inhale pressure and the exhale pressure - the difference is called pressure support.

I've been on xPAP therapy for more than 4 years. I'm trying to gradually raise my (lowP pressure - and when I raise the pressure in 0.5 I can feel the difference - so much that my sleep is disturbed for the first few nights.

Do it as gradually as you have to - and hopefully you'll reach threapeutic pressure that helps you sleep well, and does not bother your stomach.

O,

[peljbl@yahoo.com]

Okay - thanks for your help. Just got a call from the DME - dr said to come change it to 14/8 - I already changed it to 10/5. Question is - if I change it back to the 16/10 that DME set last week and then she sets it at 14/8 - if she realizes for some reason that I changed it myself - can she fix it so i can't get into it again. Guess - I'm scared that I will lose control and be stuck at the DME's mercy. Course I will change the 14/8 back to 10/5 after she's here -only reason I'm letting come is she says she has to fit my new mask - I want the mask so I'm stuck. Do you know if she can fix it so I can't change it again??? I mean I really feel like I have to be able too since the dr has been so difficult.

[Goofproof]

Kind of a Loaded Question!!! Is it better to play with a revolver with two bullets in the cylinder or one, it really doesn't matter unless you know where hte bullets are.

Without the software and reader, you or your doctor don't have a clue how your treatment is doing. If your treatment pressure is too low, you don't get treatment. Jim

[peljbl]

Goofproof - thanks for your opinion but I have to tell you - other than 3 yrs ago when i got this machine - no one has ever asked to check it - so other than the sleep studies - no one ever reads a smartcard -not even sure if I have one so I see the pulmonologist once a year - at her request - if I hadn't mentioned waking up once a night - nothing would have been checked. I do hope to get the pressure up where it should be - but slowly til and when I can tolerate. If I can't tolerate it - then what do you suggest - stopping use of the machine all together?

[riverdreamer]

I think Goofproof might be suggesting that you get the software and card reader yourself. Many of the people on this board can help you learn how to read the resulting information.

On whether the doctor or DME can lock you out of the machine: NO. They can set it up so that changes can only be made through the clinical menu, but they cannot lock you out of the clinical menu. It is a good idea to try to keep friendly relations with your doctor. I always explain why I have made changes, and I have the reports from my software to back up my decisions. My doctor has given me approval to make any changes I wish. If your doctor seems open, I would try to establish a similar relationship.

If not, you still have the right to make changes.

I have found, like Ozij, that making changes in small increments makes the change easier to tolerate. I am surprised to find that the pressures I am at now feel like almost nothing. I do have to adapt to each increment of change, even though I cannot consciously feel it. Since you have a Resmed, I am guessing you can change the pressure in .2 of a level at a time.

If you get the software, you will be able to see what is preceding any breathing events. It shows whether it is more likely that leaks, pressure that is too low, or other issues might be related to apneas or hypopneas. This makes it much easier to decide how high the pressure really needs to be.

[peljbl]

Thank you - i will try to that - changing the pressure by .2 increments - seems more sensible than going from 10/5 straight up to 16/10. I'm certainly not against raising the pressure - I just want to be free from the bloating, burping and pressure but I also want to be compliant, so I will try.

As for the smart card and program - does everyone do this - it sounds involved and technical - is it really helpful and useful? Guess I am feeling somewhat undeducated about this. Not like me - with all my medical problems - I'm usually on top of everything.

[BeanMeScot]

Reading your data would be the smartest thing you could do. It would show how you did at the pressure levels that you set. You might find a lower pressure setting than the doctor is recommending that still gives you a good AHI.

[CollegeGirl]

What you're experiencing ("air in your gut") is called aerophagia. If you look up on the top right section of this screen under "popular tags" you'll see one with this word - try clicking it, and checking out all the information on this board about it. A common cause of it is damage caused by reflex disease (GERD) which can actually be silent (in other words, asymptomatic). Successful treatment can mean repair of the sphincter between your stomach and esophagus, and less air getting through there. You might want to consider getting tested.

[WorksinSleep]

I am glad all of you are sleep professionals. You need to be better educated about your equipment before you go changing your pressures. To little air and you can have obstructive, mixed apneas and hypopneas. Too much air will cause you to central apneas. You have a certain pressure and should not change them because you will cause more harm for your body. So search google some more before you cause more harm to your body or just listen to your doctor or dme.

[ozij]

Another bored troll looking for action.
O.

[rested gal]

Need advice - is lower setting better than not using at all

I'm not a doctor or anything in the health care field. I do think using at least some pressure is better than not using the machine at all. I agree absolutely with ozij:

Using it is much better than not using.
I would raise it gradually - and I would make the change at the same time inhale pressure and the exhale pressure - the difference is called pressure support.

A few times I've experienced the kind of aerophagia that was extremely painful. So painful that I can certainly understand why a person might have to quit CPAP treatment completely no matter how important they knew "CPAP" was. I think you did right to move the pressure down to a level you could tolerate at all, peljbl.

As for the smart card and program - does everyone do this - it sounds involved and technical - is it really helpful and useful?

I personally think that with a ResMed machine, the data you can get from the LCD window is sufficiently informative. I definitely would want software for other manfacturers' machines, but I wouldn't bother getting the ResMed software, myself. I'd use the AHI and leak info that's available in the mornings from the machine's window to make my tweaking decisions with a ResMed machine. Just my opinion.

riverdreamer's right:

On whether the doctor or DME can lock you out of the machine: NO. They can set it up so that changes can only be made through the clinical menu, but they cannot lock you out of the clinical menu.

The button-pushing routine you already know how to do, peljbl, to enter into the "clinical" menu will always be the same. Once in the clinical menu, you can change every setting on the machine as you wish.

I second CollegeGirl's recommendation to get the possibility of acid reflux damage checked out:

What you're experiencing ("air in your gut") is called aerophagia. If you look up on the top right section of this screen under "popular tags" you'll see one with this word - try clicking it, and checking out all the information on this board about it. A common cause of it is damage caused by reflex disease (GERD) which can actually be silent (in other words, asymptomatic). Successful treatment can mean repair of the sphincter between your stomach and esophagus, and less air getting through there. You might want to consider getting tested.

I'd get a thorough exam by an ENT (enterogastrologist; "ear-nose-throat" doc.)

http://www.sciencedaily.com/releases/20 ... 080008.htm

"These are patients without significant heartburn symptoms, who are experiencing acid reflux during sleep," explained William C. Orr, Ph.D. of Lynn Health Science Institute in Oklahoma City, OK. "'Silent reflux' may be the cause of sleep disturbances in patients with unexplained sleep disorders."

"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.

[jnk]

Rested gal and ozij,

Do you think there is any chance the use of an autobilevel could help the OP? Depending on the amount of time during the night the OP needs higher pressures, might an autobilevel allow the pressures to remain relatively low much of the night while shooting up occasionally to deal with, for example, dream-sleep when on the back, which may lessen the aerophagia trouble?

( https://www.cpap.com/productpage-bundle ... undle.html )

Also, if the high-pressure needs of the OP are positional, such as higher when sleeping on the back, might finding a way to keep that from happening make the overall pressure needs lower?

jeff

[ufo13]

peljbl:

Have to agree with all the above reply's, especially rested gal's! Hope the advice given in the above posts help you, and I also would not be afraid to work to get the machine settings comfortable for you, while you work on the other things like checking into the cause of the aerophagia!

Best to you,

Steve,
ufo13