CPAP just isn't working. Need advice

[Longwalksonthe]

Hello everyone,

I've posted here before asking for advice and most everyone said i should raise my min pressure, so i did. If i raise it higher than 6.2ish i get really bad Aerophagia, even sometimes at 6.2 or lower i will get it as well, but not nearly as much.

So i've left it at 6.2 min and 20 max for a few weeks and i also have been using max liners because i drool really bad and will always wake up because of the drool and have to wipe off my mask. The mask liners have helped with that, but i think they are also causing large leaks, as you will be able to see in my data.

I've been using CPAP for almost a year, and it's been a nightmare since the beginning. I can remember maybe a handful of times where i've really noticed it helped me but 85% of the time i'm still feeling drowsy all day, especially while driving which is why i got this in the first place.

I did an at home study in the beginning and was determined to have about 15 events per hour. I'm 23, not overweight at all, go to the gym every week and have a good diet. I cannot deal with this my whole life and i've been thinking about trying to get an in lab sleep study to really pinpoint what my issues are and then try to get surgery to fix this. CPAP obviously isn't working and my sleep doctor doesn't seem to know crap so this is why i'm coming here again.

Here is some of my data:
https://imgur.com/a/4dtDp

You will notice i usually use it 3-5 times a night, sometimes longer than other times because i literally can't stand the machine, sometimes i'll wake up with really bad aerophagia and just take the mask off because my stomach is absolutely killing me. Whats the point in using it if it hasn't helped me for a year.

So any advice you have would be greatly appreciated. Thanks

[Pugsy]

Talk to your doctor about using a bilevel machine because of the aerophagia issues.

6 hours of sleep using the machine isn't enough to feel better and add in wake ups due to belly issues...a recipe for failure.

There are times where your pressure needs are significantly higher than your minimum pressure. You are already using maximum exhale relief...time to consider using a different machine to hopefully better help with the aerophagia.

[Longwalksonthe]

Talk to your doctor about using a bilevel machine because of the aerophagia issues.

6 hours of sleep using the machine isn't enough to feel better and add in wake ups due to belly issues...a recipe for failure.

There are times where your pressure needs are significantly higher than your minimum pressure. You are already using maximum exhale relief...time to consider using a different machine to hopefully better help with the aerophagia.

Thank you for all the replies you've given me since i first came to this site! I will talk to my doctor about that then. Do you know how that would work with insurance coverage? I just graduated college so i don't have the cash to shell out for a new machine.. But insurance should cover the new machine just like they did the old machine right?

Also, do you think i should try and get an in lab sleep study as well since they give so much more information than an at home study?

[LSAT]

It's NOT the min pressure that is causing you problems. You are averaging 11-12 for most of the night. When you start the machine it starts at the min and then takes you to whatever pressure your auto machine feels you need to stop events. I'll bet that if you set the machine at about 8-13, you would feel better but your AHI may increase. Another option would be to set the machine to CPAP rather than AUTO and set pressure at 12.

[Longwalksonthe]

It's NOT the min pressure that is causing you problems. You are averaging 11-12 for most of the night. When you start the machine it starts at the min and then takes you to whatever pressure your auto machine feels you need to stop events. I'll bet that if you set the machine at about 8-13, you would feel better but your AHI may increase. Another option would be to set the machine to CPAP rather than AUTO and set pressure at 12.

But wouldn't that give me bad aerophagia since i get it when my min pressure is higher than 6.2?

[Pugsy]

If your doctor will get on board and document the need for bilevel because of inability to tolerate the pressures you need because of the aerophagia your insurance should cover the expense.

And yes...going to fixed pressure is likely to cause the aerophagia to be worse but you are using a lot more than 6.2 most of the time anyway. It's going quite high and staying up for a considerable bit of time.

You might be able to find a workable compromise with your current machine by limiting the maximum and letting a few apnea events slide by and that could be tried while waiting on bilevel trial and/or approval.

I wonder what would happen if you did 7 minimum and 12 maximum???? I think that most likely the AHI will be too high but you never know...maybe those high pressures are because of the Flow limitations and maybe allow some FLs to happen would be an acceptable compromise.

[Longwalksonthe]

If your doctor will get on board and document the need for bilevel because of inability to tolerate the pressures you need because of the aerophagia your insurance should cover the expense.

And yes...going to fixed pressure is likely to cause the aerophagia to be worse but you are using a lot more than 6.2 most of the time anyway. It's going quite high and staying up for a considerable bit of time.

You might be able to find a workable compromise with your current machine by limiting the maximum and letting a few apnea events slide by and that could be tried while waiting on bilevel trial and/or approval.

I wonder what would happen if you did 7 minimum and 12 maximum???? I think that most likely the AHI will be too high but you never know...maybe those high pressures are because of the Flow limitations and maybe allow some FLs to happen would be an acceptable compromise.

Okay, thank you very much for all the advice. I will contact my doctor this week and try those suggestions as well, Thank you.!

[fog.apnea]

Is your prescribed max setting really 20? Since you mentioned using the hose therapy for an year am assuming you might have tried to fiddle with the max pressure setting earlier on ... do you recall noticing any difference (if and) when you lowered the max pressure setting?. Couple more responses also indicating you need to take a look closer at your max pressure setting.

In my personal experience I have noticed that the apap machines are more reactive to settings on the machine than what you need, so the settings should be configured as best as possible to what you need. A single titration study is not going to be accurate for few reasons as I understand. My prescribed setting was 10-13 and during a 2 mo visit to the doc I tried to convince him that the min is a bit high for me based on the charts .. he didn't agree (limited time to go through the charts in detail) so I took it down 1cm bit a time myself and currently at 8-13 and my therapy response is no different. Not saying it might be that case for your but take it FWIW, do your own due diligence and ask your doc the right questions in response to what you noticed.

[mangos21]

have you tried sleeping in other positions.. a poster named roster solved his aerophagia and cpap issues by sleeping in the "falcon position"

[Longwalksonthe]

Is your prescribed max setting really 20? Since you mentioned using the hose therapy for an year am assuming you might have tried to fiddle with the max pressure setting earlier on ... do you recall noticing any difference (if and) when you lowered the max pressure setting?. Couple more responses also indicating you need to take a look closer at your max pressure setting.

In my personal experience I have noticed that the apap machines are more reactive to settings on the machine than what you need, so the settings should be configured as best as possible to what you need. A single titration study is not going to be accurate for few reasons as I understand. My prescribed setting was 10-13 and during a 2 mo visit to the doc I tried to convince him that the min is a bit high for me based on the charts .. he didn't agree (limited time to go through the charts in detail) so I took it down 1cm bit a time myself and currently at 8-13 and my therapy response is no different. Not saying it might be that case for your but take it FWIW, do your own due diligence and ask your doc the right questions in response to what you noticed.

Yea, my prescribed settings were 5-20. I've tried messing with the settings to no avail. I've lowered max to as low as like 12, i've lowered and raised min settings, i've tried everything and my doctor doesn't really seem to know much because when i told her i was changing settings, she said "you're not even supposed to have access to those settings" and that was it. I've slowly lowered settings over time and my results are all scattered.

[Guest]

It's NOT the min pressure that is causing you problems. You are averaging 11-12 for most of the night. When you start the machine it starts at the min and then takes you to whatever pressure your auto machine feels you need to stop events. I'll bet that if you set the machine at about 8-13, you would feel better but your AHI may increase. Another option would be to set the machine to CPAP rather than AUTO and set pressure at 12.

+1

It's obvious that ranges of pressures ain't workin' for ya. In essence, you're doing the same thing over and over and expecting different results. Time to "K I S S" (Keep It Simple) and see how that works for awhile. Look at your reports where the pressure is when you DON'T have any events and take some clues from that. When the pressure goes up, you have more.

[Cpapian]

Have you always used a full face mask?

The reason I ask is I just recently went from a nasal mask to nasal pillows. It felt more refreshing with the pillows, stronger force from the air. So I turned the pressure down from 10.5 to 9.5 and results are basically the same so far.

What I am thinking is the larger the mask, the more undirected air floating around. The mask being kind of like the plemun of a furnace. So what blows into the mask and doesn't go into your lungs is a lot and you swallow it.

If you tried a smaller mask type and lowered your maximum pressure ( a lot) you might get the same amount of amount of air in your lungs but less in your stomach.

Just something to think about.

[Rhrh]

6 hours per night is not enough to feel better? I'm averaging like 4 hours, maybe 4.5, and I was told I was doing great!

I do feel like crap still, and well, I've got a lot of new issues that may be coincidental.

I am not sleeping more than 6 hours per night since I first starting having sleep issues 6 months ago, CPAP or not. I have a lot of aerophagia too, among other things.

With insomnia before CPAP, and still present, I could not get 6 hours of sleep regularly.

[palerider]

6 hours per night is not enough to feel better? I'm averaging like 4 hours, maybe 4.5, and I was told I was doing great!

You were told wrong, you need to use the cpap all night, every night. Not using it is not sleeping.

Few, if any, people are going to feel good only sleeping four hours a night.

[LSAT]

xxyzx aka idiot