My fight with aerophagia (air swallowing).

[Sleeper Agent]

Don't be too quick to set the high so tight. Remember if you have an event the machine needs to go as high as needed to open up the throat. I bought into the set it tight thing and even preached it for a time, but noticed the machine hit the upper limit so I opened it and decided to let the machine figure it out. I do limit mine at 16 kinda like a safeguard against damaging my system if the machine gets carried but like the other night proved it wasn't my apnea but the leaks that drove the machine high.

The trick is to look at 1) the percent of the night spent at low pressures and 2) the OA index. I stopped even looking at OHA because Hypopnea's pop up like weeds. With my restless legs and tossing and turning I decided most are false so stopped worrying about it. As long as OA's are running under 1.5 the machine is doing it's job. I tried to play the "how low can you go" game but once you are tuned in accept it. I went for months not even looking at scores unless there was something going on like this week.

Thanks for the advice. I tried pressure 7 for some time and it seems like the optimal pressure. Also tried pressure 8 and 9, but they don't noticeably differ from 7.

For tonight I will try a narrow range of 6-7 and see how much time the machine spends at 7. Hopefully this does not give me painful stomach bloating like straight up 7 does.

[Sleeper Agent]

Narrow APAP between 6 to 7 (EPR 2) appears to be quite good. AHI 1.31!

Median pressure: 6.4
95% pressure: 6.98

That means 50% of the time my pressure is 6 to 6.4. Right?

There is some stomach discomfort but the bloating isn't as bad as straight up 7, and there is no pain. So this might just work. Will try the same setting again tonight.

[OldLincoln]

Yes that's what it means. Now try opening the top to a higher number and see what the median goes to. Likely it will stay pretty low. With 90% at 6.98 that means it was knocking on the door trying to stop AH's but the machine was blocked at 7. You might want to keep sliding the top number up and leave the low at 6.

[Pugsy]

Since 7 cm seems to be the dividing line between comfort and big aerophagia issues I don't know that I would worry about giving the machine more room to go over 7 cm. The AHI is nice a low and sure doesn't point to any need to do that and just because a machine might want to go there sometimes doesn't mean it just has to go there. For all we know it might want to go there because of a little flow limitation that really isn't clinically significant.
Sometimes we just have to make compromises.
Just because a machine might want to go a little higher doesn't mean that it has to go there especially if when it goes there bigger problems are created.
There's no rule that says just because a machine hits its maximum that it just has to be given more room to roam around...especially if it is a known fact that going higher creates problems.
With an AHI of less than 2 and someone saying that aerophagia was greatly improved...I wouldn't care if the machine spent all night at 6.99....if letting it go over 7.0 caused more problems than it fixed and in this situation...there isn't even a real need to fix a problem with more available pressure.

What you say would be fine for someone without severe known issues with aerophagia but in this situation I think limiting the max to 7 is the best thing to do for this person because of the aerophagia and there's nothing that really needs fixing in terms of AHI.

With 90% at 6.98 that means it was knocking on the door trying to stop AH's but the machine was blocked at 7. You might want to keep sliding the top number up and leave the low at 6.

[mon]

I had a lot of aerophagia using nasal masks. I found using a ResMed AirFit P10 is the answer. My nasal airway is cut off as soon as I put any rigid mask on my nose. I used to use a Sleepweaver Elan nasal mask which worked due to there being no pressure across the bridge of my nose. I think because when wearing a mask on the bridge of my nose cuts my nasal airway off. It causes the AUTOSET to go higher to push through the nasal blockage to stop the apneas and this causes the aerophagia. Whatever it doesn't happen to me with the AirFit P10.

[bv1800]

Yes that's what it means. Now try opening the top to a higher number and see what the median goes to. Likely it will stay pretty low. With 90% at 6.98 that means it was knocking on the door trying to stop AH's but the machine was blocked at 7. You might want to keep sliding the top number up and leave the low at 6.

The median (which is mid point of the list of readings, in ascending or descending order, without regard to time of the reading) won't change at all. The 'mean' will change, but median won't.

[Sleeper Agent]

Up EPR to 3 (from 2), while keeping the narrow range of 6 to 7. Aerophagia seems to be almost completely gone!

Unfortunately, AHI 3.45, with 20 central apneas spread all over. Not sure what is happening. Maybe EPR 3 was too much.

Kept the mask on for 8 hrs 26 mins. Woke up at 7.30 (slept at 11 pm) and did not go back to sleep even though I totally could. Seems to be an improvement over yesterday. Not sure what is happening to my body anymore.

Going to go back to EPR 2 and the same narrow range to gather more data.

[Pugsy]

You really need to try a setting for about a week to get any idea of patterns and trends unless the results are horrible.
20 centrals spread out over the entire night isn't horrible. AHI of 3 something isn't horrible either.

When you go changing things on a nightly basis you are going to be chasing your tail most of the time because we don't sleep the same way each night and it's entirely possible that the difference in AHI could have happened with no changes to any settings.

[Sleeper Agent]

Autoset narrow range 6-7, EPR 2. Got an AHI of 1.7 last night with minor aerophagia but no big discomfort!

[Sleeper Agent]

2 weeks on autoset range 6-7. AHI stable at around 1-2 every night. Minor aerophagia...tolerable. Median pressure around 6.4-6.5. 95% pressure around 6.8-7.

However, on 2-3 occasions my sleep was disrupted with bloated stomach pain after close to 7 hours continuously with the mask on. On 2 of them, I ate close to bedtime.

Will continue monitoring. However, I think I have done all I can short of sleeping on a wedge. If avoiding food close to bedtime resolves the occasional issues, I would say I have won this fight!

[sawinglogz]

If avoiding food close to bedtime resolves the occasional issues, I would say I have won this fight!

I haven't been able to find any published support for this approach, but it matches my experience as well.

I was having some issues with LPR, and as those have subsided, my aerophagia seems to have improved as well. There are other variables in play, so it's not a rock-solid correlation, but for others who are battling aerophagia, it's worth trying this approach.

I try to leave at least 3 hours between meal and bedtime. I also avoid drinking large quantities of water in that time period. Just small sips here and there.

[RicaLynn]

So THIS is why I've been so flatulent the last couple days! This morning I woke up and belched like a bullfrog for the first hour (much to my daughter's chagrin). I did notice last night on the few occasions when I awakened I had some significant leaks through my barely parted lips. I have an appt with my DME tomorrow to try out some new masks, perhaps he'll have some insight (he's a hosehead as well, makes me just a bit more confident in what he has to say).

Can't ever have too much information unless it's your kids telling you about great sex

OldLincoln, I laughed so hard I snorted my coffee!

[bv1800]

So THIS is why I've been so flatulent the last couple days! This morning I woke up and belched like a bullfrog for the first hour (much to my daughter's chagrin). I did notice last night on the few occasions when I awakened I had some significant leaks through my barely parted lips. I have an appt with my DME tomorrow to try out some new masks, perhaps he'll have some insight (he's a hosehead as well, makes me just a bit more confident in what he has to say).

While I don't have the knowledge of many on these boards, I'm not sure that a new mask will help. If you are swallowing air, now, you are either going to swallow air or exhale out of your mouth and have severe dry mouth (like wake up multiple times per night and have your tongue stuck to the roof of your mouth). Having a machine that lower pressure on exhale or lowering your pressure is likely to be needed.

[RicaLynn]

While I don't have the knowledge of many on these boards, I'm not sure that a new mask will help. If you are swallowing air, now, you are either going to swallow air or exhale out of your mouth and have severe dry mouth (like wake up multiple times per night and have your tongue stuck to the roof of your mouth). Having a machine that lower pressure on exhale or lowering your pressure is likely to be needed.

The mask refit is to hopefully solve some of the skin irritation I've developed around my nares, and I intend to ask about possible leak issues as well. I'm only five days into my therapy, so I'm fairly certain this is part of the tweaking process to be expected with my S9 AutoSet. But better to make the DME aware of it now, eh?

[palerider]

Can't ever have too much information unless it's your kids telling you about great sex

OldLincoln, I laughed so hard I snorted my coffee!

or your parents.