Frustration: aerophagia & pillow rainout

[JustTia]

Soooo, continued frustration with aerophagia. I set the EPR to 3, and thought that had helped because I was ok for a couple of days. But it's not unusual at all for me to go a couple of days with no or only minor air swallowing. There seems to be no rhyme or reason to it, unfortunately. Last night when I woke up at almost 1 am with painfully distended stomach, I awoke in the same position that I had fallen asleep in. The same position that I fall asleep in every night, in fact. Lying on my side, with my lower half slightly twisted so as to be in a more prone position, with the top leg bent at the knee and kicked up.

So...background on pressures and such. When I got my cpap on June 24, the pressure was set at 12, in cpap mode. On 7/2, after complaining to my sleep doc of aerophagia at a follow-up, mode was changed to auto with 5-15 range for pressures to see if that helped. It didn't seem to. My AHI improved very slightly (tenths of a point, lol), but I'm still struggling with aerophagia. Since I started using nasal pillows, I also use a chin strap. Not sure if this is significant or not, because I had the same problem without the chin strap when I was in a FFM.

Can you tell me if you see something that I'm not seeing, something that has bearing on this? Last night in particular, my stats are:







The break between 12:30 and 1:00 are when I woke up hurting. Turned off the machine, got a drink and took gas-x, then back to bed.

[Pugsy]

You may need a bilevel pressure machine so that you can use more than 3 cm difference between inhale and exhale to get your aerophagia under control.

In the meantime about all you could maybe do is if you are going to use APAP mode you might try limiting the maximum pressure so it doesn't want to hit 15. Sometimes there's a fine line between where so and so pressure is okay and doesn't cause so much pain and just a little more does cause the pain. You may have to compromise and allow a few apnea events to sneak past the defenses (and you have some wiggle room since your AHI is so low) just to avoid the aerophagia issues.

I don't know where your fine line might be (or even if you have one) but since you had problems with cpap at 12 then it may have to be below 12 but maybe you didn't use EPR when using 12 cpap and with EPR of 3 at 12cm wouldn't be so bad.
Maybe try limiting the max to 12 and keep EPR to 3 and see what happens with the aerophagia and AHI.

[JustTia]

You may need a bilevel pressure machine so that you can use more than 3 cm difference between inhale and exhale to get your aerophagia under control.

In the meantime about all you could maybe do is if you are going to use APAP mode you might try limiting the maximum pressure so it doesn't want to hit 15. Sometimes there's a fine line between where so and so pressure is okay and doesn't cause so much pain and just a little more does cause the pain. You may have to compromise and allow a few apnea events to sneak past the defenses (and you have some wiggle room since your AHI is so low) just to avoid the aerophagia issues.

I don't know where your fine line might be (or even if you have one) but since you had problems with cpap at 12 then it may have to be below 12 but maybe you didn't use EPR when using 12 cpap and with EPR of 3 at 12cm wouldn't be so bad.
Maybe try limiting the max to 12 and keep EPR to 3 and see what happens with the aerophagia and AHI.

That's kind of what I was thinking, Pugsy. Compromise between low AHI and comfortable pressure levels. I'll try tonight lowering the max to 12 and see how that works.

[palerider]

your low pressure doesn't come into play much, because you have flow limitations at the low pressure and the autoset ramps up quickly to near max, or max, to deal with those, and then you have problems with aerophagia.

you might want to *raise* the lower limit at the same time you're dropping the upper one.

if your lower isn't so low, you might not have as much trouble with the flow limitations, and less flow limits would avoid the autoset wanting to ramp up ...

[JustTia]

That makes sense, PR. Thanks!

[palerider]

That makes sense, PR. Thanks!

autosets react aggressively to flow limitations and snoring, and less so to apneas and hypopneas. the idea being, that flow limits and snores are often precursors to apneas, so if it can bump the pressure to prevent the apnea from happening, it does. if you're already having an apnea, it doens't react instantly, but rather watches to see if it's going to recurr... robysue has a better handle on the exact 'when it does what' sequence.

when you post screenshots from sleepyhead, if you hit the ^ by the calendar, it'll show more useful info, and hit F8 to turn off the sidebar. then you can rearrange the stripcharts by dragging them up and down so that the first four are

events
flow
pressure
snore
flow limit

(ok, first five) you can also shrink the size of the charts so you can get more on each page, and you can double click on the scale numbers on some of the charts, and it will autoscale so it's not as squished.

makes it easier to see everything going on

[JustTia]

That makes sense, PR. Thanks!

autosets react aggressively to flow limitations and snoring, and less so to apneas and hypopneas. the idea being, that flow limits and snores are often precursors to apneas, so if it can bump the pressure to prevent the apnea from happening, it does. if you're already having an apnea, it doens't react instantly, but rather watches to see if it's going to recurr... robysue has a better handle on the exact 'when it does what' sequence.

when you post screenshots from sleepyhead, if you hit the ^ by the calendar, it'll show more useful info, and hit F8 to turn off the sidebar. then you can rearrange the stripcharts by dragging them up and down so that the first four are

events
flow
pressure
snore
flow limit

(ok, first five) you can also shrink the size of the charts so you can get more on each page, and you can double click on the scale numbers on some of the charts, and it will autoscale so it's not as squished.

makes it easier to see everything going on

Thanks! I haven't learned my way all around sleepyhead yet. I'm liking it so far, though!

[JustTia]

Yay, my climateline arrived today! Along with a small mirage quattro to try again (Apria gave me the medium, which was AWFUL in part because it was huge on my face and head). If the quattro works well, it will be my back-up for cold & flu season, or to occasionally give my chin strap the night off, lol.

I feel officially old now. Packages from the DME feel like Christmas in July.

[JustTia]

Ok, PR, I think I've gotten my sleepyhead screen shot appropriately resized and arranged now, lol. Here's the data from last night. I added the climate line, left it set on "auto" and 74 degrees. Cause I can't stand hot air, lol. I also changed the range on my pressures from 5-15 to 7-14 to see if that would help with aerophagia at all. I woke up fine this morning (and slept the longest that I have since getting the machine!), with no noticeable air swallowing. But, like I said before, it's hit or miss so it's going to take more than one night to call it a complete success. As for rainout - I woke up with drops of water in the pillows. Not enough to wake up and bother me, but there was water in it. This is *with* the barrel cozy and the climate line. But, it was also pouring rain all night outside. Which is pretty much ALWAYS the weather conditions when I get water in the pillows, LOL! So I'm not really sure if there is anything that I can do to fix that or not. I'm open to further suggestions, since I'm not 100% on the laws of physics and so forth (I'm a reader and writer and philosopher. Not so much on the math and science stuff) so I'm not sure which way to go on the temp and humidity levels with the climateline, which is why I just left it at auto and set it to my actual room temp. Help there would be great, lol.

[Pugsy]

If the condensation in the nasal pillows doesn't wake you up then don't worry about it.
Your choices are to increase the ClimateLine temperature or the ambient room temperature or add another barrel cozy. Either of those choices might be more annoying than a tiny bit of water as long as that tiny bit of water doesn't disturb your sleep.
I doubt reducing the humidity to be delivered will make much of an impact because I suspect if your ambient humidity is already quite high (you say you mainly get the rain out in the pillows when it is raining outside) because I suspect the humidifier isn't adding all that much water in the first place with the higher ambient humidity during times with rain.

I do know of a few people who have used 2 barrel cozies with success though.

[Guest]

As to rainout I have discovered atmospheric humidity is a huge issue for me. During the winter months when the house HVAC is in heat mode I have to run my BiPAP ASV with humidity setting of 2 to 3 with heated hose. During the very humid summer months here in the Southeast I turn the humidity to zero with no hose heat as the machine seems to collect water from the atmospheric humidity of my environment. During spring I adjust to the zero setting into summer and fall toward a setting of two as we transition into winter. As xPAP is basically just a fancy air compressor air quality going in has to have some effect on output.

[palerider]

Ok, PR, I think I've gotten my sleepyhead screen shot appropriately resized and arranged now, lol.

that's just about perfect! all the relevant data in one shot! the only thing that would make it better is to highlight just the parts where you had data instead of having the big blank spot on the left. (normally that's not an issue)

however what you got is quite good enough!

and, it looks like a good night. I think you could use a higher starting pressure. and possibly a lower top.

your leaks are good your events are good, but your flow limitation is driving the pressure up, you can see where you had that flow limit not long after starting, and up went the pressure... higher initial pressure may help keep that from being the issue right at the start.

hoepfully robysue will take a look and see what she thinks, she's really good at this.

I'll let other people handle the rainout and climateline issues, since I normally don't use any water in mine

[JustTia]

Ugh. So, I guess the Quattro, in any size, is out. And now I have a small that I just ordered that doesn't work. That's how it goes, I guess.

I made myself three different liners to try, of varying thicknesses. One, the recommended thin cotton jersey. The second a soft but thin microfleece. Thicker than the jersey, but still lightweight. The third was organic bamboo fleece (sweatshirt material, but slightly thinner) that is really silky soft but denser than the microfleece and thicker than the jersey. I figured maybe I could find a combination there somewhere that would work.

No dice. I tried the new size small first. I already knew that it leaked like a sieve unless I tightened the straps uncomfortably, which I know is not how the quattro is supposed to work. So I put in the jersey liner and laid down to get busy adjusting straps. No matter what I did, it leaked - especially at the sides of my nose near my eyes. Tried dialing the knob closer and further. Tried keeping the top straps kind of loose, but the bottom tighter. No matter what I did, it leaked - unless it was hurting somewhere. Tried each of the liners and readjusted in turn.

Gave up and decided to try to medium that I have, but with the small head gear because the medium head gear bunches up and wrinkles from being too tall/big for my head. I actually got this, with the jersey liner, to pass the "smiley" test on the s9 but I could still feel a teeny bit of leakage in the corners of my eyes. And when I ignored that I just wore it anyway, back when I first got it, I wound up with double vision that sent me to the doctor thinking something was terribly wrong with my eyes. So that would not do.

I really didn't want to give up. And I'm kind of tenacious like that, lol. So I got the small mask back out, sans straps. Attached it and just *held* it in place with my hand. Voila - no leaks, even at the highest pressure in my range, and it was totally comfortable! So I thought...hmmm, if I can get it to sit right, then I just need to keep playing with the strap adjustments until the straps replicate my hand holding it where it is.

Yeah, right. I gave up, finally. And now I sit here with my cheekbones hurting from all of the adjusting and trying to get it to stop leaking. I guess I'm sticking with my pillows. I had such high hopes, too, lol. I really do wish I could find a ffm that would work with my scrawny nose because I'd love to get rid of the chin strap. I'd just tape my mouth and be done with it, but I have super sensitive skin and a lot of different adhesives cause irritation and rashes. Not something I want on my face, lol.

[JustTia]

Update on aerophagia and rainout after several nights with new settings:

AHI is hovering around .5 or less. A few of the OA's that are being recorded are actually when I took the mask off because I had woken up. I have auto start/stop enabled, so I take it off and it just blows mad air for a few seconds before it figures out that I'm not wearing it, lol. Oddly enough, these times don't make a blip on the leak rate at all. Go figure.

Aerophagia seems better. To refresh - I narrowed my pressure range from 5-15 to 7-13 and did away with ramp, and set EPR to 3. I still wake feeling like I swallowed a little air, but in truth I think that can't be entirely eliminated because I have GERD and I'm pretty sure the valve is damaged from that. But it is tolerable now, and hopefully will get better as my body gets used to therapy. I'm just thrilled that I'm not waking up feeling like I swallowed a whole watermelon in my sleep.

The rainout has not changed one iota, and I'm at a loss with it. I got the climateline and started out with it on auto, set to about what my room temp is. Then I switched to manual and set the humidity to 1.5 and temp to a couple of degrees above room temp (76) because I can't stand to breath hot, swampy air. That still didn't work, so I turned off humidity and kept temp at 76. I still wake up with rainout, *just* in the pillows (and yeah, I have a barrel cozy). I don't want to double up cozies because it already presses against my upper lip some. I don't want to make it even thicker/bulkier. So, like I said, I'm kind of at a loss. And now I'm starting to develop a sore on my septum just inside my left nare. I thought it might be because humidity was too low, so I turned up the humidity to 2, but woke up in the middle of the night with water trickling from my nose and pillows dripping. Gross. So I turned humidity back down. Last night I rubbed the inside of my nares with KY jelly before masking up, and irritation seems less.

I don't understand what's causing the sores. It comes and goes. This is, I guess...the third time, maybe, that a sore has shown up in the same spot since I started using the swift fx for her. The pillows fit very comfortably. I started out with small, but figured out that medium is more comfortable. When they inflate, I don't feel anything at all inside, just like it's supposed to be. Nice seal, no leaking, and so comfortable that as I drift off to sleep I am able to completely forget that I'm even wearing pillows at all. So it's not that the pillows don't fit well and are rubbing inside. If it's not that, and it doesn't seem to be related to humidity (or at least, upping the humidity didn't help because it caused a whole other problem), I'm at a loss to make it better. I just randomly wake up with a sore spot that wasn't there the night before.

Overall, I feel like things are going pretty well. Just ironing out the last kinks so that I sleep comfortably without waking up with water, or air swallowing, or sore nose.

[Pugsy]

Do you have some Lansinoh lanolin ointment/cream? If not, get some. I think it will help with the sores in nostril issues.
Found in the baby aisle of most stores where nipples and bottles are found.

The rain out in the nasal pillows....it's physics in action. You are going to have to warm up either the air in the nasal pillows more or warm up the bedroom air temperature. You have to prevent the cooling of the air in the nasal pillows. It's physics in action....warm air holds more moisture and when it cools it can't hold onto the moisture anymore and condensation occurs.

One question...how often do you wash the nasal pillows? Any chance some of the moisture you are feeling might be residual moisture from washing and simply not quite dry?...and maybe adding to the problem?