Everything was going swimmingly with my APAP...

[CorgiGirl]

AHIs under 5 with my pressures set from 10-20, 90% at trending at 13. This was true from August 2008 to May 2010.

But in the last month or so, my 90% has been 17-20 with AHIs in the 20s-40s. I moved my lower pressure up to 15 and then slowly tried to move it up further, but I just can't take that much pressure even with Cflex. Ramp helps me get to sleep, but the higher pressures wake me up. And the aerophagia is awful. Once, I ended up puking in my mask because of it. (Sorry if that's TMI.)

So, a new sleep study with xPAP says I need CPAP at 20 or a BiPAP. Since I have "failed" at CPAP under 20, I'm picking up my new BiPAP tomorrow morning.

And I have a few questions, of course.

1) Has anyone had this experience? Fine at 10 and all of a sudden something changed and you needed a BiPAP? I'd like to hear about your experience. I haven't gained weight, so that's not part of the issue. I can't see my sleep doc for another couple of weeks, so I have no idea what she thinks has happened.

2) What strategies have worked for combating aerophagia? I've searched for it and read what's here...and have tried most of it. So any additional help will be most appreciated.

3) How do you adapt to BiPAP from APAP? Is it very hard?

Thank you in advance!

[Goofproof]

Don't suppose you have the software and reader for your machine so you could post your dailies. That would be a help. So would a profile in TEXT not ICONNY. Do you have GERD problems, if so might try doing without caffine, and maybe raising the head of the bed 4 inches. Jim

[Komodo]

I switched from Cpap, to an Auto Vpap, and WOW what a difference!

While my pressure of 17cm on Cpap didn't really bother me THAT much, it was at the upper limit of my tolerence.
When I switched to Vpap at 18cm I was prepared for the worst! Boy was I WRONG!!!! Compared to my Cpap, it didn't feel like it was blowing air at all.

I don't think you'll have ANY problem adjusting to a Bi-level machine!

[DreamStalker]

Hey Corgi, long time no see.

You should get checked out and make sure you don't have something else going on like enlarged thyroid or something.

Hope you get the treatment back on track.

[DoriC]

Have you checked out your mask cushions? Maybe a new one or a different style? Anything to do with weather changes, humidity? Just brain-storming. Hope you get the answers here.

[CorgiGirl]

Don't suppose you have the software and reader for your machine so you could post your dailies. That would be a help. So would a profile in TEXT not ICONNY. Do you have GERD problems, if so might try doing without caffine, and maybe raising the head of the bed 4 inches. Jim

Hi, Jim,

I do have the software and could post dailies...which dailies are you looking for? Before I moved the pressures up? After?

My machines are in text in my signature. I'll be changing that today when I get the BiPAP.

I do have GERD and it's well controlled with medication. We have a water bed, so raising it isn't an option, unfortunately. But I do use a wedge pillow to get my head up. And I avoid caffeine as much as I can.

Thanks,
CG

[CorgiGirl]

Hey Corgi, long time no see.

You should get checked out and make sure you don't have something else going on like enlarged thyroid or something.

Hope you get the treatment back on track.

Thanks, DS. I have recently had a physical exam and my thyroid function was checked and it appears to be normal. But I'll ask about it when I get to see my sleep doc. Thanks for the suggestion.

CG

[Wulfman]

AHIs under 5 with my pressures set from 10-20, 90% at trending at 13. This was true from August 2008 to May 2010.

But in the last month or so, my 90% has been 17-20 with AHIs in the 20s-40s. I moved my lower pressure up to 15 and then slowly tried to move it up further, but I just can't take that much pressure even with Cflex. Ramp helps me get to sleep, but the higher pressures wake me up. And the aerophagia is awful. Once, I ended up puking in my mask because of it. (Sorry if that's TMI.)

So, a new sleep study with xPAP says I need CPAP at 20 or a BiPAP. Since I have "failed" at CPAP under 20, I'm picking up my new BiPAP tomorrow morning.

And I have a few questions, of course.

1) Has anyone had this experience? Fine at 10 and all of a sudden something changed and you needed a BiPAP? I'd like to hear about your experience. I haven't gained weight, so that's not part of the issue. I can't see my sleep doc for another couple of weeks, so I have no idea what she thinks has happened.

2) What strategies have worked for combating aerophagia? I've searched for it and read what's here...and have tried most of it. So any additional help will be most appreciated.

3) How do you adapt to BiPAP from APAP? Is it very hard?

Thank you in advance!

What types of events are causing the pressure increases?

What sleeping position? (you didn't mention that)

Have you ever tried CPAP mode? (straight pressure) I've had a belief that pressure changes can actually cause more events.

Good to see you again. Don't stay away so long.


Den

[PST]

Hey there, CorgiGirl--

I like Wulfman's suggestion to try straight CPAP. I hate to say it, but I have never heard of someone having such a sudden decline in treatment effectiveness after years of success. I'm curious who told you that you needed bipap. That's the kind of news I would expect to hear from the doctor. I realize they get busy, but your story calls out for professional analysis. It resembles stories I believe I’ve seen on this forum of people who start having central apneas at higher pressure, or a kind of APAP positive feedback loop where higher pressure causes more centrals, which causes the APAP to push higher. I know the algorithm in modern machines is supposed to avoid that, but something has gone off the rails in your case. I ordinarily don't like to mess with my settings when things are okay, but it sounds like you don't have much to lose by trying something different. CPAP at 13 or some other number that used to work for you might be an experiment to start out with. I would also tell my doctor I thought the problem was urgent.

[CorgiGirl]

Thanks for all the suggestions, everyone.

Let me try to answer some of the questions....

Den, I sleep on my side and my stomach, with my mask hanging off the side of the pillow.

I have not tried straight CPAP. But remember, I did wonderfully for 18 months with my APAP at very moderate levels.

PST, I'm sorry that I wasn't clear about what had happened to lead to getting the BiPAP. I did go to my sleep doctor. In fact, I faxed her three days of data showing nearly constant apneas and no hypopneas. She ordered a second sleep study with titration. The results of that study are that I need either CPAP at 20, which I already know that I can't tolerate, or BiPAP at 18-22. I picked up the BiPAP this morning and it's wonderful. Much more natural breathing method. I do have post-arousal centrals, according to the summary of the data, but not any other kind. As I understand it, post-arousal centrals are relatively normal and benign. (This comes from another thread and was contributed by Muffy.)

I have managed to get an appointment with my sleep doc next Wed., so that's a bit earlier than I originally thought. I will certainly be asking her if she has a clue as to what happened to make such a drastic change in my OSA. I'm just afraid she's going to say she doesn't know...it just happens sometime....

Thanks again,
CG

[Wulfman]

Thanks for all the suggestions, everyone.

Let me try to answer some of the questions....

Den, I sleep on my side and my stomach, with my mask hanging off the side of the pillow.

I have not tried straight CPAP. But remember, I did wonderfully for 18 months with my APAP at very moderate levels.

PST, I'm sorry that I wasn't clear about what had happened to lead to getting the BiPAP. I did go to my sleep doctor. In fact, I faxed her three days of data showing nearly constant apneas and no hypopneas. She ordered a second sleep study with titration. The results of that study are that I need either CPAP at 20, which I already know that I can't tolerate, or BiPAP at 18-22. I picked up the BiPAP this morning and it's wonderful. Much more natural breathing method. I do have post-arousal centrals, according to the summary of the data, but not any other kind. As I understand it, post-arousal centrals are relatively normal and benign. (This comes from another thread and was contributed by Muffy.)

I have managed to get an appointment with my sleep doc next Wed., so that's a bit earlier than I originally thought. I will certainly be asking her if she has a clue as to what happened to make such a drastic change in my OSA. I'm just afraid she's going to say she doesn't know...it just happens sometime....

Thanks again,
CG

That's why I asked about what types of events you were seeing in the software reports. "Something" has changed......and you should be able to see some evidence of what is causing your pressures to increase.


Den

[CorgiGirl]

That's why I asked about what types of events you were seeing in the software reports. "Something" has changed......and you should be able to see some evidence of what is causing your pressures to increase.

My reports were showing almost continuous apneas, all night long. AHI in the 30s. Almost no hypopneas. Raising the minimum pressure to 15 dropped the apneas by about half, no effect on the hypopneas.

Before this change, I'd had a fairly equal mix of apneas and hypopneas, AHI of 5 or under for 21 months.

I don't have the raw data from the sleep study yet, but I got the summary from the DME today. It describes a "difficult titration" due to poor sleep efficiency and post-arousal central apneas" and "Distorted sleep architecture." I had no REM sleep. AHI was 35...65 central apneas and 119 hypopneas. Spontaneous arousals increased as the night went on. Too much stage 1 sleep and not enough Stage 2 as compared to normal. (49% stage 1, 37% stage 2, 14% slow wave.)

Any insights are most appreciated.

CG

[DreamStalker]

Have you had your machine checked to make sure it is putting out the right pressure ... search for mamometer (forum spnsor sells them or you could make your own or take to DEM to get checked).

[gasp]

Regarding aerophagia, have you tried sleeping in a slightly raised position (assuming the aerophagia is from opening your mouth)? For me, sleeping this way reduces events and thereby my instinct to open my mouth.

[CorgiGirl]

Morning (at least it's still AM out here on the Left Coast )

DS, my machine was checked and is pumping out the correct pressure. Sorry I didn't include that before....

G, I have a short wedge pillow which doesn't seem to help much so far.

Thanks for the suggestions!

CG