Help required to reduce AHI and Aerophagia

[Jude92]

Thanks for your input ozij. That's very reassuring.

This was my 2nd night with minimum pressure at 5. Very similar to the first night. While I did I sleep a bit longer, I again woke up feeling like a balloon being pumped with air ready to burst. I had to take the mask off after a while to grab a little bit more sleep. Here's the chart - https://imgur.com/a/tkpEyWm

Small reduction in CA and OA, but big increase in Hypopneas from the previous night.

[Jude92]

Results from my 3rd night with minimum pressure 5 - https://imgur.com/a/cVStdy4

Slightly longer sleep than previous nights (about 6 hours). Hypopneas and OA similar to previous night but CA back up again.

Aerophagia has remained the same too.

[Pugsy]

I think a stroll through the flow rate graph using SleepHQ is in order.
Need to know if those flagged events are asleep events or arousal/awake related flagged events.

More pressure is indeed needed to deal with the OAs and hyponeas ....if they are real asleep events...but they may not be real asleep events and if that's the case the more pressure won't help awake/arousal events but will sure make the aerophagia monster's visit misery.

How about making sure that "more pressure" is what is for sure needed before going down that road????
Mainly because more pressure in this situation creates another significant problem. Lets see if it is even needed.

[Jude92]

Thanks for your post pugsy.

The first flagged event at 7.30 was an awakening. I couldn't say for sure what the 2nd event was.

I've just created a sleephq account. Would you mind telling me what I'm looking for or if there's some data I need to share?

Thanks again!

[Pugsy]

You have to load up a SleepHQ report so that it is public and then provide a link to that report.
Once we can access the report it is interactive for us and we can zoom in on the flow rate/breathing and look to see if the flagged events happened while asleep or awake.

I can do the zooming in and evaluation but I have never actually used SleepHQ to post those interactive links myself.
Someone else will need to explain the how to get to that point. I don't know the steps....I just know how to deal with it once it's available for review. I know it has to be public though. How to make it public though....I don't know that part.

[vandownbytheriver]

(snip)
Someone else will need to explain the how to get to that point. I don't know the steps....I just know how to deal with it once it's available for review. I know it has to be public though. How to make it public though....I don't know that part.

On the Dashboard, looking at the night you want to share. There's three vertical dots at the upper right... click them and choose Share. You get a popup dialog that has a link... click the box to the right of the link and it's now in your clipboard, you can paste it in a reply here. If you want to use that link again, or if you want to deactivate it, go to Share Links in the left pane. Easy!

[Jude92]

Thanks for your help vandownbytheriver!

Here's a link to my report from 31st March - https://sleephq.com/public/81a4ceaf-56f ... f11546d3b5

Link to last night's report - https://sleephq.com/public/169d1ca2-605 ... a3a1b12d3f
Last night's Oscar chart - https://imgur.com/a/z8lVBul

CA back down again and bloating remains the same.

I'm on vacation for the next 6 days so won't have access to my laptop to get oscar data or new sleephq data. I will have my DreamMapper app which only provides limited data.

Thanks again!

[Jude92]

I'm back from my vacation so can share some more data.

Here is a link to my Oscar reports from April 2nd, 4th, 5th, 6th, 7th & 9th - https://imgur.com/a/YXfoJwE. I didn't really get any sleep on the 3rd due to being awaken by family members I was staying with, and I was travelling overnight on April 8th so didn't have my machine on. Please note, the times will look strange as I was on vacation in the USA which is a 5 hour time difference.

Here are my SleepHQ reports:

April 2nd - https://sleephq.com/public/3df26e88-d5d ... 271c35593e
April 4th - https://sleephq.com/public/8a462d3f-ec2 ... 937b17d4a5
April 5th - https://sleephq.com/public/d966a232-34f ... 931f9c0008
April 6th - https://sleephq.com/public/64ff5eb8-ee9 ... 3615d086ad
April 7th - https://sleephq.com/public/286b51cd-53d ... 547958535e
April 9th - https://sleephq.com/public/1d5f79cb-518 ... 920bafbfd1

A big takeaway from the past week is that once I got settled into my new environment I got 2 of the best nights sleep I had in a long time on April 6th and 7th. My aerophagia also massively went down while I was away. I also turned my humidifier up to 5 as my mouth was getting dry in the hotel after the first couple of nights.

My first night back in my own bed last night resulted in my aerophagia returning in a big way. I had to temporarily turn the machine off before 1am as it was unbearable. I then took the mask off completely at about 5.45am due to discomfort in my stomach.

Any suggestions/help would be much appreciated.

[vandownbytheriver]

So you liked the 6th and 7th but not the 9th?

Massive leaking 6&7th... much less so on 9th. Pressure took you up to 12cm on the 6th. Looked like you restarted the Ramp on the 7th at 11:30am... was that for pressure relief?

Looks like it wants to treat you at 8cm. All that pressure jumping around is not fun to sleep through.

[Jude92]

Yeah, 6th and 7th were great, and I felt a lot less tired upon wakening than I did on the 9th or really any other day in the past few weeks. I'm guessing that restart on the 7th was for pressure relief but I can't recall exactly.

How do you suggest I proceed from here. Is another pressure change worth a try?

Here is last night's Oscar chart - https://imgur.com/a/KwctkYW and sleepHQ report - https://sleephq.com/public/b268e0dd-e63 ... 81702f0c8b

I've been finding it hard in my own bed even having the pressure at the minimum pressure of 4 as it feels like the air is going straight into my stomach. The past couple of nights I've been trying to go to sleep with the mask on and machine off, hoping the machine turns on after I fall asleep. This has worked but is there a setting on the dreamstation where you can set the machine to come on at a certain time? I'm guessing it's turning on at the moment when it notices a difference in my breathing.

Last night's sleep was similar to the previous. The gap from 3.30am was for a trip to the bathroom.

[vandownbytheriver]

How do you suggest I proceed from here. Is another pressure change worth a try?

Frankly those pressure changes make no sense. Are you hitting a Reset button or something to cause the pressure drop?

Turn off any Flex and try another night. Divide and conquer.

[Jude92]

Thanks for your post vandownbytheriver. Any time you see the pressure drop to 4, that's me hitting the ramp button to relieve pressure for comfort. All other changes are automatic from the machine.

I watched a video from one of the SleepHQ guys who recommends trying a fixed pressure to view the affects on AHI and aerophagia. I think I might give that a go to test it out. This should hopefully help me work out the maximum amount of pressure I can handle for aerophagia and what volume I need to get a lower AHI score.

[Jude92]

I thought I would give you all a bit of an update on the last few weeks on CPAP. I started trialling set pressures over 3 day periods as suggested by the SleepHQ guys to treat my aerophagia (I tried to get 3 days of solid usage to get enough data to look at). I started at 5, then increased by intervals of 0.5. When the pressure was at 5, my aerophagia was pretty much gone, but my tiredness had gone up (AHI Scores: 9.6, 8 & 9.3)

At 5.5 the bloating started again (scores 7.5, 6.6 & 7.1).
At 6.0 bloating was back to its worse level again (scores 4.4, 11.5 & 5,5)
At 6.5, the only proper night's sleep I could get I scored 6.4. I was unable to fall asleep with the mask on as it became too uncomfortable.

After this, I contacted my physiologist to enquire about a nasal mask in the hope that this would make a difference as it was becoming such a burden to both fall asleep and stay asleep. She agreed to order me a Philips Respironics NuancePro Gel Frame mask however told me that I was not allowed to change the pressure on my machine as they wouldn't be able to stand over my treatment at different settings. She then set the pressure to MIN 4.0 & MAX 7.5.

While still using my full face mask, I tried to breathe more through my nose and the bloating appeared to lessen for a few days before returning (scores 6, 6.4, 4.5, 11.2 & 10.6). That 4.5 was my best sleep in a couple of weeks.

I then got my nasal mask which feels more comfortable than the full face mask and I took to it straight away. Scores for the first 4 nights were 7.3, 7.5, 6.3 & 9. However, unfortunately the bloating hasn't improved at all.

Here's a sleepHQ overview to show my data over the past few weeks - https://sleephq.com/public/45d958d7-a93 ... 0ecedc5795

I can provide more sleepHQ or Oscar graphs if anyone would like to see them.

To be honest, I'm completely disheartened by the whole thing. I've put so much effort into trying to make this work for the past 3 months and I'm no further forward. I have a few questions I'm hoping someone could help me with:

From looking at my graphs from the past few days, my hypopneas appear to be worse as my pressure goes higher (here's a great example - https://sleephq.com/public/a00ec008-aad ... 7eaf26922c). Is this normal, and would it be worth decreasing my pressure a bit to see if this helps (while also potentially helping my aerophagia)?

The physiologist noted that an alternative to CPAP could be a mouthguard which can help with sleep apnea. Is there anything to show that this can work as I can't seem to find anything on this?

Supposedly Bipap machines are good for treating aerophagia (https://www.cpap.com/blog/bipap-aerophagia/). Can anyone explain how a bipap machine differs from a cpap machine which uses the flex function?

If anyone has any advice, it would be greatly appreciated as I'm beyond frustrated now. Sorry for the long ramble!

[vandownbytheriver]

From looking at my graphs from the past few days, my hypopneas appear to be worse as my pressure goes higher (here's a great example - https://sleephq.com/public/a00ec008-aad ... 7eaf26922c). Is this normal, and would it be worth decreasing my pressure a bit to see if this helps (while also potentially helping my aerophagia)?

Were you awake from 05:30 to 06:20? That's when the pressure hit a max... no events noted. You are at lower pressures with lots of Flex, this can cause CA's. The monthly graphs do not support your conjecture, at least in early April you had high pressures and low AHI. I'm assuming that the aerophagia was raging then, hence the changes.

The physiologist noted that an alternative to CPAP could be a mouthguard which can help with sleep apnea. Is there anything to show that this can work as I can't seem to find anything on this?

I have had success with using a mandibular advancement device (MAD). It entirely depends on where your airway is obstructed.... I was able to see 2cm pressure lowered by advancing my jaw for an hour before bed. I did not sleep with the device... I avoided clenching my jaw until morning... I also taped my mouth to help with jaw drop. Walmart sells this as SnoreMD, a ratcheting boil-n-bite MAD, for 40USD. I had to use it upside-down because of my overbite. I eventually gave up use of it after bi-level titration; I'm on some severe pressures that keep me open no matter what (17/21cm). I did notice my bite changing, it's moved back since I discontinued it. I can now advance my jaw at will by jutting the lower jaw until I can bite my upper lip with my lower teeth... I think the device loosened up those joints somewhat... it stays advanced until I clench some. I normally sleep with my jaw relaxed and advanced anyway, so it is forward a little in the morning. Note that this was in addition to APAP, not instead of. If you're going to try that, I suggest an O2Ring or other recording ox monitor... not cheap, but without it you're kind of shooting in the dark. Generally useful for adjusting pressures, that's why they use it in the sleep lab. If your O2 is good I don't care how many events you have!

Supposedly Bipap machines are good for treating aerophagia (https://www.cpap.com/blog/bipap-aerophagia/). Can anyone explain how a bipap machine differs from a cpap machine which uses the flex function?

During APAP the Flex/EPR causes the exhalation pressure to be lowered... it's sucking your exhale out. For bi-level the inhalation is pumped.. it's punching up your inhalation. What this means is the average time at the higher pressure is lessened... in effect you're living at the lower pressure and experiencing the higher pressure only in spurts. This can help by reducing the average pressure your stomach valve sees. I had no aerophagia problems until I went to the high pressures I was titrated at... this is brought on by the higher pressures, not bi-level per se... I was at 13cm. If I was using 21cm Flex 4cm I'm sure it would be much worse. I built up my muscles and don't have as much problems with it now... been at these pressures since February.

IMO aerophagia does not happen because your mouth gets the air... your stomach entrance sees the same pressure whether you're nasal or oral breathing. The V-COM valve is recommended for aerophagia... it adds a restriction to the inhalation to prevent slamming pressure to the stomach. It is contra-indicated for bi-level since it interferes with the purpose. It is cheap, 20USD, so worth a try if you can get it where you are. There may be a positional component to your events as well... see if you can stay off your back. Set your hi limit just below where the bloating gets bad IMO... more important to build muscles than to count events.

[Jude92]

Thanks for your response vandownbytheriver.

Were you awake from 05:30 to 06:20? That's when the pressure hit a max... no events noted. You are at lower pressures with lots of Flex, this can cause CA's. The monthly graphs do not support your conjecture, at least in early April you had high pressures and low AHI. I'm assuming that the aerophagia was raging then, hence the changes.

No, I wasn't awake at those times, however I was awake several times between 7am and 8am. I'm struggling to find much correlations in the data so may have been reading too much into the increased hypopneas. I've been on CPAP for 3 months now at various pressures and 2 different masks, and my AHI never really changes too much (it tends to be between 4 and 10). Here's the data overview of the past 3 months - https://sleephq.com/public/03d66077-bb8 ... 1b6095db61

Thanks for the info on MAD. One potential issue with this for me is that I currently wear teeth aligners and will be on a nightly retainer soon. I'm not sure if this would prevent me from being able to use such a device?

Also another thing to note, I have quite a small throat (it takes me longer than most to eat). Would a small throat/airway be a cause of sleep apnea, and if so are there any common remedies for this? Would a MAD device help with this?

Thanks again for your explanation of the difference between cpap and bipap, that actually makes a lot of sense. The V-Com is something I will ask my physiologist about. I wasn't able to find one in the UK after a quick look but will ask her about it for sure.

Regarding sleep position, I always sleep on my side (I've tried both sides and there isn't much difference between them on their impact on aerophagia or AHI) but last night I tried sleeping on my back for the latter part of my sleep. My aerophagia wasn't too bad today, but AHI score increased to 12.8 with a big increase on CA Apneas. Not sure if that was the cause, but interesting to note. Here's the graph - https://sleephq.com/public/b6e3e6c5-a0b ... 5055668c6f