My fight with aerophagia (air swallowing).

I'm glad you found a setting that works! Maybe you can increase the pressure very gradually and benefit even more in the future. Those hypopneas during the first hour could be because you were really tired then, or sleeping in a different position than normal, or something like that. You may want to watch for those in the future and see if you can spot a pattern. In my case, my deepest sleep is in the first 2.5 hours. If I look at the data, I can often see a slight change in my respiration after that period each night. Those first 2.5 hours are also when I get the most apnea/hypopnea events.

Just trying to present alternatives based on my experience.

englandsf wrote:Just trying to present alternatives based on my experience.

Thanks!

I had an AHI of 3.8 and 9 obstructive events last night. Not sure if pressure 6 is too low. Have to try it for a few more days.

Some observations: 1) clumps of hyponea events have been showing up for 2 days in a row during the 1st hour of sleep. 2) my mask have to be tightened to quite an uncomfortable level to avoid leak, leaving red marks on my face in the morning. This is because the flabby part of the mask does not inflat as much as it did during pressure 7,8,9 to complete the seal.

At least I know now that the aerophagia is gone at pressure 6. Strive on I guess.

Sleeper Agent wrote:I had an AHI of 3.8 and 9 obstructive events last night

Doesn't tell me enough because number of hours is absent and event category breakdown is absent.
9 OAs over 6 hours is nothing at all to be worried about. 9 OAs over 90 minutes is a different story.
If the bulk of the AHI is central...we ignore those anyway.

Sometimes when severe aerophagia is a problem then we just have to make compromises with what we find is acceptable therapy.
AHI of 3.8 if it were all OAs...is still within acceptable limits if you slept well and feel decent and don't have any aerophagia issues.

The fact you report that your mask isn't inflating well at the lower pressure and has to be tightened to the point of pain is troublesome because we don't sleep so great when we are uncomfortable.
And Sleeping good is one of the primary reasons we do this CPAP stuff...not getting a perfect AHI math score.

Leak control can be a pain. Have you tried using a mask liner? They can make the mask much more comfortable. They can also help to reduce leaks. And they can make leaks less annoying, so you can sleep through them. Some people say that they can reduce leaks by loosening the headgear a bit. I haven't found that to be the case for me, but you may want to give it a try. You might also consider visiting your CPAP supply place to see if they have a different mask that fits your face better.

I agree with Pugsy about staying comfortable. I've been fighting leaks for years. My average leak rate is around 50, which is really high, but I'm sleeping well. When I was fanatical about leak control, I was able to get the leak rate under 20, but I was sore and miserable all the time. I'm hoping that someone will someday build a mask that fits me well. In the meantime, I'll settle with what works best for me, even if the numbers are bad.

Pugsy wrote: Doesn't tell me enough because number of hours is absent and event category breakdown is absent.
9 OAs over 6 hours is nothing at all to be worried about. 9 OAs over 90 minutes is a different story.
If the bulk of the AHI is central...we ignore those anyway.

19 clear events, 9 obstructive, 4 hyponea.

Agreed. I usually don't worry about the centrals. I have no memory of what happened during 1.30 to get that clump of 6. I wear a backpack with a tin container in it...perhaps I did roll over. Not sure. I remember waking up at after 4.00 however.

Pugsy wrote: The fact you report that your mask isn't inflating well at the lower pressure and has to be tightened to the point of pain is troublesome because we don't sleep so great when we are uncomfortable.
And Sleeping good is one of the primary reasons we do this CPAP stuff...not getting a perfect AHI math score.

Also agreed. I should look into the mask thing. I don't feel as good this night as I did during the previous nights when I had AHI 0.98,1.6,2.8 etc however. But its still waaaaaay better sleep than I had before CPAP.

mrog wrote: Leak control can be a pain. Have you tried using a mask liner? They can make the mask much more comfortable. They can also help to reduce leaks. And they can make leaks less annoying, so you can sleep through them. Some people say that they can reduce leaks by loosening the headgear a bit. I haven't found that to be the case for me, but you may want to give it a try. You might also consider visiting your CPAP supply place to see if they have a different mask that fits your face better.

I agree with Pugsy about staying comfortable. I've been fighting leaks for years. My average leak rate is around 50, which is really high, but I'm sleeping well. When I was fanatical about leak control, I was able to get the leak rate under 20, but I was sore and miserable all the time. I'm hoping that someone will someday build a mask that fits me well. In the meantime, I'll settle with what works best for me, even if the numbers are bad..

My median and 95% unintentional leak rate tends to be 1.20-2.40 L/min. When you say 50 and 20, do you mean L/min?

Thanks for suggesting the mask liner! I completely forgot about that.

Sleeper Agent wrote: I have no memory of what happened during 1.30 to get that clump of 6

There's a good chance it was REM stage sleep related where it isn't unusual to need just a little more pressure to prevent the airway collapse. You most likely saw an increase in pressure around that time frame also.

First REM stage sleep is typically about 90 minutes after sleep onset and as the night goes on REM stages come sooner and last longer.
See the hypnogram here for the typical REM sleep pattern.
http://en.wikipedia.org/wiki/Sleep
When I was using APAP pressures I would see clusters of events that corresponded with pretty much all the REM stages when I used minimum of 8 cm but they pretty much disappeared when I used 10 cm minimum.
I am lucky in that aerophagia wasn't an issue for me or I would have to have chosen between allowing a few events to happen or use more pressure.

In your situation that cluster isn't horrible and it is random and doesn't seem to happen all night with each REM stage and I wouldn't worry about it overly much. REM stage sleep is a common time frame where pressure needs may change even when no changes in sleeping position.

Oh...the person with the 50 leak number...that is 50 L/min with the S9 machine and it's scary high if it is up there the bulk of the night. Now if he is reporting only the maximum then maybe not such a big deal. If it's the 95% number then it's still probably scary high but we would need to see the leak graphs to know just how scary.
Now if it were a Respironics leak number then not a big deal but I think that person shows a S9 in their profile.

Sleeper Agent wrote: My median and 95% unintentional leak rate tends to be 1.20-2.40 L/min. When you say 50 and 20, do you mean L/min?

Yes, that's L/min.

Pugsy wrote: There's a good chance it was REM stage sleep related where it isn't unusual to need just a little more pressure to prevent the airway collapse. You most likely saw an increase in pressure around that time frame also.

In your situation that cluster isn't horrible and it is random and doesn't seem to happen all night with each REM stage and I wouldn't worry about it overly much. REM stage sleep is a common time frame where pressure needs may change even when no changes in sleeping position.

Thanks for the analysis. I came to the conclusions as well. I am using straight up CPAP with constant pressure 6, and no ramp however (I actually enjoy the pressurized air lol).

Will continue monitoring the situation and see if pressure 6, EPR 2 is a good long term solution.

Pugsy wrote:Oh...the person with the 50 leak number...that is 50 L/min with the S9 machine and it's scary high if it is up there the bulk of the night. Now if he is reporting only the maximum then maybe not such a big deal. If it's the 95% number then it's still probably scary high but we would need to see the leak graphs to know just how scary.
Now if it were a Respironics leak number then not a big deal but I think that person shows a S9 in their profile.

Here's a typical night for me:


My average leak rate for the last week was 55.88. My 90% leak rate was 74.40. It's not good. I've tried tons of different masks, liners, and headgear modifications. I've only found two ways to get my average leak rate under 20 L/min. 1) Lower the pressure to a non-therapeutic level. Or, 2) tighten the headgear to the point where it makes my head and neck hurt for a couple of weeks afterwards. I don't like either of those options, so I live with the leaks. I'm open to suggestions if you have any.

mrog wrote:so I live with the leaks. I'm open to suggestions if you have any.

First thing to do is do 30 minutes on the machine with the mask and make sure that there are zero leaks anywhere to see if you can even get a flat line 0 leak line on the graph. You don't even have it when you first start out the night. I would want to make sure that there isn't a leak somewhere in the circuit besides at the facial skin mask surface area.... like holes in hose or connections...that sort of thing.

Your leaks are probably the worst I have ever seen that lasted so long. Pretty much the entire night it WELL above 24 L/min and so far above that your AHI is probably next to nothing because the machine is clueless as to what is going on. You could be having hundreds of airway collapses and the machine totally miss them.

Something is horribly wrong here...even mouth breathers using nasal pillows don't have this sort of leak.

So use the machine while awake and see if you ever can get a 0 leak for time while awake and you know darn sure things shouldn't be leaking at least on the face.
If you have a new hose...try a new hose and check old hose for holes.

chunkyfrog wrote:Some find that using a bilevel is helpful...

Note that bi-level + leaks is almost guaranteed to make aerophagia worse:

The leaks make it harder for the device to detect when you're switching from IPAP to EPAP, and so as your diaphragm (and the rest of your airway) begins to relax after inhaling, that extra bit of IPAP goes right down your gullet.

Fortunately, leaks have been pretty manageable for me lately, though for some reason my current cushion is leakier than its predecessor.

Pugsy wrote:So use the machine while awake and see if you ever can get a 0 leak for time while awake and you know darn sure things shouldn't be leaking at least on the face.
If you have a new hose...try a new hose and check old hose for holes.

I can't get the leak rate anywhere near zero, even while awake. By adjusting the angle of the mask, I can choose to have it leak at the top or the bottom, but I can't eliminate the leaks. (I prefer having it leak at the bottom so it doesn't blow in my eyes.) I'll try a different hose to see if that helps. Thanks for the tip!