My fight with aerophagia (air swallowing).

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Pugsy
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Re: My fight with aerophagia (air swallowing).

Post by Pugsy » Tue Jul 29, 2014 4:37 am

mrog wrote: 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 leak
There's something wrong if you can even get 0 flat line leak while awake and if you can't at least get a 0 flat line leak with a mask while awake....and your only choices are leak at the top or the bottom..the mask isn't working...it's either the wrong size or simply that mask isn't suitable for your facial structure.

Have you ever used the mask fit feature with your machine? Where it blows your prescribed pressure and lets you adjust for fit and gives you a smiley face or frowny face if the fit is good?

Full face masks have more surface area to deal with so simple physics is going to make sealing more difficult but people manage to get it done all the time. It's not impossible but your leak graphs scare the devil out of me and I am not a person who scares easily with a little ugliness every now and then in the leak department. I am not kidding when I say I see reports with nasal masks and people are mouth breathing all over the place and the leaks aren't as bad as what I saw on your report.

If a new hose doesn't fix the issue (never hurts to try the obvious simple fix first) then you need to look at maybe a different mask.
Which ones have you tried? "Tons" of masks and liners (found you said that elsewhere) doesn't help me much.
Were you able to get decent leak lines when your pressure was 13 and has it only been since the increase to 17 that you have had such ugly leaks?
Have you ever tried a nasal pillow mask?

Maybe we ought to start a thread of your own for your issues instead of continuing to hijack this thread. Normally not a big deal but if we don't find something easy...like a big hole in your current hose....you may need a lot of help devoted to just your needs.

At this point I am amazed that you can even sleep with amount of leak I see on your report.

Oh...also check the anti aspyhxia valve on your mask to make sure it isn't stuck open. Do you know how to do that?

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palerider
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Re: My fight with aerophagia (air swallowing).

Post by palerider » Tue Jul 29, 2014 8:56 am

mrog wrote: 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!
maybe you have the wrong size mask.

they come in several sizes, based on the distance between the indentation under your lip to the top of your nose.

if you've got the wrong size mirage quattro, you'll have tons of problems.

see here: https://5faacd0c97cf0d23c6dc-064f3cd61b ... mplate.pdf

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Re: My fight with aerophagia (air swallowing).

Post by JustTia » Tue Jul 29, 2014 9:54 am

palerider wrote:
mrog wrote: 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!
maybe you have the wrong size mask.

they come in several sizes, based on the distance between the indentation under your lip to the top of your nose.

if you've got the wrong size mirage quattro, you'll have tons of problems.

see here: https://5faacd0c97cf0d23c6dc-064f3cd61b ... mplate.pdf
Thank you for that template! I'm liking my swift fx pillows, but my previous mask was a mirage quattro that was a medium. I could NOT get it to stop blowing air into my eyes or out the bottom, unless I tightened it up so much that it hurt. I told the RT that it was too big, and she disagreed and said it was just the structure of my nasal bridge that was the problem. According to that template, I need a small. A medium comes *above* my eyes! No wonder that thing was SO uncomfortable and made my vision double and blur. I'm going to order another in a small because I like the idea of having a backup FFM for colds and such.

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Re: My fight with aerophagia (air swallowing).

Post by palerider » Tue Jul 29, 2014 10:00 am

JustTia wrote:
Thank you for that template! I'm liking my swift fx pillows, but my previous mask was a mirage quattro that was a medium. I could NOT get it to stop blowing air into my eyes or out the bottom, unless I tightened it up so much that it hurt. I told the RT that it was too big, and she disagreed and said it was just the structure of my nasal bridge that was the problem. According to that template, I need a small. A medium comes *above* my eyes! No wonder that thing was SO uncomfortable and made my vision double and blur. I'm going to order another in a small because I like the idea of having a backup FFM for colds and such.
dat's why I dug it out I use a small too.. well, sort of borderline between small and medium. it's not perfect, but it's not terrible, with a mask liner.

just another damnation of the medical community, your RT should have had that template and stuck it up to your face and said "ah, you take a small". *shakes head*

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Tue Jul 29, 2014 10:16 am

Tried pressure 7 and EPR 3 again last night. Woke up after 5 hours with a huge bloated stomach. Took Gas X, which made it even more bloated and painful. Never taking Gas X again.

However, the AHI is GREAT at pressure 7 (AHI = 1.19). Unfortunately, I only managed 6 hrs 43 min of sleep with the mask on. Spent 1 hour waiting for the bloat to go down.

Paradoxically, I felt refreshed and awake when I woke up after 5 hours. But felt like shit after going back an addition 1 hour 43 mins (mask on) and 45 minutes (mask off). Another observation: I think my stomach starts bloating shortly after I begin sleeping with the mask on during the night.

Going back to pressure 6 and EPR 2 tonight.

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Re: My fight with aerophagia (air swallowing).

Post by mrog » Tue Jul 29, 2014 10:47 pm

Pugsy wrote:Maybe we ought to start a thread of your own for your issues instead of continuing to hijack this thread. Normally not a big deal but if we don't find something easy...like a big hole in your current hose....you may need a lot of help devoted to just your needs.
Good idea. Please see this topic.
palerider wrote:they come in several sizes, based on the distance between the indentation under your lip to the top of your nose.
Thanks, palerider, for the template!

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Wed Jul 30, 2014 12:19 pm

Back to pressure 6 and EPR 2. Slept much better. 8.3 hours with mask on continuously. Still woke up in the morning with a bit of stomach bloating and gas, but definitely tolerable. Posters on this thread were right: its better to tolerate a slightly higher AHI in order to sleep comfortably through the night!

Hyponeas have started showing up. Also, while median leak is 1.20, 95% leak went up to 8.40. Only 1 obstructive event all night. I consider this a victory. (although there is still a slight problem: my stomach muscles become pretty sore from all the bloating)

Image

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Re: My fight with aerophagia (air swallowing).

Post by CoffeePgh » Fri Aug 01, 2014 4:25 am

Sleeper Agent wrote:
Paradoxically, I felt refreshed and awake when I woke up after 5 hours. But felt like shit after going back an addition 1 hour 43 mins (mask on) and 45 minutes (mask off). )
This happens to me every night! At 2:30am, I feel great. At 5am, I'm exhausted.

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Fri Aug 01, 2014 8:27 am

CoffeePgh wrote: This happens to me every night! At 2:30am, I feel great. At 5am, I'm exhausted.
Yep, same here. I did an experiment once: woke up at 5.30 am feeling wide awake and energetic. So I started my day at 5.30 am.

It was horrible lol. Was high for a few hours but starting at around 8.30-9 am, began to lacked focus and struggled to stay awake all day. I came to the conclusion that its better to go back to sleep until I clock >7 hours.

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Fri Aug 01, 2014 8:32 am

So far pressure 6 and EPR 2 seems to be working. Minimal aerophagia. Does not bother me.

I guess there is a sharp cut off pressure of N, where 6 <= N <= 6.6, where aerophagia begins. (6.6 gave me the same bloating and pain as pressure 7)

I wonder if I should try pressure 6.2 and 6.4 (machine moves in 0.2 increments). I do feel more refreshed at pressure 7 and my AHI is lower (0.88 to 1.5 etc).

Or should I sleep on pressure 6 EPR 2 for say an entire week? Maybe feeling more refreshed at 7 is just temporary fluctuations.

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Re: My fight with aerophagia (air swallowing).

Post by OldLincoln » Fri Aug 01, 2014 6:09 pm

Been a long time since I've approached this subject. Rooster (remember him?) and I had quite a go a few years ago. First of all the terminology “meteorism” in contrast to “aerophagia” isn't really important. A long time ago I researched aerophigia and read numerous med papers where patients had serious incidents from ruptured stomachs (mostly EMT's over-pressuring with the airway bellows, kinked or ruptured intestines from CPAP and other causes. It is serious and should be fully investigated until solved. So now the med dict includes CPAP as a cause and eliminates the dangerous part of a few years ago.

I, and several others here had serious problems resulting in stomach pain - ofter severe, and all day "venting" (akin to farting except it's relatively not very smelly room air compared to sulfuric digestive gas which is very smelly). Tough to vent when in high level business meetings all day (called for many and frequent quick breaks). My straight CPAP was set to 10. My doc said Medicare would never go for a change until had it for 5 years. I showed him my research and he immediately wrote the script with me giving him the make model of all my equipment, and that was that.

Once I got my Resperionics AutoM I learned how to adjust the high/low pressure and software for stats. I moved the low pressure down until I proved that my LES (Lower Esophageal Sphincter) threshold is 7.5. Below that and my blow-through was very easy. I eventually set my low to 6.0 for comfort and that setting was good for over 50% of the night. The Auto covered the highs well and little air.

Don't let anybody tell you you are just swallowing air. That's like saying that drowning is simply drinking to much water. Any CPAP is pushing air under pressure into your lungs and unless your LES is tight some is sure to get into your stomach. Even if it is tight, everybody swallows some saliva during the night and the air goes with it. That should be like filling the sink with a dropper, not a fire hose.

Can't ever have too much information unless it's your kids telling you about great sex, so I hope this helps.
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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Sat Aug 02, 2014 9:11 am

OldLincoln wrote: Once I got my Resperionics AutoM I learned how to adjust the high/low pressure and software for stats. I moved the low pressure down until I proved that my LES (Lower Esophageal Sphincter) threshold is 7.5. Below that and my blow-through was very easy. I eventually set my low to 6.0 for comfort and that setting was good for over 50% of the night. The Auto covered the highs well and little air.
This helps a lot! I wish my threshold was 7. I had great productivity and focus at 7.

Slept for a week on 6, and never felt the energy I had at 7. Even though the data says it should be good, and only very minor aerophagia. For example, last night:

Image

9 hrs with the mask on, only 1 obstructive event (longest I had the mask on continuously btw). AHI = 2.45. (leak 2.40 both median and 95%) Why do I feel "off" and out of focus? Could it be just normal fluctuation? Or is my body simply acclimating to the CPAP?

Observation: At pressure 7, the number of obstructive events is the same, but the number of central events is lower and I began to hit lower AHI of 0.9, 1.5 etc. Could the machine be misreading obstructive events as centrals? Could the airway collapse be partial and hence registered as centrals while it is actually obstructive?

Your post gave me an idea: use autopap, set it at 6.00 minimum to avoid the aerophagia and let the machine handle the rest.

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Re: My fight with aerophagia (air swallowing).

Post by OldLincoln » Sat Aug 02, 2014 12:26 pm

Sleeper Agent wrote:Your post gave me an idea: use autopap, set it at 6.00 minimum to avoid the aerophagia and let the machine handle the rest.
That worked for me. Didn't matter how well I slept if I had to crawl in pain to the bathroom in the morning. Once I stopped the bloat I slept better and my scores fell into band. Good luck.
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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Sat Aug 02, 2014 12:37 pm

OldLincoln wrote: That worked for me. Didn't matter how well I slept if I had to crawl in pain to the bathroom in the morning. Once I stopped the bloat I slept better and my scores fell into band. Good luck.
Yep, at pressure 7, the painful bloat will wake me up after 5.5 hours and disrupt my sleep.

At pressure 6, no painful bloat. But it doesn't seem as good: I had 3 coffees and 2 sodas today and still feel sleepy. Much better than before CPAP but still not as alert and energetic when I was on 7. Even though my AHI looks great and I had the mask on for 9 hours. My doctor once said that all these are just happening on the surface of the brain and they have in fact no idea whats actually happening.

Hopefully a narrow range of APAP minimum 6, maximum 7 will do the trick!

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Re: My fight with aerophagia (air swallowing).

Post by OldLincoln » Sat Aug 02, 2014 1:02 pm

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.
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