[ASV] What setting do I change to minimize aerophagia?

I saw my sleep doctor today, and she said to minimize aerophagia, I should reduce PS min from the current 5.5 down to, IIRC, 2. Does this make sense to you? She said that aerophagia occurs during inhalation (makes sense) and that this will prevent my IPAP from going as high as it does now. Here are my machine settings according to SleepyHead:


...and here are the settings according to my PR System One 60 Series ASV:
Max Pres.: 25.0
EPAP min: 12.5
EPAP max: 16.0
BPM: Auto
PS min: 5.5
PS max: 10.0

BTW, why are the PS min/max values different from what SleepyHead reports, and is "Max pres." represented in the SleepyHead numbers in some way?

As an aside, I tried out a Dreamwear mask last night, but it leaked like a sieve so I switched back to my beloved Nuance Pro around midnight. The RT gave me an MW-size nasal cushion, but, from the sizing guide, I think I need the M. I'll pick one up today and hope this fixes it.

Thanks!

So Sincere wrote:BTW, why are the PS min/max values different from what SleepyHead reports, and is "Max pres." represented in the SleepyHead numbers in some way?

SleepyHead setting statistics is a little buggy in what it reports especially with the 960 machine. Just disregard the slight difference because you are using whatever the machine says you are using.

Lowering the PS will indeed reduce IPAP and it might help the aerophagia to not be using so much IPAP all the time.
If that doesn't work maybe a little reduction in EPAP minimum would also help as long as it didn't allow too many obstructive apnea events to slip past the defenses.

I tried am experiment last night because I habe bad aerophagia issues. I limit the ipap max on my bilevel top 21.8 to limit the amount of air when I wake up. Yesterday I read that to get it to stop you tilt you head back like if someone was giving you mouth to mouth resuscitation. I raise my ipap to 23 last night and tried it. I did not have the normal pain in my stomach like I normally would. I'm going to try keep my head back tonight and raise the ipap max to 25. I did have some had this morning but I woke up in a different position so I think some air got through

Is the simple answer to this: the bottom pressure?

Hopefullady wrote:Is the simple answer to this: the bottom pressure?

Not really a simple answer to this person's particular issue.
He's on a special machine because he has centrals and probably obstructive apneas to deal with.
Centrals need higher pressures...no way around that
Obstructives need some sort of minimum pressure to hold the airway open to prevent the airway collapse.
We don't know exactly where there might be a critical line where above so and so pressure causes the aerophagia issues and below it don't because each person is an individual and has individual lines in the sand.

We could easily reduce the pressure way down and likely eliminate the aerophagia but to do so most likely will just allow the apnea events to go untreated. So while it would be nice to be able to eliminate the aerophagia that way...we simply can't let the sleep apnea go untreated.
So the idea is to keep trying changes in pressure that will maybe reduce the aerophagia without allowing the sleep apnea to run rampant untreated.

It gets more complicated when people are using this type of machine because of why they are using it in the first place and what is usually needed.

Since the higher maximum IPAP is usually considered the first thing to look at...it makes sense to maybe just try not letting the machine go so high as often to see if it will get the job done and not let a truckload of apneas happen with the less maximum being used.

PS..Pressure support..is what is added to the minimum EPAP pressure to make an IPAP pressure.
Using less PS will mean less IPAP being used at least part of the time and it might be enough to help with the aerophagia and not let a truck load of apnea events happen.

Now for you in your situation with your machine and what it does...yeah, the minimum is what we look at because that's really all we can look at as a starting point.

Pugsy wrote:PS..Pressure support..is what is added to the minimum EPAP pressure to make an IPAP pressure.
Using less PS will mean less IPAP being used at least part of the time and it might be enough to help with the aerophagia and not let a truck load of apnea events happen.

Thanks for all the good you do on this site. I dropped my PS min last night from 5.5 to 4. I slept through the night, which is unusual, but still noticed a little gastric distention, discomfort, and burping when I woke up. A lot better than before, though, since the pain isn't waking/keeping me up. And the great thing is that I had my lowest AHI ever of 0.13--just a single hypopnea (I always think "Hip-Hop"nea when I say it in my head). I'll go with this setting for a few more nights and then drop it some more. I'll keep dropping it until my AHI starts going up and then go back to the previous, good setting. Hmm... what does it mean if I can drop it all the way to 0.0 without adversely affecting my AHI?

BTW, my sleep doctor said that a "normal" adult who has no sleep-apnea-related symptoms can have an AHI of around 4.0. I get bummed when mine goes over 1.0, which happens maybe once a week, but I guess I shouldn't.

So Sincere wrote: Hmm... what does it mean if I can drop it all the way to 0.0 without adversely affecting my AHI?

I don't know that it means anything other than you will have changed the way the machine functions so that it works more like a regular apap machine for at least the starting part of the night.
It's not the PS that is controlling the obstructive apnea events...it's the EPAP minimum doing that.
Now PS can affect the hyponeas because often IPAP is what is needed to help with the hyponeas and if you lessen the IPAP by lessening PS...you could potentially cause an increase in hyponeas....potentially...not guaranteed. Hyponeas can be affected by both EPAP and IPAP (and thus PS).

I wouldn't go to 0 PS if it were me.....even if the AHI was really low unless I was still having major gastric issues. The PS is what offers the comfort upon inhale and exhale at the higher pressures and I for one, like that comfort.