EPR settings and aerophagia

Hello Everyone- Have been having a horrible time with aerophagia lately and would love to have an APAP but cannot afford to buy a new machine just now. My DME suggested that I put the EPR setting on 3 to try and help with this thing. However, when I put the EPR up to 2 last night my AHI shot up to 5.6(the highest it has been in a LONG time) and I feel very tired today. My gas pains and pressure ARE better but I know there has got to be a solution for this. Should I leave the EPR at 2 and set my pressure higher than its normal 12.0?? How high should I set it? As high as 13 or somewhere inbetween? My Opus nasal pillows probably won't stand too high a pressure without leaking. THANKS for any help!!!

EPR is not going to help the condition, lower pressure would. EPR has 2 different pressures similar to what a bilevel machine delivers, one for inhale (IPAP) and one for exhale (EPAP).

Let's say your CPAP pressure needed to keep your airway patent is 13 cm. If you use a EPR=3, then that means your new pressure settings are:

IPAP=13 cm
EPAP=10 cm

With EPR off or straight CPAP the above would be 13/13 or both pressures the same. the EPAP pressure or exhale pressure is the one that does most of the work and keeps your airway splinted open. Lower that particular pressure using EPR setting and you effectively lower your CPAP pressure by 3 cm (hey Resmed is allowing patients to change their pressure without a prescription, where is the cpap police).

My suggestion would be to lower your pressure even more, I would:

Lower CPAP pressure from current 13 to say 10 cm. Then use a lower EPR setting say 2 so it is more comfortable for you to breathe.

So adjust for comfort using EPR, then lower pressure so it doesn't aggrevate the aerophagia. You will also need to avoid pasta and control stomach acid, I would suggest trying a PepcidComplete tablet (Berry ones taste pretty good, cheaper at Costco) before bed and see if your condition does not improve. Costco also has "Acid Controller", comes in a tiny bottle of 120 tablets, it is pretty cheap but PecidComplete still works better in my opinion.

You need to control your stomach acid and lower CPAP pressure to allow the LES to heal and aerophagia goes away. For me that is killer thing to do, I love mexican food, more jalipenos the better.

To change it, hold the right - center buttons down simultaneously at the same time to access the menu and change it. I would try lower to 10cm, using EPR=2 that effectively lowers pressure to about 8.0 cm.

Okay Snoredog- I know I must sound STUPID but I really do not understand your instructions. My pressure is set at 12, why would I want to lower it to 8cm. Wouldn't that give me worse results as far as my AHI and HI goes? When I set the EPR at 2 last night and checked my stats this morning they read: Pressure: 11.0, Leak:.34, AHI: 5.6, AI: 0.0, HI:5.6. I know the leak rate seems higher than it should be but even with taping I can't seem to get it much lower than around .22 most nights. I am going to read over your post again and see if maybe I am missing something but I guess I don't really understand the whole reasoning. Please see if you can explain it for this "thickhead". I would be very grateful. As far as the Pepcid goes, I do take one every morning before breakfast and try to eat healthfully. I'll try taking one before bed and see if that helps. I also use a wedge pillow but it doesn't always help. THANKS for your help!!!

Grumpygirl, here's what I think is happening, and I'll stress that it's just my opinion. Feel free to use or ignore, at your discretion, any parts which seem to fit, or don't fit your situation.

Since your AHI went up, that suggests that pressure is too low. (With EPR, your machine is displaying a form of BiPAP operation. There is no strict rule about setting IPAP and EPAP. Although IPAP often corresponds with CPAP setting, sometimes EPAP needs to correspond with CPAP setting.) Of course, raising your CPAP pressure up now will likely increase aerophagia even with EPR turned ON, so you simply may not benefit from EPR.

Don't despair about aerophagia though. I finally seem to have subdued mine. What I think worked for me was improved digestion. I attribute that improvement to taking cayenne pepper daily. I can't say that'll help your aerophagia, or digestion, or that you'll even want to try it, but if you're at all interested simply google cayenne pepper and read some of the claims made for this therapeutic herb which has been effectively used since long before "modern medicine" was even a remote concept.

Regards,
Bill

GrumpyGirl, you're not stupid. Since EPR made thing better as far as aerophagia is concerned, but resulted in worse AHI, lowering your pressure doesn't make much sense.

I don't know your machine, but I remember some Resmeds let you set the pressure with fractions.

I would raise my pressure the minimum amount possible, keep the ERP, and see what happens. That way, you'll have slightly higher pressure where it counts, in the exhale, and still have it less than your max.

If you can't do a fraction pressure raise, try an ERP of 1 - maybe that too will help your aeropahgia.

O.

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, aerophagia

[quote="grumpygirl"]Okay Snoredog- I know I must sound STUPID but I really do not understand your instructions. My pressure is set at 12, why would I want to lower it to 8cm. Wouldn't that give me worse results as far as my AHI and HI goes? When I set the EPR at 2 last night and checked my stats this morning they read: Pressure: 11.0, Leak:.34, AHI: 5.6, AI: 0.0, HI:5.6. I know the leak rate seems higher than it should be but even with taping I can't seem to get it much lower than around .22 most nights. I am going to read over your post again and see if maybe I am missing something but I guess I don't really understand the whole reasoning. Please see if you can explain it for this "thickhead". I would be very grateful. As far as the Pepcid goes, I do take one every morning before breakfast and try to eat healthfully. I'll try taking one before bed and see if that helps. I also use a wedge pillow but it doesn't always help. THANKS for your help!!!

Thanks Snoredog for the detailed explanation. I do understand what you are saying but lowering my OVERALL pressure from 12 seems like it would be voiding my therapy. For example- last night I set my machine on a pressure of 12 with the EPR of 1. My stats this morning look like this:

Press: 11.6
Leak: .44
AHI: 5.4
AI: 0.5
HI: 4.9

With those stats I cannot tell if the EPR is the culprit or the leaks. I know I still have the horrible bloating etc. caused by the aerophagia and feel VERY tired today. I think maybe tonight I will just set the darn machine on a pressure of 11.6 and forget the darn EPR and see how that works. I'm getting frustrated with this now and physically miserable. Fatique and monster "gas" just don't mix!! I do appreciate your post and the time you took to really explain the whole thing. What do you think of just turning down the pressure without the EPR?? THANKS AGAIN!!!!

I'd leave the settings for at least a week at a time before changing. Anything can cause a spike for one night. It might even be that the EPR caused you to sleep less deeply because you're not use to it yet which in turn caused your AHI to go up. I'd try EPR of 1 for a week, then EPR of 2, then EPR of 3 and then decide what to do when you have more reliable data.

I've noticed that when I change any setting my AHI goes up for a day or two, and then settles to a new range. Even going away for a long weekend, and then getting back to my own bed gave me a spike in AHI for two nights.

Colin