Need to reduce Aerophagia and increase CPAP use.

[JoRehovot]

Hi all, I joined this forum a couple of years ago after being diagnosed with sleep apnea. Aerophagia is a huge problem for me. I read a lot and asked a couple of questions and got some great advice (EPR now set at max) but I didn’t get around to downloading the software and uploading screenshots. Now I have downloaded Oscar and I now have data from the last 5 months.
I have a lot of nasal congestion, so I take a decongestant most nights, but even with that I can’t use a nasal mask.
I use my cpap regularly, but I get gas so badly within 2-3 hour of using it that I have to get up and walk around for a while to get rid of it, so at least once a night I'm up with an enormous burp (that’s a good night) sitting in bathroom hoping to let it out the other end, or sitting on the edge of my bed leaning to one side then the other to try to burp some more. Sometimes I go back to sleep without the mask because it’s more comfortable, and because I can’t face waking up full of gas again, but then I wake up desperate for air.
I can only sleep about 4-5 hours a night with the mask on. (Except when I take a sleeping pill, but I try to limit that to once a week max, because otherwise I just get used to it and it doesn't work any more) I have the minimum pressure set at 10, thanks to the advice to others on this forum which guided me, because if it's lower I wake up gasping.
I suffer from anxiety and sometimes breath very shallowly during the day as well, and in fact at night I don’t think I stop breathing much without the machine, I just don’t breathe deeply enough. Yesterday evening something happened which upset me, and last night’s sleep was a fairly typical “good” night. As in I didn’t get enough sleep but I feel like I can face the day and AHI was only 1.26, with no events.

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Woke up at 2:40 full of gas. Several big burps. Went to the bathroom and got rid of more. 3:20 felt OK enough to try to sleep some more. 5:20 got up worrying, knowing I wouldn’t fall asleep again easily. Felt as though I hadn’t slept much since 3:20 but machine shows otherwise. Tried to sleep again at 6:30 but wasn’t able to. (That last bit I was definitely awake and breathing shallowly, and then trying to deepen my breath and meditate to fall asleep again, but it didn’t work so I decided to get up and write to you guys.)
If it’s helpful I can post other nights, such as the previous night, where I only use the machine for 3 hours and AHI was 0.76 but I went back to sleep without the mask and woke up breathing really shallowly and feeling terrible. Then couldn’t get my breath back to normal for several hours after, even after 10 minutes exercise, that I forced myself to do. I’m assuming that night’s info’s not useful because the problematic time was when I was NOT using CPAP.
I would welcome all suggestions. Thanks in advance for your help!

[Pugsy]

How did you come up with the 10 cm minimum you are using?

I think maybe reducing the minimum would be a good starting point to see if we can reduce the aerophagia issues.
Keep EPR at 3....maybe try 7 minimum with maximum at 15 (it won't go up there without a good reason anyway).

[JoRehovot]

Hi Pugsy,
Thanks for the quick response!

I started off at min 7 and max 10. (The technician didn't change it from what it had been when I was (not) using a nasal mask). It wasn't helping me at all so I upped the pressure to 8, which still didn't make much difference, so then I upped it to 10 and changed the max to 15. Somewhere in there I discovered EPR

I'll try what you suggest tomorrow night. Tonight I need to make sure to get the best possible sleep, so it will be a sleeping tablet night, as I am singing in a big concert tomorrow evening.

Thanks again!
Jo

[Pugsy]

It's the pressure that isn't your friend when it comes to the aerophagia.
You may have to make some compromises between keeping the aerophagia monster away and allowing an occasional apnea to happen.
You have to decide which devil is the worst devil to deal with.

There's definitely room for a pressure reduction in terms of AHI numbers. Need to find a pressure that doesn't feed the aerophagia monster and see how well that pressure deals with the OSA and maybe fine tune it ever so slightly.

With the settings I suggested the machine can go higher if it needs to but at least it will be lower when it doesn't need to be up there fighting apnea events. Sometimes lower for a good chunk of the night will keep the aerophagia monster away.

[JoRehovot]

Right. I'll give it a go. (I'm in Israel which is GMT+2 so I haven't had a night since you first responded )

[zonker]

Right. I'll give it a go. (I'm in Israel which is GMT+2 so I haven't had a night since you first responded )

hi, jo! i'm responding to reinforce what pugsy has written. she is spot on!

your aerophagia problem reflects my own. if you want to read the whole tedious story, see here-

viewtopic/t173195/zonkers-cribsomewhere ... r%27s+crib

the tl;dr version is, i managed to conquer the ball of gas monster. the good news lays in your particular machine. it has the ability to raise pressure by .2 increments rather than 1. increments only. this is the tool i used to get past the problem.

it took a matter of MONTHS, but i totally disregarded my ahi number. i figure, what's the point of a good ahi if i can't sleep? besides, it wasn't that great of a number. so i went back to where aerophagia didn't flare up. i can't remember the settings, but the min was very low.

i then starting increasing my minimum by .2. i let that set for days. then tried another increase of .2. sometimes, i got aerophagia so bad, i had to go back .2 and let it settle.

the good news is that my minimum used to be at 7 or 8 or something with aerophagia. my minimum now is 15.4 with NO aerophagia!

will that work for you? dunno, but you may want to try it to see if it works for you.

good luck!

[JoRehovot]

Thanks Zonker, that's really encouraging!

Sent from my SM-A505F using Tapatalk

[zonker]

Thanks Zonker, that's really encouraging!

Sent from my SM-A505F using Tapatalk

i live to serve.

[JoRehovot]

OMG, I made the change. Worst night for years. Woke up after 3 hrs breathing shallowly. Pain in chest and head. Eventually dragged myself to the bathroom, no energy to move. Got my breath back and decided I should try again (maybe I was on my back a lot). Went back to sleep for another couple of hours and woke up feeling the same. It's now 5:50 am and I'm going to set the minimum back to 10 and see if I can sleep enough to be able to work today.

Sent from my SM-A505F using Tapatalk

[JoRehovot]

Didn't get back to sleep. Here's the charts for last night. As you can see, it doesn't look terrible at all. But it definitely felt it. I had a much smaller amount of gas than I've had recently, but still some (although I ate late because of the concert, so that could also have caused it this time.)

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OK guys n gals, I'm in your hands. What do I do next? Not keen to try that again or increase minimum pressure by only a small amount. Seems like it's a recipe for another bad night. But if you say I should stick with it I'm willing to try.

I'm pretty sure I sleep better without a mask on my face than like this. BTW, I also have a nasal mask, which I've never got on with, but right now I'm not very congested, and the other thing I was thinking of doing before I started this thread, was to try that again.

Thanks for whatever advice you can give.
Jo

[JoRehovot]

One more point for info. My problems are worst when I'm on my back. Bad when I'm on my side. Better when I'm on my front. I like to sleep on my front, but I can't do that with my current mask. I still have a problem on my front but it's milder. Without the machine I used to start on my front and then roll onto my back in the night. With the machine I sleep mostly on my side.
I was thinking of trying the SleepWeaver Anew mask, which seems like it would allow me to sleep comfortably on my front, but it also seems like a lot of people have problems with that mask. Thoughts...

[Cpapian]

Couple of small things ..... you mention nasal congestion ...... have you tried a nasal rinse/neti pot. You might find that a nasal rinse before bed will clear up the congestion and let you sleep better without drugs.

Another thing is the drugs, decongestants and sleeping pills may be contributing to your sleep problems and/or shallow breathing and to some extent may be counteracting each other. Just a thought there.

Have you heard of sleep hygiene? It's basically a list of good sleep habits. Following these rules can help a person fall asleep and stay asleep. You can google it. You don't have to do them all, just start with a few relevant ones and take it from there.

You might wonder why I am bothering to mention these things when you are dealing with the equipment issue. They do go hand in hand.

Lastly, I go to sleep on my stomach and use three masks ..... the P10, the N 20 and the P 30i. (Not all at the same time!!!!) I have tried the Dreamwear FFM, but the fit was too wide for me. But all of them work with sleeping on my stomach. There is a stomach sleeping position ..... the falcon position ...... you can do a search on this forum for it. See if that helps you at all. You can modify it to work for you.

[JoRehovot]

Hi Cpapian,
Thanks for your suggestions. I haven't tried a nasal rinse but I have tried sprays etc. and nothing made much difference. I have heard people say how marvelous a neti pot is, but it sounds horrible to me!

In terms of the drugs, I don't take a sleeping tablet more than once a week so I don't think that's part of the problem. I do take decongestants fairly often but I do have nights without them and my sleep is consistently worse when I try to manage without. However, on that subject, I have mentioned elsewhere, but not in this thread, that I have severe Restless Leg Syndrome and I take Sifrol (pramiprexole - 0.75mg) for it every night. It's not something that I can manage without. I would not sleep at all without it, but it may contribute to my symptoms (although I was on it for at least 10 years before these symptoms started to show).

I know about sleep hygiene and I try to do those things. I'm not always consistent about them.

Interesting that you are able to sleep on your stomach with a mask. I'll look into the falcon position.

Thanks!
Jo

[Pugsy]

How about a very small reduction in pressure minimum instead of such a big drop all at once?
Maybe just 0.4 cm or so.

As for stomach sleeping...it can be done with a full face mask but does present some extra challenges.
Maybe look for a full face mask (if that is the type you must use) that has less of a footprint on your face so as to not get in the way so much when sleeping on your stomach.
ResMed's F30 or F30i or Respironics DreamWear....not as much mask touching the skin.

[JoRehovot]

Thanks Pugsy,
Yes I think I'll try reducing the minimum pressure from 10 downwards slowly instead of from the bottom up. Sounds less likely to totally disrupt my sleep.
And thanks for the mask suggestions. I'll look into them.
Jo