Finally, 5 hours of sleep! But it looks like CA’s are the culprit

[Catchsomezzzs]

Hi everyone! I was diagnosed with moderate sleep apnea (30 ahi/hour) and started on Adjustable PAP about two weeks ago. The startup has been difficult for me, but the prospect of not waking up feeling like I’ve run a marathon is too enticing to stop trying. My principal problem is that I am jarred awake normally after exactly two hours, without a clue why. I am often in the middle of a dream. An even bigger problem is that I wake up with a terrible stomach ache due to the all the air that I’ve swallowed, and I have to take a break of about an hour in order to “deflate”.

Well last night, with the help of a chin strap over my full face mask, I finally slept nearly five hours in my first segment. But I’d love to solicit your input with respect to what may be causing my wakeup and/or the extreme Aerophagia. I have an appointment with a sleep doctor on Monday, and I’d love to go into it more informed with your help. So thank you in advance.

I am attaching screen shots of the whole night (second image), and highlighting in yellow the section just before I wake up that causes concern. And then above that, I have to attached the screen shot of the zoomed in section (first segment of sleep only) so you can see that it was a CA that appears to have woken me up while in REM (I assume that because I was having a vivid dream). I am also attaching my Fitbit sleep summary which points to probability that my REM was interrupted at 4am. You’ll also note in the Fitbit graph that once I take off the mask at about 6am that my ahi’s go through the roof!)

I know there are strict recommendations on how to present data, and since this is my first time, I apologize in advance that if I have not provided helpful information, but I am deeply appreciative for any insight you may have, based on what I have posted, on why I may be waking up, and also what could be causing the Aerophagia that is sabotaging my best intentions! Any other insights you may have will be very welcome too. Thank you for being here for me as my therapist has been less than worthless!

[Pugsy]

Welcome to the forum.

Can you do another screen shot of that CA/central that you are concerned with that is flagged at approx 4:00?
Same level of zooming in but instead put the flagged event at the far right so that I can see the breathing that went on before the CA flag happened.

Did you know that it is considered normal to wake after a REM cycle? Google "sleep stages" and look at the hypnograms...all of them show a little wake up after REM. Now most of us don't remember the wake up because we aren't awake long enough to formulate a memory but that doesn't mean it didn't happen.

For the aerophagia stuff...your belly full of air....add EPR to your therapy....turn EPR (exhale relief) on and set it to 3 and see what happens tonight.
If you don't know how or what I am talking about...all explained in the manual.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

[zonker]

I know there are strict recommendations on how to present data, and since this is my first time, I apologize in advance that if I have not provided helpful information, but I am deeply appreciative for any insight you may have, based on what I have posted, on why I may be waking up, and also what could be causing the Aerophagia that is sabotaging my best intentions! Any other insights you may have will be very welcome too. Thank you for being here for me as my therapist has been less than worthless!

welcome to the zoo! i am not an expert. one will be along shortly. i just wanted to mention two things-

1.as far as i can see, your charts are arranged properly. they are arranged like mine and folk have little to complain about with mine. oh, they may want you to get rid of the pie chart but it's fine for now. and if the experts need to see something particular to your situation, they'll tell you.

2. are you using epr on your machine? (Exhale Pressure Relief)

aerophagia is my bitter and sworn enemy. i'm a unique case, but i've recently had it come back to get me as i've decided to increase my minimum pressure.

but epr has helped me tremendously over the last eight months or so.

good luck!

ETA:

pugsy was typing at the same time as i was, so there is one of your experts, right there!

[Pugsy]

You can turn off the pie chart and that will allow the statistics to come into view.
No need to redo what you have already done though. I mention it for future postings.
To turn it off...go to Preferences/Appearance tab and just remove the check mark for show pie chart.
The pie chart is pretty much useless anyway.

I am not sure but I don't think that the CAs are the culprit in the wake ups but instead a symptom of the wake up.
You might want to go here and review all the videos.
http://freecpapadvice.com/sleepyhead-free-software

That's why I wanted to see more of the breathing pattern that happened before the flagged CA....to me it doesn't look like you were asleep when it was flagged. Looks like you were maybe half awake before it was ever flagged.

[Catchsomezzzs]

Thank you very much, Pugsy and Zonker!

Pugsy, thanks for helping me to understand that my awakening is probably just a normal part of the sleep cycle following REM, and this may very well be the case, and just problematic in my situation since the arousal is with a belly full of air that wakes me all the way up — and keeps me up for a while. In fact, this just occurs to me: could it be possible that when the CA event happens, that air is going directly into my abdomen since I am not breathing it into lungs??? And that the ensuing aerophagia makes whaat should have been just a “soft”awakening into a “hard”one? Just a thought.

So I will definitely want to explore ERP. The only problem right now is that my therapist says that I can’t make any changes myself (He acts like he’s Big Brother always watching remotely, and says “insurance won’t pay if I touch the settings”). Furthermore, he told me that since my settings are very high (11-20) that I will not be a good candidate for ERP, although I can’t get him to explain why, so this is why I made an appointment with a sleep doctor for Monday. Hopefully he will allow me to lower the maximum from 20 down to a comfortable level and then set up ERP at 3 (I’m crossing my fingers because I really want to love my CPAP experience and right now there’s not a lot of love going on!). Below are the two charts you mentioned might be helpful. Both of them show the 4:01 CA on the far right, but one of them is panned out further to show earlier hypopneas. Thanks to both of you again for your help, I really appreciate the time you have taken to review my concerns and make your helpful suggestions.

[Pugsy]

Your "therapist" is full of crap.
Insurance doesn't care one whit if you change anything or not. All insurance cares about is if you use the machine the required minimum number of hours within whatever time frame your insurance goes by. Most of the time it is the same that Medicare uses which is over 4 hours a night for 21 out of 30 nights.

EPR....has always been considered a comfort feature and always has been considered patient's choice to use or not use or adjust.

And he's also full of crap about not being a good candidate since your pressures are over 10...big load of crap...if anything you need it more because of the higher pressures.

Picture me shaking my head and mouthing "what a dumb ass"....

No...the air flow/pressure isn't bypassing your lungs at all and sneaking into the stomach.
What is happening is there is a constant pressure in your esophagus and your LES (lower esophageal sphincter) is a bit weak for some reason and it's allowing that air to enter the stomach.

Read this
wiki/index.php/Aerophagia

Generally the first line of defense in dealing with aerophagia is a bilevel pressure situation...and by using EPR at 3 we are making your normally fixed single pressure machine, act like a bilevel machine with a 3 cm difference between inhale and exhale.
Real bilevel machines can do more than the 3 cm difference. So we max out whatever exhale relief is available first and see if that helps or not. Definitely talk to your doctor about it. Your therapist isn't doing you any favors with his lies.

There are some other things which can also be tried in an effort to reduce aerophagia symptoms but sometimes simply adding in exhale relief is all that is needed. Just plain stupid to not at least try it.

[Catchsomezzzs]

Thank you, Pugsy. (can you hear my big exhale of relief?). I’m excited to anticipate receiving constructive information from the doctor on Monday, but in the meantime I am floating high on the hope that you have provided. Unhelpful, mean people like my therapist should find other jobs! I’ll be sure to keep you updated, I know this is going to work! thanks again

[palerider]

The only problem right now is that my therapist says that I can’t make any changes myself (He acts like he’s Big Brother always watching remotely, and says “insurance won’t pay if I touch the settings”).

This is one of those cases where you have to wonder... "is this bozo LYING or just INCOMPETENT"

Furthermore, he told me that since my settings are very high (11-20) that I will not be a good candidate for ERP,

*EPR ok, after that, I'm voting for "incompetent".

[Catchsomezzzs]

Thanks Palerider. The typo (ERP vs EPR) was mine, not that of the therapist. I assume he is competent, just not very helpful, and he clearly likes to wield his authority instead of offering real help. But that’s not a problem now that I have a better resource in the form of helpful people like you on this board. I will enlist help of doctor to get me to the right settings. I am hopeful!

[zonker]

Thanks Palerider. The typo (ERP vs EPR) was mine, not that of the therapist. I assume he is competent, just not very helpful, and he clearly likes to wield his authority instead of offering real help. But that’s not a problem now that I have a better resource in the form of helpful people like you on this board. I will enlist help of doctor to get me to the right settings. I am hopeful!

actually, given it's connection to aerophagia, i think ERP works rather well!

[palerider]

Thanks Palerider. The typo (ERP vs EPR) was mine, not that of the therapist. I assume he is competent,

The incompetence comment wasn't about ERP vs EPR, it's because of the crap you're being told.

I will enlist help of doctor to get me to the right settings. I am hopeful!

Don't get your hopes up.... but, who knows, you might get lucky.

[SDBud]

Hopefully he will allow me to lower the maximum from 20 down to a comfortable level

Generally, the LAST THING you need to worry about in the max pressure, UNLESS it is set to less than the machine max, AND your data shows you're hitting that level.

The machine will ONLY hit that level if you need it, just like your car CAN probably do over 100 mph, but never does, unless you force it to.