Allergies, aerophagia, dry mouth, acid reflux, central apnea events

[Katerific]

I'm fighting a few things recently. My spring allergies kicked in and now nose breathing is more difficult. Nasonex is helping, especially during the day, but doesn't keep me completely clear at night. I use a FFM. Now my mouth is painfully dry at night, waking me up. I have the humidity turned up to 5. I used Oscar to determine that my best minimum pressure is 9 in preventing most apneas, but I get aerophagia a lot more. When the aerophagia is bad, I wake up choking on stomach acid. I tried turning on A-Flex at level 1 last night to combat the aerophagia and woke up at 2 hours with 18 CA. So at 1:00am, I turned off A-Flex and only had 1 more CA all night. I have tried A-Flex and C-Flex several times and always see a significant increase in CA. When I tried reducing the minimum pressure to 8.5, I get a lot more OA and hypopneas, wake up a bunch and feel terrible the next day. To combat all this I take Nasonex and omeprazole in the morning, Pepcid at bedtime, don't eat close to bedtime, put blocks under the head of the bed and even tried turmeric for the aerophagia. I've tried neti pot rinses nightly and Afrin for only 3 days in a row. I called the doctor's office and got azelastine nasal spray. That gave me stomach pain and I stopped using it. I was cruising along fine until the allergies kicked in and I didn't have heartburn until the aerophagia started.

Does anyone have any advice?

[LSAT]

Basic Gerd recommendations...Raise the head of your bed and sleep on your left side

[Julie]

Have you tried lowering your humidity setting for a couple of nights by a serious amount? It may seem counterproductive if in fact it's very dry where you live, but if e.g. there have been storms, etc. the local humidity may be quite high, if temporarily, and you may be adding to congestion with such a high setting. And have you tried lowering (just by 1-2 cm) your min. pressure setting to see if it helps the aerophagia? And possibly tried changing or even eliminating some of the meds you're taking? Unfortunately with GERD and/or most similar things that bring on too much acid your system can overreact by producing MORE acid rather than doing what you'd like to reduce it - it's how your digestion works at times. I also went around and around but now only take half a small Tums before bed and have no more trouble.

[Katerific]

Thank you for the suggestions. I had a better night last night. It rained all day, so I turned the humidity on my machine down and still had good nasal breathing. I didn't take the Pepcid at bedtime and didn't have any heartburn during the night. I woke up at 1:30 with a little aerophagia, so I took a dose of Pepto Bismol and then slept until the alarm went off. One night is not a pattern, but I feel better.

[DreamDiver]

I'm fighting a few things recently. My spring allergies kicked in and now nose breathing is more difficult. Nasonex is helping, especially during the day, but doesn't keep me completely clear at night. I use a FFM. Now my mouth is painfully dry at night, waking me up. I have the humidity turned up to 5. I used Oscar to determine that my best minimum pressure is 9 in preventing most apneas, but I get aerophagia a lot more. When the aerophagia is bad, I wake up choking on stomach acid. I tried turning on A-Flex at level 1 last night to combat the aerophagia and woke up at 2 hours with 18 CA. So at 1:00am, I turned off A-Flex and only had 1 more CA all night. I have tried A-Flex and C-Flex several times and always see a significant increase in CA. When I tried reducing the minimum pressure to 8.5, I get a lot more OA and hypopneas, wake up a bunch and feel terrible the next day. To combat all this I take Nasonex and omeprazole in the morning, Pepcid at bedtime, don't eat close to bedtime, put blocks under the head of the bed and even tried turmeric for the aerophagia. I've tried neti pot rinses nightly and Afrin for only 3 days in a row. I called the doctor's office and got azelastine nasal spray. That gave me stomach pain and I stopped using it. I was cruising along fine until the allergies kicked in and I didn't have heartburn until the aerophagia started.

Does anyone have any advice?

GERD and Allergies combined are a challenge. OTC pharmaceuticals are also frustrating. My doc said Proton Pump Inhibitors (PPI's) like omeprazole are better for short-term two-week courses only. Long-term they can have fairly undesirable side-effects. He suggested Famotidine (Pepcid) an H2-blocker instead. Famotidine can also have long-term side effects, but the consequences are according to him not nearly as bad as PPI's. LSAT and Julie have great suggestions. It looks like you're getting somewhere.

If you're getting aerophagia, it's likely you'll need to explore limiting your max pressure to the point just below where you get aerophagia. Why not post a few more example daily graphs so we can see some progress? You might get some tips from pros on where to set your Max after that.

Chris

[Miss Emerita]

I'm glad you're feeling a little better. For the dry mouth, you might try Xylimelts, which are little discs that stick to your teeth or gums and stimulate the production of saliva during the night.

[weiss27md]

I have the same issues with allergies, dry mouth, reflux and CAs. But I also have bruxism and anxiety. My central apneas are usually below 5 ahi so still working on that. PAP user for almost a month, using a VAuto. Not sure what causes the dry mouth since I don't really have any mouth leaks anymore when using a soft cervical collar. For allergies I just have nasal congestion with swelling, not mucus. I turned off humidity last night and slept pretty good. Reflux is getting better. Just don't eat within 3 hours of bed and watch your diet. Less carbs and caffeine seem to help.

[Julie]

Collars and chinstraps don't keep your lips closed... tape or FF masks do.

[Katerific]

I woke up this morning with stomach distension from hell. I'm attaching the last 2 night's Oscar reports. The first one is from 5-5-20. I felt pretty good when i woke up. The second is this morning's report. Any suggestions will be most welcomed.

Oscar 5-5-20.png (120.88 KiB) Viewed 4437 times

Oscar 5-6-20.png (122.35 KiB) Viewed 4437 times

[Julie]

Can you remind us why your max pressure is so low - capping the min. when it might need to go higher?

[Katerific]

I have the max at 11 because I get aerophagia with higher pressures. I am trying to get just enough pressure to control AHI while keeping aerophagia at bay. I was doing great before allergies set in. My AHI was almost always between .7 and 1.5 and max pressure never went more than 9.5. My allergies just cause swollen nasal passages. No sneezing or runny nose.

[DreamDiver]

I have the max at 11 because I get aerophagia with higher pressures. I am trying to get just enough pressure to control AHI while keeping aerophagia at bay. I was doing great before allergies set in. My AHI was almost always between .7 and 1.5 and max pressure never went more than 9.5. My allergies just cause swollen nasal passages. No sneezing or runny nose.

Allergies are a challenge... With acid reflux, are you using a wedge to elevate your head? That may also help with nasal congestion. And Aerophagia-induced belly gas just sucks, as many of us can attest. You'll have to judge for yourself if you need to lower your Max further in order to better reduce Aerophagia.

Are you using hypoallergenic filters? They're finer than some of the coarse filters that come with some machines and screen out most allergy-inducing particulates.

Also, since your snore is mostly irrelevant and you're experiencing nasal congestion, why not swap your snore graph out for flow limitation? It may give some better perspective as to why your pressure keeps scudding across the top of your pressure graph.

It's unnecessary to pin most stuff to the top. Leaving event flags pinned allows you to scroll through all the other graphs in order to match it up with event flags.

I'm hoping that once we see your flow limitation graph, some of the pros can offer you more than sympathy for nasal congestion.

Chris

[Pugsy]

I'm hoping that once we see your flow limitation graph, some of the pros can offer you more than sympathy for nasal congestion.

There's not going to be a flow limitation graph available. OP is using a Respironics machine which doesn't do flow limitation graphs like the ResMed machines do. Instead the FLs are flagged like any other event up on the events graph when in auto mode only.
FLs were minimal on this last graph.

[Katerific]

I have a wedge but can't figure out how to sleep on my side on a wedge. Any tips on that?

[Pugsy]

http://freecpapadvice.com/sleepyhead-free-software
Go to the above link and watch the videos. While it mainly is talking about central apneas or clear airway apneas bear in mind that we aren't limited to just centrals. We can have flagged arousal/awake events in any event category. I know this for a fact as I see them quite often.

The more pressure thing is causing you some significant problems in terms of aerophagia issues.
Let's make sure you really need more pressure in the first place since more pressure is a problem for you.
Remember the machine doesn't know if you are awake or asleep. All it measures is air flow and sometimes the irregularities associated with awake/arousal breathing cause the machine to think that the airway is compromised because of apnea events and it will react accordingly when it reality more pressure can't do anything to improve awake/arousal related events.

Your machine could possibly be mistaking your allergy related congestion symptoms and breathing for apnea symptoms. It's something that just happens because the machine only measures air flow and the reduction in air flow that occurs because of swollen nasal mucosa mimics the reduction that comes from sleep apnea airway collapse reductions in flow. The machine simply can't tell the difference.

Normally we wouldn't care and just let the machine do its thing but in your situation the machine doing its thing means more pressure which causes a problem for you in terms of aerophagia.
Lets back up and figure out first of all if those flagged events are real asleep events or instead if they are arousal related events and simply didn't need more pressure in the first place.

You may have to walk a very fine line in terms of pressure settings or maybe even make a compromise and allow some apnea events to slide by the defenses so that you don't make yourself ill with the aerophagia issues. We can't be trading one problem for another.
Sometimes we let a little problem slide so that we don't experience a bigger problem.

Only way to know what to do or why we do something is to figure out first....are those events flagged real or not.
Then we can explore various options.