Making progress or should I discontinue APAP? Trying to figure out if apnea is the cause of my daily exhaustion

[Doce]

3-2-21.png (84.35 KiB) Viewed 817 times

3-4-21.png (89.92 KiB) Viewed 817 times

3-5-21.png (94.18 KiB) Viewed 817 times

[Doce]

Happy to report that I am now getting more use to the mask and the machine. Maybe even getting the numbers dial better.

I am having a couple of issues that I'd like to gain your feedback on.

I've bumped up my pressure quite a bit from 7.4 to 11, and likely 12 soon. This seems to be helping reduce my flow limit charts that recently decided to get worse then the beginning of treatment. Doing so has caused major aerophagia. The reason I am not able to keep the mask on all night is because of aerophagia. It seems once I get to a pressure at anything above a 7.4/7.6, aerophagia starts.

Here is another issue to throw in... I've noticed that when I turn off EPR, I have less fake centrals and real centrals in general... Overall, It seems my sleep is less disrupted with EPR off. However with EPR off, aerophagia is even worse. I tried the soft cervical collar and hated it. Tried tapping mouth shut, but I have chronic nasal issues and breath out of my mouth at night. Tried sleeping on a wedge, but that didn't help the aerophagia. What are some other things to try for this situation?

[Julie]

What happens when you raise the max pressure setting (which looks like it wants to go up so bad)?

And look at the postings (lots) on aerophagia from the forum search bar.

[Doce]

What happens when you raise the max pressure setting (which looks like it wants to go up so bad)?

And look at the postings (lots) on aerophagia from the forum search bar.

Thank you for the response. I've seem to have tried most of the things that returned in the search results. At this point, I don't know how to continue with the aerophagia, cheeks blow out, and chasing a higher and higher pressure. Really lost at this point. I don't recall the data looking this bad when the pressure was lower a year or two ago.

Anyways, here are a couple of screenshots with the higher pressure.

4-5-21.png (92.23 KiB) Viewed 727 times

4-10-21.png (94.25 KiB) Viewed 727 times

[Miss Emerita]

Doce, you need relief from aerophagia, so I would drop the pressure back down to something that gives you that relief. You can then try inching your minimum and maximum up, .2 at a time, if you see a need for higher pressure.

I'd also suggest re-introducing some EPR. Maybe start with 1 to see whether that makes a dent in the FLs.

Honestly, I wouldn't worry that much about the CAs unless they skyrocket in frequency.

If a cervical collar isn't for you, you might double-check whether you're using a low firm pillow and maintaining good alignment of your head and torso, at least as far as you can tell. On some of your charts, your FLs as well as your events are fairly clustered.

And I'd really suggest that you make a note each day of your settings, basic stats, AND how rested you feel during the day. You need especially to note the latter.

BTW, I recently read this article about insomnia and a certain type of anemia:

https://academic.oup.com/biomedgerontol ... 80/2929466

More broadly, iron-deficiency anemia is associated with restless leg syndrome. I mention these issues because I think anemia was one of the things your doctor was looking into.

[Doce]

Doce, you need relief from aerophagia, so I would drop the pressure back down to something that gives you that relief. You can then try inching your minimum and maximum up, .2 at a time, if you see a need for higher pressure.

I'd also suggest re-introducing some EPR. Maybe start with 1 to see whether that makes a dent in the FLs.

Honestly, I wouldn't worry that much about the CAs unless they skyrocket in frequency.

If a cervical collar isn't for you, you might double-check whether you're using a low firm pillow and maintaining good alignment of your head and torso, at least as far as you can tell. On some of your charts, your FLs as well as your events are fairly clustered.

And I'd really suggest that you make a note each day of your settings, basic stats, AND how rested you feel during the day. You need especially to note the latter.

BTW, I recently read this article about insomnia and a certain type of anemia:

https://academic.oup.com/biomedgerontol ... 80/2929466

More broadly, iron-deficiency anemia is associated with restless leg syndrome. I mention these issues because I think anemia was one of the things your doctor was looking into.

Thank you for your reply. I appreciate it.

A few months ago I begun taking an extended release iron pill. My iron was within the normal range, but the doctor said he wanted to see it higher. I haven't noticed any differences yet.

I went full on with 3 EPR, and noticed a big drop in flow limitations. That is very interesting to me to understand how that works. I was under the impression that EPR could increase flow limits by causing instability of the airway with the fluctuating pressures. If someone could explain why flow limits drop with EPR on, that would be interesting to learn about. Honestly though, I feel worse today, but it could be because I remember waking up what seemed like every hour last night.

Next up, I am going to begin dropping the pressure until the aerophagia dissipates, while keeping an eye on the resulting oscar data.

Here's an image from last night.

4-11-21.png (89.36 KiB) Viewed 698 times

[Miss Emerita]

That's a dramatic difference in FLs. Here's the theory behind using EPR:

EPR creates a differential between the pressure for exhalation and the pressure for inhalation. What's relevant to FLs is that you get a pressure boost when you inhale, which can support you as you breathe in, creating a smoother inhalation without less need for extra effort to overcome a limitation.

A little bit more theory, while we're at it:

Your minimum pressure on exhalation is what helps to avoid obstructive apneas. It can also help with hypopneas and a little bit with FLs.

CAs come in several basic flavors. One is "sleep-wake junk," where you have actually awakened or partly awakened and are breathing more irregularly, as we are prone to do when we're awake during the day. Another flavor occurs during sleep and results from improved efficiency in breathing, which washes out enough CO2 to reduce the drive to breathe. How much is "enough" varies from one person to another and can vary for the same person over time. These are "treatment-emergent" CAs, and they often diminish with time. Other flavors include high-altitude CAs, CAs due to neurological problems, and CAs whose cause is unknown; all of these would have shown up on a sleep test, at least if the test were performed at the same altitude as your home.

[ChicagoGranny]

I have chronic nasal issues and breath out of my mouth at night.

In this day of modern medicine, there is no reason to live like that. Schedule an examination of your airway and a consultation with an ENT/Allergist. Mouthbreathing can contribute to aerophagia and airway collapse.

Tried sleeping on a wedge, but that didn't help the aerophagia. What are some other things to try for this situation?

A wedge that causes the body to bend at the abdomen can make things worse. There is a larger wedge that extends below the hips. However, it is more convenient to use riser blocks under the legs at the head of the bed.

Here are some tips on dealing with aerophagia - http://cpaptalk.com/wiki/index.php/Aerophagia

[Doce]

Appreciate everyone's help along the way with this journey. Here is another update.

I wanted to try bipap and made the switch to an Aircurve S10 VAUTO (and got it for a great deal) because I'm having issues with exhaling against higher pressures and aerophagia. This is a little bit of a learning curve for me with pressure titration on a bipap. Here is a screenshot from last night. Is there a method to which pressure (IPAP vs EPAP) to raise or lower first? My understanding is that EPAP needs to be adjusted to a level that eliminates OSA and the IPAP needs to be adjusted to a level that will eliminate any lingering hypopneas and reras. Where do you suggest I go from here with pressures? I am thinking auto mode, EPAP 5.6, IPAP 9.2, PS 3.2 (yes it is a narrow range.)

More info but first off, I know my auto machine settings are vary narrow and I'm doing that on purpose to examine micro changes in my sensitivity to pressure differences.
I am also aware my PS is only 3.2 (.2 higher then what a Resmed Autoset can provide with EPR but the idea is that this machine will allow me to have a greater difference in pressures once I am dialed in. Hypothetically, EPAP 5.6, IPAP 9.

I need at least a difference in pressures of 3(PS) to exhale comfortably and it also greatly reduces flow limits on OSCAR. Once EPAP is higher that 6-7, I start to have issues exhaling.
Once IPAP pressure are over 8.4-9, I wake up with aerophagia...

5-25-21.png (90.73 KiB) Viewed 569 times

[Pugsy]

IPAP also helps out with OAs so minimum EPAP isn't quite as critical as some might think.

Since you have a known problem with IPAP and aerophagia I would concentrate on whatever settings are simply the most comfortable for you that allow you to sleep more soundly.

You are going to need a tight range and that's fine as long as your numbers are within acceptable limits AND you are sleeping good and hopefully feeling good.

If it were me I would try minimum EPAP 4....PS 4....max IPAP 9.0 and see what happens. I love PS of 4...for me it is just like natural breathing. This is an extremely tight range but if you never hit the max or hit it only briefly...who cares.

Just play around with the settings and see what happens...listen to your body.