Burping, reduce my pressure? How much?

[jeffishere]

Hi all!
I'm in my 3rd month using my S9 Autoset with nasal pillows and sleeping much better, but just recently for some unexplained reason, I've been noticing too much air pressure in the middle of the night, (waking up thinking "why is this thing blowing so hard??) and have been burping up air in the early morning hours.
My Rx was for 9. So my minimum pressure is 4 and my max. pressure is 9. I'm thinking of lowering my max. pressure to 8 and see how that goes.
Any suggestions?
Thanks!

[Cuda]

Have you looked at your data? If you are almost never going above 8cm maybe its a good idea, if you are spending a lot of time between 8-9cm maybe its not such a good idea. How can you stand 4cm? I never could. Maybe it its pushing air in more while you sleep and its ramping up pressure. I was taking in air with the same machine and mask on APAP but on CPAP it seems better, thats why I am thinking I fall asleep with one pressure and get use to it and it ramps up and I start swallowing air. So maybe reduce your range at the lower level? Like 7-9cm instead of 4-7? Try looking at your charts, if when you fall asleep you always go up to a certain pressure maybe you do not need the lower setting. If you have trouble falling asleep at the higher setting you can use the ramp feature. Just my thoughts. Wide swings with APAP caused me problems, 1) swallowed more air and 2) mask fit issues.

[Pugsy]

You have the software???
Check to see where the pressure is going to and why. Events or leaks?
Use EPR? A change in EPR might be enough to relieve the burping problem.

[jeffishere]

My APR is ON, set to "patient"
Choices are 1, 2, 3, or "patient"
My average press. over 3 months is 8.2

[LinkC]

If your Avg is 8.2, I would leave the max at 9. Lowering it to 8 would likely allow your AHI to climb. And that's more important than aerophagia (IMHO). I often wake up, sit up and burp a couple of times. Not every night, but often. For some, aerophagia is just part of the deal. I certainly wouldn't jeopardize my treatment over some belching.

[Cuda]

I agree. I know I swallow air as I get a few burps at night and lets just say the rest finds another path out in the morning. If you AVERAGE 8.2 that means you use 8-9cm quite a bit. Try bringing up that minimum first and use EPR, the higher the setting the more relief on exhale. I use EPR 3 myself. If you set to "patient" in the advanced setup you can toy with it easier during the night. If you do not have the software you can get it now from ResMed, do a search for "Uncle Bob" on this forum and choose any post, he has the link to the software and the manual in his profile. I just deal with the burps and.....other bodily air relief.

[jeffishere]

Thanks all! It's not the burping that bothers me, that's a side-effect, the issue for me is that in the middle of the night the darn thing really seems to be forcing more air, or pushing air much stronger than it seems I need. The ideal would be not to actually notice the process until I breathe in, then enough air is provided, then an easy exhale. This is like a constant wind when I really only need a tiny breeze or nothing at all until I actually initiate a breath. Have you ever balanced perfectly on a teeter totter? The slightest move will send you gently up or down. Nice. Effortless. All I can think of is that at other times in the night while I'm sleeping I must need all that force. Certainly don't need it when I'm trying to fall back to sleep.

p.s. RE: the EPR...."If you set to "patient" in the advanced setup you can toy with it easier during the night." What does that mean?

Thanks again!!
Jeff

[BlackSpinner]

You need to get software so you can see in detail what is happening when the pressure raises. You need to know if it is because of a leak. You use nasal pillows so maybe your mouth is wide open. 9 is not high. Mine is 9 steady, no epr.

[Pugsy]

RE: the EPR...."If you set to "patient" in the advanced setup you can toy with it easier during the night." What does that mean?

I believe it just means that you can change the EPR setting if you wish. If it wasn't set to patient then you would not be able to play with the EPR settings. You would have to use what DME set up and would be locked out of any changes on your own.

[jeffishere]

Yes my mouth may be open (and drooling no doubt...I should video my sleep). I checked the machine and my leak rate over the last 3 months was 1.2 L/min.

So the consensus so far seems to be don't lower the max press., but possibly RAISE the min. pressure or try the EPR at 3?

Thanks!!

[kteague]

My non-technical input is that I have to start my night on my right side to avoid an uncomfortable excess of air in the belly. If I start on my left side, it's bad. However, I can turn to my left side during the night with no trouble. Maybe it's just me.

[Pugsy]

I use an APAP. I normally use Aflex which is the Respironics form of exhale relief. Last Thursday night I decided to do an experiment and turned AFlex off. My pressure settings are 10 min and 20 max. It works for my needs. I can use 10 cm min without any real issues. I did not sleep well that night and Friday morning I woke up with considerable discomfort from aerophagia. Friday night I turned my AFlex back on and won't go without it again. I normally sleep well and have zero aerophagia issues. I have not checked my data from that night but I often see high pressures on my reports and never knew they occurred. Sleep right through them. So even if by chance my pressures were near 18 Thursday night (I see that fairly often) in the past they haven't bothered me so the only difference was the AFlex.

It is possible that you are sensitive to the slightest pressure change and it can be disrupting to your sleep. Some people do better on straight CPAP for this reason or with a tighter range.
You could try using EPR of 3...that drops your pressure during exhale 3 cm.. down to 6 cm.
You could try raising the minimum pressure so that you have a tighter range in case it is the pressure changes themselves that are disrupting your sleep.
You could try straight CPAP at your prescribed pressure of 9 (maybe a wee bit below) but I would watch those events carefully on your reports. There is a reason that pressure wants to stay near 9..... if I was going to go lower as an experiment I would go in small increments.
If you do use EPR it is possible that events can occur when that pressure is being reduce during the exhale phase because the lowered pressure may not be enough to prevent the events.
From what you are saying about where the pressure wants to stay at... I wouldn't be reducing that maximum without a very close eye on the reports. Instead I would probably try EPR or a tighter range first. If you are sensitive to pressure changes...even EPR might bug you. You might even do better with straight cpap.

[Cuda]

I agree with Pugsy, would try APAP 7-9 with ERP at 1. That will start you out at 7 in and 6 out which is mild and still give you that 9cm top end. Or as Pugsy said just straight CPAP mode at 9cm with EPR at whatever you need to feel comfortable. Or possibly the best choice considering you are sensitive to pressure while falling asleep maybe just CPAP at 9cm and use the "ramp feature" which will slowly take you up to 9cm over a certain amount a time, the s9 can do so over 45 minutes, you should be asleep but if not the "ramp up" is so slow you should be use to 9cm by the time you get there. Just remember to use "mask fit" at the highest pressure you may see when sleeping.

[BlackSpinner]

Yes my mouth may be open (and drooling no doubt...I should video my sleep). I checked the machine and my leak rate over the last 3 months was 1.2 L/min.

So the consensus so far seems to be don't lower the max press., but possibly RAISE the min. pressure or try the EPR at 3?

Thanks!!

Open mouth means lost therapy and pressure that tries to handle that. This is the most important part to address. Until you do everything else a wast of time.