Using EPR-results and questions

[grumpygirl]

Hello All- For the last two nights I have tried using my Autopap with the EPR set at 1. I was titrated at 12 cm but have been unable to use that high pressure due to horrible aerophagia. For about a week now I have awakened with awful gas and a gut that looked like a baketball along with horrible pain in my abdomen due to the gas. My Resmed was set at 10.2 with EPR of 1 only during the ramp stage. I have been dealing with this problem fairly often along with terrible fatique for over a year now. So, two nights ago I decided to try the EPR at 1 fulltime. I set the pressure at 11 with the EPR at 1 and crossed my fingers that it would help with the aerophagia- I was desperate.

My results have been better than I had hoped. I have only experienced a little aerophagia and have slept through the night both nights. So far I am not nearly as tired as I have been but I am not convinced that I have solved the problem.

My stats look kind of confusing. The first night my leak rate was .00, AHI- 1.7, AI-0.4, HI- 1.3. I felt pretty good that day. Last night my results were not as good-my leak rate was .00, AHI-2.4, AI- 0.1, HI- 2.3. Those results were pretty high for me but I didn't feel too bad during the day-in fact I didn't even need a nap in the afternoon. How could that be- I usually have much lower results but feel so tired and sluggish during the day? Why would I feel better with higher AHI and HI??

My question is this- should I raise the fixed pressure a little to maybe 11.4 with EPR 1 fulltime in order to lower my stats a little or just keep it where it is for a while and see what happens?
How could this little bit of a change have what seems to be such profound results?? Wonder if I will eventually feel extremely tired again or if this may be a more permanent solution?? Thanks-GG

[cowlypso]

In general, you should only make one change at a time, and wait at least a week or two before making another change.

I would leave things just like they are for at least a week, then check the data. After a week, if you still want to bump the pressure, do it and wait another week to evaluate.

[pap4life]

Frankly, I don;t think that those AHI changes are all that drastic, and in fact I would be delighted to have those readings. That said, I firmly believe that small AHI changes can not make a drastic change in our daily dispositions. I'll probably get an argument here on that. I think daily psychological events can also make our feel-good ratings change rapidily even though our AHI numbers for the night were down or lower then the night before.

Perhaps, you might change the EPR to a 2 and see if the gas problems ease up some.

[Pugsy]

It is common to have nights vary in all sorts of data. I might have an AHI of less than 1 tonight and the next night AHI of 3 or 4. With no changes in anything that I did or could see.

I suspect you feel better simply because you are sleeping better and not having the pain and discomfort from such bad aerophagia. If it were me...I wouldn't change a thing. I wouldn't increase the pressure trying to reduce an AHI of 2.4 down to 1.7 especially at the risk of triggering aerophagia again. It is not a huge difference and we can normally vary that much or more night to night anyway. Often there is a threshold where aerophagia sits quietly on the sidelines till you up the pressure just a little more and wake it up and it really goes to work on you. Now if the AHI was 4 to 5 or more and you didn't feel so good then yeah, inch the pressure up a bit but if you are sleeping better and feeling better that is what is the most important thing. Not a minor difference in a couple of numbers that are both well within accepted limits.

[robysue]

My stats look kind of confusing. The first night my leak rate was .00, AHI- 1.7, AI-0.4, HI- 1.3. I felt pretty good that day. Last night my results were not as good-my leak rate was .00, AHI-2.4, AI- 0.1, HI- 2.3. Those results were pretty high for me but I didn't feel too bad during the day-in fact I didn't even need a nap in the afternoon. How could that be- I usually have much lower results but feel so tired and sluggish during the day? Why would I feel better with higher AHI and HI??

There's more to getting restorative sleep than just obtaining an AHI near 0. Among other things, you have to actually get some unfragmented sleep and you need to get some Stage 3 sleep and some REM sleep. It could be that your long term battle with aerophagia was fragmenting your sleep by waking you up in pain off and on during the night. It could be that your long term battle with aerophagia was hindering your ability to get into and stay in Stage 3 or REM sleep. It could simply be that waking up with painful aerophagia was giving you enough daytime pain to deal with that you just couldn't feel at your best.

But the change to the current setting (pressure set to 11cm, EPR =1 all night long) seems to have done a lot to solve the aerophagia issue (at least on these two nights). And NOT having the aerophagia may lead to less fragmentation of your sleep during the night, more Stage 3 sleep, and more REM. All of which would easily overcome any potential problems caused by the AHI going from something below 1.0 to the AHIs you report (1.7 and 2.4) since even the higher of these is still well below the accepted upper end of "normal" at AHI = 5.0.

Like the others, I would encourage you to keep the current settings for at least a week or two. See if the current luck with reduced aerophagia continues. And monitor both the AHI and how you feel during the day. If the AHI stays below 3.0 for the most part and if the aerophagia stays away and if you continue to feel better during the day time, then keep the current settings long term and don't worry too much about not having a perfect AHI because if all that happens, you may have finally located your sweet spot.

[Lizistired]

Ditto what Rested Gal said. If you are more prone to apneas in deeper sleep stages and don't get there, you can have a very low AHI but feel like crap. AHI isn't everything. Aerophagia is miserable.

[apneawho]

Ditto what Rested Gal said. If you are more prone to apneas in deeper sleep stages and don't get there, you can have a very low AHI but feel like crap. AHI isn't everything. Aerophagia is miserable.

Ditto what they said.

[grumpygirl]

Well, the rejoicing was short lived!! The last two days I have been so very tired during the day that I am almost not functioning. This morning I woke up at 4 a.m. with aerophagia-not as bad as before but very uncomfortable nonetheless. I am frustrated and depressed about this- I thought I had finally found a solution to this neverending fatique and gas. What do I do now?? Go back to straight cpap with pressure at 10.2 with EPR 1 only on ramp or up the pressure to 11.2 maybe and EPR 1 Fulltime ?? My stats the last two days have been fairly normal for me with AHI of around 1.7 with 0 leaks and low HI also.

I am so confused I feel like a mess------------- Any suggestions??? GG

[robysue]

Well, the rejoicing was short lived!! The last two days I have been so very tired during the day that I am almost not functioning. This morning I woke up at 4 a.m. with aerophagia-not as bad as before but very uncomfortable nonetheless. I am frustrated and depressed about this- I thought I had finally found a solution to this neverending fatique and gas. What do I do now?? Go back to straight cpap with pressure at 10.2 with EPR 1 only on ramp or up the pressure to 11.2 maybe and EPR 1 Fulltime ?? My stats the last two days have been fairly normal for me with AHI of around 1.7 with 0 leaks and low HI also.

I am so confused I feel like a mess------------- Any suggestions??? GG

So sad to hear about the latest set back.

As for what to do?

I'd leave the EPR set at full time. And right now, I think I'd even leave the pressure setting alone for at least a few more days.

I also think that if you're not keeping a daily log, maybe you should. Taylor the log to track the things that you think might be useful in teasing apart what might be going on. And track everything for a couple of weeks before trying to tease apart possible correlations in the data. I'd suggest something that lets you make the following notes about these things:

• A measure of just how bad the aerophagia is during the night and at waking up for the morning. Also whether it bothers you a lot in the daytime
• A subjective measure of how you'd rate the quality of your sleep when you wake up in the morning. By subjective measure, I mean things the PAP machine can't tell you: How rested do you feel when you first wake up? Did it feel like you tossed and turned a lot during the night? Have any trouble getting to sleep? Any trouble staying asleep?
• A basic sleep log with the following data:
  • Time you went to bed
  • Estimated time to get to sleep
  • Estimated number of wakes (don't worry about when the wakes happen)
  • Time you got up in the morning
  • Estimated total sleep time (i.e. how long you think you actually slept during the night.)
  • A note or two about anything significant you remember about any of the wakes. Something like "Woke up with aerophagia twice" is plenty enough detail.
  • If you want to be fancy, compute your sleep efficiency. Sleep efficiency = (Estimated time sleep time)/(Time in bed).
• A subjective measure of how alert/sleepy and how much fatigue you have during the day.
• Time and content of your last meal for the day AND any snacks after suppertime.

And since GERD and aerophagia are often interrelated in CPAPers, it's worth looking at some GERD self-help tips ([url=http://www.medicinenet.com/gastroesopha ... /page6.htm]Life-style changes for helping GERD symptoms[/url) and trying some of them. And maybe ask your doc about recommendations for dealing with possible GERD issues.

[Lizistired]

EPR should be set to what feels comfortable to you for breathing. Reduce your pressure as needed to eliminate the aerophagia. Give yoursefl time to adjust to that pressure and see how you feel.
Then if you feel you need to, try to increase to your titrated pressure or a pressure that makes you feel better.

[Perrybucsdad]

I also think that if you're not keeping a daily log, maybe you should. Taylor the log to track the things that you think might be useful in teasing apart what might be going on. And track everything for a couple of weeks before trying to tease apart possible correlations in the data. I'd suggest something that lets you make the following notes about these things:

I can't agree with this more. I went to the point of creating an electronic log that I update every morning. It tracks all kinds of items (that I find useful) but you need to figure out what works for you.

You could do this all on paper as it does not need to be anything really fancy, or you could do something a little more complicated and do one in MS Excel (or some other spreadsheet program). This would allow you to find thing possibly more quickly or calculate some items.

At 60+ days into my xPap therapy, I find this log to be invaluable as one of the items I track is free form notes. In here I put down what I may have changed, and note how I feel in the morning or the previous day. I find this information to be very helpful in tracking what I did and how I felt.

[rested gal]

The previous "dittos" have me confused a little...I don't think I had posted anything in this thread

Anyway, I'll say "ditto" to the people who have mentioned that the differences in AHI grumpygirl mentioned seem like normal night-to-night variations. They looked that way to me, too.

And ditto to low AHI numbers not telling the entire story about whether sleep is going well, or not.

And... ditto to making changes slowly.

And well, ummm... ditto to just about everything everyone has posted in this thread so far.

See? There wasn't any reason for me to post. But I'll do it anyway to offer my encouragement to you, grumpygirl.
You've been getting good advice. Glad to see you're trying hard to get everything about your therapy going right -- and comfortably. Painful aerophagia ain't fun, at all.