New User CPAP Troubles....

[rwhargis]

New to the CPAP game and not doing very well. Have a RESmed S9 auto and have trouble getting bloated when I use the machine. Have been using off and on for two months as it is a problem waking me up (bloated) when I have to get up very early to go to work and it is just hard to deal with.
Doc changed me to a VPAP machine but when I tried it things went nuts. The resp. therapist at Apria said he thought the VPAP was inducing apneas (AHI went from 6 up to 35). Sent that back after 3 short usages of about 1 hour each. Changed from the NASAL mask to the FULL FACE mask as I was having what I think is called puffing through my mouth. The big problem is I get my stomach full of air and also gas and it wakes me up after about 1.5 hours. Trying to keep my head straight so as not to block the air way but no help. Sleep study said I did best at 8 cm H2O. Changed pressure setting from AUTO of 4 to 20 to FIXED at 9 to AUTO of 4 to 9. The last setting seem to be best for less bloating but still have it. Averaging 1.5 hours a night but last night had a mega run of 7 hours. Average AHI running 7 or less of mixed apneas (see below). RESmed (and Doctor) says mixed central and obstructive, Sleephead is listed below. What is a "Clear Airway Apnea" anyway? Although only woke up a couple of times last night stiffed it out for 7 hours but still had stomach cramps and gas this morning. I thought this thing was suppose to help me sleep..... I wonder if I even need this machine as I appear to be on the low end. I sleep better with out it. Also, it appears I am on the low end of oxygen saturation (SpO2) and am on O2 at night since major neck surgery 4 months ago. Not on O2 with the CPAP as they thought the increased air flow might increase the O2 level. Don't know about that yet as I haven' done a O2 sleep recording yet. Anyone else having this kind of problem?
Discouraged in Denver - Bob

Sleephead: AHI Apnea / Hypopnea Index 7.04 (over 7 hours): Hypopnea 1.08, Unspecified Apnea 0.00, Obstructive Apnea 1.22, Clear Airway Apnea 4.74

[Julie]

Hi, normally I would say that you could try lowering your pressure by a notch, but you're already on a fairly low setting and I wonder if there's something else you haven't considered... i.e. if you normally eat or drink something close to bedtime which, by itself would not cause trouble, but with cpap is causing gas, like anything 'dairy', or beans, or chocolate, or .. whatever you normally have... is there any way you can experiment a bit by cutting back on something even if it doesn't make sense otherwise?

I also considered that your low setting at 4 (the default 'bottom' for machines) is so low that you must need to gasp for air at first, and doing so may fill you up like a balloon! If your usual hover numbers are around 8, why not set things for e.g. 6 or 7 and the top at ?? 10 or 15 just to see what happens over a few nights?

[Wonderbeastlett]

I use a straight cpap pressure and I've been feeling pretty good with it! I do sometimes have areophagia and wake up with stomach pains. I honestly don't know how to stop the swallowing of air but I have to agree with Julie! There might be something else causing this. Do you drink alcohol before bed? Perhaps there are medications you're on that might hinder your sleep? Or even medications helping to aid your muscles relaxing!?

The best advice is to not give up! Even if you have to try every pressure setting by itself, it's better for you in the long run! I'm in my twenties and I feel pretty young to have to be strapped to a machine every night but if I get a longer life, I'm happy! I know it can be pain but keep trying masks and pressures until you find what works for you!

[brucifer]

Bob, the following article, Aerophagia in CPAP Users, is a few years old, but it addresses exactly what you are experiencing: http://www.cpap-supply.com/Articles.asp?ID=170 Hope you are able to continue your CPAP therapy and find a solution for the bloating. Best of luck.

[Pugsy]

SleepyHead was originally written for Respironics machines and they used the term "clear airway" and ResMed machines call them "centrals". Resmed compatibility with SH was added later but the "clear airway" terminology remained.
Clear airway (central) apnea is a cessation of air flow and the airway is open.
Obstructive apneas and hyponeas are caused by a collapse of the airway tissues so the cessation of air flow is due to tissue collapse. We treat the apneas caused by collapse of airway tissues with pressure enough to hold the air way open.
Clear airway events already have the airway open so pressure increase or changes won't help.

Not all central or clear airway events warrant concern. The machine is limited in what it can assemble data wise and it often will flag a false positive central meaning one that wouldn't be flagged in a sleep lab where the tech has the added data from the EEG for brain waves (make sure you are asleep) and thoracic belt activity.
It is common and normal to have centrals at sleep onset/sleep stage transition and even sometimes we hold our breath when we turn over in bed and the machine might flag it as a "central". These would not be flagged in a sleep lab.
If your sleep is fragmented and disturbed then the clear airway (central) index may be elevated because the machine may be flagging events that normally would not be flagged.

http://adventures-in-hosehead-land.blog ... er_19.html
You might read this blog. It is written by one of our forum members Robysue. She also battles aerophagia at what normally we would think as really low pressures. Hopefully she will stop by here and offer her ideas on what you might do to help relieve some of your symptoms.

[rwhargis]

THANKS to you all for the time and effort to help me get a grip on this CPAP problem.
The suggestions about changing the settings are good although I don't do alcohol and don't eat much after dinner I appreciate the thoughts on the food and I don't take any meds either..
The link to the definition of what I seem to have i.e. "Aerophagia in CPAP Users" was GREAT because as usual I find I'm not the only one with this problem and gives me incentive to check with the Doc and play with the settings on the machine. I also appreciated the description of how SleepyHead evolved, how it works and what "clear airway" means. It really helps to know what you are looking at in these reports. So thanks to you all again and I'll be continuing to get this to work. I'll be re-reading all your posts again and again to make sure I don't miss anything!
Thanks!
Bob

[Lizistired]

If you did best at 8, why are you at 9?
Have you tried straight 6 or 7 just to get used to it?
I think any therapy is better than no therapy.
Aerophagia sucks!
Check your EPR setting on the S9. The DME's usually set it at 3 which means the pressure drops 3cmh2o every time you exhale.
For some of us it disrupts normal breathing. It makes me feel like I have to breathe with the machine.
I would reduce the EPR as much as you can and then increase the pressure as you get used to it.
Auto is a great feature but some of us do better on straight cpap. That may be more common at lower pressures.

[kaiasgram]

It is common and normal to have centrals at sleep onset/sleep stage transition and even sometimes we hold our breath when we turn over in bed and the machine might flag it as a "central".

I'm curious -- Is there a time "marker" for distinguishing a true central from an 'artifact' ? I had a 32 sec "clear airway" the other night. Is that more likely a true central than an artifact? I don't imagine I'd hold my breath that long turning over in bed.

[Pugsy]

I'm curious -- Is there a time "marker" for distinguishing a true central from an 'artifact' ? I had a 32 sec "clear airway" the other night. Is that more likely a true central than an artifact? I don't imagine I'd hold my breath that long turning over in bed.

Not really, that I have ever heard of anyway.
I understand what you are wondering. There just isn't any way to know for sure. Even if it was a random "true" central they/it wouldn't be a concern in the very small frequency that you see them.

Did I ever send you the Firehope thread? If not you might read this and be sure and go to the links in his posts. They are still active as I just checked them. viewtopic.php?f=1&t=68846&st=0&sk=t&sd=a
It appears that he really did have some pressure induced centrals and you can see the frequency of his and compare it to the frequency of yours.

We all can have a few "real centrals" (assuming they would meet sleep lab criteria to be flagged as central) here and there in the night and they aren't a cause for alarm when they are random and infrequent. It is only when they are present night after night, hour after hour, and in larger quantities than we would like to see, that we start worrying.

[kaiasgram]

Did I ever send you the Firehope thread? If not you might read this and be sure and go to the links in his posts.
We all can have a few "real centrals" (assuming they would meet sleep lab criteria to be flagged as central) here and there in the night and they aren't a cause for alarm when they are random and infrequent. It is only when they are present night after night, hour after hour, and in larger quantities than we would like to see, that we start worrying.

Thanks Pugsy, I read over the Firehope thread and I see what you mean.

[chunkyfrog]

To rwhargis:
it is important to use your cpap every night--even if it is at a lower pressure or a shorter time.
This will help you get used to therapy; and likely the aerophagia will go away.
On-and-off therapy is just prolonging your misery.
Find a sleep position that feels better, drink water or walk around when you wake with a full belly, don't eat within 3 hours of bedtime; whatever helps.

[kaiasgram]

and am on O2 at night since major neck surgery 4 months ago. Not on O2 with the CPAP as they thought the increased air flow might increase the O2 level. Don't know about that yet as I haven' done a O2 sleep recording yet.

Bob, are you saying that they stopped the O2 when you started on CPAP and haven't monitored your O2 level since?

[rwhargis]

I haven't been on oxygen when I use the CPAP (don't have the adapter). The doctor said they would run an oxygen recording test after I used the CPAP for a couple of weeks to see how it was going. Never have been able to use CPAP enough to go back to the O2 problem. I did buy a O2 sleep recording device and have been monitoring my levels almost every night. I'm not sure if the recording device is accurate however. The finger monitor I got at Walgreens shows about 4 points higher than the recording O2 device. Running about 95 with O2 and 89-90 with out. I've been using the O2 when I haven't been on the CPAP. Will try to compare to the doctors office reading when I go back in.

Sleep study showed best pressure at 8, Sleep Doctor said to set at 9. I think I'll try it on the CPAP setting instead of AUTO and set it to 8 and see what happens.......