Can't Handle the Pressure!!

[TiredMominCanada]

Okay so last night the machine was set at 11.6cm again, with the ramp starting at 9cm for 20 minutes...I had no problem falling asleep and YAY this morning AHI 1.1!!!
BUT I feel like I'm going to explode this morning - my stomach is bloated and painful and I am very (ahem) gassy I'm assuming that this is aerophagia.
Any tips on treating/eliminating this? Should I lower the pressure a bit? I do have the EPR on all night at 3.

Side note-my doctor is 4 hours away and I have to see him by Skype and it takes a long time to get an appointment. I'm wondering if I should book an appointment with him as I can't seem to handle 11.6 never mind my prescribed pressure of 15. I'm wondering if I need BiPap?? Also I'm also doubting the titration capabilities of the sleep tech, if my AHI is 1.1 at 11.6cm, why the prescription of 15?

PS you guys are an amazing source of understanding and support. It is incredible that you take the time to help us beginners! Thank you a million times!!!

[123.Shawn T.W.]

Where did you get the 1.1 AHI from? Machine? or a software program?

I'd be tempted to drop the presure a tad, but one night doesn't really set a precident!

Of course your belly is already giving you feedback!

It would be nice to see what software is showing in graph form, if you don't have any software, Sleepyhead is FREE and works GREAT!

[ReadyforRest]

TiredMominCanada … I’m coming up to 3 months on xpap now. And I’m in Ontario too. So I can relate to a lot of what you’re going through. I started on cpap with a fixed pressure for the first month, then was switched to autopap and am VERY happy they did that.

When you do your Skype (or meet in person) with the sleep doc, make sure he knows that the higher pressure is helping your AHI’s. But you should also strongly stress to him that you’re having a lot of aerophagia, and that your stomach feels like it’s going to explode at these higher pressures. I would ask him for a lot more information on why he doesn’t want you to have an auto machine, and what exactly qualifies someone for an auto machine in this province [*see below], because I question his decision to not put you on autopap. It would help you with the aerophagia, because it only gives you higher pressures when you need them, then it drops back down to a lower, more tolerable pressure when you don’t.

During my 1 month on the trial machine, when my pressure was set at just 8 cm on straight CPAP, I had quite a bit of air in my stomach and gas attacks … … both during the night and the next morning. And gosh, 8 cm is a lot lower than your fixed pressure! Also, during that first month, I was regularly having AHI readings between 12 and 15. So it was helping somewhat, but for me, it wasn’t optimal treatment on straight cpap. (For you, that may be different, and you could very well reach optimal treatment on cpap.) During titration, they had to raise my setting to 9 cm, but sent me home with my machine unchanged and still at 8 cm saying the doctor had to do it. 2 weeks later, I had to bring in the trial machine to my follow-up appointment. The sleep doctor told me that I was having a lot of OA’s in REM sleep, and that women tend to have more OA’s in REM (I didn’t know that). Because of that, she felt that I qualified for an auto. Fortunately, my trial machine was a ResMed S9 Autoset that had been put in CPAP mode for my trial. So when the doc said I needed autopap, she changed it right then and there in the office to auto with the settings at 14 cm over 7 cm.

That first night on auto, my AHI dropped below 5 for the first time (4.72 to be exact)! In the almost 2 months since then, I’ve experienced far fewer problems with gas, AND my AHI’s have continued to gradually drop down to where they are now, which is anywhere between 0.7 and 3. I’d like them to be more consistently lower, like 1 or under, so we still may need to do some tweaking with my settings, but I’m very happy with the change to autopap.

So maybe you should investigate with your doctor if auto might be better for you. I’m not saying that it is. Maybe cpap IS better for you and I’m going off on a tangent, LOL. (It wouldn’t be the first time ) Forgive me if I am, and carry on, LOL. But it can’t hurt to find out all you can about the different machines and what you qualify for, and ask questions.

Just FYI, in Ontario, the Assisted Devices Program (part of OHIP) pays 75% of the cost of either a cpap or apap machine, but you have to qualify for the higher priced apap machine. They don’t just hand them out without a really good reason to do so (or so my DME says). The ResMed CPAP machine is around $1,300 or $1,350 here in Ontario. An Autopap machine is more … My ResMed S9 AutoSet with H5i Humidifier came to $1,585.00. The ADP (Assisted Devices Program) covered $1,188.75 of that.

In order to get that coverage, my sleep doc had to provide a letter to the DME (which the DME sent in to ADP when I bought the machine) stating that I qualified, and why.

It’s a form letter. Here’s what mine said. It will give you an idea of what (in part) qualifies a person to get an autopap here:

"This request is made on behalf of XXXXX XXXXX for an auto-titrating Positive Airway Pressure (APAP) System for treatment of her Obstructive Sleep Apnea Syndrome (OSAS). The following medical eligibility criteria, as outlined by the Ministry of Health and Long Term Care for treatment of OSAS with an APAP system are applicable for this patient’s condition.

[x ] Has polysomnologically documented OSAS requiring a fixed CPAP pressure of 10 cm H2O
[ ] Requires ___ cm H2O in supine and ___ cm H2O in non-supine
[ ] Requires >10 cm H2O in REM and 8 cm H2O in non-REM

[this was handwritten in:] "Unable to obtain optimal titration in REM Sleep.”

In follow-up, XXXXX XXXXX has found the APAP system to be a significant clinical improvement over fixed CPAP and much more tolerable."


I suspect that the doctor routinely fills in the minimum numbers that are required to qualify a patient for coverage.

And just to add, I don’t know what your readings were from your titration, but my doc said that in REM sleep I was experiencing more OA’s, and that women in particular tend to have more OA’s in REM than men do. Straight CPAP did not address this issue, since I required higher pressure during periods of REM than during other stages of sleep. That alone necessitated the prescription for autopap. Again, I’m not suggesting that this is your problem. But if you were having more OA’s in REM during your titration, then that is good information for you to know, in order to be your own advocate (if you need to be) to get your sleep doc to change your prescription.

I don’t know if you have an SD card with your trial machine, or if you have the ResMed or Sleepyhead software, but it might be a good idea for you to look at your data to see what’s happening at night. REM usually occurs roughly 60 to 90 minutes after you go to sleep.

Just some thoughts from another newbie … disregard if you see fit.

[Todzo]

Okay so last night the machine was set at 11.6cm again, with the ramp starting at 9cm for 20 minutes...I had no problem falling asleep and YAY this morning AHI 1.1!!!
BUT I feel like I'm going to explode this morning - my stomach is bloated and painful and I am very (ahem) gassy I'm assuming that this is aerophagia.
Any tips on treating/eliminating this? Should I lower the pressure a bit? I do have the EPR on all night at 3.

Side note-my doctor is 4 hours away and I have to see him by Skype and it takes a long time to get an appointment. I'm wondering if I should book an appointment with him as I can't seem to handle 11.6 never mind my prescribed pressure of 15. I'm wondering if I need BiPap?? Also I'm also doubting the titration capabilities of the sleep tech, if my AHI is 1.1 at 11.6cm, why the prescription of 15?

PS you guys are an amazing source of understanding and support. It is incredible that you take the time to help us beginners! Thank you a million times!!!

Hi TiredMominCanada!

Gassy tummy, for me, becomes less if I sleep on my tummy. Sometimes I take a pillow and sort of sleep with tummy on top of it (usually kind of on my side). Be careful to not block the lossy mask vent!

If I were you I would probably raise the head of my bed a couple of inches and reduce the pressure 1 cm/H2O. Or perhaps just raise the head of the bed (the gassy tummy could be GERD related) and watch the data for a few days.

I have a little list to get the pressure down – following.

Things I have found move the Obstructive Apnea Prevention Pressure need down:

1. Reduce Stress!!! Stress tends to cause an inflammatory reaction in the body – inflamed airway tends to collapse easier.
2. Raise the head of your bed a couple of inches (I use cheap concrete bricks from a building supply store - <$5 for both). I know of at least one doctor who recommends this for pressure issues. It does seem to make things better in general I have noticed in my own data, and is known to help prevent GERD. I also kind of think that if there is more blood near the feet there is less blood filling the tissues in the airway passage so less pressure needed to push them back.
3. Eat anti-inflammatory foods. Less inflammation, less OSA.
4. Stay away from processed foods. I think just say no to GMOs. Stay away from preservatives. Take good care of your microbiome. I believe doing so will reduce inflammation so less OSA and less pressure needed to prevent OSA.
5. Take some cooking classes and start a long term relationship with a dietitian. Your body longs for good food prepared from scratch. Feed it well, it can better treat you well.

Have a great week!

Todzo

[TiredMominCanada]

Below is last night's sleepyhead graph (not sure what happened around 3am - I don't remember taking the mask off. I had horrible dreams the last two nights as well - maybe more REM sleep?

ReadyForRest,thank you so much for sharing your Ontario experience! I am going to get in touch with the sleep clinic and ask for an appointment with the sleep doctor for sure. Although I'm far from an expert, when I look at my sleepyhead graphs from the last month, I see a definite pattern to my AHI numbers which may be that they occur more during REM sleep.

My only concern now is that I've purchased the S9 Elite, will the DME take it back and switch me to an Autoset if I can get the prescription? Probably not!!

I'll keep things as they are and see how tonight goes. I'm also going to start keeping a sleep diary that includes how I feel the next day.

[archangle]

Aerophagia:

Sometimes it goes away after a while. Don't get too worried yet.

Try not to be ladylike once you wake up. Just "let it all out" unless you're somewhere you just can't get away with it. Sometimes you can help it along by mental effort or moving around.

Some people have said that tilting their head backwards or forwards to change the angle of their neck during sleep helps with aerophagia.

Screenshot:

Why is there no Flow Rate airflow waveform in your screenshot? If necessary, click the "event flags" tab in lower right and turn it on. If it's just below the bottom of the screen, drag it up to the top.

[TiredMominCanada]

Flow Rate showing!

[Denial Dave]

Wow I'd love to have your leak rate

[Pugsy]

Wow I'd love to have your leak rate

You and me both.

TiredMom....great report. You might try a 0.2 decrease in pressure to see if that helps with the aerophagia for right now.
Sometimes there is a fine line that you can sneak below that won't impact the overall therapy that much. You might get lucky.

[archangle]

If you're concerned about the 3 AM gap, that spike in the flow rate looks like you may have turned the machine off and put it back on around then.

Actually, since you're using ramp, you should be able to look at the pressure graph. If the machine was turned off and back on, you should see the pressure ramp back up after the gap.

Do you have your machine set to auto start?

[TiredMominCanada]

Good point archangle! Yes it is set to autostart and yes the pressure ramps up at 3am, I guess I took my mask off and then put it back on 1/2 hour later!! I'm going to have to glue it to my head! I feel awful this morning again and my AHI was 6.6 last night. I will look at my graphs after work - this is frustrating!!

[Denial Dave]

what happened around 23:40?

I see a matching spike in leak rate & Resp rate...

My guess is that they are why there is a resultant increase in your AHI

[archangle]

Good point archangle! Yes it is set to autostart and yes the pressure ramps up at 3am, I guess I took my mask off and then put it back on 1/2 hour later!! I'm going to have to glue it to my head! I feel awful this morning again and my AHI was 6.6 last night. I will look at my graphs after work - this is frustrating!!

That's a warning sign that you were abducted by Pugsy's aliens.

[Pugsy]

Yep, my alien friends are working Canada at the moment. Thank goodness.