CPAP, weight loss, and magical symptom relief

[kem377306]

I have been on CPAP for a little over 2 years now. I had great results when I first started it and love it. However, I recently lost weight, which has coincidentally brought up some speculation from me. I am also having a lot of GI issues and a lot of nights cannot wear my CPAP mask because I have a lot of burping and the CPAP makes it worse/makes it so I can't get the burps out! I'm worried next time they read my results my insurance will stop paying because my compliance is probably pretty low right now because of that. Anyway. For the past 2 years, if I nap or sleep without my CPAP machine, I've always woken up with a sore throat that causes me to cough/wheeze when taking a full breath. It goes away within an hour or two of the sleep. Well, I realized 3 nights ago when I had to go without my CPAP all night that I woke up in the morning just dandy! I have been keeping an eye on it and have not been able to wear my mask the last 3 nights, and absolutely NO sore throat in the mornings! I'm wondering if maybe the weight loss has improved and/or gotten rid of the sleep apnea? I'm 5'4", and when I got my machine weighed about 206lbs, my highest was 240lbs about 1.5 years ago, and I've now maintained 190lbs for a week. It seems that this isn't a big enough change in weight, but I can't think of any other explanation...anyone have any thoughts? Should I be telling my doctor and having another study done? I was thinking the best way might be to wear the mask and check the data in the morning and see what the machine thinks...but I have nasal pillows and I know if I roll over the mask leaks some until I wake up and fix it, so I'm worried if I go that route the data might not be accurate...any help would be appreciated! Thanks!

[LSAT]

Losing weight and waking up without a sore throat does not mean your SA is cured. Have another sleep study...that's the only way to know for sure.

[RestedRebel]

I'm 5'4" tall, lost over 85 lbs. and still need my machine. My weight is in the same ballpark range yours is, so I have a feeling that you do need another sleep study to make sure you're cured. I have to admit that I'm skeptical, though. I do tend to roll on my back, and that's when I have my 'events.'

Don't risk going without your machine. It's not worth it.

[Woody]

You didn't post what type machine you had. So when you say look at the data are you talking about
just looking at the hours used or are you talking about downloading data to look at how many
apnias you had? I have a apap and found losing 45lbs did almost nothing for the presure I need.
A friend I have lost 80lbs and is no longer obese. Instead of helping her sleap apnia she now needs
more pressure, So you realy need some measurements to make shure your weight loss has helped.

[jweeks]

... when I got my machine weighed about 206lbs, my highest was 240lbs about 1.5 years ago, and I've now maintained 190lbs for a week.

Hi,

Congrats on losing the weight. Yes, weight loss can change your sleep disorder. With a 50 pound loss, consider talking to your doctor about doing a new sleep study. I have lost 165 lbs from my peak weight of 330 lbs. When I was in the 240 to 270 range, I had nasty issues with air getting into my stomach. It sounds like a silly issue, but it is extremely painful. In that weight range, I was in what I call a "zombie zone" where I lost enough weight that I was ingesting air, but hadn't lost enough to really back down on the CPAP pressure. Once I was under 230, my pressure needs dropped considerably. However, I still have to use the machine. In my case, my breathing issues are a structural thing that was made worse by weight, but it wasn't caused by weight. Losing weight helps make it much easier to live with, but for me, it wasn't a magical cure.

-john-

[Guest]

Thanks for all the replys! I sent my sleep doc a message. I had some trouble posting...I have an account, but I guess I wasn't logged in, so it asked me to input a user name when I posted. BUT, once posted, the side bar told me it was posted both as "Ivan101", and as my account, "kem377306"...so I thought that info would be visible...

I have the resmed S9 autoset. I use the Swift LT for her nasal pillow mask. I know how to look up the clinician's view of data on the machine, and I also have the resmed software on my computer, thanks to this site So I can look up my data pretty easily...but my doctor doesn't know I have access to these things...I doubt she would care, but I'd rather not find out!

John - Thanks for the info. I have a question for you...one of the reasons I've had to fore go the CPAP for 3 nights is because about 2.5 months ago I started having a major problem with air in my stomach that caused me to feel the need to burp a lot, however, a lot of times they didn't come out, and instead I felt like someone had their fingers in my neck choking me! I find it worse when I lay down, especially on my side. If I wear the CPAP, it just forces the air back down into my stomach and makes the pressure in my stomach, throat worse (plus I can't burp laying down). If I put on the CPAP, I need to sit up and take it off every few minutes and stay that way for a few minutes until the burp passes and the pressure gets lower. So, I just do without so that it doesn't take me 32-3 hours to get to a place where I can stay laying down long enough to pass out. It's been very frustrating. I had an upper endoscopy done (as well as a colonoscopy) a couple weeks ago and everything's normal. What exactly was your nasty issues with air getting into your stomach? I'd assume you mean only when the mask was on...but because of what's been happening to me, I just want to make sure that your nasty issues aren't like what I've been going through...

Thanks!

[mgaggie]

I had terrible aerophagia when I first started Cpap. I've had to be careful about my eating habits. For example, I find I can't eat too late in the evening, and certain foods will make me worse like ice cream (I can have it during the day, just not at night). Stress is also a factor for me, last night I was so wound up about something I kept swallowing air and my GERD played up.

If you feel a burp in your tummy and can't get it out, try pressing on your stomach quite hard. I find that works for me.

Good luck!

[purple]

I have found that the best things for my belching air was to go to a bi level machine (or as PR calls it, a BiPap) Just insurance, like Medicare, does not want to provide a bi-level machine, and makes up reasons why the should not.

[Ivan101]

hmmm...okay so now I'm doing research and talking with my doctor. She said to change the setting to 10 and see what happens (I confessed I knew how to mess with the settings and had the software) and she asked me to update her in 10 days. But I was looking at my machine's specs (ResMed S9 Autoset) and see it's an APAP machine...I checked and it's set on straight CPAP right now...do you think changing to APAP might help the burping?

[Pugsy]

But I was looking at my machine's specs (ResMed S9 Autoset) and see it's an APAP machine...I checked and it's set on straight CPAP right now...do you think changing to APAP might help the burping?

It might as long as you limit the maximum to a level where the aerophagia symptoms are hopefully reduced.
Also using EPR at 3 might help. It allows the machine to function sort of like a bilevel machine with pressure support of 3 cm.
You would need to find a pressure combination that lessens the chance of aerophagia but still did a decent job preventing the apnea events...maybe make a little compromise depending on where the line happens to be between bad aerophagia and not so great apnea prevention.

So in theory...using APAP mode the machine stays at a lower pressure most of the night and only increases when need to prevent the apnea events and hopefully when increased the aerophagia doesn't rear its ugly head.
Example...you are using 10 cm cpap mode now?? I don't remember if you are using EPR or not and if not you might try EPR at 3 to see if the aerophagia is reduced...
or another example...switch to apap mode...limit maximum to 10 cm and maybe use starting pressure of say 6 or 7 cm and see if the AHI stays acceptable and let the machine increase up to 10 cm only if needed instead of using 10 all night long. You can still use EPR in APAP mode to help reduce overall pressures used.
So in theory...using less pressure helps reduce the air getting into the stomach and digestive system.
Just have to cross your fingers that less pressure sometimes...doesn't mean a lot more apnea events all the time...if you know what I mean.

[jweeks]

What exactly was your nasty issues with air getting into your stomach? I'd assume you mean only when the mask was on...but because of what's been happening to me, I just want to make sure that your nasty issues aren't like what I've been going through...

Hi,

My prescription was BiPAP on pressures of 14 exhale, 20 inhale. When I was 330 lbs, that worked really, really good for me. When I started to lose weight, I got into a situation where I needed a pressure of at least 16 (on the inhale side) to get good sleep, but anything over 15 caused me to get air in my stomach. It was a choice...either turn it up and sleep good, but then wake up in pain every few hours, or turn it down and feel like a zombie the next day. I was on a really aggressive medically supervised diet at that time. I was losing about 10 lbs per month. The issue came on suddenly when I dropped to about 275 lbs, and it went away just as suddenly when I dropped to around 245 lbs. Thankfully, that was only about 90 days or so.

Even after the air ingestion issue went away, I still had trouble getting good sleep due to UARS. I would have nights where the machine would not record any sleep disorder events, but I would wake up feeling like I was a zombie. If I moved the pressure up, I'd sleep much, much better. However, I'd start getting pressure induced events, something that never happened when I was 330 lbs. This gradually went away over time. I'm not sure why. I might be that my body adapted to my new smaller size, or it might be due to a lot of exercise including a focus on upper body and abdominals, or it might be that I finally got lean enough for the skin to tighten a little more in my airway.

Net-net is that weight loss dramatically improved my OSA, but there were some challenges along the way with my CPAP treatment as my body was changing and my brain was adapting.

-john-

[hueyville]

I was having bloating of stomach, burping, etc at high pressures on cpap. Turned on cflex set at 3 then all was good.