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[grayghost4]

the machine is a 660 not an auto

[Wulfman...]

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Have you tried putting your machine on auto bipap and then tweak from there (particularly the exhale pressure)

I still think you'd do better sleeping on your side and incline your bed so the acids stay in your stomach. No eating after 6pm.

That would be impossible. He doesn't have an Auto Bi-PAP. It's a straight pressure Model 660.


Den

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[Wulfman...]

the machine is a 660 not an auto

Sorry, GG4. I didn't see your post (on this second page).


Den

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[Pugsy]

In your situation I don't think that a bipap that will auto adjust the pressures would be any huge advantage to you.
It might want to auto adjust to a higher pressure for a reason that is less worrisome than the higher pressures would cause gastric issues. Now it might also allow you to use a lower pressure for a good bit of the night and only increase perhaps briefly and thus lessen the chance for the gastric issues to be such a problem.
If your issues were related to REM sleep then that is where auto might be helpful but it appears the bulk of your issues are related to supine sleeping pressure needs. Even if you did have an auto adjusting machine you would still need to keep a tight rein on the pressures. In your situation I think that if you had an auto adjusting machine that you would have to keep it in such a tight range that you would be pretty much using fixed bilevel anyway. That's why I didn't bring up the auto adjusting thing for you and I am a big fan of auto adjusting machines.
Now if your pressure needs were related to REM stage sleep then yeah...bigger possible advantage but based on your snores that are pretty constant all night long...that's not REM because REM comes in cycles that are fairly easy to see when pressure is suboptimal.

[Pugsy]

Did the snores wake you up last night?
How was your overall sleep quality last night?
How bad is/was the gastric issue?

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[Pugsy]

You know if it were me and the gastric issues were a bigger problem than the snores then I would reduce the pressures (which would help the belly) and let the snores slide.
That's why I asked if the snores woke you up. Other than the snores your reports look really good and sometimes we have to make compromises in what we have to deal with. The pressures you need to deal with the snores cause significant gastric issues.
We try to find a pressure that won't cause gastric issues and not let too many apnea events happen.
You aren't having very many real apnea events at these pressures so in terms of apnea events (OAs and hyponeas) there is some wiggle room to reduce the pressure and not have a huge increase in OAs and hyponeas. Unfortunately the snores rear their ugly head but the snores (which are indications of the airway trying to collapse) aren't growing up to become full grown apneas so unless they are actually disturbing your sleep then maybe just compromise and allow them to happen in favor of reduced gastric issues.

It's not ideal but sometimes life doesn't give us ideal and it looks like you drew the short straw in that regard this time.
We simply don't have anymore room in the pressure settings to find something that will prevent the snores that doesn't cause gastric issues to be worse.
This is where we try to figure out which devil is worse and deal with that devil as best we can and maybe let the lessor devil slide a little. If the snores aren't disturbing sleep but the gastric issues are (along with daytime issues) then we deal with the worse devil and that would be the gastric issues.

If it were me I would reverse course and concentrate primarily on relieving the gastric issues first and not worry so much about ugly snores unless they started waking me up.

I would also talk with my doctor about why side sleeping makes it worse because that is not a common reaction at all...and this makes me wonder if something else is going on (like the hiatal hernia or LES issue).

When you were doing fixed pressures at what point did you have significant gastric relief and what did the snores and AHI look like at that point? Or have you never had significant gastric relief irregardless of the AHI and snores?

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[Pugsy]

How low did you go with fixed cpap pressure in your experiments?

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[Pugsy]

When you had the really high AHI nights what was the breakdown into event categories?
I am wondering if they were predominately Clear Airway and maybe elevated because of awake/semi awake stuff and not obstructive in nature.
Your high AHI nights are really not that common and actually more the fluke than anything else. Makes me wonder just what they were made of.