Correlation Mask Type and Pressure Settings and aerophagia

[SleepyDeb]

It will be one year this August I have been using apap fulltime. It has been a struggle - like with most of us our first year. There have been a few annoying issues during this time, but one in particular is aerophagia. When I was tested, a nose mask was used and I didn't have bloating the next morning. I later realized at home that I open my mouth in REM sleep (I wasn't in REM during the study hardly at all, and it's noted in the report). I switched to a full mask which is what I am using now -had to change from small to extra small - but other than that, that's what it has been - and it works so much better for me. The problem is that I then began to have extreme aerophagia problems. My recommended settings from the study were 5 - 15. Sleepyhead has shown that I stay around 13.9. Because the bloating has been so severe - along with sinus pressure - I have reduced the top number to 9 - over time - and use a 10 minute ramp at 6 (wasn't using ramp before). My events have been 1 or under at this reduced number - my events at the high number averaged about 1.5 to 2.5 - still very good, but with the bloating. The bloating has improved tremendously at the changed settings and I'm feeling pretty good. Here are my questions for you:

- Do you think the mask type (full vs nose) indicates a different setting should be used?
- I have a lung condition where scoliosis curves into the lung on one side slightly - I often think my lungs are just too small to handle such a high pressure - my doctor doesn't seem to have an answer to that
- Why would my auto settings have me at the highest pressure during the evening yet when I reduce the high setting my events are less; I don't have as much bloat; and I feel the same the next day?

Sorry for the long post, but I wanted to wait a while and see what happened with the changes I have made. Also, just want you to know that my doc seems to be a by-the-book type rather than individualizing to meet the needs of each patient. Thanks for any insight. I will also write another post on weight gain.

[Pugsy]

Sometimes there is a fine line in terms of pressures used where a person has the aerophagia symptoms and they don't.
Sometimes when apap/auto mode allows for a higher maximum pressure the machine will cross that line in an effort to prevent the airway from closing but maybe it doesn't need to go that high urgently.
If your AHI is low with the maximum pressure limited so that the machine can't cross that line...and you are sleeping decently and feeling decent during the day then I would think that is an acceptable compromise.

Sometimes the machine will want to use higher pressures to better prevent flow limitations which may not be all that critical to eliminate because they don't all grow up to be full blown 10 sec plus apneas.

I don't understand this question.

- Do you think the mask type (full vs nose) indicates a different setting should be used?

If you are talking about the mask type setting on your machine...you should use the correct choice....it's mainly for leak calculations and doesn't really affect delivered pressure at all.

[ChicagoGranny]

My events have been 1 or under at this reduced number

Since you have problems with aerophagia, you should use the lowest settings that keep your events low.

Since your AHI is very low at max pressure setting 9.0, you could lower it to 8.0 and see what happens. I would keep lowering it until the AHI goes up to an unacceptable level and then raise it back to the lowest setting that gives an acceptable AHI.

[SleepyDeb]

Pugsy - The mask question wasn't asked clearly. I was wondering if pressure settings would different based on a full face mask or nose mask. As I mentioned, the study had me using a nose mask that I later realized was completely wrong for me because of my mouth opening during REM. Just thought maybe if you're using a full face that the pressure settings should be lower.

Thanks to both of you for your replies.

[ChicagoGranny]

my mouth opening during REM. Just thought maybe if you're using a full face that the pressure settings should be lower.

I think the question is not relevant because if your mouth opens during REM while using a nasal interface, then you are probably losing the therapeutic pressure and having apneas.

Just an anecdote from my own experience while using a FFM. My pressure requirements are much higher when my mouth opens during sleep. So even though I use a FFM, I want to minimize the mouth openings while sleeping. What helps a great deal is a firm foam spinal collar. It prevents the jaw from dropping. I have less dry mouth, and SleepyHead shows the APAP pressure does not range so high.

I like the DMI Universal Firm Foam Cervical Collars -
http://www.walmart.com/search/?query=DM ... %20Collars

The firm works better and lasts longer than the soft. There seems to be no loss in comfort with the firm over the soft.

The cells in the foam break down over time. One lasts me about four months.

Typically the 3-inch width fits a smaller person, and the 3.5-inch fits a larger person. Some may need to change the size up or down on the second order.

Walmart ships free to your closest store for customer pickup.

[Pugsy]

Most of the time people using a nasal mask seem to need more pressure with a full face mask instead of less pressure...count your blessings if you can use less with a full face mask if that is what you are wanting to use.

[ChicagoGranny]

count your blessings if you can use less with a full face mask if that is what you are wanting to use.

Or to put it another way, don't look a gift horse in the mouth ...

... especially when he is in REM.

[SleepyDeb]

LOL. Thanks again...and I'll look into the cervical collar.