Please help with settings

[WSLam]

I have been using my Dreamstation for a while now, but only recently did I discover OSCAR and started looking at the data.

Namely I have two issues:
1) Is the high Flow Limitation number an issue? If so, what can I do about it?
2) I have noticed that in the past few weeks, I woke up being completely bloated.... It appears that I am swallowing a LOT of air during the night, and when I wake up, I feel like a fully inflated balloon...Any suggestion what I can do about this?

Thank you in advance.

[Pugsy]

How are you sleeping and feeling other than the air in the belly issues? We call it aerophagia.
wiki/index.php/Aerophagia

The flow limitations aren't horrible and reducing their numbers would mean you would need to use more pressure which will likely make the aerophagia worse.

Can you post a detailed nightly data report in the format explained here.

viewtopic/t158560/How-to-post-images-for-review.html

We need to see the graphs to be able to try to figure out what we can change in the settings that might reduce your aerophagia symptoms and not cause your OSA AHI to increase.

[WSLam]

Thank you so much for your reply.
Here's the graphs. Thank you in advance:

[Pugsy]

How are you sleeping and feeling other than the air in the belly issues?

Please answer this question. It's important.

[Pugsy]

What position do you start off the night sleeping? Is it by chance on your side and you end up on your back?

The first third of the night your max IPAP was around 10 cm but the last 2/3 it was up around `14 and that's a recipe for the aerophagia monster to come calling. More pressure feeds the aerophagia monster. So we wonder what changed to cause such a rather dramatic increase in pressure needs. The 2 most common causes are supine sleeping or REM stage sleep. REM comes in cycles and isn't prolonged so I doubt REM related. That leaves supine sleeping as a probable cause.

Flow limitations can disrupt sleep so that is why I asked about sleep quality and how you feel. More pressure is needed to maybe deal with them.
Aerophagia also messes with how we feel so sometimes we have to make a compromise and accept maybe less than ideal.

Depending on sleeping position question answer....there's a 3rd potential factor that can affect pressure needs. Chin tuck. We sleep in a position where the chin gets tucked and essentially narrows the airway a bit. A lot of people opt to use a cervical collar to help with chin tuck issues. It keeps the jaw up and doesn't let it drop so the airway doesn't get narrowed.

For the aerophagia issues I would first try to keep the machine from wanting to go to 14 IPAP for 2/3 of the night. If the pressure will stay lower then there's a good chance that the aerophagia monster won't come calling.

The Flow Limitation issues...for now I would put on the back burner for now depending on the answers to the above questions and success or failure of dealing with the aerophagia issues.

[WSLam]

How are you sleeping and feeling other than the air in the belly issues?

Haha, sorry, forgot to reply.
I sleep quite well. I don't think my apnea was that bad to begin with, frankly, I use the machine mainly so my wife won't complain my snoring. I'd say the belching issue is what bothers me the most. If it means I have to sleep a little 'worse' as a tradeoff to having less belching, I would like to experiment.

[WSLam]

I am pretty much on my back the entire night. Even though I used to sleep on the side, I find that with the cpap mask, I end up lying on my back. I have never found myself waking up in any other position since I started using the CPAP machine.

[Pugsy]

Okay....lets target the belly problem. I don't normally have those issues but I have had them a few times and they aren't just annoying sometimes with the belching and farting.....they can make a person actually physically ill the next day with a lot of belly pain and nausea.

The prolonged IPAP of 14 is what I would try to limit first to see how much it might be a culprit in the belly issues.

What I suggest is limiting max IPAP to 12 and see what happens. No other changes just yet.
Will be monitoring AHI to see if changes much and keeping one eye on the FLs which are on the back burner for now.

Do you know how to get into the clinical menu setup area to change the max IPAP setting? If not you can go here and request the clinical/provider manual which explains the secret button pushing combination to get into the clinical menu set up area and make that change. You can request it via email attachment. Instructions are down about 2/3 down the page.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

There is also a shortened version that explains how with a video...you can watch it if you want to but I do strongly urge everyone get the provider manual and read it because there is a lot of good information in it that isn't in the user manual.
https://www.apneaboard.com/dreamstation ... structions

So limit IPAP max to 12 tonight and report back tomorrow how things went. I have other thoughts as well but prefer to make one change at a time so we can best gauge the results.

[WSLam]

Thank you so much.
Here's the graphs for setting IPAP Max to 12. AHI is now higher... I assume that is bad?

[Pugsy]

I expected the AHI to be worse but actually it's not as bad as I expected. Ths is actually within what we might expect a normal nightly variation to be. This isn't alarming to me at all right now.
You didn't even hit 12 cm last night. You hit 11 cm briefly and that's as high as it went. Reducing IPAP didn't cause the AHI to go up....the machine simply didn't want to go higher.

My main goal at the moment...get your aerophagia issues gone and hopefully not cause the AHI to go way up..

How did you sleep? How do you feel? How's the aerophagia? .....I always need to know this information as well as the numbers and pretty graphs. The numbers are just part of a very big picture.
You didn't even hit 12 IPAP last night...so it's really important to know if the 11 you did hit very briefly caused a stomach issue or not.

[WSLam]

Thank you again Pugsy,

I definitely woke up with less aerophagia this morning, but I did feel that I woke up several times during the night. (but could be because of other factors). I will try another night with the IPAP Max at 12 and look at the data again tomorrow.

So am I right to understand that the higher the iPAP Max, the higher the chance of aerophagia, but the lower the iPap Max, the higher the chance of a higher AHI number?

[Pugsy]

So am I right to understand that the higher the iPAP Max, the higher the chance of aerophagia, but the lower the iPap Max, the higher the chance of a higher AHI number?

IPAP max doesn't mean much at all UNLESS you actually go to the IPAP max.
You didn't even go to 12 on this most recent report and you wouldn't have no matter what the IPAP max was set at. You could have had it set at 25 IPAP max last night but the machine simply didn't want to go any higher than it did.

So lowering the IPAP max really didn't tell us anything since you didn't hit it.

You had less aerophagia because for some reason whatever it was that was causing your machine to go to 14 IPAP for 2/3 of a night the night before didn't happen last night and the machine barely made it to 11 and that was for a test pressure probe.
Overall you simply spent less time at a much lower pressure because that's all that was needed and it wasn't related at all to the change in max IPAP. Something physically happened so you didn't need as much pressure.
Since you say you almost always sleep on your back and I assume you didn't spend all night on your side...makes me kinda scratch my head as to why you didn't need the higher pressures that you needed the night before. Something changed but I don't know what.
Maybe chin tuck is more of a factor than we realize.

Your AHI increase...statistically unimportant and not related to pressure. The bulk of the increase was central/CA and those aren't pressure related anyway.
IPAP max being lowered won't cause a higher OA/hyponea count unless the machine maxes out and really wants to go higher and can't go higher.
EPAP minimum is actually the better choice for dealing with too many OAs/hyponeas than IPAP max might be.

[Pugsy]

Now....the fact you didn't go higher than 11 cm (and that was really a brief test pressure probe) and you don't have aerophagia issues means that we are on the right track in terms of figuring out whether IPAP or EPAP is the trigger for your aerophagia issues.
It's a good thing because we can't really drop EPAP to try to resolve potential aerophagia issues plus dropping EPAP (if we could) would likely create OA/hyponea increases more than we want. In auto mode your minimum EPAP won't go below 4 as a setting choice.

I still don't know where the IPAP line in the sand is for triggering your aerophagia issues. What I was looking to see was a prolonged period of time at IPAP 12 max and then a report on aerophagia or not. It didn't happen...you never hit 12.

So continue with the IPAP max of 12 setting for now. Lets see what tonight holds.

Since you report that you don't think you feel like you slept well last night I am betting a good chunk of that AHI is going to be false positive flagged events anyway. Awake/arousal breathing irregularities getting flagged by mistake because the machine only measures air flow and can't know sleep status. Awake/arousal breathing is very irregular when compared to asleep breathing and often results in a higher AHI that means nothing more than a crappy night's sleep because we didn't sleep well and it not related to sleep apnea at all.

Finally...we don't sleep the same each night and AHI numbers are going to vary a lot even with good solid sleep. Heck...it can vary hour to hour so don't get all in a panic when you see a rather remarkable change one way or the other. It's a normal variation.
A change from 1 to 2...meaningless....a change from 1 to say 5...we take notice of and do further investigation when we see it in a developing pattern. We DON'T go making big changes based on one night anyway.

Remember...numbers are just numbers and a part of a big picture and we can't target numbers alone for evaluation of anything because there are so many things that can skew the numbers.

[WSLam]

Hu Pugsy, here is the chart from last night:


So how did I feel? I was quite tired, but also note because I only slept for 5 hours. It's always difficult to gauge how much of it is because of my inherent messed up sleeping habit, or because of non-optimized settings. Do let me know what you see in the chart. I am still trying to learn how to read the data.

Thanks again.

[Pugsy]

How's the belly issue? This pressure experiment is to try to determine pressures that cause belly issues or not.

Am I understanding correctly....you slept poorly during the 5 hours? Wake often, toss and turn a lot?