Aerophagia is going to make me quit...

[Tallredrider]

Update: Since I figured out that my back sleeping is my main problem, I have had pretty good success with simply willing my way to not sleep on my back. I haven't had to resort to the old tennis ball in the back shirt pocket trick yet. My AHI has consistently been less than 5 as long as I keep off my back.

I still have some nights with Aerophagia. I have played with some settings on the machine and although it is an Airsense 10 that is capable of Bipap, I have found that I actually like the feel of CPAP better. I may play with it some more, but I like that CPAP fills my lungs fuller, even though I have turned the pressure down to just 5 cm H20. Even at the low pressure level, the AHI remains about 3 or so. Out of the blue, I wake up with the air in the stomach some mornings and can't seem to identify anything in the OSCAR data that is different from any other nights. So I am still happy to hear of any additional ideas to prevent aerophagia. I have the head of the bed elevated a little, I use a piece of tape over my lips, and a chin strap. All of that has helped a little, but lowering the pressure has helped the most.

Interestingly, my OSCAR data mostly shows hypopneas rather than apneas with CPAP of 5 cm. Last night I slept with the mask on for almost 6 hours, with 17 hypopneas and just one OA for an AHI of 3. Is that weird?

[Pugsy]

Hyponeas are just OAs that don't quite make the diagnostic criteria to earn the OA flag.

OA....air flow reduction of 80 to 100% that lasts for at least 10 seconds.

Hyponea....air flow reduction of 40 to 79% that lasts for at least 10 seconds.

[Tallredrider]

It has been a while since I have visited.

My aerophagia has gotten better, but mostly because I really dialed down the pressures. I am now at 4cm and 6cm. Interestingly, even very low pressures seem to be enough to keep me from having many apneas. I have also taped my mouth shut and wear a chin strap. I look sort of like Hannibal Lecter when going to bed.

I did have a small resurgence of it and reviewed much of the advice here and elsewhere and saw that folks suggested that nasal pillows might be better than the full face mask I was wearing. Now that I have my mouth 100% taped shut, and the chin strap, I decided to give it a try. The nasal pillows seem to work pretty well. I initially tried it with just a single piece of tape from nose to chin and my lips kept letting air out. But I now am all but duct taped shut and it works great with a full mouth taping.

I have noticed that my AHI as calculated by my machine is much improved with the nasal pillows compared to the full face mask. I typically get 1-3 AHI with the pillows and 3-5 with the face mask. I have a pulse oximeter that gives a full night reading and frankly don't see any difference between the two.

So the question number 1 for the gurus is whether the machine detects events better with the mask, or does it miss events happening with the pillows? I do not feel a difference in sleep quality, but have been pretty religiously wearing the pulse oximeter, and then occasionally switching masks. I always get higher AHI with the mask, but feel the same and have a pretty identical oximetry pattern.

Question 2: I am pretty sure the exhalation ports on the pillows are not as good as those on the mask. It just seems obvious when I wear them side by side sitting on the bed. Much of the nasal pillow exhaust goes right back into the tube. I have occasionally felt like I had to rip it off in the night and hyperventilate, which is not a lot of fun. I wonder if I am breathing my own air too much when that happens. I have the ResMed Airfit P10 nasal pillow system. I am happy to try another system, or maybe an over the nose system would work for me now that I have figured out how to put the concrete and rebar over my lips at night. Thoughts?

[jimbud]

1. whether the machine detects events better with the mask, or does it miss events happening with the pillows?

No. But some of us have noticed that it will take 1cm or 2cm more pressure with the full face masks vs the pillow masks to get the same AHI.

Question 2: I am pretty sure the exhalation ports on the pillows are not as good as those on the mask.

Both are engineered to work as designed. The P10 mesh vent has to be cleaned very well or it will get restricted/gummed up. I soak and wash in dawn soap then rinse, after that I hit the mesh vent with a
Water Pic to make sure it is completely cleaned out.

JPB

[Miss Emerita]

To Jimbud's advice about cleaning I would add that you should have a regular replacement schedule for the P10.

But I'm curious: why do you say the exhaled air goes back into the tube? It goes out into your room, right? And the air in the tube comes from the intake in your machine, right?

[Tallredrider]

To Jimbud's advice about cleaning I would add that you should have a regular replacement schedule for the P10.

But I'm curious: why do you say the exhaled air goes back into the tube? It goes out into your room, right? And the air in the tube comes from the intake in your machine, right?

When I put the nasal pillows on, disconnect the tubing, plug the tube and exhale, I find it pretty difficult to exhale through just the mesh only. I would die after 10 minutes if I only could exhale through the mesh. Some of the air has to be going back into the tube and machine. So I am convinced that I am recycling some of my exhaled air. Whether that really makes any difference, I am not sure, but wanted to draw on the collective wisdom of the group to see if that might be why I wake up gasping on occasion. Interestingly, my Oscar data showed nothing on the 1 time I am sure I captured it. I will be paying closer attention. My working theory is that I am getting an overload of CO2 when I feel that way, thus triggering a hyperventilatory response.

Doing this with my full face mask, I can exhale quite easily through the exhalation ports. I have cleaned the screen, but didn't scrub it. I also haven't been using it that long, so I really doubt that they are dirty.

[palerider]

To Jimbud's advice about cleaning I would add that you should have a regular replacement schedule for the P10.

But I'm curious: why do you say the exhaled air goes back into the tube? It goes out into your room, right? And the air in the tube comes from the intake in your machine, right?

When I put the nasal pillows on, disconnect the tubing, plug the tube and exhale, I find it pretty difficult to exhale through just the mesh only. I would die after 10 minutes if I only could exhale through the mesh. Some of the air has to be going back into the tube and machine. So I am convinced that I am recycling some of my exhaled air. Whether that really makes any difference, I am not sure, but wanted to draw on the collective wisdom of the group to see if that might be why I wake up gasping on occasion. Interestingly, my Oscar data showed nothing on the 1 time I am sure I captured it. I will be paying closer attention. My working theory is that I am getting an overload of CO2 when I feel that way, thus triggering a hyperventilatory response.

Doing this with my full face mask, I can exhale quite easily through the exhalation ports. I have cleaned the screen, but didn't scrub it. I also haven't been using it that long, so I really doubt that they are dirty.

There are several things at play here, first, when you're trying this with the FFM, the anti-asphyxiation vents are open, they open automatically when there isn't any pressure in the mask, so that you don't suffocate if the power goes out, you're supposed to be able to breathe easily with the machine off.

A nasal or pillow mask doesn't have AA vents, because you'll just naturally open your mouth if you can't breathe through your nose.

Now, as to trying to breathe through the P10 mesh, no, you can't do that, any more than you could breathe through the vent holes in your full face mask.

What happens under normal operation with the P10 is that it's constantly venting while in operation, from about 20liters of air per minute at a pressure of 4cm, to about 50lpm at a pressure of 20cm. The higher the mask pressure, the faster the P10 (or any mask) vents air.

Yes, some of the exhaled air *does* travel up the tube, but all of it is vented out before you take another breath, you can tell this yourself by putting your hand right next to the vent and feeling the temperature of the vented air, you can feel the air warm when you exhale, and then cool off between breaths, that's because the air you exhale is hotter than the air coming from the machine. I can easily feel the vented air getting warmer as I exhale and then cooling off before I inhale again.

If you're waking up gasping, it could very well be that you've got a buildup of CO2, but that happens because you're pressure is too low and you're having apneas, which cause CO2 to build up.

[chunkyfrog]

Just throwing this out there:
" . . . As a family doc, I considered sleep apnea, but I am not an overweight guy, and have a giant mouth, so didn't think it was likely. . . . "

This is more proof that wrong ideas can perpetuate all the way
into the minds of those who really should know better.
The Pickwick Papers should never be a reference for medical professionals.
People are dying because their doctors are clinging to 200 year old ideas.
You were courageous to reveal your profession.
Too many, like you, learn the truth only through personal experience.

[Tallredrider]

Well...I am still working on some things. For the most part, a full face mask, low pressures, taping my mouth shut, and learning to sleep on my side has cured my apnea and helped a ton with aerophagia. My Oscar data has been terrific.

I would prefer to grow a short beard and have done so lately. But my mask leak gets to be excessive when I do that. It also seems to contribute to an increase in apneas and a general sense of poor quality sleep as well.

Which brings me back to my nasal pillows. I have tried them a few times since my last post and still got the same results. It doesn't quite make sense why I would get gasping and feel short of breath with the same pressure on a mask with my mouth taped shut vs nasal pillows with my mouth taped shut. Would it be common to need higher pressures with nasal pillows vs a full face mask? I am thinking of giving it a go again. I also find the mask sometimes gets mashed against my face from the pillow, which can be uncomfortable. This doesn't happen with the nasal pillows. Any new ideas?

[SleepGeek]

This doesn't happen with the nasal pillows. Any new ideas?

You haven't given any details about the pillow size or pressure used?

I tend to think if using a smaller pillow that will reduce the volume of air you are getting esp. IF the pressure is low.

I always recommend when using pillows to start with the largest size first.