Help with air swallowing !

[Howie57]

I'm sure hoping for some help / advice.
I'm new to this therapy. Have only had my machine a week but have yet to get any sort of relief. Let alone the distress it is causing my wife. Here is my info.
I was diagnosed with severe apnea. I was told that I was have 60 episodes per hour.
I was prescribed a machine and mask.
i have a Remstar Plus set at 18.
My mask is an Ultra Mirage.
I have to where a chin strap.
Two real problems;
1. Horrible problems with air in stomach after as little as 2 hours. Wakes me up with pain and bloating.
2. Even with a chin strap cinched tight my lips still flap.
3. I am also having acid reflux that I have never had until I have been inflated like the Goodyear Blimp.

I would really like to know what I should do from here.
Should I go to Bipap or some other machine.
Thanks in advance
Howie

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, mirage

[Linda3032]

I would definitely complain to the doctor, and ask for a Respironics Bi-Pap Auto with Bi-flex.

https://www.cpap.com/productpage-advanced.php?PNum=2335

And here is some more info from Snoredog and Rested Gal. I'm sure they can chime in with more info.


Snoredog:

a bi-level machine is like a straight cpap machine but has 2 separate pressures for inhale and exhale instead of a single pressure found on cpap.

For example if you were titrated at 15cm on cpap. With a bi-pap you could have 15cm inhale pressure and 11cm exhale pressure, a 4cm span. Cflex and EPR generally have only a max. 3cm difference.

Bi-flex is a feature like Cflex which drops the pressure on exhale automatically, it is based upon your breathing pattern. In fact, the Cflex feature found on cpap machines was derived from the Bi-Flex feature on Bi-Level machines.

Bi-Flex = relief feature found on Respironics Bi-level machines.
C-Flex = relief feature found on Respironics CPAP machines.
EPR = relief feature found on Resmed machines, does not work in auto modes.

Respironics invented and owns the Patent to Bi-flex and C-flex features.

Bi-pap Auto: Same as a cpap autopap machine but it also has 2 separate pressures for inhale and exhale in addition to other settings for rise times etc..

Bi-paps are generally used at higher titration pressures to offer more relief on exhale than a cpap machine can offer with features like Cflex or EPR. Bi-paps also can go to much higher pressures such as 4-25cm, 4-30cm or higher (vs. 4cm to 20cm on most xpaps).




rested gal

Bi-level is a type of machine. You set one pressure (higher) for inhaling (the "IPAP" pressure) and a separate pressure (lower) for exhaling (the "EPAP" pressure.

Bi-Flex is not a type of machine. Bi-Flex is a comfort feature found in Respironics BiPAP (bi-level) machines.

Bi-Flex slightly reduces the beginning of the already lower "EPAP" pressure when you first begin to exhale each time. During the remainder of the exhalation, the regular EPAP pressure comes back in.

In other words, "Bi-Flex" in a Respironics bi-level machine acts much the same way "C-Flex" does in other types of Respironics machines. C-Flex is a comfort feature available in many of their straight cpaps and autopaps.

Either one, Bi-Flex or C-Flex, simply drops the start of each exhalation somewhat. Makes breathing out feel more comfortable for many people. Both Bi-Flex and C-Flex can be adjusted to "1, 2, or 3". A setting of "3" for Bi-Flex or C-Flex gives the most drop in pressure at the start of the exhalation. The "1, 2, 3" settings do not mean the pressure will drop that many cm's. The amount of drop Bi-Flex and C-Flex give to the start of an exhalation depends almost entirely on how forcefully a person breathes out. Both can be turned off if a person prefers not to use them.

Bi-Flex and C-Flex can be turned on only through the "setup" menu on a machine that has it. So, if the homecare provider did not turn that comfort feature on when they set up the machine that has one or the other bult into it, it won't be available.

"Bipap" is often used as a generic word referring to any manufacturers' bi-level machine, even though BiPAP is Respironics' trademark name for their bi-level machine. BiPAP with Bi-Flex is their bi-level machine with their "Bi-Flex" comfort feature in it.

My edit: oops...was typing and didn't see snoredog's response. He described it well!
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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, respironics, resmed, bipap, C-FLEX, cflex, Titration, CPAP, auto, AutoPAP Machine, Bi-Level Machine

[Linda3032]

And in the meantime, you might try:

1. Acid reflux medicine (like Zantac).

2. Turn the pressure down from 18. Maybe try 14 until you get a new machine. 14 is better than not using the machine at all.

3. Does your machine have C-flex? If it's new and you just got it, it should have c-flex. Try the cflex pressure at 3, or if you are using it at 3 already, turn it down some. Or even off. Sometimes cflex disrupts your regular exhale and causes air swallowing.

But definitely call your doctor on Monday. Very few of us have a pressure of 18 and use straight cpap (Tooley is the only one I can think of). Even an auto would be better, but not as good as a bi-pap.

[tomjax]

This question comes up about once a week and you have reason to be concerned.

It is not surprising at all that a pressure of 18 would cause your problems and the first question I would ask is how this pressure was determined and why an APAP would not be better.

I would expect absolutely no benefit from reflux meds of any Gas-X products such as mylanta because it is not metabolic gasses, but simply ingested air that the "GAS" products do not help.
Some may report that their condition improved greatly while taking these products but not BECAUSE they were taking them.

Most people with aerophagia find it to be self limiting, but at 18, it may be more difficult for you, hence the question about an APAP vs cpap.

[Carsonsmom]

I have been on therapy for a couple of months and had the same problem with my CPAP. They tried lowering my pressure but then I felt like a zombie in the morning. So now I am on a loaner APAP and the doctor is going to take readings off the card in it. I still swallow air but not nearly as bad as I did on the CPAP. Now we will see what the doctor says next week.

Good luck. It is awful pain. Gas X helps a little

[NightHawkeye]

Hi Howie,

Welcome to cpaptalk.

I'd like to reiterate what Linda said. Likely the best machine for you is the BiPAP-auto. The other thing you need to know is that it folks here had much better success getting the BiPAP-auto covered by insurance than they have getting automatic-CPAP machines. At your pressure, your physician shouldn't have any problem prescribing the BiPAP-auto for you.

The advantages the BiPAP-auto offers you that no other machine can offer are:
1) Automatic pressure control, so that a lower pressure will be used when possible. This alone will lower aerophagia for you.
2) The BiPAP function itself reduces aerophagia because of the lower pressure during the exhale cycle when aerophagia often occurs.

Taken together, you should experience significantly reduced aerophagia with the BiPAP-auto.

Good luck with your therapy, Howie, and don't be timid about calling your physician's office, describing your problem in excruciating detail to them, and then requesting, also in great detail, exactly how you would like them to specify a machine on your new prescription.

It's your therapy. Take charge of it. You don't want to become one of the 50+% who drop out from CPAP therapy.

Regards,
Bill

[Snoredog]

your pressure is way too high to be on straight cpap. Go back to your doctor and tell them to either put you on a bipap (as long as you don't have central apnea).

but the way insurance is, you have to first try and fail on regular cpap before they will pay for bipap. You have done that, I would request a auto-bipap.

[Snoredog]

This question comes up about once a week and you have reason to be concerned.

It is not surprising at all that a pressure of 18 would cause your problems and the first question I would ask is how this pressure was determined and why an APAP would not be better.

I would expect absolutely no benefit from reflux meds of any Gas-X products such as mylanta because it is not metabolic gasses, but simply ingested air that the "GAS" products do not help.
Some may report that their condition improved greatly while taking these products but not BECAUSE they were taking them.

Most people with aerophagia find it to be self limiting, but at 18, it may be more difficult for you, hence the question about an APAP vs cpap.

You'll love this one:

Licorice Root, works like a charm and only $8 for a bottle, not for long term use but H Pylori bacteria says seeya in the presence of it.

[sleepy hollow]

pressure in the first few nights is common. Often times docs will lower the pressure and slowly raise it up over time until you become use to it.

Auto may help in these situations.

Try wearing it during the day while awake in smalll sessions until you are use to it.

Bipsp may be more appropriate but requires and additional titraton or bilevel titration study.

Give it a few more nights then definately talk to the dr