Aerophagia and sudden pressure ramps

[mehfisto]

About two weeks into therapy. Was tolerating okay last couple of weeks, but last two nights have been very rough. Kept waking up feeling like I was choking. When I'd look at the pressure, it had ramped up to 15-16. I had to reset the machine, and start back at 7 to fall back asleep. I kept feeling like I was swallowing air, had to burp, and kept waking up. Once I fell asleep on my side, it seemd to calm things down - I woke up on my back. I know I need to do something about that.

However, the last couple of days is when this has started. Lots of CA events, AHI > 10, when most of the last two weeks it's been < 7.

Appreciate any insight. I did set the max to 14 on the machine for now.

[zonker]

.

I kept feeling like I was swallowing air, had to burp, and kept waking up.

welcome to the zoo! aerophagia is a bear to deal with. i know, because i suffered from it myself a year or two ago when i was trying to raise my pressure to get my ahi down. i didn't expect it to happen, but there it was!

i can recommend lowering your pressure. yes, i said LOWER. others may add something more or even give some contrary advice. but imho, you aren't going to get anywhere with your therapy if you have to fight the aerophagia. it just isn't comfortable to deal with.

i would suggest you lower your minimum pressure to 6. see how that goes in fighting the aerophagia monster. if it goes well, raise that minimum pressure to 6.2. leave it there for a few nights. if that goes well, raise it by .2 and leave it for a couple of nights.

you see where i'm going here. it's a very long process and you may not have the patience for it. but it's what i did and i overcame the monster.

good luck!

[ozij]

I only had aerophagia (and very bad, at that) when my max pressure zoomed.
It seems to me - based on this single night that your obstructive + central clusters start when your pressure drops to the minimum, and then machine starts playing catchup and drives the pressure higher and higher.
That's the reason I would not drop the minimum.
I would actually try keeping the minimum a bit closer to the median to keep you from dropping to "Apnea inducing lows" and I'd try fixed pressure for a while to see if you can handle that without aerophagia and how that pressure affects your AHI.
I think you're doing right to cap the max at this point.

I wonder if the change from the first two weeks is because you're falling into deeper sleep, possibly dreaming, and therefore the minimum doesn't prevent as many events as it did.

[Miss Emerita]

Your obstructive apneas are mostly clustered. This suggests a postural problem. You mentioned back-sleeping, which may be part of it. Do try to stay on your sides. Another possibility is that you're sometimes tucking your chin down toward your chest, which can narrow your airway, making it easier for OAs to happen.

If you use several pillows, or a high pillow, try using a lower pillow. And many people get relief from OA clusters by using a soft cervical collar to keep the head and neck in the right position. More here:

http://www.apneaboard.com/wiki/index.ph ... cal_Collar

For now, I wouldn't worry too much about the CAs. They may represent "sleep/wake junk," and as you sleep better, with fewer disturbances, they are likely to abate. Also, once you can avoid the higher pressures by addressing the OAs, the CAs may fade away for that reason too.

[zonker]

I only had aerophagia (and very bad, at that) when my max pressure zoomed.
It seems to me - based on this single night that your obstructive + central clusters start when your pressure drops to the minimum, and then machine starts playing catchup and drives the pressure higher and higher.
That's the reason I would not drop the minimum.

yeah, i realized that i hadn't said anything about max pressure long after i'd posted that and was too lazy to go back and edited in anything.

good point.

[ozij]

For now, I wouldn't worry too much about the CAs. They may represent "sleep/wake junk," and as you sleep better, with fewer disturbances, they are likely to abate. Also, once you can avoid the higher pressures by addressing the OAs, the CAs may fade away for that reason too.

Agree!

[robysue1]

Aerophagia is a real bear to deal with: I know---for most of the first 2 or 3 years of PAPing, aerophagia was a constant threat to my sleep quality. Waking up with a hard stomach full of air that looks like you've swallowed a basketball is nobody's idea of fun. (You can read about my early encounters with aerophagia at viewtopic.php?f=1&t=55868&p=523291&hilit=goose#p523291

Since you say you can tolerate your min pressure of 7 just fine in terms of getting to sleep, I'd leave the min pressure along. But I'd reset that max pressure quite a bit lower. For the immediate future, I'd tolerate some less than ideal AHI numbers in favor of experimenting to find out the max pressure that does not trigger the aerophagia. I'd recommend starting lowering the max pressure down to something like 10 or 11 for a couple of days. See if that fixes the aerophagia. And then if the AHI is still acceptable, I'd leave the settings alone. If the AHI is too high with a max pressure of 10 or 11, try to increase the pressure slightly and leave at the new setting for at least a couple of days to see whether the aerophagia comes back and whether the AHI gets back to the range you want it to be.