can't find my fixed pressure, varied results (positional?)

[tempuser]

After watching lankylefty27's videos, I find myself here. I have had set my machine to 4-20 too long. had incredible painful aerophagia when I could sleep for even 1-2 hours with it. Got myself a mandibular advancement device, it reduced snoring but that's about it regarding daytime sleepiness. anyways after watching lanky's videos, I first narrowed pressure range, then tried on a different fixed pressures with EPR level 1 or 0. By the way I am using resmed autoset 10 with f20 mask because of mouthbreathing. and I have used my mandibular device with cpap for not being able to tolerate high pressures since starting pressure adjustments.

I have one sleep session with 9 pressure with 1 EPR and the result is perfect; see screenshot_16. I'm guessing for this whole session my position was perfect, because today I Increased the pressure by 1, and the results are worse; screenshot_21

I am thinking of getting MMA surgery in future but I still want to be treated with CPAP before getting to that point. I am trying sleeping with a full backpack to try to sleep on side.

I also want to share with a wide pressure range results for you just incase it might be a help; screenshot_22

https://ibb.co/album/N2pd41

[Miss Emerita]

Welcome! Unfortunately the web site is at capacity for attachments. Could you post yours by using a hosting service like Imgur and providing links? We'd love to do what we can to help once we can view your charts.

[tempuser]

https://ibb.co/album/N2pd41

these are the pictures. I can go zoom in any place as needed. thank you in advance.

[robysue1]

After watching lankylefty27's videos, I find myself here. I have had set my machine to 4-20 too long. had incredible painful aerophagia when I could sleep for even 1-2 hours with it.

I need some clarification: Did you get the incredible painful aerophagia when the machine was set at 4-20? Or did you get the painful aerophagia after you started trying different fixed pressures?

The data you posted to ibb includes two days with total usage of about 2.5 hours and one day where the usage is listed as 11.5 hours with that usage apparently broken across one or more afternoon naps (between 12:00pm and 15:30, an evening nap (or an unsuccessful attempt at going to bed early) between 20:30 and 22:00, and the main sleep for the "night" between 5:30 and 12:00noon. And you've highlighted the 7 hour main set of night-time sleep between 5:30 and 12:00noon.

So my next question is: What does your sleep schedule look like?

From the small sample of data you've posted, it appears that you don't have a very consistent sleep schedule in terms of either when you are getting to bed or how long you are sleeping with the CPAP.

And an inconsistent sleep schedule with multiple days where usage is only about 2.5 hours would easily explain continued problems with daytime sleepiness: CPAP works best when you use the mask all night, every night. And typically humans get better quality sleep when there is some consistency in both bedtime/wake up times AND the total sleep for the night. (And that's true even for folks without sleep apnea problems.) A typical adult human also needs somewhere between 6 and 9 hours of sleep every day, with most people needing somewhere around 7-8 hours to feel their best.

Now not everybody can establish a consistent sleep schedule because of other constraints in their lives, such as shift work and taking care of infants and small children. But unless there's a reason for why you are sleeping so little (with the machine) on some nights and so much on other nights, that's an issue that needs to be addressed.

And if incredible painful aerophagia is still an issue even after experimenting with LankyLeft's suggestions, then we need to know that. (And don't give up hope: I had extremely incredible painful aerophagia for the first 6 months of PAPing which left me miserable and exhausted and sleepy in the daytime and miserable and unable to sleep during the nighttime. With a lot of help from cpaptalk and my husband I was able to work through my issues and eventually started sleeping well with my machine.)

anyways after watching lanky's videos, I first narrowed pressure range, then tried on a different fixed pressures with EPR level 1 or 0. By the way I am using resmed autoset 10 with f20 mask because of mouthbreathing. and I have used my mandibular device with cpap for not being able to tolerate high pressures since starting pressure adjustments.

More questions designed to help us help you:

1) Does sleeping with the mandibular advancement device (MAD) allow you to reduce the pressure enough to take the edge off the aerophagia? (It should, but you didn't tell us whether any of the posted data was with or without the MAD in place.)

2) Is the MAD genuinely comfortable? In other words, when the MAD is in your mouth are you comfortable enough to get to sleep in a timely fashion?

3) Has either narrowing the pressure range or using any of the different fixed pressures taken an edge off of the aerophagia?

4) Have you ever tried EPR = 2 or 3? If so, is the aerophagia better, worse, or about the same depending on the EPR setting?

I have one sleep session with 9 pressure with 1 EPR and the result is perfect; see screenshot_16.

That would be this shot, wouldn't it:

Yes, the AHI data, the leak data, the flow limitation data is all "great" here. But, and this is a BIG BUT, you only used the machine for just under 2.5 hours.

Nobody wakes up feeling refreshed and rested after 2.5 hours of sleep for a whole night, no matter how great the sleep was. Now, if this was just a "morning nap" because you had a lousy nigh sleep (without the CPAP?) the night before, then this nap probably did help you through the rest of the day.

But the point is: You can't really draw meaningful conclusions about what settings will optimize your CPAP therapy based on one 2.5 hour morning nap.

I'm guessing for this whole session my position was perfect, because today I Increased the pressure by 1, and the results are worse; screenshot_21

Here's the next set of data when you used a fixed pressure of 10 cm:

The leaks look worse than they actually are: Your 95% leak rate is 3.6 L/min. That means for 95% of the whole day's data, your leaks were at or BELOW 3.6 L/min, which is well under Resmed's definition of large leak (24 L/min), and you have a median leak rate of 0.0 L/min, which means that for at least 50% of the night, you had no detectable excess leaking going on.

Objectively the AHI is a lot higher, but the reason it's higher is that this data includes a whole bunch of CAs, and many of those CAs look (at this level of zooming) to be part of sleep-wake-junk OR post arousal CAs. In either case, that means many of those CAs are not real events that would have been scored on an in-lab sleep test.

Rather, those CAs point to this being a very restless set of sleep. So the question then becomes: Why? Why were you having trouble getting to sleep and staying asleep? Why were you apparently doing a lot of tossing and turning?

Some possible answers:

1) More aerophagia problems?

2) Stress going on in your life that is not directly related to CPAP and worrying about the quality of your sleep?

3) Stress that is directly related to CPAP and worrying about the quality of your sleep?

4) Discomfort in bed caused by the MAD? the CPAP itself? Or that full backpack you were wearing to try to force yourself to sleep on your side?

5) A bedroom that is too cold or too hot to sleep comfortably? A bedroom with too much light coming in through the windows since the time stamp on the period you posted is from 5:30 AM to Noon?


Finally you write:

I am trying sleeping with a full backpack to try to sleep on side.

The full backpack may be creating far more problems than you think it is creating.

Yes, sleep apnea can be worse when folks sleep on their backs. Yes, some people's apnea is quite positional and the AHI is substantially higher when they are sleeping on their back. But if an APAP/CPAP is set up correctly, a person should be able to sleep comfortably in any position, including on their back, and the APAP/CPAP will still prevent the vast majority of obstructive events from occurring.

The goal of PAP therapy is to sleep well with the machine all night long, every night. And to sleep well means sleeping in a position that is comfortable for you. If you have a strong preference for sleeping on your back and you have to resort to wearing a full backpack in order to encourage yourself to stay off your back, that's a pretty good sign that for your body, sleeping on your side is not particularly comfortable.

So in my opinion, the things you need to focus on are: What measures will help prevent the aerophagia when you are using the pressures you need to control your apnea when you are sleeping in your favorite, most comfortable position---even if that favorite position is on your back.

[tempuser]

Thank you so much for your time and such detailed response. I am sorry for not being clear enough.

1- Aerophagia was a problem before I started using MAD.
2- All the data I uploaded was with MAD on my mouth. I have no discomfort with MAD while sleeping. I use it, because without MAD, I was having severe aerophagia problems with 4-20 range or even with max 11 pressure. And MAD also helps with leaks because I can not retract my jaw to completely open it.
3-Aerophagia was not reduced and woke me up like crazy/crippled me in the morning even with EPR(3).
4- sleep schedule is normally 01:00 AM to 08:30/09:30 AM, the reason for short usage times is that the only data with fixed pressure(cpap) I have right now is the recent holidays where sleep schedule was a little messed up. And I tried to use the mask whenever I can to find out a good fixed pressure.


But from your response I realized I need longer experimental hours with the fixed pressures to adjust a good pressure. Which I will try to achieve.

Here's the next set of data when you used a fixed pressure of 10 cm:

The leaks look worse than they actually are: Your 95% leak rate is 3.6 L/min. That means for 95% of the whole day's data, your leaks were at or BELOW 3.6 L/min, which is well under Resmed's definition of large leak (24 L/min), and you have a median leak rate of 0.0 L/min, which means that for at least 50% of the night, you had no detectable excess leaking going on.

Objectively the AHI is a lot higher, but the reason it's higher is that this data includes a whole bunch of CAs, and many of those CAs look (at this level of zooming) to be part of sleep-wake-junk OR post arousal CAs. In either case, that means many of those CAs are not real events that would have been scored on an in-lab sleep test.

Rather, those CAs point to this being a very restless set of sleep. So the question then becomes: Why? Why were you having trouble getting to sleep and staying asleep? Why were you apparently doing a lot of tossing and turning?

for this part of your response I uploaded couple of "CAs" that the machine flagged. almost all of those CAs are like the ones I uploaded here: https://ibb.co/album/ZLtyYc are these Obstructive or central, I do not understand. this session was almost 7 hour usage.

I will also ditch the backpack in my future trials and let myself find a pressure that covers all sleeping positions.

And yes, I am worrying and stressing about the quality of my sleep and sleep apnea in general too much because it's been wrecking my life for years and the stress cumilatively added-up so much that I can't stop thinking about fixing it or thinking about it many times during daytime. 4 months ago I returned from my mandatory military service and it was hell. Got in a sleep test, got ahi score of 78, oxygen percentage dropped below 70. lost 20 pounds, got my turbinates reduced, got a MAD devices. basically I am pushing all the buttons to have a good nights sleep none of those worked by itself, so I am back to my cpap trying to achieve success.

Again, thank you so much for your time and effort.

[Pugsy]

Why are you wanting to use a fixed pressure as opposed to auto adjusting pressure?

3 of the 4 zoomed in central flags you just posted look to be more arousal related...I would be looking to try to figure out why so many arousals if it were me.

Do you take any medications of any kind? If so, what?
Any other physical or mental health issues going on?

[robysue1]

First, I agree with Pugsy about those close-ups of the CAs: Three of the four are clear post-arousal events and the fourth one might be.

Thank you so much for your time and such detailed response. I am sorry for not being clear enough.

1- Aerophagia was a problem before I started using MAD.
2- All the data I uploaded was with MAD on my mouth. I have no discomfort with MAD while sleeping. I use it, because without MAD, I was having severe aerophagia problems with 4-20 range or even with max 11 pressure. And MAD also helps with leaks because I can not retract my jaw to completely open it.

So we can probably rule out the MAD as the cause for the arousals.

3-Aerophagia was not reduced and woke me up like crazy/crippled me in the morning even with EPR(3).

And this points to aerophagia as a likely cause for the arousals. More on this in a bit in a separate post.

4- sleep schedule is normally 01:00 AM to 08:30/09:30 AM, the reason for short usage times is that the only data with fixed pressure(cpap) I have right now is the recent holidays where sleep schedule was a little messed up. And I tried to use the mask whenever I can to find out a good fixed pressure.

I think what your experiment showed is that you're going to need to be sleeping during your normal sleep time with the mask on all night long (as painful as this sounds) before you will have the data you need to figure out what pressure(s) are a good compromise between treating the OSA (in terms of AHI) and not triggering the aerophagia so that you can actually sleep well with the mask on your face.

And that's going to require a bit of patience.

I will also ditch the backpack in my future trials and let myself find a pressure that covers all sleeping positions.

I personally think ditching the backpack is a good idea: You don't need to be adding something that is designed to create discomfort while you are asleep. And that's the whole idea behind putting something on your back while sleeping---the hope is you'll be uncomfortable enough when you are sleeping on your back that you'll arouse enough to change position.

And yes, I am worrying and stressing about the quality of my sleep and sleep apnea in general too much because it's been wrecking my life for years and the stress cumilatively added-up so much that I can't stop thinking about fixing it or thinking about it many times during daytime.

The problem with worrying and stressing and obsessing about the quality of your sleep all the time is that all that stuff often makes the sleep quality get worse instead of better. Now, I'm not saying you shouldn't be worried about bad sleep or you shouldn't work on fixing bad sleep. Fixing bad sleep is important, but it takes time and patience, and while you are working on fixing the sleep problems, it's important to allow yourself to let go of the worrying and stressing about the bad sleep. More on this by itself in a bit in a separate post.

4 months ago I returned from my mandatory military service and it was hell. Got in a sleep test, got ahi score of 78, oxygen percentage dropped below 70. lost 20 pounds, got my turbinates reduced, got a MAD devices. basically I am pushing all the buttons to have a good nights sleep none of those worked by itself, so I am back to my cpap trying to achieve success.

Yes, you're "pushing the buttons", but there is far more to getting a good night's sleep than just pushing the buttons.

My guess is that with an AHI = 78 and O2 desats down to 70 on your diagnostic sleep test, the critical step in getting to high quality sleep is learning how to sleep well with the CPAP. And learning how to sleep well with the CPAP means mastering the aerophagia in your case. There's good reason to hope that when you get the aerophagia under control, your body will start sleeping better while using the CPAP. But you will need to be patient: CPAP is not an instant fix for bad sleep, and if there is anything at all other than OSA that is adding to the bad sleep problems, those other issues have to be fixed as well before the sleep quality will improve: CPAP fixes OSA, but it doesn't automatically fix sleep problems not caused by OSA.

More targeted information to come in following posts.

[tempuser]

First, I agree with Pugsy about those close-ups of the CAs: Three of the four are clear post-arousal events and the fourth one might be.

Thank you so much for your time and such detailed response. I am sorry for not being clear enough.

1- Aerophagia was a problem before I started using MAD.
2- All the data I uploaded was with MAD on my mouth. I have no discomfort with MAD while sleeping. I use it, because without MAD, I was having severe aerophagia problems with 4-20 range or even with max 11 pressure. And MAD also helps with leaks because I can not retract my jaw to completely open it.

So we can probably rule out the MAD as the cause for the arousals.

3-Aerophagia was not reduced and woke me up like crazy/crippled me in the morning even with EPR(3).

And this points to aerophagia as a likely cause for the arousals. More on this in a bit in a separate post.

4- sleep schedule is normally 01:00 AM to 08:30/09:30 AM, the reason for short usage times is that the only data with fixed pressure(cpap) I have right now is the recent holidays where sleep schedule was a little messed up. And I tried to use the mask whenever I can to find out a good fixed pressure.

I think what your experiment showed is that you're going to need to be sleeping during your normal sleep time with the mask on all night long (as painful as this sounds) before you will have the data you need to figure out what pressure(s) are a good compromise between treating the OSA (in terms of AHI) and not triggering the aerophagia so that you can actually sleep well with the mask on your face.

And that's going to require a bit of patience.

I will also ditch the backpack in my future trials and let myself find a pressure that covers all sleeping positions.

I personally think ditching the backpack is a good idea: You don't need to be adding something that is designed to create discomfort while you are asleep. And that's the whole idea behind putting something on your back while sleeping---the hope is you'll be uncomfortable enough when you are sleeping on your back that you'll arouse enough to change position.

And yes, I am worrying and stressing about the quality of my sleep and sleep apnea in general too much because it's been wrecking my life for years and the stress cumilatively added-up so much that I can't stop thinking about fixing it or thinking about it many times during daytime.

The problem with worrying and stressing and obsessing about the quality of your sleep all the time is that all that stuff often makes the sleep quality get worse instead of better. Now, I'm not saying you shouldn't be worried about bad sleep or you shouldn't work on fixing bad sleep. Fixing bad sleep is important, but it takes time and patience, and while you are working on fixing the sleep problems, it's important to allow yourself to let go of the worrying and stressing about the bad sleep. More on this by itself in a bit in a separate post.

4 months ago I returned from my mandatory military service and it was hell. Got in a sleep test, got ahi score of 78, oxygen percentage dropped below 70. lost 20 pounds, got my turbinates reduced, got a MAD devices. basically I am pushing all the buttons to have a good nights sleep none of those worked by itself, so I am back to my cpap trying to achieve success.

Yes, you're "pushing the buttons", but there is far more to getting a good night's sleep than just pushing the buttons.

My guess is that with an AHI = 78 and O2 desats down to 70 on your diagnostic sleep test, the critical step in getting to high quality sleep is learning how to sleep well with the CPAP. And learning how to sleep well with the CPAP means mastering the aerophagia in your case. There's good reason to hope that when you get the aerophagia under control, your body will start sleeping better while using the CPAP. But you will need to be patient: CPAP is not an instant fix for bad sleep, and if there is anything at all other than OSA that is adding to the bad sleep problems, those other issues have to be fixed as well before the sleep quality will improve: CPAP fixes OSA, but it doesn't automatically fix sleep problems not caused by OSA.

More targeted information to come in following posts.

Why are you wanting to use a fixed pressure as opposed to auto adjusting pressure?

3 of the 4 zoomed in central flags you just posted look to be more arousal related...I would be looking to try to figure out why so many arousals if it were me.

Do you take any medications of any kind? If so, what?
Any other physical or mental health issues going on?

Now that I learn a little bit about arousals, could it be that salivia buildup with MAD be causing arousals during sleep? To pugsy: I try to fix pressure because videos from TheLankyLefty27 talked about how apap should be used to find yourself a fixed pressure, and the algorithm doesn't work well enough to set a proper range.

Tonight I will remove the MAD tighten the mask to prevent any leaks and up the pressure along with EPR(lvl 2).

[Pugsy]

To pugsy: I try to fix pressure because videos from TheLankyLefty27 talked about how apap should be used to find yourself a fixed pressure, and the algorithm doesn't work well enough to set a proper range.

Well.....while I respect Jason's (LankyLefty) opinion I don't agree with it and I am far from the only one.

That auto adjusting algorithm works really well for a lot of people (myself included) as long as the minimum is set optimally.
It works especially well for people whose pressure needs change significantly with either sleeping position or even REM stage sleep.

My OSA is 5 times worse when I am in REM stage sleep and I might need 6 to 8 cm more pressure just during REM.
REM makes up about 20% of the night. I don't want to have to use 6 to 8 cm MORE pressure all night just to deal with that 20% of the night I might need more pressure. It would mean using 15 cm or more all night long when the other 80 % of the night I might only need 8 to 10 cm pressure. You tell me how much fun you think 15 or more all night would be?????

Figure out the arousal causing issues first and THEN you have solid sleep data to evaluate in terms of pressure needs.
Used fix or auto adjusting...your choice...just understand how it all works and what to expect.
Also understand that while Jason is a nice guy....he doesn't walk on water. What he says is not always the gospel.
He's not a fan of EPR and auto adjusting algorithms but that doesn't mean that they are necessarily bad for everyone...some people maybe but not everyone.

Work on your sleep quality issues because if you aren't asleep it messes up the data and without sleep none of this stuff matters much.

[robysue1]

After watching lankylefty27's videos, I find myself here. I have had set my machine to 4-20 too long. had incredible painful aerophagia when I could sleep for even 1-2 hours with it. Got myself a mandibular advancement device, it reduced snoring but that's about it regarding daytime sleepiness. anyways after watching lanky's videos, I first narrowed pressure range, then tried on a different fixed pressures with EPR level 1 or 0. By the way I am using resmed autoset 10 with f20 mask because of mouthbreathing. and I have used my mandibular device with cpap for not being able to tolerate high pressures since starting pressure adjustments.

and

1- Aerophagia was a problem before I started using MAD.
...
3-Aerophagia was not reduced and woke me up like crazy/crippled me in the morning even with EPR(3).

So aerophagia is the big issue: It's caused problems right from the start and adding the MAD and narrowing the pressure range and attempting to switch to fixed pressure and setting EPR = 3 have NOT helped the problem.

So before we start talking about what things to try in effort to fix the aerophagia, I want to give you some idea of what is likely happening.

Aerophagia is caused by air getting into the stomach, often by swallowing. And preventing it really requires preventing the air from reaching the stomach. Now several things can lead to air getting into your stomach when you are asleep, particularly with a CPAP:

1) Air getting trapped in your mouth. This often happens when the tongue moves out of position and your mouth is closed, and once the air is trapped in the mouth, swallowing is a natural reflex to get rid of the air. The natural resting position of the tongue should be touching the roof of your mouth with the tip touching the gum line near the upper front incisors. When the tongue is in this position, it effectively isolates the oral cavity from the nasal cavity and the upper airway. Training the tongue to stay in position can sometimes be done by paying attention to where the tongue is when you are awake and not talking and not eating/drinking anything.

2) Higher pressures (either EPAP or IPAP) can cause some people's tongues to move out of position. Higher pressure can also create a situation where the valve to the stomach is more prone to opening, which also allows air to get down into the stomach.

3) Gerd issues. Gerd can weaken the sphincters at both ends of the esophagus. Add a bit of pressurized air from the CPAP, and air can get into the stomach. Getting the gerd under control can help with controlling the aerophagia. And even if you don't have gerd issues, many self-help gerd tips can help with aerophagia.

4) Even if you don't have full-fledged gerd issues, digestive issues in general can lead to aerophagia issues. In other words, it's important to not eat too close to bedtime and it's important to not eat foods that trigger indigestion when you're trying to control aerophagia. Limiting caffeine and alcohol near bedtime is also useful.

5) During an arousal it's common to do a simple swallow, but with the CPAP, that simple swallow can lead to swallowing air. And this can set up a really bad feedback loop: More arousals lead to more aerophagia which leads to more arousals which leads to more aerophagia which .... And then you wake up at some point feeling like you've swallowed a basketball and your stomach is rock hard. And it doesn't really matter what caused the original arousal (or the original bit of aerophagia), once the feedback loop starts, the fix is to find a way to break the feedback loop. Now the CPAP data you posted seems to point to a probable problem with arousals. So the possibility of a feedback loop between arousals and aerophagia is very real concern.

Now different people with aerophagia problems can have very different responses in terms of pressure settings of the machine. A few people have a pretty clear "cutoff" line---if the pressure is often above n cm, they get aerophagia, but if the 95% pressure is below n cm, they don't get aerophagia. For other people, its more subtle---i.e. aerophagia may be worse at higher pressures, but even at lower pressures, some air gets into the stomach, and in this case minimizing arousals can be critical.

So where do you start in trying to rein in the aerophagia?

I would do the following:

1) Work on identifying a pressure range where the pressures are usually low enough to not cause severe problems, but also allow the machine to increase pressure when needed to deal with the OSA. (Yes, this means using APAP, and like Pugsy, I disagree with TheLankyLeft's dim view of APAP and EPR.) Note, however, that this does not mean using APAP wide open with a range of 4-20. What range you should start with really depends on what the APAP data said about both your AHI and your median, average, and 95% pressure levels. And it also means taking into account how much aerophagia you had. The little bit of data that you've given us for fixed pressure at 9 and 10 cm is just not enough to base a guess on. Much more on this later.

2) Read through some on-line gerd self-help guidelines and start implementing some of them. In particular, make sure there are several hours between supper and bedtime, and don't eat things that trigger stomach problems for supper. Eliminate caffeine and alcohol if possible for a while.

3) Keep a sleep log for the next month where you note the following things:

• Bedtime
• Time out of bed.
• Estimate of how long it took you to get to sleep. Do NOT rely on a clock to figure this out.
• Estimate of how many wakes you remember. Do NOT try to remember the wakes. When you wake up in the night, the point is NOT to remember the wake, the point is to get back to sleep as fast as possible. In the middle of the night when you wake up for no apparent cause, assume it's a normal post-REM wake and allow yourself to go back to sleep without setting up worrying about the wake. When you wake up, estimate the number of wakes from what you remember about the night. You're aiming for this to be something like 0-2 on a good night.
• Wild guesstimate of how much sleep you think you got for the entire night. It doesn't matter (for now) whether your estimate is reasonably accurate.
• Rate the aerophagia. Use a simple 0-5 scale: 0 = No aerophagia, 5 = painful, "I swallowed a basketball" aerophagia.
• Any (short) notes about the night[/i]. In particular, if you wake up in the middle of the night with aerophagia, that's worth noting.
• CPAP settings (if you've changed them)
• median, average, and 95% pressure settings
• AHI and CAI

The point of the sleep log is to keep track of the data needed to find a pressure setting range that doesn't trigger the aerophagia. So that does mean you will need to change pressures, but unless you keep track of all the data in one place, it will be hard to build a correlation between how bad the aerophagia is and what the pressure level is. At the start of this experiment, I would also suggest that you not worry at all about the AHI even though you want to record it. The idea is that if you can find a pressure level or a pressure range that doesn't trigger the incredible painful aerophagia, you have a starting place for where to start in titrating to find a pressure level that won't trigger too much aerophagia while still preventing most of your obstructive events. (As the number of arousals goes down, the number of those CAs should also go down.)

A wild-ass guess of a plan for how to identify the appropriate pressure range for you
Now here's my wild-ass guess for where to start trying to find a decent pressure setting or pressure range that will simultaneously do an ok job of managing the OSA and not trigger the aerophagia: I would start would be with the lowest Min Pressure that I could breath comfortably with: Some people genuinely don't like trying to sleep at pressures as low as 4-6 cm because they don't feel like enough air is coming into the mask to inhale comfortably. And I'd set the Max Pressure maybe 2 or 3 cm above the Min Pressure.

As an example, if you're not comfortable breathing at 4cm, but you are comfortable breathing at 5cm, I'd set the machine in APAP with a pressure range of 5-7 or 5-8 cm. (At these low pressures, you might as well leave EPR = 0 or EPR =1.) Yes, this will probably allow way too many events to happen, but the question is whether you get aerophagia. Now, if there is NO aerophagia or very minor aerophagia for a couple of nights running at 5-7 or 5-8, then increase the Max and Min pressure settings by 0.2cm (if you're impatient, you can try a 0.4cm increase). And use these settings for a couple of days.

Rinse and repeat: As long as the aerophagia doesn't raise its ugly head, keep raising the Min and Max Pressure settings by 0.2 or 0.4cm every few days until you reach a pressure range that seems to keep the OSA under control without triggering the aerophagia. But if aerophagia raises its ugly head, go back down to the previous setting where aerophagia wasn't a big issue for you.

Now by the end of the month, one of thee things is likely to have happened:

Best case scenario: You find a pressure range where the aerophagia is not an issue and your OSA is controlled: In other words, the AHI is significantly below 5 AND you are waking up feeling reasonably well rested/refreshed in the morning. In this case, you're done: You've found pressure settings that work for you.

Likely case scenario: You find a pressure range that every time you go above that range, the aerophagia raises its head. But the maximum pressure range you find that you can use isn't doing a good job of managing the OSA: In other words, the AHI pretty close to 5 or somewhat above 5 most days and/or you're not feeling any better even though you don't have any aerophagia issues any more. In this case, you can then move on to tackling how best to improve the AHI and, just as important, how you can improve the way you feel when you get up in the morning. That could involve increasing just the min pressure. Or just the max pressure. Or adding EPR with an increase in pressure. The data would be used to help figure out what to do.

Worst case scenario: You find a pressure range that every time you go above that range, the aerophagia raises its head. But the maximum pressure range you find that you can use is not managing the OSA at all: In other words, your AHI is significantly higher than 5 on most nights and you can't explain the elevated AHI as just being caused by a lot of post-arousal/sleep transition CAs that would not be scored on a sleep test. In this case, where you go next is going to depend on just how bad the aerophagia is when you increase the pressure past the range where you know it doesn't cause problems. Cross that bridge if/when it happens.

[robysue1]

And yes, I am worrying and stressing about the quality of my sleep and sleep apnea in general too much because it's been wrecking my life for years and the stress cumilatively added-up so much that I can't stop thinking about fixing it or thinking about it many times during daytime.

The problem with all the worrying and stressing is that you are making it harder for yourself to just go to sleep. Yes, I know how trite that sounds, and I've been there, done that, and have the scars to prove it.

In my own very long, very hard adjustment to xPAP therapy, learning how to let go of worrying about all my sleep issues was very, very difficult. But in the long run, that was an important part of the puzzle to solve.

Yes, I had to fix the sensory stuff (primarily the aerophagia) before I could learn to sleep well with the machine. But it was only after pulling my hair out worrying about everything related to xPAP and how hard it was and how much my sleep was still fragmented that I finally was able to take the best lessons I'd learned along the way and quit obsessing over my sleep every single day.

You might want to start by trying to find a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow. This book has two parts---the first focused on plain old insomnia and the second on sleep disordered breathing. Now some of comments about how to treat the sleep disordered breathing is (more than) a bit controversial, but it does give a good layman's view of how/why sleep disordered breathing is a problem in terms of sleep quality.

But both parts of the book deal with the idea of how arousals can disrupt sleep quality, and some of the comments about insomnia hold for dealing with all kinds of bad sleep problems: Fixing the problems takes time, and while there is work that has to be done to fix the problems, obsessing about the bad sleep and hoping to find a magic bullet to fix the problems can be counterproductive. In other words, allow yourself to focus on other things most of the day. And when it's time for bed, rather than worrying about how bad your sleep currently is, focus on the fact that you are working on improving it, even if tonight turns out to be a big disaster.

The purpose of the sleep log I mentioned in the previous post is to give you a place to record both your minor victories as well as your frustrations. Once you fill in the data, do your best to NOT focus on sleep for the whole rest of the day. Live your life as best you can and then worry about addressing the bedtime worries about sleep when it's bedtime.

[robysue1]

Now that I learn a little bit about arousals, could it be that salivia buildup with MAD be causing arousals during sleep?

Could be. Or maybe not. I have been sleeping with a TMJ guard for close 35 years and I drooled before using it, I drool with it, and I drool on the occasional nights that I forget to use it. But boy, on those nights when I forget to use it, I sure wake up with sore TMJs.

Tonight I will remove the MAD tighten the mask to prevent any leaks and up the pressure along with EPR(lvl 2).

I would urge you to keep the MAD in your mouth since you say that it is comfortable. Ideally the MAD should reduce the pressure needed to prevent most of your OSA events from occurring, and that in turn should help with the aerophagia.

And make sure you do not over-tighten the mask. Over-tightening the mask is an easy way of triggering leaks. Moreover, on the data you posted earlier, leaks were NOT a significant issue. So there's no point in doing things differently in a way that might create a problem with leaks.

Getting the aerophagia under control should help the overall sleep quality. And I've posted a strategy (used by Zonker) for tackling the aerophagia problem while (slowly) working up to finding a pressure that controls the OSA while not causing aerophagia.

Working on sleep hygiene and getting the obsessing about poor sleep quality under control may also help improve your overall sleep quality as well.

[livsmonster]

Now that I learn a little bit about arousals, could it be that salivia buildup with MAD be causing arousals during sleep?

Could be. Or maybe not. I have been sleeping with a TMJ guard for close 35 years and I drooled before using it, I drool with it, and I drool on the occasional nights that I forget to use it. But boy, on those nights when I forget to use it, I sure wake up with sore TMJs.

Tonight I will remove the MAD tighten the mask to prevent any leaks and up the pressure along with EPR(lvl 2).

I would urge you to keep the MAD in your mouth since you say that it is comfortable. Ideally the MAD should reduce the pressure needed to prevent most of your OSA events from occurring, and that in turn should help with the aerophagia.

And make sure you do not over-tighten the mask. Over-tightening the mask is an easy way of triggering leaks. Moreover, on the data you posted earlier, leaks were NOT a significant issue. So there's no point in doing things differently in a way that might create a problem with leaks.

Getting the aerophagia under control should help the overall sleep quality. And I've posted a strategy (used by Zonker) for tackling the aerophagia problem while (slowly) working up to finding a pressure that controls the OSA while not causing aerophagia.

Working on sleep hygiene and getting the obsessing about poor sleep quality under control may also help improve your overall sleep quality as well.

profanity removed by moderator

[Pugsy]

Please folks....I just banned the potty mouth piece of crap since he/she is posting this shit in multiple threads.
Let it go...don't respond to it.
Ignore and move on. Not worth it at all.

[robysue1]

Please folks....I just banned the potty mouth piece of crap since he/she is posting this shit in multiple threads.
Let it go...don't respond to it.
Ignore and move on. Not worth it at all.

Thanks.

Let's hope that tempuser(OP on this thread) is not put off the potty mouth you banned and gets the help he/she needs to make their xPAP therapy work.