Aerophagia and hiccups are kicking my butt

[sleepydad11]

I'm at just about my 2-month mark for starting CPAP. Not every night, but once a week, I am getting woken up by pretty extreme stomach bloating or excessive hiccups. I could really use some help because it's very disruptive. I don't want to quit CPAP but starting to wonder if it's worth it with these issues.

Last night around midnight, the hiccups jarred me awake again, and I had trouble falling back asleep. I wound up doing so without the mask. https://sleephq.com/public/34263f9d-d17 ... a47aea4c35

2 nights ago 5 a.m., I had to wake up, walk around the house, and do a bunch of stretches because my stomach hurt so bad. https://sleephq.com/public/bf927909-4d5 ... 7c9ab91149

What's so weird is the night between was excellent https://sleephq.com/public/25aba128-303 ... e43697350b

Here's my full sleephq link https://sleephq.com/public/teams/share_ ... /dashboard

Here is my setup

- Airsense 11
- Fixed pressure 7.8
- EPR 1
- Nova Nasal Mask - https://www.fphcare.com/us/my-sleep-apn ... nova-nasal
- V-Com
- Wedge pillow
- Long pillow to my right so I am basically forced to sleep on my left side

[Pugsy]

Try increasing the EPR to 2. Might help with the aerophagia. Even consider 3 EPR.

I have no idea about the hiccups....sorry.

[sleepydad11]

Try increasing the EPR to 2. Might help with the aerophagia. Even consider 3 EPR.

I have no idea about the hiccups....sorry.

I definitely had them with EPR 2 so maybe I'll try 3?

Is EPR 3 and vcom compatible? And do I need to adjust pressure or anything?

[Pugsy]

Is EPR 3 and vcom compatible?

Sorry but I don't know much about VCom thing but I don't see how it would be a problem.
Maybe someone who uses it and EPR can offer their input.

I definitely had them with EPR 2 so maybe I'll try 3?

It's worth trying 3 EPR and if that doesn't offer needed relief then maybe a bilevel machine is in order.
A bilevel machine...commonly referred to as "bipap" offers the ability to go higher the 3 with the difference between inhale (IPAP)
and exhale (EPAP).
It's really your only alternative if 3 EPR doesn't help or help enough.

do I need to adjust pressure or anything?

Not at this point just yet anyway. Some people say that you should increase baseline press for each EPR setting. Sometimes it's needed but sometimes it isn't needed and I would want proof if it is needed for sure especially since we know you already have really bad aerophagia. What I usually tell people is just make the EPR change and then look at the reports and see if there was a marked increase in either obstructive apneas or hyponeas....and then you get to maybe increase the baseline to compensate for the Pressure Support change (which is what EPR is) or make a compromise in AHI numbers. I don't see the sense in using a higher pressure unless it is really needed.....especially when someone is having severe stomach issues.

BTW I don't understand much about hiccups but all my life when I get hiccups that persist...I drink 9 sips of water (or soda or whatever)
without breathing. Works 99 % of the time.

You do need to contact your doctor if you can't get relief with EPR of 3....He is the one that has to start the process of getting a bilevel machine to try.

[sleepydad11]

Is EPR 3 and vcom compatible?

Sorry but I don't know much about VCom thing but I don't see how it would be a problem.
Maybe someone who uses it and EPR can offer their input.

I definitely had them with EPR 2 so maybe I'll try 3?

It's worth trying 3 EPR and if that doesn't offer needed relief then maybe a bilevel machine is in order.
A bilevel machine...commonly referred to as "bipap" offers the ability to go higher the 3 with the difference between inhale (IPAP)
and exhale (EPAP).
It's really your only alternative if 3 EPR doesn't help or help enough.

do I need to adjust pressure or anything?

Not at this point just yet anyway. Some people say that you should increase baseline press for each EPR setting. Sometimes it's needed but sometimes it isn't needed and I would want proof if it is needed for sure especially since we know you already have really bad aerophagia. What I usually tell people is just make the EPR change and then look at the reports and see if there was a marked increase in either obstructive apneas or hyponeas....and then you get to maybe increase the baseline to compensate for the Pressure Support change (which is what EPR is) or make a compromise in AHI numbers. I don't see the sense in using a higher pressure unless it is really needed.....especially when someone is having severe stomach issues.

BTW I don't understand much about hiccups but all my life when I get hiccups that persist...I drink 9 sips of water (or soda or whatever)
without breathing. Works 99 % of the time.

You do need to contact your doctor if you can't get relief with EPR of 3....He is the one that has to start the process of getting a bilevel machine to try.

Thanks! I'm rolling with EPR 3 tonight so we'll see how it goes. I do have a follow up with my sleep doctor in a few weeks so I'll be sure and bring it up. I did mention that I'd like to potentially do a titration study which they were on board with. So maybe I'll follow through on that if this persists

[sleepydad11]

@pugsy

Last night with epr 3 was decent. I was sleeping well until my son came in sick just before midnight

https://sleephq.com/public/f8e57e69-aab ... 485b1e8825

I did have some burping but it wasn't bad. We'll see if this continues.

[Pugsy]

That's a start. Need more time using that setting to get a better idea how well it works.

Next thing to consider trying is reducing that fixed pressure of 7.8 (while keeping an eye on the OAs and hyponeas of course).
Maybe something like 7.2 ...we don't know at what point the air doesn't seem to enter the stomach so much.

[sleepydad11]

That's a start. Need more time using that setting to get a better idea how well it works.

Next thing to consider trying is reducing that fixed pressure of 7.8 (while keeping an eye on the OAs and hyponeas of course).
Maybe something like 7.2 ...we don't know at what point the air doesn't seem to enter the stomach so much.

For sure, thanks. I'll keep things where they are for a few nights and drop down to 7.2 if I'm still having issues

I found a Glasgow Index data analyzer and last night was by best score to date so maybe I always needed EPR 3, we'll see