zonker's crib--somewhere over the rainbow

[zonker]

now let me ask you, from your experience of being on this forum so long-would it be possible that i could just gut it out(see what i did there?) and i could get over the hump of aerophagia?

Some people report that the aerophagia monster finally stays away...others say the least little bit of venturing past the line where the pressure causes centrals never changed even after years of therapy.
RobySue is one of those long time forum members who never could get to the point where she could use the higher pressures she sometimes would need. She ended up having a to use an auto bilevel machine at an extremely tight range and just accept the compromise that some nights her AHI might be a little higher than she would really want it to be.
But you don't like bilevel...so you can't have that aerophagia fighting ammunition in your arsenal.

Let me ask you another question...are you absolutely certain that the foggy feeling won't happen if you get your AHI lower?
Are you certain that a low AHI means no foggy feeling?

I have only had really bad aerophagia twice in my 9 years of cpap use. It was much more than a big belch or a big fart...it was horribly painful and caused nausea that lasted all day. If I had a choice between that aerophagia and a higher AHI and a foggy feeling that eventually went away....I would take the foggy feeling every day of the week because I would eventually feel better during the day. The 2 times I had the aerophagia really bad I was sick from the time I woke up until I went to bed.

yes and truly, at around an ahi of 1, i don't feel the foggy/fuzzy. now, to be absolutely sure, i'd have to get back to that ahi and experience it again. that may just be a false memory because of my lingering feeling that lowest ahi is best.

the bilevel troubles me because of the cost. and i know there are members comfortable with buying peer to peer, but that's not me. i'm sure it's fine. my trusted, intelligent daughters do it all the time. but i've never been comfortable with it.

i think i'd have to go on for a very long time with my therapy not improving at all without apap before i'd start considering the cost of a bilevel acceptable.

you know, i just stopped and looked at some charts from last month. for five days, i had set my machine at 8.6 min and had epr on. my ahi ranged from 0.56 to 1.12. and i don't remember the foggy feeling or aerogaphia. then it started climbing upwards. i responded by turning up my min to 8.8.

since then, i've only had a couple of nights where i've gotten back to an ahi of around 1.

do you think i should lower my minimum and see what happens?

[Pugsy]

EPR is bilevel. If you don't like EPR you won't like (or do well with bilevel).

You need to learn about SWJ flagged events and real asleep events.
http://freecpapadvice.com/sleepyhead-free-software

To be honest I don't know what to offer for pressure adjustments at this time. Lots of bouncing around going on and I don't have any proof that your higher AHI is a real event or SWJ event.
If they are SWJ flagged events and not real...more pressure won't fix them and they would be more of a symptom of poor sleep quality and the poor sleep quality might be a factor in your foggy feeling. Chicken or the egg type of thing.

A week or so ago I had an AHI over 2.5 I think it was. Highly unusual for me but I had a rather yucky night's sleep. The AHI was a mixture of centrals, OAs and hyponeas. I took the time to zoom in on each flagged event and every one of them was post arousal/SWJ flagged event. Not real...I wasn't asleep when they were flagged. I didn't have one single real obstructive in nature event anywhere.
I didn't feel so great...had the foggy dragging butt thing but it wasn't from the AHI...it was from the crappy sleep.

If you didn't have the belly issues then I wouldn't see any harm in trying to kill whatever you are having with more pressure but you are having belly issues and some significant issues at that. So I wouldn't advise the more pressure thing UNLESS I as damn sure that what we were wanting to kill with more pressure is able to be killed with more pressure.
Someone looking at my report from that crappy night I had might be quick to tell me that I just need more minimum but more minimum wouldn't help me because I wasn't asleep when all those events got flagged.

So if it were me and I was in your shoes I would back up and use the lower minimum and then keep a real detailed log about how I slept (your foggy feeling) along with sleep position if known... so that you can really evaluate the results and I would take the time to evaluate whatever flagged events show up at the lower pressure....and then decide if more pressure is even needed. If you aren't asleep when those events get flagged then it wouldn't matter how high your pressure was and in your situation more pressure comes with some baggage being the aerophagia issues.

Wouldn't it be really something if with your AHI of 2.8 you only had 0.4 of that which was real and the rest of it you weren't asleep?

[djams]

AHEM!

back to me, cuz it's all about me-

screenshot-10-09-18.png

Well that's pretty rude. Not sure we were finished discussing my flatulence.

I'm going to throw out what I've been thinking throughout this entire thread.

Have you tried the standard APAP mode since you've had the machine? I notice that your pressure goes up at the beginning of the night, and never really comes back down. You end up staying in the 10-12.5ish range almost all night.

Seems to me like these two features of the "for her" mode *could* combine to keep your pressure in that higher range all night, and contribute to your aerophagia.

• Slower pressure decays

• If two apneas occur within a minute, the pressure reached in response to the second apnea will
  become the new minimum treatment pressure until the next treatment session.

It's odd to me that the slight changes in min pressure are causing aerophagia, because you spend almost zero time at that pressure. Would seem to me that it's the pressure throughout the night causing the problem.

Maybe in regular APAP mode you'd see bigger pressure declines throughout the night, and maybe help alleviate the aerophagia.

That's a lot of maybe's, but I thought I'd throw the idea out.

[palerider]

AHEM!

back to me, cuz it's all about me-

screenshot-10-09-18.png

Well that's pretty rude. Not sure we were finished discussing my flatulence.

I'm going to throw out what I've been thinking throughout this entire thread.

Have you tried the standard APAP mode since you've had the machine? I notice that your pressure goes up at the beginning of the night, and never really comes back down. You end up staying in the 10-12.5ish range almost all night.

Seems to me like these two features of the "for her" mode *could* combine to keep your pressure in that higher range all night, and contribute to your aerophagia.

• Slower pressure decays

• If two apneas occur within a minute, the pressure reached in response to the second apnea will
  become the new minimum treatment pressure until the next treatment session.

It's odd to me that the slight changes in min pressure are causing aerophagia, because you spend almost zero time at that pressure. Would seem to me that it's the pressure throughout the night causing the problem.

Maybe in regular APAP mode you'd see bigger pressure declines throughout the night, and maybe help alleviate the aerophagia.

That's a good point, a 0.2 min pressure change is so tiny as to be completely irrelevant, plus, as you say, pressure's higher than that all night, it's got to be something else.

[djams]

AHEM!

back to me, cuz it's all about me-

screenshot-10-09-18.png

Well that's pretty rude. Not sure we were finished discussing my flatulence.

I'm going to throw out what I've been thinking throughout this entire thread.

Have you tried the standard APAP mode since you've had the machine? I notice that your pressure goes up at the beginning of the night, and never really comes back down. You end up staying in the 10-12.5ish range almost all night.

Seems to me like these two features of the "for her" mode *could* combine to keep your pressure in that higher range all night, and contribute to your aerophagia.

• Slower pressure decays

• If two apneas occur within a minute, the pressure reached in response to the second apnea will
  become the new minimum treatment pressure until the next treatment session.

It's odd to me that the slight changes in min pressure are causing aerophagia, because you spend almost zero time at that pressure. Would seem to me that it's the pressure throughout the night causing the problem.

Maybe in regular APAP mode you'd see bigger pressure declines throughout the night, and maybe help alleviate the aerophagia.

That's a good point, a 0.2 min pressure change is so tiny as to be completely irrelevant, plus, as you say, pressure's higher than that all night, it's got to be something else.

I also keep thinking about how "for her" mode "makes mountains out of molehills" on the FL chart for Pugsy. It looks like zonker's pressure line is responding to the FL's for the most part. But if the FL chart is somehow off, or different in ways that we don't understand, what does that mean for zonker? Seems like a big unknown.

[zonker]

EPR is bilevel. If you don't like EPR you won't like (or do well with bilevel).

You need to learn about SWJ flagged events and real asleep events.
http://freecpapadvice.com/sleepyhead-free-software

To be honest I don't know what to offer for pressure adjustments at this time. Lots of bouncing around going on and I don't have any proof that your higher AHI is a real event or SWJ event.
If they are SWJ flagged events and not real...more pressure won't fix them and they would be more of a symptom of poor sleep quality and the poor sleep quality might be a factor in your foggy feeling. Chicken or the egg type of thing.

A week or so ago I had an AHI over 2.5 I think it was. Highly unusual for me but I had a rather yucky night's sleep. The AHI was a mixture of centrals, OAs and hyponeas. I took the time to zoom in on each flagged event and every one of them was post arousal/SWJ flagged event. Not real...I wasn't asleep when they were flagged. I didn't have one single real obstructive in nature event anywhere.
I didn't feel so great...had the foggy dragging butt thing but it wasn't from the AHI...it was from the crappy sleep.

If you didn't have the belly issues then I wouldn't see any harm in trying to kill whatever you are having with more pressure but you are having belly issues and some significant issues at that. So I wouldn't advise the more pressure thing UNLESS I as damn sure that what we were wanting to kill with more pressure is able to be killed with more pressure.
Someone looking at my report from that crappy night I had might be quick to tell me that I just need more minimum but more minimum wouldn't help me because I wasn't asleep when all those events got flagged.

So if it were me and I was in your shoes I would back up and use the lower minimum and then keep a real detailed log about how I slept (your foggy feeling) along with sleep position if known... so that you can really evaluate the results and I would take the time to evaluate whatever flagged events show up at the lower pressure....and then decide if more pressure is even needed. If you aren't asleep when those events get flagged then it wouldn't matter how high your pressure was and in your situation more pressure comes with some baggage being the aerophagia issues.

Wouldn't it be really something if with your AHI of 2.8 you only had 0.4 of that which was real and the rest of it you weren't asleep?

hmm....you've given me a lot to chew over and i don't want to just blurt out something without first taking time to digest what you've said.

the one item i really want to thank you for is the info about EPR=bilevel. i think i may have picked that up here on the forum (it may have even been palerider saying it to me.) but i'll be sure to keep it in mind.

[zonker]

AHEM!

back to me, cuz it's all about me-

screenshot-10-09-18.png

Well that's pretty rude. Not sure we were finished discussing my flatulence.

I'm going to throw out what I've been thinking throughout this entire thread.

Have you tried the standard APAP mode since you've had the machine? I notice that your pressure goes up at the beginning of the night, and never really comes back down. You end up staying in the 10-12.5ish range almost all night.

Seems to me like these two features of the "for her" mode *could* combine to keep your pressure in that higher range all night, and contribute to your aerophagia.

• Slower pressure decays

• If two apneas occur within a minute, the pressure reached in response to the second apnea will
  become the new minimum treatment pressure until the next treatment session.

It's odd to me that the slight changes in min pressure are causing aerophagia, because you spend almost zero time at that pressure. Would seem to me that it's the pressure throughout the night causing the problem.

Maybe in regular APAP mode you'd see bigger pressure declines throughout the night, and maybe help alleviate the aerophagia.

That's a lot of maybe's, but I thought I'd throw the idea out.

as fascinating as your flatulence may be, it just may be time to move on!

btw, Fascinating Flatulence may be the name of my new band.

i see what you are saying about using the for her mode vs straight apap. i know i've tried both. i don't remember offhand if one was a better "experience" for me. i'll go look at my "me and my airset" post and see if i mentioned it.

i really don't get why my very slight push up of minimum is causing such an uproar either. but the aerophagia visits me later in the night, not when i first start out, if i remember correctly.

at any event, i'm trying a different tact now. once that's over, i may try turning off the for her mode.

[zonker]

That's a good point, a 0.2 min pressure change is so tiny as to be completely irrelevant, plus, as you say, pressure's higher than that all night, it's got to be something else.

it's certainly frustrating, i'll give you that.

[zonker]

I also keep thinking about how "for her" mode "makes mountains out of molehills" on the FL chart for Pugsy. It looks like zonker's pressure line is responding to the FL's for the most part. But if the FL chart is somehow off, or different in ways that we don't understand, what does that mean for zonker? Seems like a big unknown.

<sigh> sometimes i think that *I* am the big unknown!

[palerider]

i really don't get why my very slight push up of minimum is causing such an uproar either. but the aerophagia visits me later in the night, not when i first start out, if i remember correctly.

I'd be willing to bet it was just coincidence.

[palerider]

the one item i really want to thank you for is the info about EPR=bilevel. i think i may have picked that up here on the forum (it may have even been palerider saying it to me.) but i'll be sure to keep it in mind.

Yup, EPR and pressure support (the purpose behind bilevel) have the same effect, lower pressure on exhale, higher pressure on inhale. the only difference is that EPR maxes out at a difference of 3, and pressure support can (on resmeds) go up to 22... though that's crazytalk.

[zonker]

EPR is bilevel. If you don't like EPR you won't like (or do well with bilevel).

You need to learn about SWJ flagged events and real asleep events.
http://freecpapadvice.com/sleepyhead-free-software

To be honest I don't know what to offer for pressure adjustments at this time. Lots of bouncing around going on and I don't have any proof that your higher AHI is a real event or SWJ event.
If they are SWJ flagged events and not real...more pressure won't fix them and they would be more of a symptom of poor sleep quality and the poor sleep quality might be a factor in your foggy feeling. Chicken or the egg type of thing.

A week or so ago I had an AHI over 2.5 I think it was. Highly unusual for me but I had a rather yucky night's sleep. The AHI was a mixture of centrals, OAs and hyponeas. I took the time to zoom in on each flagged event and every one of them was post arousal/SWJ flagged event. Not real...I wasn't asleep when they were flagged. I didn't have one single real obstructive in nature event anywhere.
I didn't feel so great...had the foggy dragging butt thing but it wasn't from the AHI...it was from the crappy sleep.

If you didn't have the belly issues then I wouldn't see any harm in trying to kill whatever you are having with more pressure but you are having belly issues and some significant issues at that. So I wouldn't advise the more pressure thing UNLESS I as damn sure that what we were wanting to kill with more pressure is able to be killed with more pressure.
Someone looking at my report from that crappy night I had might be quick to tell me that I just need more minimum but more minimum wouldn't help me because I wasn't asleep when all those events got flagged.

So if it were me and I was in your shoes I would back up and use the lower minimum and then keep a real detailed log about how I slept (your foggy feeling) along with sleep position if known... so that you can really evaluate the results and I would take the time to evaluate whatever flagged events show up at the lower pressure....and then decide if more pressure is even needed. If you aren't asleep when those events get flagged then it wouldn't matter how high your pressure was and in your situation more pressure comes with some baggage being the aerophagia issues.

Wouldn't it be really something if with your AHI of 2.8 you only had 0.4 of that which was real and the rest of it you weren't asleep?

i do know about sleep/wake/junk and have taken it into consideration on many of my sleepyhead graphs. there is a tendency on my part to have particular swj events around 7 am until i fully awake at any time between 8 and 8:30 am. i also know about how to work the mouse to highlight the sleep time without the swj events. it's pretty remarkable what a difference it can make.

however, on the charts that i've posted, even eliminating swj doesn't bring down my ahi by very much. i think that's one of the reasons i started posting some charts. i couldn't fiddle with 'em and make anything look good. besides, was feeling fuzzy/foggy and had slight headaches.

oh, wait...i just reread what you said and that wasn'r anywhere NEAR your point. sorry about that. <sigh> it's that not knowing what's real or not that bothers me. makes it hard to correct it if you can't pinpoint it. and i already have a small issue with waking up in the night. i've been assured that i should just roll over and forget about it. and truly, getting back to sleep isn't an issue. i just would rather not wake up at all.

as to your night of ahi of 2.5...well, that's a one off for you. and that will, of course, happen. and i wouldn't be disturbed by having nice, decent sleep with the low numbers that seem to make me feel good, then suddenly having a one off. that i could just shrug off and carry on. but it's NOT a one off that concerns me here. it's the numbers going in different directions, with me having poor sleep, that concerns me.

so in the end, i guess i AM doing as you suggested. i must have read your post and absorbed more than i thought! i've ran the last two nights at 8.6 min as apposed to 8.8. after tonight, i'll post charts for input.

and i do understand what you are saying. that swj could be spread throughout my night and not just showing up at the beginning or end of my sleep. but it seems to me that i can only rely mainly on the perception that i have of a lower number equals better sleep. because the other way means i have no control over it. no way to make corrections. no way to improve.

[zonker]

i really don't get why my very slight push up of minimum is causing such an uproar either. but the aerophagia visits me later in the night, not when i first start out, if i remember correctly.

I'd be willing to bet it was just coincidence.

which? the increase in min causing an uproar? or that the aerophagia visits me later?

[palerider]

i really don't get why my very slight push up of minimum is causing such an uproar either. but the aerophagia visits me later in the night, not when i first start out, if i remember correctly.

I'd be willing to bet it was just coincidence.

which? the increase in min causing an uproar? or that the aerophagia visits me later?

That a 0.2cm pressure change has *any* effect whatsoever. I think you changed it, and just happened to have a bad night, (they happen, without *ANY* changes)... and you've assumed that the bad night had something to do with a minimum pressure change which is irrelevant based on your pressure curves.

[zonker]

i really don't get why my very slight push up of minimum is causing such an uproar either. but the aerophagia visits me later in the night, not when i first start out, if i remember correctly.

I'd be willing to bet it was just coincidence.

which? the increase in min causing an uproar? or that the aerophagia visits me later?

That a 0.2cm pressure change has *any* effect whatsoever. I think you changed it, and just happened to have a bad night, (they happen, without *ANY* changes)... and you've assumed that the bad night had something to do with a minimum pressure change which is irrelevant based on your pressure curves.

i take your meaning. now, i have to go look at past charts to see what i can see regarding pressure. though it prolly won't help as, so far, i haven't kept a diary of this stuff.

thanks for the clarification.