Aerophagia tug of war

[Snoregone Conclusion]

When it comes to making changes, at least on the ResMed machines, when you run the mask fit option, that’s pumping out max pressure. If you can put your mask on your face and not have a problem breathing for a minute (where “problem” is harm) then changing the pressure to anything the machine can do seems probable to be harmless. I’m sure there are some people that have special conditions where that’s not true, but they’re likely under special care already.

[oneillseanm]

Though it's only been one night on these new settings, I thought I'd share the results.

The change: Fixed CPAP of 6 changed to Auto APAP of 4-8 with EPR 3.

How I feel: Very little aerophagia bloating this morning. Some nights are better than others, but I think it's very possible these settings allowed me to increase the pressure and improve the bloating. That's great.

The results: The increased top end of the pressure range seemed to improve my obstructive apneas (2.27 to 2.05 over one night). Overall, unfortunately, this night turned out to be on the higher end of my settings journey. It looks like there's still room for improvement on the OAs with higher pressure, though. I see I had continued OAs even when the pressure maxed out. Since I was able to tolerate the pressure, it seems like it might be worth increasing the top end of the pressure range a bit.

Oddity: According to my settings history, I actually experienced an improvement in Total AHI when my pressure transitioned from max 9 to max 6. This was only for a short time in the beginning, though. And I had a very rocky start.

one last thing, please....if you try the soft response, could you let me know how it went? and, please, please would you respond in this thread?

I'm afraid I can't give any valuable input. It turns out my machine had been operating in Soft Response mode all along. I appreciate the recommendation, though. I'm glad you had me take a look at the setting.

[Pugsy]

Before you start worrying about increasing the pressure in an effort to kill something...make sure it is real and able to be killed with more pressure.

Go here and watch the videos and learn how to zoom in on those events and figure out if you were really asleep when they got flagged.
If you weren't asleep they don't count and more pressure isn't the answer.

http://freecpapadvice.com/sleepyhead-free-software

The machine isn't perfect...it can and will make mistakes sometimes. It only measures air flow...it has no idea if you are asleep or not.

Normally we would just say let the machine sort it out but if you have a fine line between where pressures cause the return of the aerophagia monster and him staying away....make sure you really need more pressure first. Awake events or arousal/post arousal events...don't count and you don't need more pressure for those. What you need is simply better sleep and less arousals...and that's a whole different discussion.

[Pugsy]

Sometimes we also have to make compromises and maybe accept a higher AHI as a workable trade off when getting a lower AHI ends up causing more problems than having a slightly higher causes.
You have to decide which is worse...a little higher AHI or a visit from the aerophagia monster type of thing.

Numbers don't tell the whole story....you have to factor in how you slept and how you feel in general. Best numbers in the world don't mean squat if you feel like crap or slept like crap.

[oneillseanm]

Sage advice as always. Thanks for sharing that. I'll definitely watch the video and dig into the results.

[nicholasjh1]

When I first made changes to my therapy, the nurse practitioner asked why I had made changes. I told her I had fewer events and slept better after the changes, so she never said anything else again. I see her again next week and have made more changes since i saw her last. I'll wait and see if she notices or says anything.

Yes, My PA did mention it, but I said it was helping me sleep better, and she said "well, it's not below what I prescribed (7-20) so I guess that's fine. "

[zonker]

one last thing, please....if you try the soft response, could you let me know how it went? and, please, please would you respond in this thread?

I'm afraid I can't give any valuable input. It turns out my machine had been operating in Soft Response mode all along. I appreciate the recommendation, though. I'm glad you had me take a look at the setting.

oh, how funny! well, it's just something i thought i'd share just to see if it helps.

carry on!

[RonS]

For what it's worth I solved my aerophagia by moving to fixed bi level and having a second sleep study specifically instructed to test on the side rather than supine that showed that sleeping on my side my apnea was well controlled with lower pressure. I have always slept on my side, probably because I didn't breathe on my back lol.

At 14.5 I could feel bubbles being pushed down into my stomach, so I knew I had to be under 14. I also only felt the bubbles happening when I was resting between breaths, so I theorized that bilevel would be helpful, and it was. But the total solution was moving to the lower and fixed pressure rather than leaving the machine(s) to bounce around.

Your mileage may vary -- I've been doing this for a lot of years now and this is what worked for me.

[oneillseanm]

Hi everyone. For anyone interested, I thought I'd share an update on my new settings. Its been over three weeks, so I have some good data and experience to evaluate.

The change: Fixed CPAP of 6 changed to Auto APAP of 4-8 with EPR 3.

The results: Overall, AHI has increased from an average of 2.45 at the fixed CPAP of 6 to 3.63 at the APAP of 4-8. Some nights are worse, with AHIs in the 6-8 range. And though there's definitely some junk in the readings, most of my events do seem legit on closer examination.

How I feel: Not much aerophagia to speak of. That's great. For some reason, I'm able to tolerate this setting. On the downside, I'm more tired and exhausted than I used to be.

[Pugsy]

You know if it wasn't for that one ugly cluster at around 5:30 the night was actually quite decent.
Hard to know if that was related to REM sleep or if you were on your back at that time.
Is it possible you were on your back? We can't do much about REM related stuff but sometimes we can try harder to stay off our backs.

[solracotos]

Hi everyone,


The problem: Aerophagia. From day 1, I've been waking up uncomfortably, sometimes painfully, bloated. My doctor responded by lowering the pressure from 8 (starting point) to 6. This seemed to help a bit. Unfortunately, the problem is still there and I'm at the bottom of the pressure range. On top of that, I still experience an average hourly AHI of 3. I would like to drive this number down, but that, I assume, would mean raising the pressure. And that, I assume, would make the aerophagia worse.

Does anyone have any sage advice to share?

I'm 3-week old CPAP user. I have the same machine and mask as you. I also suffered from air swallowing and high AHI. I have a constant pressure of 11 with an EPR of 2.

During my first week my AHI values ranged from 12 to 14. On top of that I was waking up because of leaks and aerophagia. so I then decided to buy a nasal cushion mask(Dreamwear Nasal mask). Ohh boy that was the best decision. My aerophagia ceased, the mask is much more comfortable,. And more importantly my AHI dropped to less than 5 in just one night.

I know my number is still not perfect but I thought I share with you anyways.

[oneillseanm]

Solracotos, thanks for sharing that. It's good to hear you've had success with the mask switch. I may give a nasal cushion a try next time insurance lets me order a new mask.

Pugsy, thanks as always. It is possible I was on my back at that time. Though I fall asleep on my side, I tend to wake up on my back more often than not. I'll have to keep working on staying on my side. Do you happen to have any recommendation for any further adjustment to my settings?

[Pugsy]

I can't think of any adjustments right now considering what you are dealing with.
You need more pressure....sometimes but not all the time.
Sort of caught between a rock and a hard place in that regard.
More pressure tends to feed the aerophagia monster and he's not very nice. Having ugly clusters of OAs isn't very nice either.
You have to decide which of your choices is the worst choice and try to avoid.
Only you can decide that. Which devil makes you feel worse.

Me....I value how I feel during the day a LOT. If killing all the OAs made me sick all day then I would simply not try to kill all the OAs.
Goes back to what I always have said....sometimes the cure is worse than the disease and you are the only person to judge that.

I don't do this cpap stuff just so I can be sick all day and be miserable. I would make compromises and then maybe later revisit the more pressure thing hoping that maybe the body isn't so quick to feed that monster.

You might do marginally better on bilevel. Forum member Robysue ended up going that way for her aerophagia issues.
Like you she had to keep the EPAP and IPAP in a really tight (and low) range but using 4 PS instead of 3 PS helped her do it.
Would it help you...dunno and it's tough to get the doctors on board to fight with insurance for bilevel when someone only needs low single digit pressures for the most part.

If you are bored and have some time...read her blog as well as some of her posts.
Wish she was active right now to help you out but she's not right now.
Her blog
http://adventures-in-hosehead-land.blog ... er_19.html

and a list of her posts which number in the thousands but you could filter some of that with maybe searching for posts about aerophagia
search.php?author_id=52030&sr=posts

She was successful getting her doctor and her insurance on board for bilevel for her aerophagia issues...and she uses something like
EPAP of 4 with PS of 4 and IPAP max of 10...very tight range.
Her AHI isn't always so low...runs 2 to 3 because she needs a little more pressure but her belly simply won't tolerate it and she decided the belly pain was a worse devil than a little higher AHI devil.

Just an out there on a long skinny limb idea...don't know if it would even help you or not...I don't know how much pressure it would take to break up the ugly clusters when they happen.

Finally while an AHI of 3 or 4 with an ugly cluster isn't ideal...it's not the end of the world either. It's better than no therapy and it's maybe for 20 minutes or so.
If I were in your shoes....I would let it slide and be comfortable during the day and not make myself sick with belly pain (been there and done that myself and I just wouldn't want to do it again if I could avoid it).
Maybe in 3 to 6 months revisit the more max pressure to see if the whatever is letting the air sneak into the gut has maybe decided to not be a trouble maker....it can happen. People have reported that it can go away.

[oneillseanm]

Well, thanks again for taking the time to give such a thoughtful response. I don't know how you have enough free time to help us all out so much. I really appreciate it.

After reading your take on the issue I decided to try out a pressure bump. The aerophagia has been popping up less and less frequently lately. With the last setting you proposed, I hardly experienced any at all. Maybe it's just fading away as I'm getting used to therapy. So I'm going to take another pressure step and see what happens. The setting is now APAP 5-9 EPR 3, up from 4-8 / 3. After a few weeks of data collection I'll share more results.

Thanks again!

[palerider]

I don't know how you have enough free time to help us all out so much. I really appreciate it.

She makes time, because she cares about people too much.