Leak Rate

[Pugsy]

I don't know about the "should" part but I certainly think that you "could" likely reduce the minimum if you want to try it and it probably won't hurt anything.
Only problem might be that if you are used to that amount of air movement if you go lower you may feel a bit air starved.
Your AHI is nice and low...you have some room to reduce the minimum and not have it allow many events (if any).

[Ograx]

I’m just interested to see if I reduce pressure if it has any effect on the wakeups. Had about 5 last night and ended up being stuck awake at 5 am.

Going to try reducing by .2 nightly and see if events increase or get any kind of negative effect. I’ve never had the pressure need to be more than about 10.5 and I seem to coast lots of night at the minimum.

[palerider]

I’m just interested to see if I reduce pressure if it has any effect on the wakeups. Had about 5 last night and ended up being stuck awake at 5 am.

Going to try reducing by .2 nightly and see if events increase or get any kind of negative effect. I’ve never had the pressure need to be more than about 10.5 and I seem to coast lots of night at the minimum.

The smart money says to *raise* your pressure, so that you don't keep having so many events that wake you up.... your pressure curve is very jagged, caused by having repeated breathing events.

I'd start with a minimum of 8.

[Ograx]

SO do you think that my wakeups are being caused by the breathing events??

Im going to post last nights data as I did have 5-6 wakeups and the same wakeup at 5am with unable to be able to go back to sleep.

I'll set it back to 6.2 then for tonight and what do you recommend increasing it by ?? What pressure amount and spread out by how many days?

I had to turn EPR off because I was getting these Cheynes cycles that were a little scary and when I had the pressure at 7 I couldn't really work because my stomache hurt so bad with bloat.

[Pugsy]

I am sorry but I have no idea what might be causing those frequent and unwanted wake ups.
The leaks are still a maybe factor though.
The pressure change to almost 10 might be a factor also.

Impossible to tell from the data shown and there are no flagged events anywhere close to the wake up to maybe blame it on breathing related.

I see no reason to be increasing your pressure especially since you are having problems with aerophagia.
I see no reason to not be using EPR to help reduce the aerophagia.

I would target leak control first if it were me on the chance that the leaks are maybe causing the wake ups.

[Ograx]

So Pugsy you disagree with paleriders thoughts above about the need for pressure increase ?


Not trying to start argument just trying to learn the ins and outs of this!

[Pugsy]

Well.....did PR know about your aerophagia issues prior to his recommendation to increase the minimum?
I don't remember if you really mentioned it before and I can't see page one.

If you look at the pressure graph...while it looks really wild...part of that is the scale it's being shown at.
Some nights it didn't even make it to 9 cm and the worst I see lately was 11.02.

PR tends to be a lot more aggressive with his minimum pressure recommendations than I am. We just look at things differently.
Now if you were having a lot of flagged events...for sure more minimum but you aren't.
Now you might be having some minor breathing restrictions that are causing the pressure to want to go somewhere to fix things but they aren't bad enough to earn a flag. Are they maybe disturbing your sleep? Maybe....maybe not.

PR likes to see pressure lines that don't move around much....me not so much because you should see mine sometimes.

It is worth trying more minimum to see and normally I would suggest it as at least something to try....at least until someone starts talking about bloated belly issues at the pressures they are using now.
More pressure will definitely increase aerophagia issues but only maybe fix the wake up issues.
If it wasn't the for sure cause aerophagia issues to worsen then I wouldn't have a problem with more minimum when there doesn't appear to be an obvious urgent need.

Besides....it's not like your pressure is going from 6 to 16 all night long....instead it's going from 6 to maybe 9 or 10. Looks wilder than it really is due to the scale of the graph.

So you have 2 people here that look at things a bit differently...both with good reasons for our thoughts and ideas. I tend to be ultra conservative....PR not as conservative at times.

You get to decide how you want to proceed....conservative or not or maybe make a compromise.
I don't think that he meant an immediate change to 8 cm in your situation since there isn't a truckload of OAs we need to kill...maybe gradually work up that new minimum idea he has.
That's what I would suggest if that's want you want to try....go up in small increments and see how your belly handles it and see if it helps the sleep quality or not.
Those wake ups may not be related to airway issues at all. More pressure may not do anything except cause more belly issues.

[palerider]

Well.....did PR know about your aerophagia issues prior to his recommendation to increase the minimum?
I don't remember if you really mentioned it before and I can't see page one.

Nope, he didn't... he was just looking to smooth out the pressure curve somewhat, so that there weren't the repeating pattern of pressure going low enough to trigger sleep disturbing events.

If there's aerophagia, then there's an unfortunate balancing act that has to be performed.

I tend to be ultra conservative....PR not as conservative at times.

It's like getting a second opinion

I don't think that he meant an immediate change to 8 cm in your situation since there isn't a truckload of OAs we need to kill...

Actually, he did... but he wasn't aware of aerophagia issues.

OP is already hitting 10, so 8 shouldn't be too bad if not for the aerophagia.

Hope that makes things clearer.

[Ograx]

So I’d like to test this out and minimize aerophagia.

Is slightly increasing the pressure over the course of a few weeks the best way to go?

I guess what I’m getting at is does the body adapt to the pressure and learn to deal with aerophagia on its own or is it just something you have to deal with?


Also I can’t use the EPR setting as it gives me churns stokes respiration problems and centrals from hell.

[Pugsy]

Sometimes people do find that with time the aerophagia issues fade away but not everyone will have that happen.
So another "maybe".

If you want to try more minimum pressure to see if it helps with reducing the wake ups....go with small incremental changes in that minimum since you can't use EPR to help you out.

How high did you have it when the bloating reared its ugly head?

[Pugsy]

About EPR triggering centrals...sometimes that will also go away.
Also sometimes people can use a little less EPR and have it not cause the centrals and sometimes just a difference in 1 cm with EPR will make a huge difference in the number of centrals.

Did you ever try just EPR of 1 or 2 or did you always use just 3 EPR?

I have a friend who gets 15 centrals and hour with the equivalent of 4 EPR (she uses a bilevel machine so has what is equal to EPR at 4 available) but if we reduce it from 4 to 3 then she doesn't get any any centrals to speak of. Her minimum pressure was 16...she really needed some exhale relief at those pressures.

[palerider]

I guess what I’m getting at is does the body adapt to the pressure and learn to deal with aerophagia on its own or is it just something you have to deal with?

Zonker is an example of someone who fought the aerophagia monster and won... he just kept sneaking his pressure up little by little, and he did seem to get used to handling it over time, he's now getting really good numbers, and good sleep, and no painful bloating... but it took him a while to get to that point.

[zonker]

I guess what I’m getting at is does the body adapt to the pressure and learn to deal with aerophagia on its own or is it just something you have to deal with?

Zonker is an example of someone who fought the aerophagia monster and won... he just kept sneaking his pressure up little by little, and he did seem to get used to handling it over time, he's now getting really good numbers, and good sleep, and no painful bloating... but it took him a while to get to that point.

meerkat.gif

it took me what i consider a RIDICULOUS amount of time to tame that monster. but worth it in the end.

i made a mistake recently and thought i'd bump my minimum by a wee .2 , which i thought would be fine.

nope, back to my old minimum as soon as the aerophagia jumped me!

[Ograx]

I tried all the EPR settings and yeah they all gave me those centrals from hell.

It was around 7.0 minimum when I noticed the bloating and it hit me pretty hard and lasted for a good 6 hours.

I tried 6.6 last night and didn't notice anything this morning but did have that bubbly cheek feeling and woke up in middle of night with dry mouth and from what I am assuming based on data a large mouth leak. ( I have been undecided whether I should try upping or lowering pressure first so I tried one night with a .6 jump and had lots of leaks and not the greatest sleep so I am going to try the easier option first and do the decrease.) (Data Attached)


My wakeups kinda going back over them seem to be at about the 3-4 hour sleep mark then like clockwork every 90 minutes after that so it seems to me like sleep cycle wakeups and I just get woken up by them more than the normal person does. Then at about 7 hours or just shy of sleeptime wise I'm just woken up and can't get back to sleep. I know I need more than this amount of sleep and when I can back to sleep after this I do feel quite good so I am positive that my amount of sleep needed for optimal function is in the 8-9 hour range.

[Pugsy]

Bummer....but you might revisit a little EPR in about 6 months or so. It wouldn't be impossible for the situation to change.

Is your machine one of the ones that has the Soft Response option available?
My machine doesn't have that option so I haven't personally tried it but if you have that option then it might be worth trying.

I think you might be right about the wake ups being simply normal post REM cycle wake ups that you unfortunately don't just roll over and go back to sleep and not remember. Those wee hours of the morning when it is worse for you..that's when we have more REM cycles.
Unfortunately I don't know of any sure fire fix for post REM wake ups so that you don't become fully awake.
Maybe a combination of factors might help.

If you want to continue with the more minimum pressure thing then I think I would go about it slowly...inch your way up slowly and see if you can fool the aerophagia monster into staying away.