Been a while

[Miss Emerita]

Jack o, there's a clustered pattern to your events. This could be due to back-sleeping, REM sleep, or tucking your chin down toward your chest. A couple of things to try:

a soft cervical collar or a "snore collar," which would prevent chin-tucking,

a fairly low pillow,

a pillow with a raised area where your neck rests,

as much side-sleeping as you can manage.

[Jack o]

Thank you so much Pugsy and Miss Emerita,

I will try to get a soft cervical / snore collar hopefully today and will make a pillow adjustment.
I did not think of and therefore did not mention that I have had an achy neck upon awakening for several weeks - which may tie in with the potential chin tuck that you both have pointed out.
And I will go to sleep on my side and hopefully stay there.

[Jack o]

When Pugsy mentioned chin tuck I stupidly did not pay much attention.
After increasing pressure did not help and Miss Emerita’s reinforced what Pugsy had said about the chin tuck I bought a soft cervical collar yesterday (and also replaced what had become a wedge shaped hard pillow with a flattened feather pillow). I used both last night and made no change in pressure in order to isolate the collar/pillow change to see its true effectiveness. Great result, last night my AHI dropped significantly to 2.86. Aerophalgia, however did increase. I also intentionally, as usual, went to sleep on my back and woke up on my side as usual. Went to bed around midnight and the largest AHI was at 1am, probably on my back.I realize the ideal is an AHI of zero which is a great goal but I will see what the best livable situation will be for me. So my thought for tonight is to do exactly the same as last night to confirm the cervical collar success. See how all goes with AHI and aerophalgia. If AHI remains low and aerophalgia acceptable just make small pressure changes to try to zoom in on what settings work best for – lower AHI/livable aerophalgia. If aerophalgia worsens (my gut says it may very well) then I plan to decrease pressure – maybe just the high setting which is at 15 but keep the low setting at 8. A work in progress.

Thanks so very much for all your suggestions especially the cervical collar. So much more helpful than my pulmonary MD.

[Pugsy]

Sometimes we just have to make compromises in what are acceptable results on several fronts.
Last night's results are acceptable if your aerophagia issues aren't making you too miserable. We don't want to trade one problem for another.

You now understand what you need to do and look for and have some tools to help you sort out what might be the best compromise for you..
For sure just keep with the one change at a time thing. That way you can best evaluate the results that change may have brought you.

Maybe back up the max and see if that helps the belly issues and doesn't allow too big of an increase in the AHI. A change in minimum downward probably won't make a difference in the aerophagia issues as your machine is essentially setting a new minimum on its own once you go to sleep and the airway starts trying to close off. So in your situation I suspect the maximum is going to be more critical in the belly issues area.

Remember....how you feel overall is a critical issue and not just what the AHI might show. A nice low AHI doesn't mean much if you feel like total crap the entire next day because of belly issues.

Good job...now you have some tools to help you sort out your problem and you better understand what you are doing.

[Jack o]

Thank you.
I will remain the same for tonight.
If AHI result is similar tonight, tomorrow I will change the Low/High-
From: L8/H15
To: L10/H14
and proceed accordingly after seeing the next 2 nights' results.
New Motto - "Un-tuck the Chin!"

[Miss Emerita]

Delighted to see this progress! You have a great plan, and I'll be curious to hear how it goes. One point, though: don't think of 0 as your goal. Anything under 2 is good, and anything under 1 is great. When you're down in those ranges, really what you want to go on is how soundly you are sleeping and how rested you feel during the day.

[zonker]

Delighted to see this progress! You have a great plan, and I'll be curious to hear how it goes. One point, though: don't think of 0 as your goal. Anything under 2 is good, and anything under 1 is great. When you're down in those ranges, really what you want to go on is how soundly you are sleeping and how rested you feel during the day.

+1

chasing zero is futile.

[Jack o]

Thank you all.
As the challenge it progresses, I will keep you posted.

Zonker,
You had told be a while back how slowly you moved your pressures looking for the right setting.
I guess you found it seeing the 0.52. I was surprised to see how high your pressures are set.
I must assume you don't swallow air like I do.

[Pugsy]

If I had to choose between accepting an AHI between 2 and 3 or 4 or even 5 and being miserable with belly issues I would take the higher AHI any day of the week.
Sometimes we make compromises out of necessity....maybe not ideal but it's not the end of the world to have an AHI of 3 or 4 and feel good otherwise and we ward off the belly issues.

I am lucky in that I don't normally have aerophagia issues...I say normally because over the years I have had bad aerophagia issues twice.
It was so bad I was ill the next day with severe belly pain and nausea....it was horrible.
I can tell everyone that if I had to choose between letting a few apnea events slip past the defenses and that belly pain I would gladly be happy with a slightly higher AHI...there is no shame in just accepting a slightly higher AHI as a trade off for feeling decent during the day.

[zonker]

Thank you all.
As the challenge it progresses, I will keep you posted.

Zonker,
You had told be a while back how slowly you moved your pressures looking for the right setting.
I guess you found it seeing the 0.52. I was surprised to see how high your pressures are set.
I must assume you don't swallow air like I do.

i DID swallow air! that's why i had to move up oh so very gradually. i was training my body to get used to that swallowing of air.

you might try the same.

after following the advice of the experts here, i am now at or below an ahi of 1.

[ChicagoGranny]

a wedge shaped hard pillow

Were you using a wedge-shaped pillow because of reflux symptoms?

[Jack o]

Hello,
2nd night in a row with soft cervical collar and flat pillow. AHI -Tues. 2.8, Wed. 2.3 But too much aerophalgia.
Setting was at High 15 and Low 10. Tonight plan to set High 13 and Low 8 and see if less gas and the affect on AHI.

[zonker]

Hello,
2nd night in a row with soft cervical collar and flat pillow. AHI -Tues. 2.8, Wed. 2.3 But too much aerophalgia.
Setting was at High 15 and Low 10. Tonight plan to set High 13 and Low 8 and see if less gas and the affect on AHI.

sounds like a plan to me. other than the gas, how are you feeling after waking up?

[Jack o]

The gas/aerophalgia is something that in the past has built up more and more day after day. I don't feel good (but glad the AHI is lowered considerably) but gas mostly dissapates after a couple hours.
For the few months that you did not hear from me I had been set on Low 5 or 6 and High 8 or 9 and I was happy with an average AHI of 5 to 6.
Then all went to hell when I started tucking my chin (thanks to Pugsy and Miss Emerita I learned that I was doing that).
So I now have between 2 and 3 AHI for a couple nights along with gas. My thought now is to lower the pressure gradually to reduce the gas and see how low I can keep the AHI. Would be nice to be at the 3 AHI level without gas.
Thank God I learned about the Chin tuck.

[zonker]

The gas/aerophalgia is something that in the past has built up more and more day after day. I don't feel good (but glad the AHI is lowered considerably) but gas mostly dissapates after a couple hours.
For the few months that you did not hear from me I had been set on Low 5 or 6 and High 8 or 9 and I was happy with an average AHI of 5 to 6.
Then all went to hell when I started tucking my chin (thanks to Pugsy and Miss Emerita I learned that I was doing that).
So I now have between 2 and 3 AHI for a couple nights along with gas. My thought now is to lower the pressure gradually to reduce the gas and see how low I can keep the AHI. Would be nice to be at the 3 AHI level without gas.
Thank God I learned about the Chin tuck.

keep at it. go slowly. there is no reason to hurry the process.

good luck!