Aerophagia w/ Bilevel machine

[mgundy]

Hi All,

This board has been incredibly helpful in getting my Resmed Aircurve 10 dialed in. Right now my pressures are set at IPAP is 18 and EPAP is 14 and I use a full face mask. My AHI is always less than 5.0. Lately I've been experiencing Aerophagia and the gas and stomach pain in the morning has started to get bad enough I need to address it.

I did some research and it looks like something to try is with modifying my Exhalation pressure. I think the correct thing to try is to lower the EPAP setting, but wanted to confirm that here.

Would some board members please post some recommendations on what to do? It would be much appreciated!

-Gumbaroo

[palerider]

Hi All,

This board has been incredibly helpful in getting my Resmed Aircurve 10 dialed in. Right now my pressures are set at IPAP is 18 and EPAP is 14 and I use a full face mask. My AHI is always less than 5.0. Lately I've been experiencing Aerophagia and the gas and stomach pain in the morning has started to get bad enough I need to address it.

I did some research and it looks like something to try is with modifying my Exhalation pressure. I think the correct thing to try is to lower the EPAP setting, but wanted to confirm that here.

Would some board members please post some recommendations on what to do? It would be much appreciated!

-Gumbaroo

your AHI should be less than *TWO* (unless most of that is centrals.

Try lowering your IPAP instead, because, you know, that's the highest pressure.

[ChicagoGranny]

My AHI is always less than 5.0.

What's the breakdown (obstructive, clear airway, hypopnea)?

[mgundy]

I should have mentioned my AHI averages about 1-2 a night.

I've tried to lower my IPAP before and my AHI starts to creep back up to 5-6 and I don't sleep as well. But I could give it a try again... But I was hoping from what I read I could solve it with the exhalation pressure because I have bad sinuses and that's why my pressure needs to be so high. In OSCAR the IPAP can go up to 21 depending on the night.

[mgundy]

My AHI is always less than 5.0.

What's the breakdown (obstructive, clear airway, hypopnea)?

Here's my OSCAR chart from last night. It's pretty representative. EDIT: I can't attach any files, something about the board's quota for file attachments has been met.

Last night: AHI 2.12, CA 1.84, OA 0.14, Hyp 0.14.

I was diagnosed with OSA, but that sleep study was pretty antiquated. This board has done more for me regarding my sleep apnea than any doctor.

[ChicagoGranny]

Get an account on one of the free hosting sites, like imgur.com, and post the image link in this thread.

[mgundy]

Get an account on one of the free hosting sites, like imgur.com, and post the image link in this thread.

Thank you!

https://imgur.com/116T0Ol

[Pugsy]

You may have to make a compromise between the pressures needed to get a nice low AHI and the pressures reduced so you aren't exposing you to bad aerophagia issues.

Bear in mind that when you are evaluating the AHI and pressure needs you need to take the CA/central component out of the evaluation because more pressure doesn't/can't help the central component. Do some mental math and just look at OA and hyponea index.

Last night roughly 90% of your AHI was central apneas.

You got lots of room to reduce your pressures a bit before any increase in OA or hyponea might be a problem.
EPAP is what we normally look at for keeping OAs and hyponeas prevented.

We don't know if it is your EPAP or IPAP that is the primary culprit in feeding of the aerophagia monster but it is likely a combination of both. The constant EPAP plus wherever IPAP wants to go if you are using auto adjusting pressures which it sounds like you are if the IPAP goes up from 18 to 21.

You can use imgur.com to host your detailed report image.
I have reported the fact that the attachment storage is full again...see the sticky at the near top of the main forum page.
All I have heard has been crickets as to what can be done about the problem on the forum end.

Obviously we can't tell how much your pressure might be going up and staying up and thereby feeding the aerophagia monster.

You have a couple of options.
1....Reduce EPAP to say 12 and see what happens with your obstructive stuff in your AHI. Ignore the central/CA component.
2....Reduce IPAP maximum and again see what happens with the obstructive stuff.
3....combination of 1 and 2

Since your AHI (in terms of the obstructive stuff which is all the machine can fix) is actually extremely low....I probably would do #1 first and if that didn't help enough with the aerophagia then I would lower EPAP still and limit IPAP max as well.
If I could see the detailed report I might be able to offer more....maybe.

[Pugsy]

I just now saw your report.

Doesn't look like the machine varies the pressure all that much and most likely the times it might go to 21 are rare.
Even your max pressure number isn't very high.
The machine is almost functioning like a fixed pressure mode.

I would drop EPAP to 12 and make no other changes and see what happens to the obstructive stuff and your aerophagia issues.
If that doesn't help...drop EPAP to 10 and see what happens.

You may have to make a compromise on the obstructive index numbers but lets first seen what it takes to keep the aerophagia monster away.

The centrals....probably a good chunk are awake related false positives. The website with the videos explaining awake vs asleep flagged events is down right now I think but you can try it.
http://freecpapadvice.com/sleepyhead-free-software
We put the centrals on the back burner for now anyway.

[mgundy]

I just now saw your report.

Doesn't look like the machine varies the pressure all that much and most likely the times it might go to 21 are rare.
Even your max pressure number isn't very high.
The machine is almost functioning like a fixed pressure mode.

I would drop EPAP to 12 and make no other changes and see what happens to the obstructive stuff and your aerophagia issues.
If that doesn't help...drop EPAP to 10 and see what happens.

You may have to make a compromise on the obstructive index numbers but lets first seen what it takes to keep the aerophagia monster away.

The centrals....probably a good chunk are awake related false positives. The website with the videos explaining awake vs asleep flagged events is down right now I think but you can try it.
http://freecpapadvice.com/sleepyhead-free-software
We put the centrals on the back burner for now anyway.

Thank you!

I set my EPAP to 12 and put the PS to 5 (it was 4). I lowered the Max IPAP to 22. Does that sound good for a first try?

[Pugsy]

I don't like making 2 changes at the same time if at all possible.

If you make 2 changes and get either a really good result or a bad result you won't know which change was the cause of the change in results.

I wouldn't change PS just yet if it were me but you are free to do what you want.

[mgundy]

I don't like making 2 changes at the same time if at all possible.

If you make 2 changes and get either a really good result or a bad result you won't know which change was the cause of the change in results.

I wouldn't change PS just yet if it were me but you are free to do what you want.

Thank you Pugsy! I kept PS at 4 while lovering EPAP to 12 last night. I slept well and my Aerophagia symptoms were very reduced this morning.

https://imgur.com/wmd6wKy

I still have a little, but not death pain in my stomach like before. I still have a little stomach pain and gas this morning.

I was thinking of dropping the EPAP to 10. What do you think?

[Pugsy]

I think EPAP of 10 would be what I would try. Still keep PS at 4 though.
Your obstructive index last night was 0.43...that's very low and extremely acceptable and you have ample room to reduce EPAP without a hugely negative impact on the obstructive index.
It sure sounds like EPAP is the main component for feeding the aerophagia monster for you and if you think about it logically...it's probably the main component for most people. That constant pressure against the LES (lower esophageal sphincter) the gradually pushes past the sphincter to let air into the stomach. Keeping the constant pressure lower lets the sphincter hold itself closed more easily. At least that's my personal opinion and logic tells me that it surely is possible.

BTW one of the reasons besides my own personal, don't do 2 changes at one time, for not increasing PS is that sometimes in some people higher PS can trigger centrals. So I don't really promote PS 5 or higher unless there is a marked definite need and I don't see it being needed with you.

[zonker]

BTW one of the reasons besides my own personal, don't do 2 changes at one time, for not increasing PS is that sometimes in some people higher PS can trigger centrals. So I don't really promote PS 5 or higher unless there is a marked definite need and I don't see it being needed with you.

ah! this is why you questioned me when i miss-typed my ps at 5 rather than 4.

to the op: sorry, not hijacking your thread, just blurting stuff out.

[Pugsy]

BTW one of the reasons besides my own personal, don't do 2 changes at one time, for not increasing PS is that sometimes in some people higher PS can trigger centrals. So I don't really promote PS 5 or higher unless there is a marked definite need and I don't see it being needed with you.

ah! this is why you questioned me when i miss-typed my ps at 5 rather than 4.

to the op: sorry, not hijacking your thread, just blurting stuff out.

Yep. There is usually a method to my madness that I don't always explain.
Now I myself have tried PS 5 and 6 and I didn't have any centrals to speak of pop up but for some people just a slight difference in PS can make a huge difference in results. I have a friend who gets 15 to 20 centrals per hour with just PS of 4 but with PS of 3 she doesn't have more than a rare central or two throughout the night.
I have never tried greater than 6 PS because it simply wasn't comfortable for me. It was a struggle comfort wise just with 6 PS. I just didn't want to try 6 again and for sure not higher.

Now I think Palerider routinely uses PS of 5 or 6 (I forget exact) and he does well and likes it and no centrals to speak of.
Everyone is different in their response....that YMMV thing.
Now sometimes higher PS might be needed and if so, then we try it but just keep one eye open for centrals. It's not as common as one might think anyway. We see a lot here just because we see mainly the people with problems getting AHI down and using EPR which ends up being PS anyway. The people without a problem won't be coming here.

I have no problem with the OP in this thread at least trying PS of 5 at some point in the future if he wishes but I just don't like 2 changes done at one time for the reason I explained above. Chances are he/she won't have a problem with centrals but just in case we advise making only one change at a time unless there is a real strong reason to go making multiple changes.
Plus if IPAP does happen to be playing a big part of feeding the aerophagia monster then we are just providing more food and the monster already has a full plate with EPAP.

So I got no problem with your trying PS of 5 if you want to. It may or may not do anything at all to you and you might be like Palerider and really like the higher PS. It might be something to at least try sometime in the future to see if it by chance lets you get the improved sleep quality you desire. Just don't go trying it while messing around with stuff to limit dry mouth or rain out. Fix those problems first.
Remember .....one change at a time so you know who gets the blame or credit for the experiment.