Dog Slobber wrote: ↑Sat Oct 15, 2022 11:33 am
lynninnj wrote: ↑Sat Oct 15, 2022 10:03 am
That was just a part of why I wanted to knock the pressures down a bit though. Nothing radical going from 7 to 6.8.
With APAP, lowering your minimum pressure isn't going to lower your effective pressure. The machine will go where it wants to. In fact, lowering your pressure my result in higher pressure peaks and averages, as the machine compensates for getting a late start on events and pressure changing triggers.
If you want to curb the effects of Aerophagia you want to
start throttling your maximum pressure.
It's not quite that simple. A lot of people with aerophagia are sensitive to the overall pressure---i.e. the median pressure for the night may be more important than whether you hit your max pressure.
Here is a scenario to illustrate what I mean: If you are running in a range like 7-15 and your 95% pressure is 14, cutting your max pressure setting from 15 to 13 or 14 is not likely to do much in terms of affecting the aerophagia, particularly if your median pressure for the night is around 10 or 11 cm.
Whether cutting the minimum pressure to 6 (with or without a reduction in max pressure) will help the aerophagia is an open question: It might or it might not. If it does help the aerophagia, the question then becomes, "At what cost?" Does the number of OAs and Hs go way up? Do you start snoring again? Do you start having more flow limitations? If any of those things happen and the machine is starting to "chase" events, then lowering that minimum pressure could actually
increase the median pressure for the night. But if 6cm is actually enough to keep things under control for the most part, then it's just possible that lowering the min pressure will keep the aerophagia under control.
Another thing to keep in mind is that for some people, the trigger for aerophagia is rapid pressure increases. In this case that original 7-15 range may need to be tightened on both ends: It could be that using 8-13 might be better than either 7-14 or 6-15.
A good starting point is to make a note of the days where your Aerophagia is worse than usual, and then set your max pressure to a little less than your maximum, for that night. Wait a couple days and see how it goes. If the Aerophagia continues, lower it 0.2. Repeat until you find the point where you find your tolerance point.
If maximum pressure is the culprit this approach can work.
But if median pressure is the culprit, then this may not work.
Keep your max pressure there, but feel free to test out if you've acclimated by increasing 0.2 every few weeks or so.
There's no need to increase the pressure by 0.2 every few weeks
if the current pressure range is controlling your apnea and you are sleeping well and waking up feeling rested and refreshed.
Keep an eye out on your AHI, during your changes, sometimes managing aerophagia and AHI means walking a thin line between optimum therapy.
This is the key idea when you have serious aerophagia issues.
My own battle with aerophagia when I was a newbie was intense and prolonged. I was first prescribed CPAP @ 9cm and I was using Resmed S9 APAP in CPAP mode with EPR = 3. And while I was no longer snoring and my AHI was consistently below 1.0, I was waking up to a basketball of air in my stomach multiple times a night.
Changing to Auto mode with a range of 4-9 (with EPR = 3) did nothing to help with my aerophagia and my 95% pressure was about 8cm. But there was still no snoring and my AHI was still quite low. Changing to a range of 4-8 (with EPR =3) did nothing to help my aerophagia. Changing to 4-7 helped some with alleviating the worst of the painful aerophagia, but my AHI started to creep up. And I still wasn't sleeping particularly well because of numerous aerophagia-caused wakes plus assorted other issues.
After several months of misery, I was switched to a PR System One BiPAP Auto running in fixed BiPAP mode with IPAP = 8 and EPAP = 6. Breathing was more comfortable with the bilevel machine and my AHI once again was consistently below 1.5-2.0. But my aerophagia problems with PAP continued, and a couple of months later I was re-titrated in a lab setting to settings of 7/4. Using this setting at home completely eliminated the aerophagia problems, but the AHI crept up and I would snore on some nights.
So I was switched to BiPAP Auto mode with min EPAP = 4, max IPAP = 9, max PS = 5, and min PS =2, and that's pretty much did the trick for keeping my aerophagia at bay. (With my Dreamstation, I've also increased min PS = 3.) My 95% IPAP = 9 almost every night; my 95% EPAP is almost always between 4 and 4.5, unless it's allergy season or I'm coming down with something. (Both of these things trigger more snoring, more overall restlessness, more bad sleep, and, yes, more OAs, more Hs, and more CAs being scored.)
Flow limitations can make my PR Dreamstation sit at IPAP = 9 for long periods of time. And I've occasionally played with the max IPAP settings to see if reducing the flow limitations would lead to better sleep. But whenever I've increased max IPAP above 9, the aerophagia comes back and the flow limitations don't seem to be any better. I even did a short lived experiment once of setting max IPAP to something like 13 in an effort to see where the machine wanted to go, and flow limitations zoomed it right up to 13 and I woke up with aerophagia like I had not had since the dark old days of my horrible PAP beginnings. I've learned one lesson the hard way: IPAP pressures above 9cm don't play well with my stomach and IPAP pressures above 9cm don't make any real difference in my AHI or snoring as compared to IPAP pressures in the 8-9cm range.
On the other end of things, snoring is used to increase EPAP pressure on a PR Dreamstation BiPAP. And I still have occasional nights where I snore. And when my EPAP used to max out at 7cm (when my min PS = 2 on the System One) for any length of time, I would definitely feel the aerophagia the next morning. Nowadays, with min PS = 3 and max IPAP = 9, my max EPAP = 6 and I really don't have any aerophagia issues, except on those rare nights when I'm doing a lot of snoring and my EPAP maxes out at 6cm for long periods of time. In other words, on those very rare nights where my 95% EPAP = 5.5-6.0, I usually have some (usually mild) aerophagia, and if my median EPAP is above 5.5, the the aerophagia is worse. So I've concluded that EPAP pressures above 5.5cm don't play well with my stomach.
It's clear that sometimes max EPAP = 6 is not enough to stop all the snoring. And it's clear max IPAP = 9 doesn't eliminate all my flow limitations. But my current settings do a decent enough job on most nights and I'm sleeping well, so I'm happy to trade off typical AHIs in the 1.5-3.0 range, with the occasional night with an AHI > 4.0 and the occasional night where hubby says I snored for little or no aerophagia problems.
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