Obese w/a big gut and RERA's

[pitman]

I am very obese. I have lost 70 pounds in the past 10 months and have another 50 pounds to go to a reasonable goal weight for me. I wake up a lot during every night typically to either go the the rest room (3-4 times) or back ache from sleeping on my back. I cannot sleep on my side because my huge gut would block my ability to breath. My AHI's are always < 5 and typically between .8 to 3.8. The higher AHI occurs when I try to sleep on my side because my lower back hurts, it is more difficult to breath because of the gut. Sleeping on my back is difficult to breath because of my big gut as well. I know the solution is to continue to lose the weight which I am and will in time. My RERA's are up and down between 0 to .38. to .55 to .65 to .89. I have not nasal blockages. I am a mouth breather and use a Resmed FF that fits well and never have leaks. I sleep with a fixed 13 setting because I feel I wake up less times that if I increase the setting. I have tried setting the machine to auto @ 13 on low to 18 on high which seems to wake me up more. I think my gasping for air because of my big gut causes autos to increase airflow which wakes me up. I know, it's complex with the solution to lose the gut to see if my sleep patterns improve from an average of 6-7.5 hours with getting up 3-4 times nightly. Could the RERA's be from the gasping for air and could those drop once the weight is much lower?

[lazarus]

CPAP can be helpful to people of all gut sizes.

If obesity is restricting breathing, bilevel can sometimes help improve matters.

The choice of auto settings is all about a person's data, keeping the minimum within a cm or two of what is needed to prevent apneas. But a higher straight pressure can sometimes prevent sleep disturbance more effectively for some. That may be the case for you.

You need to be able to breathe effectively when you sleep as you lose weight, though. So as great as losing weight is, pursuing future weight loss doesn't negate the need to keep a person breathing and sleeping well before, during, and after that.

[pitman]

CPAP can be helpful to people of all gut sizes.

If obesity is restricting breathing, bilevel can sometimes help improve matters.

The choice of auto settings is all about a person's data, keeping the minimum within a cm or two of what is needed to prevent apneas. But a higher straight pressure can sometimes prevent sleep disturbance more effectively for some. That may be the case for you.

You need to be able to breathe effectively when you sleep as you lose weight, though. So as great as losing weight is, pursuing future weight loss doesn't negate the need to keep a person breathing and sleeping well before, during, and after that.

Thanks for your reply and help! I not used a bilevel before and know zero about them. All I understand about them is you set the inflow and expiration independently. I think I will ask my doctor to prescribe one to try out. Can I start out with auto settings and then tweak them as I learn the machine?

[lazarus]

In my opinion (as a non-pro), an in-lab titration is particularly helpful when bilevel is prescribed to lessen the work of breathing when nighttime hypoventilation issues may be suspected. That way the perfect difference between breath-in pressure and breathe-out pressure can be dialed in.

But a good sleep doc with experience recognizing and ruling out things like possible OHS would generally make that kind of call, not some random guy on the Internet like me.