I need some advice with my sleep apnea situation.

OMT-- do you think you spend much time awake during the night? If so, how much?

Rubicon wrote: ↑

Sun May 14, 2023 3:37 pm

OMT-- do you think you spend much time awake during the night? If so, how much?

I sleep at morning (3-4 am usually) because my work is online but most of the time at night here in Europe yes.
I bought a cervical collar too for amazon, usually take 1-2 weeks to get delivered.

Sorry my question was not clear.

Between the time you go to bed and start CPAP, and the time you get out of bed and turn off CPAP, during any of that time, are you awake? Just lying there with the machine running?

Do you have any symptoms of GERD (gastroesophageal reflux disease)?

Here's the deal. A valve at the end of the esophagus (LES) remains shut and can resist pressures 25 cmHJ2O or more. Except when you swallow and it relaxes to allow food (and CPAP pressure) to pass. So "aerophagia" ("air swallowing") is not "high pressure pressure shooting into the stomach", you either have to swallow to allow that to happen (and more pressure will allow more air) or the LES is incompetent ("busted"). This is why a visit to a good GI guy might be helpful (if you have good insurance coverage). Bad OSA (and your is well beyond bad) can cause GERD and after all this time you might have LES damage.

Here's an area where CPAP 20.0 cmH2O doesn't quite cut the mustard (be effective):



Here's an area where you're still having obstructive apneas at CPAP 14.0 cmH2O:



however there's still enough breathing effort that should trigger a BiPAP to send in a breath (that last one is a little dodgy tho).

Consequently, BiPAP 20/14 should solve almost all your issues.

That said, keep in mind there's a lot of variables that make things worse or better, but IMO that's a very good place to start.

Meanwhile, since aerophagia is by definition is a swallow, I am trying to sift through stable breathing and continuous sleep to find where (or if) swallowing is occurring, or if it occurs during unstable sleep.

Might be one swallow here during otherwise great breathing/sleep during 20.0 cmH2O:



IDK if it can be done or if it's any value, kinda inventing it as I go along.

Rubicon wrote: ↑

Mon May 15, 2023 2:43 am

Sorry my question was not clear.

Between the time you go to bed and start CPAP, and the time you get out of bed and turn off CPAP, during any of that time, are you awake? Just lying there with the machine running?

I don't think so, when I wake up is because I need to pee so I pause it then I return and fall asleep again.

I sometimes have reflux and have to take Maalox, but kinda rare maybe once every two-three months I feel the need to take it because of reflux. Not sure if I can still have the problem with the valve tho, I can see to get a visit to check it.

Today I wake up feeling well less bloated, didn't feel much discomfort at all, I sleep on my side and here is tonight results.
One thing that happened was that maybe is normal or nothing to do with this but when I was trying to fall asleep with the mask my tongue was hurting a lot.

https://sleephq.com/public/f70f5f41-5eb ... 4977558653

The SleepHQ file has only a segment of the night (I would assume some time zone thing) and there's some fine-tuning opportunities but relative to your other nights this is fabulous. Why not stick here for a while and see if it's repeatable.

Rubicon wrote: ↑

Mon May 15, 2023 2:44 pm

The SleepHQ file has only a segment of the night (I would assume some time zone thing) and there's some fine-tuning opportunities but relative to your other nights this is fabulous. Why not stick here for a while and see if it's repeatable.

Yes don't know why it looks like that this time, I will keep it for the upcoming day's and keep updating, probably will wait to have at least 2-3 day's of info.
That way there are more info of how those settings work, and how I feel about the air swallowing.

Hopefully this will work for me, I know 6 AHI's aren't the best and probably the ideal would be 1 or less, but from 75+, I thinks is a good result, and as I'm starting my journey to lose weight too, pretty sure that will help a lot too.

cpap2994 wrote: ↑

Mon May 15, 2023 4:24 pm

I know 6 AHI's aren't the best and probably the ideal would be 1 or less, but from 75+, I thinks is a good result,

In some situations we often have to accept an "okay" compromise.......at least for now because to get the AHI lower can cause more problems than a slightly higher AHI might be causing.
Lets continue with this for a few more nights and see if there is a trend here that we can identify.

Pugsy wrote: ↑

Mon May 15, 2023 4:40 pm

cpap2994 wrote: ↑

Mon May 15, 2023 4:24 pm

I know 6 AHI's aren't the best and probably the ideal would be 1 or less, but from 75+, I thinks is a good result,

In some situations we often have to accept an "okay" compromise.......at least for now because to get the AHI lower can cause more problems than a slightly higher AHI might be causing.
Lets continue with this for a few more nights and see if there is a trend here that we can identify.

I totally understand and will do that! really appreciate the help I'm getting for you guy's with all my heart for real! appreciate it a lot!

cpap2994 wrote: ↑

Mon May 15, 2023 4:24 pm

That way there are more info of how those settings work...

IMO we will absolutely need to apply the aforementioned Jason Premise (or at least a modified version of it); discuss why having Pressure Min set at "abyss" is a bad idea; and talk a little bit about the phenomenon of "CPAP Hysteresis" as part of Fine Tuning.

cpap2994 wrote: ↑

Mon May 15, 2023 4:24 pm

Rubicon wrote: ↑

Mon May 15, 2023 2:44 pm

The SleepHQ file has only a segment of the night (I would assume some time zone thing)

Yes don't know why it looks like that this time, I will keep it for the upcoming day's and keep updating, probably will wait to have at least 2-3 day's of info.

Y'know OST I don't thing it's a time zone thing. You mentioned that your bedtime is 3 - 4 AM, you are set to Lisbon time, and guess you didn't hit the sack till 6 AM so that part looks OK, but on closer examination at the beginning of the file there's a few breaths at "12:00 PM" (which are the last few breaths from May 13 which was cut off). Perhaps Sleep HQ may limit a file to 10.5 hours and/or has a different idea on what a "session" is, I shall research that when I sleaze in to SleepHQ again.

That explains the highlighted area in order to see the night's data (start time is noted as 12:00:04). Oscar loaded the entire day:



So you only slept 5 hours?

Bad cpap2994!

Rubicon wrote: ↑

Mon May 15, 2023 3:11 am

Do you have any symptoms of GERD (gastroesophageal reflux disease)?

Here's the deal. A valve at the end of the esophagus (LES) remains shut and can resist pressures 25 cmHJ2O or more. Except when you swallow and it relaxes to allow food (and CPAP pressure) to pass. So "aerophagia" ("air swallowing") is not "high pressure pressure shooting into the stomach", you either have to swallow to allow that to happen (and more pressure will allow more air) or the LES is incompetent ("busted"). This is why a visit to a good GI guy might be helpful (if you have good insurance coverage). Bad OSA (and your is well beyond bad) can cause GERD and after all this time you might have LES damage.

LES = Lower Esophageal Sphincter. Gastroesophageal Reflux Disease (GERD) is the result of this valve being weak. OSA is a large contributor to developing GERD, and you may find that you no longer have issues with heartburn after many months of proper treatment of your sleep apnea.

Ruby is telling you that a Gastroenterologist may be able to help you with this problem. Unfortunately, they can't. Well, they can prescribe you proton-pump inhibitors (PPIs) like Protonix (pantoprazole) which doesn't treat the problem. But that's about it. It doesn't prevent reflux from happening, it neutralizes your hydrochloric acid. Pepsin isn't affected and can still cause damage. What I'm saying with all of this is... don't expect the GI doctor to heal your sphincter. S/He won't.

Not eating at least 3 hours before bed and obtaining therapeutic xPAP will, over time, improve the function of your LES; thereby, decreasing/eliminating aerophagia and/or reflux.

Also, I encourage you to be evaluated by an Otolaryngologist (ENT) - They will be able to see if there are any anatomical abnormalities (deviated septum, turbinate hypertrophy, nasal valve collapse, large tonsils, etc...) and help you with your allergies.

"Nasal breathing is the preferred route of breathing when we are awake and sleep, and the nasal airway is responsible for approximately two third of the total airway resistance in wakefulness [7]."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863671/

As shown above, your nose is responsible for around half of the total airway resistance, so it's important to treat anything that could increase your airway resistance. You may find after treating your allergies that you don't require a pressure higher than 20 (which would save you from having to buy a new machine and/or reduce aerophagia.)

"One proposed mechanism is that the greater respiratory effort and the cough associated with respiratory conditions increase the pressure gradient across the lower esophageal sphincter (LES), which in turn increases the pressure and promotes the opening of the LES, concomitantly increasing abdominal pressure and ultimately increasing the risk of gastric reflux by facilitating the retrograde movement of gastric contents."
https://www.ncbi.nlm.nih.gov/pmc/articl ... lications.