Rooster, I understand your thought, that if one bothers to switch to APAP they have a desire to be successful. I do not know how the studies were set up (but will look for it). I would like to see studies of both groups having received their machines right from the outset.
The folks I am addressing here are mostly on CPAP with painful Gastric Insufflation and am attempting to explain the risks and potential solutions.
You said
"But I am skeptical that APAPs will solve aerophagia problems for many patients and I remain skeptical that it solved it for you.
What pressure were you using with CPAP when you had the problems? What pressure range are you using with APAP while not experiencing the problems? What does the pressure graph typically look like and what is the 90% pressure? "
Switching to APAP immediately solved the problem with the first night's use and it has not returned since.
My titration showed problems starting around 7cm and resolved at 10cm, so of course they set my CPAP at 10CM and the problem came with it. When after 22 months I finally had enough and told the doc to switch me to APAP or lose me, we switched with a range from 6 to 12.
Scores:
NOTE: Respironics Auto M scores everything as events with timestamps in their database. So if pressure is 6 when first turned on at 2100:00 and it goes to 6.5 at 2115:00 you get 2 events and the reporting application does the math to show you were at 6 for 15 minutes.
Arithmetic Mean is the midway mark of the total events captured, not the time spent there. Thus, when they report "Mean Pressure" the arithmetic mean would be the pressure at which 50% of the pressure
events took place. I think they intend to measure the pressure based on 50% of the minutes for the night. I would like this to be clarified by someone who is not guessing like me.
My scores over the past 211 days are as follows:
Mean pressure: 6.9 (50% time =< 6.9)
Peak avg pressure: 8.4 [? Average high of each time the pressure goes up then down?]
90% pressure: 8.6
Avg AHI: 3.9
Avg AI: 1.2
By slowly adjusting my lower limit upward I discovered my troubles start at 7.5cm so that is my threshold. The LES opens according to how much pressure is applied so the more pressure the wider it gets. With CPAP at 10cm it must have been pretty wide.
Another "thing" of mine is using the 90% pressure. If I spend 50% of the night in the 6's, 25% in 7's, 15% in 8's (my actual scores), what relevance does the 90% number (8.6) have for my treatment? To me it is meaningless. Someone else could spend 90% in 8's and 10% in 9's and still have 90% at 8.6 but the issues are very different. But I have digressed...
Rooster, I hope this helps you understand my passion for the subject.
tattooyu... Lowering CPAP pressure to a comfortable yet effective level would be great if ones threshold is above the pressure required to clear events. I suspect this is the case for many who have not experienced the pain of gastric Insufflation. In my case I need 10-12 to clear events while my LES threshold is 7.5. CPAP will never work for me.
Nissen Fundoplication is for repair of a hiatal hernia and as far as I know does not address the LES. Also, it is not a walk in the park. My son has had it done twice.
As for tracheostomy, I have considered it, but consider myself too old for it now and there are a lot of associated issues to consider. Here is the one I would get however:
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A Tracheal Button is a rigid cannula that can be placed into the tracheostomy stoma after removal of a tracheostomy tube. The button does not extend into the tracheal lumen. The tracheal button requires a mature stomal tract, and is generally used as a long-term solution for people with obstructive sleep apnea, which cannot be treated by other means.
It is generally kept closed during the day to be unobtrusive, and opened at night to eliminate sleep apnea. Since the tube does not extend far into the airway itself (like a standard tracheotomy tube), it is easy to breath and talk normally with the device in place. It does not need to be opened during the day, since there is no fixed airway obstruction, as in laryngotracheal stenosis. In sleep apnea, the blockage is due to dynamic collapse of the soft tissue of the throat during the muscle relaxation that accompanies sleep.
More Tracheal Button Info
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