Full Belly

Been using CPAP for 14 years and had a back injury 4 years ago. Problem - when I shift to my sides in the night (due to back pain), the CPAP fills my gut with air like a basketball. I wake with a pain in my gut and need to belch for 15 min. Painful tearing feeling at top of abdomen. Last year decided to have a UPPP, tongue reduction, tonsillectomy, deviated septum fix and a septoplasty turbinate reduction (yes... all at once)... (WOULD NOT RECOMMEND THIS BATCH OF PROCEDURES TO MY WORST ENEMY - WAS AWAKE FOR 7 DAYS STRAIGHT- SEVERE SWELLING AND NEEDED TO PULL AND PUSH EACH BREATH OF AIR)... net result my AHI is now 58 and CPAP does not prevent the apneas any longer. Also CPAP fills my gut with air frequently when on my back now. Not sure if jacking up pressure from 8 to address the apnea will help if my gut is already filling up with air more frequently at 8. Appreciate any ideas.

Talk to your doctor about using a bilevel pressure machine for the aerophagia.
It might enable you to use higher pressures needed to control the obstructive apneas and not promote the aerophagia so much.

Or...what machine are you currently using now? There may be some exhale relief options available to maybe mimic a bilevel machine..depends on the machine and whatever your current settings are.

Thanks for your reply. Using and S9 Auto Set. Had it on auto for a while, but found that it kept waking me up. Finally switched to CPAP mode and locked in pressure setting for better performance, though far from perfect.

New doc says that auto titration mode is used on only 1% of his patients for exact reason that did not work for me (even prior to the surgery). The system does not learn from prior nights and recalibrates based on your sleep disturbances (each of which is a waking occurance). I suppose for some folks, if you tweak up the low end threshold, you can minimize the number of calibration apneas per night... however, at a fixed setting of 8, I have plenty of interruptions besides a full gut. I have tried tweaking my sleep position with a wedge, as well as sleeping in a chair with CPAP to see if that improved, but then I deal my mouth opening up. I have tried various bands to keep my mouth shut (ie - a brace off the internet besides some home remedies) with varying success, but I still am having the apnea - especially if my head tips back (like on an airplane seat).

A lot of us have learned to fine-tune the Auto feature, so it does not run wide-open. for example, you fine you have good treatment at 8.0 cm/dl. I might set that or 7.5 as a minimum pressure, and set a maximium pressure around 14 cm/dL. That range might overcome the apneas not being treated at 8.0, and it would not under-treat like a machine set wide-open at 4.0-20.

Your concern and criticism of the auto are completely valid, when it is run as a wide-open machine. But by narrowing the range, you can improve responsiveness and limit the adverse under or over-treatment. Operating in a range would let you see how the machine responds to events, by reviewing data, without running away and waking you. I would also take advantage of the exhalation relieve feature.

And try using a soft cervical collar (at most drugstores) to keep your head up, airway open and mouth closed.

Have you tried using EPR on your S9? EPR is exhale pressure relief. Works like a bilevel machine but on a smaller scale in terms of available drop during exhale.
If you have used EPR...at what setting? If not, you might try it set to maximum of 3...it might enable you to tolerate higher pressures needed to deal with your apneas.
The surgery you had...often it makes finding a suitable effective pressure difficult even with people who don't have aerophagia issues.

If you don't know what I am talking about with EPR...the manual here explains it.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

If you are already using EPR set to 3...disregard what I have said.

Thank you everyone for your advice. I have not tried the EPR, a soft cervical collar nor tweaking the auto tune to start at 7.5 and up. Will give it a go and advise.
Thanks again!

Great! Wishing you good luck.

The idea of using the auto titration is to eventually narrow down the range you need to get good treatment and a good night's sleep. I use a range of 8.5-13.0, and have experimented with other settings. It's better to make small adjustments and observe changes in your data and how you feel over several nights or a week.

Rough Road wrote:New doc says that auto titration mode is used on only 1% of his patients for exact reason that did not work for me (even prior to the surgery). The system does not learn from prior nights and recalibrates based on your sleep disturbances (each of which is a waking occurance).

Your doctor is an idiot in several ways. The usage of auto is a lot higher than 1%. If you have problems, you can let the machine be auto, but set the pressure range to a narrower range.

Newer Philips PRS1 machines have a "OptiStart" feature that learns from night to night and adjusts the starting pressure based on previous nights. Even without OptiStart, a good doctor would look at the data your APAP provides and adjust the pressure to a more comfortable range.

The %$#@(*$@# medical mafia hates auto CPAP because they have delusions of grandeur and want to ring the register on a lot of unnecessary $leep te$t$.

There's a good chance that auto will help you, but you probably need to set it to a narrower pressure range than the default 4-20 cmH2O pressure. It can raise the pressure when you need it, and drop the pressure at other times. You might get some relief from aerophagia (gas) from this.

The links in my signature line have a link to a youtube video with a suggestion to help eliminate aerophagia by keeping your neck bent forward.

You might also try different sleep positions or sleeping in a recliner.

Are your apneas all obstructive, or are you having centrals?

Are you using software to check on the data your machine records? If not, get SleepyHead or ResScan and check your data.

Also, please get an ID on the board and fill in the equipment on your profile so it shows up on your posts. There is a link in my signature line on how to do this.

Last year decided to have a UPPP, tongue reduction, tonsillectomy, deviated septum fix and a septoplasty turbinate reduction (yes... all at once)... (WOULD NOT RECOMMEND THIS BATCH OF PROCEDURES TO MY WORST ENEMY - WAS AWAKE FOR 7 DAYS STRAIGHT- SEVERE SWELLING AND NEEDED TO PULL AND PUSH EACH BREATH OF AIR)... net result my AHI is now 58 and CPAP does not prevent the apneas any longer. Also CPAP fills my gut with air frequently when on my back now

This is a little off topic, but I'm curious if your doctor warned you of any of this as part of giving informed consent and whether any one else told you this might happen? We see people here on this forum so often who are just sure that these surgical procedures will "cure" their apnea, and I think your experience is more common. But when we point this out, it is rarely appreciated by someone bound and determined to get off CPAP by having these surgeries.

Back home and going to give the CPAP a go again. In answer to your questions:
- 9:1 ration of obstructive to central apneas.

As to the warnings, the doc was very conservative in the beginning. Focused on diet and other means to help improve. I embraced the 'no white' diet to help reduce my skin elasticity, gave up alchohol, etc.... Due to my bad back, CPAP was not working - I can't stay on my back all night. Going to my side I would wake with belly full of air - and then yank off the mask/snore/get kicked out of bed by my wife. For my back, swimming is the only thing that relieves the pain of my crushed disc - plus lower ab exercise. Once kicked out, I kicked up my workouts to get very lean - hoping this would help my apnea etc... Last year spring before the series of surgeries, I was considered moderate with and AHI of 24. Having adopted the diet for 3 years as well as consistent exercise for 4, I was not making any more progress. That's when the doc and I started talking surgeries. He flipped the safety and we did quite a few at once, and it nearly killed me. Prior to the surgery he advised that there was a 50/50 chance that my apnea would be cured (jump ball) and an 80% chance my snoring would improve. I followed up and asked point blank - is there any downside, and I was assured there was not. So after having the surgery, I literally could not breath the 2nd night after surgery meds wore off - Severe swelling - pulled and pushed each breath... simply terrifying. I did not sleep for 7 days straight till the doc pulled the splints out of my nose. - plus experienced 4 very severe apneas shortly afterward where I was literally launched from my bed. Since then, I have averaged 2-5 hours of sleep. Happiest guy I know on 2 hours, as I know I will talk to real people vs. the hallucinations experienced post op.

Now docs say that it is my tongue that is the culprit. Looking at mouthpiece (told it is low chance of success due to how severe my apnea is - 50/50); rf treatments I hear are 20% effective; hypoid bone tweak has 60% success; or lower jaw advancement (breaking my lower and upper jaw and moving forward 8-10mm)... Lovely buffet of options. Going to be put to sleep with a scope (propathol induced sleep with scope through nasal cavity) to see how airway collapses... this should help define what procedure will be more effective..... BUT... I am here, because I hate the look of the remaining options, and I am simply exhausted....

Sincerely - I am DELIGHTED to hear your ideas. Thanks you again for your kind suggestions. Giving them the college try for the next week starting tonight.

BTW... I updated my profile. Hope footer with my S9 Autoset pops up this time... Thanks again.

holy crap. Yep...that sums it up.

So...does temp/humidity seem to make ANY difference with the air in the gut?

archangle wrote:

Rough Road wrote:New doc says that auto titration mode is used on only 1% of his patients for exact reason that did not work for me (even prior to the surgery). The system does not learn from prior nights and recalibrates based on your sleep disturbances (each of which is a waking occurance).

Your doctor is an idiot in several ways. The usage of auto is a lot higher than 1%. If you have problems, you can let the machine be auto, but set the pressure range to a narrower range.

Newer Philips PRS1 machines have a "OptiStart" feature that learns from night to night and adjusts the starting pressure based on previous nights. Even without OptiStart, a good doctor would look at the data your APAP provides and adjust the pressure to a more comfortable range.

The %$#@(*$@# medical mafia hates auto CPAP because they have delusions of grandeur and want to ring the register on a lot of unnecessary $leep te$t$.

There's a good chance that auto will help you, but you probably need to set it to a narrower pressure range than the default 4-20 cmH2O pressure. It can raise the pressure when you need it, and drop the pressure at other times. You might get some relief from aerophagia (gas) from this.

The links in my signature line have a link to a youtube video with a suggestion to help eliminate aerophagia by keeping your neck bent forward.

You might also try different sleep positions or sleeping in a recliner.

Are your apneas all obstructive, or are you having centrals?

Are you using software to check on the data your machine records? If not, get SleepyHead or ResScan and check your data.

Also, please get an ID on the board and fill in the equipment on your profile so it shows up on your posts. There is a link in my signature line on how to do this.

I totally agree with archangle's post above.

There are sleep doctors who instead of sending you to a second night study to do the pressure testing, will just send you home with an auto cpap machine which makes a lot of sense considering that each night your pressure needs vary and why have it at the maximum pressure when you might only need that for 30 minutes of 7 hrs sleep.

Can't tell if your sleep doctor is incompetent or is trying to get you to keep coming back for more billable visits. In any event, I think I'd be finding me another sleep doctor.

Great results last night. Set the machine to a minimum of 7.5 with a maximum of 15; set EPR to 3 (was very comfortable), used neck brace; slept on wedge. Thank you again to everyone for your recommendations. I have new hope.
As to temp/humidity, this has only helps in the winter months, when the air is dry. It helps keeps my sinuses moist.

As to docs, the doctor that did the surgery ended up having me do a follow up homestudy test. That was completely pointless. So I switched doctors twice this year, and a new doctor wanted to get a good baseline study. I was fine with that, and I'm happy to see the results, though they indicate that I'm significantly worse off now. I'm happy to at least know that my suspicions have been validated, versus me thinking I'm continuing to lose my mind.

I still have hope that there's a procedure that can kill cure me. I've been on CPAP since 1997 and that it did work well up until five years ago until my back injury. But at the end of the day, I'm in my mid 40s, and as you all know, the apnea only gets worse as the age progresses. I figure my body can handle the surgeries easier at this age, versus in my 60s 70s or 80s. Clearly though, I did not anticipate the surgeries making me 2.5 times worse.

Hoping that I will have a similar experience in the nights to come with this new set up and well likewise let you know if I have any air problems in my gut. Last night was very good. Thank you again to everyone.