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Well, let's see, slept a tad over 2 hours last night before I woke up fighting the machine for air. Stomach was bloated as well. So, I'm still getting air in the stomach with the pressure setting at 8. I took a Zyrtec yesterday afternoon and used Vick's but my nose was still plugged up. Color me very frustrated. I go see the Gastro doc this afternoon.

Just back from the Gastro doc. She said that if, in fact, the LES is weak enough to allow the air from the CPAP through there would not be anything she could do about it outside of surgery. Her question is, "Why go to the extreme of a surgery that may or may not resolve the issue when the culprit is the CPAP?" Take away the CPAP and I'm okay. She agrees that the apnea needs to be treated and is not saying to go without it. What she's saying is there should be something we can do to with the CPAP to alleviate the problem.
Added to this problem is the fact that I am fighting the machine for air. I realized last night that I'm taking very shallow breaths. I'm fighting to exhale, not exhaling all of the way, thus a shallow breath. What do I do now? Will a bi-level machine be any better for me or is it a waste of time? I don't know.

What would be the harm in the gastro doc writing you a script for bilevel? I would think you're still in the trial period of your current machine, and have an obvious cause to fail standard CPAP. This seems to be the next logical step. Whether it works or not is kind of unknown, but your last post pretty well stated where things are situated. You need to change the therapy to make it work.

Sleeprider wrote:What would be the harm in the gastro doc writing you a script for bilevel? I would think you're still in the trial period of your current machine, and have an obvious cause to fail standard CPAP. This seems to be the next logical step. Whether it works or not is kind of unknown, but your last post pretty well stated where things are situated. You need to change the therapy to make it work.

This is true. You don't know if you don't try, as they say. I will ask.

Mike208 wrote:Just back from the Gastro doc. She said that if, in fact, the LES is weak enough to allow the air from the CPAP through there would not be anything she could do about it outside of surgery. Her question is, "Why go to the extreme of a surgery that may or may not resolve the issue when the culprit is the CPAP?" Take away the CPAP and I'm okay. She agrees that the apnea needs to be treated and is not saying to go without it. What she's saying is there should be something we can do to with the CPAP to alleviate the problem.
Added to this problem is the fact that I am fighting the machine for air. I realized last night that I'm taking very shallow breaths. I'm fighting to exhale, not exhaling all of the way, thus a shallow breath. What do I do now? Will a bi-level machine be any better for me or is it a waste of time? I don't know.

The Gastro doc might not want to step into the Sleep doc territory and write the script, but she may write a recommendation for bilevel to decrease your gastric symptoms.
I would still tell my sleep doctor what she said and your difficulty exhaling against the pressure. Maybe that will be enough for them to switch.

This is also true. I didn't think about that. A recommendation would help a great deal if nothing else.

Mike208 wrote: Her question is, "Why go to the extreme of a surgery that may or may not resolve the issue when the culprit is the CPAP?" Take away the CPAP and I'm okay.

Sorry to insult your doctor, but this is a typical idiot doctor. Someone here has a quote in their signature, "We train doctors one body part at a time."

It's disgusting that there are so many doctors out there that don't realize a man is a whole and you can't just consider an individual part and ignore the whole.

OkyDoky wrote:The Gastro doc might not want to step into the Sleep doc territory and write the script

Thanks for saying that. Sleeprider is not thinking through what he is proposing.

ChicagoGranny wrote:

Mike208 wrote: Her question is, "Why go to the extreme of a surgery that may or may not resolve the issue when the culprit is the CPAP?" Take away the CPAP and I'm okay.

Sorry to insult your doctor, but this is a typical idiot doctor. Someone here has a quote in their signature, "We train doctors one body part at a time."

It's disgusting that there are so many doctors out there that don't realize a man is a whole and you can't just consider an individual part and ignore the whole.

OkyDoky wrote:The Gastro doc might not want to step into the Sleep doc territory and write the script

Thanks for saying that. Sleeprider is not thinking through what he is proposing.

I know about territorial rights.

OkyDoky wrote:I know about territorial rights.

In business the concept is called "silos".

ChicagoGranny wrote:Thanks for saying that. Sleeprider is not thinking through what he is proposing.

I'm trainable.

My therapy has never been subject to a DME or "sleep technician". My prescriptions have always come directly from my primary care physician, and that has changed over the years. My sleep study, and ENT evaluations were submitted to my primary care provider who wrote a simple one-line prescription in 2008 that got me everything I needed. Since then I have told doctors what I need, and they write the script. Territory never played into it, and it worked.

You may well be right I'm naive, but I'm effective. Why would anyone surrender that control to an autocratic, "know it all" sleep tech that is not looking out for me rather than the cost of equipment they sell? There are options. Getting the physicians that know you and your health involved as the primary decision makers with your input seems to be logical. WTF am I missing?

You would accept anything else?

Midnight Strangler wrote:No wonder archangle has "not tried it" himself.

I don't have an aerophagia problem, so it wouldn't do anything for me. I wouldn't know if it's working or not.

RobertS975 wrote:I would try taking a liberal dose of Phazyme at bedtime. It is simethicone and will undoubtedly be less expensive in the store brand version. It may help your bloating and belching.

Realize that simethicone doesn't eliminate gas, it prevents foam from forming, I'm not quite sure how it would help CPAP aerophagia, but it might.

Sleeprider wrote: WTF am I missing?

You are missing that you are insisting a gastroenterologist write a prescription for CPAP. You are then making an analogy, but in your analogy you use an example of a GP writing a CPAP prescription. (I yell "Logic Fail"). There is a big difference between a gastroenterologist and a GP. (Google them if you don't know the difference.) Yes, my GP has written a prescription for me for a CPAP. He put on the script exactly what I told him.

You are also missing that the gastroenterologist would be overruling the instructions of the sleep doc in scripting a BiPAP. When the BiPAP doesn't solve the problem and the patient goes back to the sleep doc for help, what is the doc going to say? "Go get your smartass gastro doc to do a sleep study."???

Sleeprider wrote:My therapy has never been subject to a DME or "sleep technician". Why would anyone surrender that control to an autocratic, "know it all" sleep tech that is not looking out for me rather than the cost of equipment they sell?

Now you have this point correct. If the patient thinks he needs a BiPAP instead of a CPAP, he should be discussing it with the sleep doctor. This machine switch requires a new prescription. The "sleep tech" cannot write any prescription. See the sleep doctor.

The patient had indicated he was seeing the sleep doc:

Mike208 wrote: This is why I decided to call the doctor. This therapist isn't offering much help. I have read about the biPAP type machine and it's use in similar issues with CPAP.

But after the visit he posted:

Mike208 wrote:Well, I had a visit with the sleep specialist this morning. She said the high pressure was definitely the cause of the air in the stomach. It was lowered to 11 and the ramp time was changed to 45 min. instead of auto. I also have a new mask, one that does not have the forehead support. She thought that was putting too much pressure on the bridge of the nose. So, we'll try it tonight and see what happens. Oh, she also raised the temp. to 86 and the humidity down to 2. That was because of the congestion I have.
I asked her about changing to the biPAP if need be and she said she didn't think there was a need for it, that we can make the necessary adjustments with the present machine.

So I am not sure whether he did indeed see the sleep doc or instead saw a "lesser professional". Mike?

ChicagoGranny wrote:

Sleeprider wrote: WTF am I missing?

You are missing that you are insisting a gastroenterologist write a prescription for CPAP. You are then making an analogy, but in your analogy you use an example of a GP writing a CPAP prescription. (I yell "Logic Fail"). There is a big difference between a gastroenterologist and a GP. (Google them if you don't know the difference.) Yes, my GP has written a prescription for me for a CPAP. He put on the script exactly what I told him.

You are also missing that the gastroenterologist would be overruling the instructions of the sleep doc in scripting a BiPAP. When the BiPAP doesn't solve the problem and the patient goes back to the sleep doc for help, what is the doc going to say? "Go get your smartass gastro doc to do a sleep study."???

Sleeprider wrote:My therapy has never been subject to a DME or "sleep technician". Why would anyone surrender that control to an autocratic, "know it all" sleep tech that is not looking out for me rather than the cost of equipment they sell?

Now you have this point correct. If the patient thinks he needs a BiPAP instead of a CPAP, he should be discussing it with the sleep doctor. This machine switch requires a new prescription. The "sleep tech" cannot write any prescription. See the sleep doctor.

The patient had indicated he was seeing the sleep doc:

Mike208 wrote: This is why I decided to call the doctor. This therapist isn't offering much help. I have read about the biPAP type machine and it's use in similar issues with CPAP.

But after the visit he posted:

Mike208 wrote:Well, I had a visit with the sleep specialist this morning. She said the high pressure was definitely the cause of the air in the stomach. It was lowered to 11 and the ramp time was changed to 45 min. instead of auto. I also have a new mask, one that does not have the forehead support. She thought that was putting too much pressure on the bridge of the nose. So, we'll try it tonight and see what happens. Oh, she also raised the temp. to 86 and the humidity down to 2. That was because of the congestion I have.
I asked her about changing to the biPAP if need be and she said she didn't think there was a need for it, that we can make the necessary adjustments with the present machine.

So I am not sure whether he did indeed see the sleep doc or instead saw a "lesser professional". Mike?

Here! Somebody call? LOL I thought I would be seeing the doc the other day but saw the sleep tech. She's a bottle blonde with a big, goofy smile. I apologize to all the blondes out there. No offense intended. Anyway, she insisted my issue was aerophgia and not insufflation. And she was sure that lowering the pressure would resolve the problem. Well, we all know how well that worked. I just posted that a call to the sleep tech is in order but I meant to say that I will be calling to see the doctor.

I wonder what happened to the other post. Hmmm... I wrote that the Gastro doc was just trying to avoid putting me through unnecessary procedures. She was saying that I'm not symptomatic at any other time other than when using cpap. However, air is getting into the stomach, that we know. Perhaps the LES is weak. If that's the case the only option is surgery which brings it's own risks. And it may make matters worse or cause other problems.
I researched bipap and found that aerophagia is common with them as well. Some people go on to apap. Of course, we don't know until we try. But I think my history will suggest that the odds are against me. I'm not saying I'm beat or unwilling to try. I'm just trying to figure out what's best.
So, if surgery would be the only option to resolve the aerophagia why not just have surgery to try to alleviate the apnea? Which is the best route to take? Can you see how frustrated and confused I am?

Surgery rarely fixes apnea, but GE surg. routinely fixes gastro troubles.