ASV and aerophagia

Second night using ASV and horrible aerophagia, on a pain scale of 1-10 it was 8-9. Now what? I guess I shouldn't be too surprised as the machine is puffing bursts of air in order to correct my lack of breathing. However, it was doing that even before I fell asleep. It felt like I was fighting the machine, because it didn't like how I was breathing awake, never mind asleep (LOL). Any hope this will ever work? Feeling way too much like a "special snowflake" right now!

First things.

You should just post to a single thread so that folks who wish to be helpful can see the entire dialog and know what you have tried, what works, etc.

During the period in which you are going to sleep, breathing can become very irregular, at least mine does. The 960 will react to this irregularity almost immediately.

I'm so sorry that you are having these difficulties so early on.
Aerophagia, (air swallowing) is generally a result of pressure and the correction for it is less pressure. In your case, we need to know what the pressure settings are for your machine.

These are mine:
Min EPAP:_______________12.0
Max EPAP:_______________17.0
Min Pressure Support:______7.5
Max Pressure Support:_____13.0
Max Pressure:____________25.0
Flex Setting:______________1
Backup Rate:_____________Auto
Humidification Mode:______System One
Humidifier Setting:_________3
Ramp____________________Off

Note: to get the table to display correctly, I have used underscore characters instead of spaces to align the values.

Once we get your numbers, it will be possible to suggest a temporary modification that you can discuss with your doctor.
There are a few on this forum who have the same aeorphagia problem and their solution is a reduction in treatment pressure to a little less than optimal but which they can tolerate. Therapy that is less than optimal is none-the-less useful therapy and helpful.

The goals here is to get settings on your machine that you can tolerate so that you use the machine every night. It does no good to insist on the "correct" settings and then end up with you not using the machine at all. The same applies to rainout, mask fit/comfort problems, etc. All can, if not fixed, lead to discontinuing treatment and all do have solutions.

It's a little tough to start out with an ASV machine and also have a severe Aerophagia problem as well.
Hang in there - folks here have a lot of experience in solving these problems and will help.

For those who are interested, here is the beginning of this thread from another post:
viewtopic/t113298/Newby-user-of-ASV-Any ... dvice.html
viewtopic.php?f=1&t=113314&p=1093191&hi ... r#p1092986

Fighting the machine?

Isn't the asv supposed to follow your breathing? When you exhale it should drop the pressure, too.

Maybe the epap pressure is high enough that it is difficult to breath against.

Isn't the asv supposed to follow your breathing? When you exhale it should drop the pressure, too.

Maybe the epap pressure is high enough that it is difficult to breath against.

It does follow a person's breathing to some extent but it will also step in and deliver a burst of pressure when the central apnea is detected...it breathes for a person.

Rose needs substantial EPAP to control the obstructive apneas and looks like she is one of the 10 to 15% of the people who develop centrals because of the cpap pressure.
It's probably the substantial EPAP that is the main culprit for the aerophagia. The bursts of pressure for the centrals are of short duration but EPAP is sustained.

It might be possible to compromise a bit on the EPAP (reduce it a little) in an effort to reduce the aerophagia symptoms if those symptoms become really bad but in reducing EPAP then it's possible that some obstructive apneas will slip past the defenses. Damned if you do and damned if you don't.
But allowing a few OAs to happen might be a workable compromise if it reduces the aerophagia.
Something to talk to the doctor about and evaluate just how bad the aerophagia issues are.
Some people find that the aerophagia issues gradually go away so it might be possible to lower the EPAP for a little while and then gradually increase it later.

It's really tough when we trade one problem for another. The pressure is needed to hold the airway open and prevent the OAs and the pressure causes centrals so a different machine is needed that delivers even more pressure because that's how we deal with centrals.
But the pressure causes the aerophagia issues and for some people it is extremely painful all day long and can cause nausea too. For some people it's more than a little belching and farting which is annoying but for some people the aerophagia makes them very ill all day long and the belching and farting doesn't relieve it.

When a person has central apneas in addition to the obstructive apneas the therapy becomes more complicated and it's best to have the doctor involved with any pressure adjustments.

Pugsy +1

It might be helpful to suggest pressure changes to form a basis of discussion with her doctor.
As stated previously, fiddling with pressures in an ASV machine should not be done alone.
Keep your doctor in the loop so that you get as close to optimal treatment as possible.

JDS74 wrote:It might be helpful to suggest pressure changes to form a basis of discussion with her doctor.

Without seeing some reports I might as well just ask the magic 8 ball.
I have no idea what the machine is even doing.
I remember her APAP results though and it wanted to get up there to deal with the OAs..
With max EPAP at 17...we don't know where EPAP is even wanting to go.
She needed to use around 10 minimum I think it was to have any chance of aerophagia relief and at that setting the OAs were abundant.

But the first thing I would do is reduce the minimum PS...geez they have it at 7.5
which means with EPAP at 12 and PS min of 7.5 that makes IPAP 19.5...no wonder she feels like a puffer fish....with those settings as a starting point before anything else kicks in...that's for sure recipe for belly issues in someone with a history of GI tract problems.
Minimum PS would be the first thing I would change if it were me. Something more in line with what is usually started with...like 4. That way the baseline pressure would be 12/16 before the machine does its thing.
But the software reports really need to be evaluated first to get an idea where the machine is even going.
Maybe with bilevel being involved the obstructive stuff could be managed with EPAP minimum a lot lower.

BTW, Rose, do you have access to either SleepyHead or Encore so that you can start looking at the treatment data?
Sleepyhead runs on both Windows and Macs while Encore runs on only Windows.
I use both because of the differences in display of the data.