Advice for next path

Hey guys, I've been trying out the hose life for the last month, and while initially feeling great I've ran into some issues while attempting to optimize my sleep.
I haven't bothered monitoring my sleep on the computer, but I have been checking the 1-7-30 day average AHI and 90% pressure to see where I'm at. The best I've gotten at 4-20 was 5.1AHI, with a 90% pressure at 6.5.....So i figured raising the pressure would help me bring AHI down. I didn't have any problems at 5.5 and my AHI went down to 4.1, so I raised it again to 6.5. I woke up a few hours later absolutely bloated and gasping for air, in pain from all the oxygen I swallowed(aerophagia). I'm certain I need more pressure to keep my AHI down, but ever since then I can't raise the pressure without experiencing the air in my stomach. I've since lowered the pressure to 4.5 and don't swallow as much air anymore, but I'm still waking up after 4 hours every night and my AHI hasn't gone under 4.1.

I slept without the machine for the first time in a month the other night because of my frustration, my wife asked if I was ok the next day- Apparently I snored ALOT more than normal, although I did sleep all night.

I had surgery when I was a kid to remove the adenoids and tonsils, but I'm suspecting I may just have "narrow nasal passages" (It feels more difficult to breathe through my nose on a normal basis, but I may just be out of shape)
Would a full face mask help? Currently I use the Swift FX nasal pillows with a chin strap to hold my mouth shut (I've only woken up in a panic with my mouth open once with this setup)

I have to pay out of pocket for all my sleep needs, so I'm trying to avoid a repeating buy and regret cycle.

Any advice on the path I should take?
I'll try and get the graphs if I can find the time, it's been a pretty crazy month at work/home.

Have you installed SleepyHead yet? If not, at least find the time to do that.
https://sleep.tnet.com/equipment

What we really need to know is the event category breakdown of your AHI before we go talking pressure changes.
It's entirely possible that what you are trying to fix with more pressure isn't fixable with more pressure.

So even if you don't have the time to post an image....tell us the breakdown into each category that AHI is composed of. It's a starting point. How much is the OA (obstructive apnea) index...how much is the hyponea index and how much is the ClearAirway/Central index?
You add all 3 together to get the AHI you see on the machine LCD screen.

Once you have some time...here's how to post images and what we like to see...don't need or want all those graphs.
You can get all we need on one screenshot.
viewtopic/t158560/How-to-post-images-for-review.html

I haven't installed it- I'll get it in tonight when I'm off work. I felt so much better after the first night that I wasn't too worried about the specifics as long as it kept working...and then it stopped haha.

And thanks- I have to travel over an hour for any "good" doctors and with long wait times for everything I'd rather DW my treatment, even if it takes longer and a little bit more effort. I never got an actual titration study and it wasn't even recommended. I just got a blanket "you have osa, heres a script for 4-20 apap" and I've had bad luck with local doctors. I'll try and not ask too many stupid questions

A month is not a long time.
I needed at least 3.

Ah! The Old Take The Money and Don't Bend the Doorknob when you Leave Method. Around here, we call that the Failure Setting Method. Get the software, post the results, then help can be had in finding the correct setting for you.

As far as the nest path, you have never been on the path, first say I Can, get on the correct path, stay on it. The rewards are a longer and better life. Jim

I was expecting it to take a while to get used to, but I wasn't expecting to feel quite a bit better, and then gradually get worse.

Horrah! ran around super busy today and still managed to get it.
This was last nights attempt before I took it off.

Try increasing your minimum pressure to 6.5 or 7.0 and see how things go.

Your machine can't get to where it needs to get to best hold the airway open quickly enough to prevent the airway collapsing.
It just needs a little better head start. Common problem that is easily fixed.

Do you know how to change the pressure? It involves getting into the clinical setup menu area and you need to know the secret handshake to do that but it's easy to learn and do.
Go here and request the clinical/provider manual for your machine via email.
In it you will find the directions for how to get to the area of your settings where you can change the pressures and settings.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

These machines work best when they are preventing the airway from collapsing in the first place instead of trying to play catch up after the airway starts wanting to collapse.

As for why you felt better initially and not so much now...I have a theory about that..
The initial reduction to start with was probably rather substantial so you are more apt to notice a change but once you settle down a bit the new normal is still not quite optimal.
In other words an AHI of 5.0 is a huge improvement from an AHI of 30 so the body says "OMG I feel so much better than before" but now the before isn't 30 and an AHI of 4 or 5 is still enough disruptions to make us feel like crap. The new norm of 5 AHI takes place of the norm of 30 AHI and while the new norm of 5 is a lot better than 30...it still has room for improvement.

I had tried a minimum 6, that's the pressure where it went straight to my stomach. I'll 7 tonight and see what happens. Here's one of my logs from min 6. The "low" pressure at 6 causing aerophagia was
Oddly enough, my home sleep study gave me an AHI of 9.5 ish, and my very first night with the cpap shows an AHI of 9.08. The morning after the first night was a ridiculous improvement. It got better over the next 5 days. I still feel better actually, so I know it's still working. I'm definitely going to keep using, just need some fine tuning like you said, and maybe a change of mask!

If the setting of 6 caused problems with aerophagia then 7 is going to make it worse.

What you need is a different machine where we can add in some exhale relief to get you using a lower pressure part of the night to help reduce the aerophagia

See this
wiki/index.php/Aerophagia

You can't really get any exhale relief with this machine. Unless the aerophagia goes away on its own this machine maybe isn't a good fit for you.

Maybe try 5.5 minimum and see what happens.

A ResMed brand machine with EPR or even a bilevel machine might be needed.

Pugsy wrote: ↑

Thu Aug 30, 2018 8:42 pm

If the setting of 6 caused problems with aerophagia then 7 is going to make it worse.

Is the slightly higher minimum causing the aerophagia, or is it the spikes of higher pressure causing it? It looks like several hours of sleep with some spikes to a pressure of 10.

zoocrewphoto wrote: ↑

Thu Aug 30, 2018 8:52 pm

Is the slightly higher minimum causing the aerophagia, or is it the spikes of higher pressure causing it? It looks like several hours of sleep with some spikes to a pressure of 10.

Don't know. Might be a combination but actually very little time was spent above 6...really about an hour or so over the entire night so I lean towards the minimum being the primary culprit.

One thought I had was to try a fixed pressure but and also investigate if the ugly cluster and higher pressures was maybe related to supine sleeping.

So...maybe a fixed pressure like at 6 cm...and figure out if that ugly cluster is supine related or REM related.

Maybe as air in your stomach is an issue increase the minimum pressure really slowly rather than going straight to a minimum of 7 increase the pressure by 0.2 every other night hopefully you body will learn to not let the air down into your stomach

So I'm stubborn and went straight for 7 last night. What I noticed was what I'll call "blowby" into my stomach EVEN while awake and paying extra attention to my breathing (I stayed awake for 30minutes with it on 7 to see how it felt). 7 didn't feel like a lot of pressure and it wasn't uncomfortable though. When I woke up I felt like I had more air in the stomach, but nowhere near as bad as one of my first nights trying 6. It seems like my AHI are pretty inconsistent looking at the day to day values, they're all over the place.

A little back ground- I had went from 4 to 5.5 after 14 days of use, then 6 (2 days later) and experienced major discomfort- lowered it to 5.5 for 2 days and still had major discomfort in the mornings, dropped it back to 4 and ran for 2 weeks again before putting it at 4.5.

Last night sucked At this point I guess I'll start browsing better machines with EPR and see what happens.

When looking at your report can you spot known awake times?
We know the first 30 minutes so all those events flagged up to around 20:30 aren't real and they don't count.
What about at the end of the night? How much, if any, awake time did you have at the end of the night.

Awake events don't count in the therapy evaluation process. Remember these machines can't determine sleep status...all they can measure is air flow and awake irregular breathing can and will confuse the machine and it will flag awake breathing by mistake.
They don't count. You have to be asleep for them to matter.

I was woken up sometime between 12:15 and 12:30, maybe a tad bit sooner than that. I vaguely recall seeing 12:08 on the clock, but that could have been 12:18. I was in/out until I gave up and turned it off