Tyrone747's therapy

Here's last night's results. 0.0! I feel more rested but still not great. You can see my sleep was quite broken. I tried going to bed early but just couldn't so I got up for 3 hours. Last night I tried a new mask which hopefully doesn't confound things too much, the Airtouch F20. At 2 am it developed a large leak with pressure above 10. It was practically hovering above my face lol. I briefly went back to the Dreamwear FFM but decided to give the F20 another shot because the memory foam really is quite comfortable (except on the nose bridge where it pinches somewhat). So I cinched it down and tried again. Around 5 am I had aerophagia problems again. 3 large belches. Not as much stomach pain this time but I wonder if that's just because I wasn't on high pressure for as long. So I believe it is the max pressure that is the cause. Tell me what you think. I set it back to 6-10 and went back to bed and slept ok. Without the fooling around with masks for 30 minutes and dealing with aerophagia for 20 minutes I think I would have had a pretty good sleep. Any suggestions on how to proceed from here? Could you tell me about the Flow Limit. graph? How much limitation is 'normal'? I often wake up in the morning with one or both nostrils blocked. Nasal rinses before bed don't seem to help much. I think nasal congestion is really hurting my sleep so I'm going to try eliminating dairy which I know I'm sensitive to and see if that helps. Kind regards.

tyrone747 wrote: ↑

Tue Mar 26, 2019 7:30 am

Here's last night's results. 0.0! I feel more rested but still not great. You can see my sleep was quite broken. I tried going to bed early but just couldn't so I got up for 3 hours. Last night I tried a new mask which hopefully doesn't confound things too much, the Airtouch F20. At 2 am it developed a large leak with pressure above 10. It was practically hovering above my face lol. I briefly went back to the Dreamwear FFM but decided to give the F20 another shot because the memory foam really is quite comfortable (except on the nose bridge where it pinches somewhat). So I cinched it down and tried again. Around 5 am I had aerophagia problems again. 3 large belches. Not as much stomach pain this time but I wonder if that's just because I wasn't on high pressure for as long. So I believe it is the max pressure that is the cause. Tell me what you think. I set it back to 6-10 and went back to bed and slept ok. Without the fooling around with masks for 30 minutes and dealing with aerophagia for 20 minutes I think I would have had a pretty good sleep. Any suggestions on how to proceed from here? Could you tell me about the Flow Limit. graph? How much limitation is 'normal'? I often wake up in the morning with one or both nostrils blocked. Nasal rinses before bed don't seem to help much. I think nasal congestion is really hurting my sleep so I'm going to try eliminating dairy which I know I'm sensitive to and see if that helps. Kind regards.

Glad you are feeling more rested! That is the goal.
I'm sorry to hear you are fighting with finding a comfortable mask, but that is pretty much true for everyone around here. When you find that special one, you will promise to live with it forever!

I think the clever people round here will tell you to raise the lower pressure - your machine keeps having to jump up above 9 to fix your flow limitation, and raising the lowest level helps it get there faster.

Thanks. What would be an appropriate minimum setting? Is 10 too low for a maximum? I'd like to avoid aerophagia but don't want to short change myself on therapy. I'm thinking of trying 8-10 tonight.

What about using EPR all the time instead of only Ramp mode? Could that help with aerophagia and allow me to keep the max setting at 20?

You need to try diff settings yourself to be sure, or even half sure. No one else can do that for you and you should try one change at a time for at least a couple of nights each so you get a more definitive idea about things. Our guesses (even educated) are still speculative and second-hand if you know what I mean - try stuff, see how it goes and then try others.

tyrone747 wrote: ↑

Tue Mar 26, 2019 4:17 pm

What about using EPR all the time instead of only Ramp mode? Could that help with aerophagia and allow me to keep the max setting at 20?

That's what I would do if it were me.

Ok I'm going to try 8-20 with full time EPR 2. Or should I try 3? Though from my reading my GERD might make me more susceptible to aerophagia since the sphincter doesn't stay closed.

The last two nights I tried going back to CPAP mode to try to find out my pressure threshold that aerophagia starts at. At 9 inH20 I had no aerophagia but last night at 11 I had bad gas and belching. Tonight I will try 10. Unfortunately even at 11 I still feel quite bad this morning. Not sure if it's the apnea or the aerophagia making me feel this way but it's discouraging. Now I'm questioning whether the good feelings I had in the past weeks on a pressure of 5 were just placebo.

Feel tired but ok this morning. At some point I took my mask off which I don't remember but I got it back on eventually. I changed the pressure from 9 down to 7 which I do remember was because I was having some mild belching. Tonight I'm going to sleep on my side instead of stomach and see if stomach sleeping is causing my aerophagia. I took a Claritin before bed on the advice of Dr. Falcon but it didn't seem to have any effect on my stuffiness. I woke up with my left sinus plugged. I'm also going to switch from the Airtouch F20 to the Dreamwear FFM tonight since the Dreamwear seems to keep my nose open better. I'm going to leave pressure at 7 so I can get some rest tonight without aerophagia. Once I'm rested I'll try again on higher pressures while side sleeping and I'll also try EPR.

The EPR makes it so much easier to breathe. You should try it.

I'm concerned EPR affects and increases the CO² levels creating central apnea.

tyrone747 wrote: ↑

Fri Mar 29, 2019 10:39 am

I'm concerned EPR affects and increases the CO² levels creating central apnea.

EPR DECREASES CO2.

Wonderful night for the first time in a while. Woke up 3.5 hours before my usual time and couldn't get back to sleep due to having energy. Settings were fixed CPAP 7 with EPR 2. No aerophagia finally. I slept on my side the entire night instead of stomach which may have helped also so I'm not sure if it was the EPR or position change. EPR is ok but it doesn't kick in quite fast enough on exhale which is a bit weird feeling.

I taped my mouth under the Dreamwear FFM for the first time and actually kind of like it. Tonight I will tape with Dreamwear nasal cushions for more comfort since I won't need the FFM. I will set APAP 7-8 and keep increasing the max setting by 1 until I get back into aerophagia then reduce setting. Then try for higher with EPR 3.

Exciting to be getting rest again finally!

tyrone747 wrote: ↑

Sat Mar 30, 2019 5:22 am

Exciting to be getting rest again finally!

excellent news! and looks like you have a clear path forward. i, too, had to conquer the aerophagia monster. so just remember to take it slow and steady. i know it's not easy to refrain from making big jumps forward, but it will work out in the end.

good luck!

Thanks Zonker.

I feel fairly well after last night. Sleep was looong finally which is nice. I used the Dreamwear Nasal Cushion mask and mouth taped. I do remember waking once with air leaking from my mouth slightly still. Perhaps I should tape across my mouth instead of a vertical strip up and down? Tonight I think I'll go back to taping under the Dreamwear FFM. My nose feels a bit bruised under my nostrils from the way the nasal cushion applies pressure so it could use a rest. The leaks I had last night were disappointing. I'm not sure why they were so bad. Could be leaking from the corner of my mouth or could be mask fit or both.

Obvious thing on the chart is a ton of central apneas. What's causing them and how to fix them? Perhaps my brain just isn't used to the pressure and they will go away with time? Perhaps they are caused by APAP changing pressure, though the pressure change is so small that seems unlikely. Not sure what to do about those.

Interesting Sleepyhead changes EPAP and CPAP pressure on the graph with EPR on while in APAP mode but does not do it in CPAP mode. I hope this doesn't mean EPR is lowering my inhale pressure while in APAP mode.

No obvious aerophagia symptoms this morning other than some short spasming just beneath my sternum. Possibly my stomach sphincter pulsating or just my body being weird. Though I think I'm on the edge of the limit of how much pressure I can handle at 8. Tonight I think I'll press on to APAP 7-9 though I fear that will push me over the edge to aerophagia land. We shall see.