Tweety: Tweaking Aircurve VAuto settings for aerophagia

I too have noticed that the FL graph simply looks a bit uglier in the for Her mode when compared to the regular auto mode.
Mine isn't nearly as active as yours though but more active than I used to see on the S9 models.
To be honest...as long as I am sleeping good and feeling good and happy with the numbers...I really don't worry too much about how pretty or ugly the FL graph might be AND if I had to deal with the aerophagia monster to get a pretty FL graph...I would be real happy with the FL graph I was seeing even if maybe it wasn't the prettiest. While I don't normally have any major aerophagia issues I have experienced a handful of night where it was bad and so bad that I was ill the next day and I sure wouldn't want to be dealing with that on a regular basis. Given a choice between pretty FL graphs and aerophagia issues and maybe some not so pretty FL graphs and no aerophagia issues and I was sleeping good and feeling good....I would take not so pretty any day of the weak. I do this cpap stuff so that I will feel better overall and not to get bragging rights for pretty graphs.

Glad you are liking the Bleep and seem to have adjusted to it quickly. I have trimmed down the time for my nightly routine with the Bleep to between 10 and 15 seconds and I am all done. Quite a trimming down when initially it was minutes and now just a few seconds.

Thanks Pugsy. I appreciate your perspective. It took a few months to figure it out (and I wouldn’t have without lurking on this forum), but I’m sleeping so much better on cPap than at this time last year without it. No need to let my perfectionist nature ruin a good night’s sleep

Dog Slobber wrote: ↑

Mon Jun 10, 2019 4:39 pm

One thing that helped me when I had aerophagia troubles was sleeping on a wedge pillow.

btw, thanks for this, Dog Slobber. I've started sleeping on piled up pillows (not a wedge, but a good approximation) on my back, and that is the one position that I can sleep in without aerophagia. I eventually have to turn on one side later in the night just for comfort, but less time on my side means less air in my belly in the AM. Plus, I've been able to increase my max pressure to 9.6 and it's not always pegged at the max now.

An update: I’ve been happy with my settings, therapy-wise, on my Resmed Autoset for Her (in aPap mode, Min 7, Max 9.4, EPR 3, but have had ongoing problems with very uncomfortable aerophagia--I dread going to sleep. I feel like I was sleeping well but the discomfort on awaking is awful. So I’m giving an Aircurve 10 VAuto a try, hoping the extra options might help. Any advice on which settings I should focus on? I’m poring over my clinician's manual, and stalking Dog Slobber’s Auto thread for tips .

Before switching machines, I dropped my For Her settings down to the lowest level I felt would let me sleep (Min 7, Max 8.8, EPR 3), but was still getting lots of aerophagia, plus I'd started clenching and grinding my teeth at night (which had stopped with cPap therapy), having more arousals, and waking up feeling like it was not quite enough pressure.

Current Aircurve VAuto settings are Min EPAP 4, Max IPAP 10, PS 3.4 (similar to the Autoset so I could acclimate but not helping the aerophagia). Everything else is at default. I tried PS 3.8 last night and liked it a lot, but that made the aerophagia worse so I dropped it back to 3.4. I don't know enough about the other settings yet.

Other things I’m doing: Sleeping on an incline, using the Dr. Dakota to keep my chin up, taking omeprazole as needed for reflux (currently on day 9 of 14-day course). I had an endoscopy about 10 years ago with a hiatal hernia diagnosis.

Below are graphs from my For Her at the settings that work when I’m not having aerophagia (Min 7, Max 9.2, EPR 3), and the most recent Aircurve graph. All CA events are either at sleep onset or SWJ.

My aerophagia morphed into plain old gas.
Not cpap related--but eating too late in the evening, followed away by horrible bloating and pain.
When I broke that habit (mostly), the pain/bloating went away.
It might not be your problem, but it is always worth a shot.

chunkyfrog wrote: ↑

Tue Nov 12, 2019 2:56 pm

My aerophagia morphed into plain old gas.
Not cpap related--but eating too late in the evening, followed away by horrible bloating and pain.
When I broke that habit (mostly), the pain/bloating went away.
It might not be your problem, but it is always worth a shot.

Y'know, that's a good point. I already know to stay away from chocolate in the evening (so sad...) and wine and especially carbonated sodas. Makes my hubby happy because I'm always the designated driver. I've seen elsewhere in this forum about not eating 3 hours before bedtime (just when my sweet tooth kicks in). I'll try to be more disciplined. Or maybe I'll just stay up 'til 3am

How many times do you think you woke up last night?
Approx how much time spent awake with mask on?
When you did wake up....did it take very long to get back to sleep?

Just an observation. I have less aerophahia with a ps of 4 than I do with a ps of 3. Maybe it was increasing your max pressure and not the ps that caused the problem.

Okay....how about a total about face just to see if we can get you some therapy without the aerophagia monster coming for a visit?

One night experiment.....Change over to S mode on the AirCurve 10 VAuto
EPAP 3 (yes it will go down to 3)
IPAP 7
this will give you PS of 4
See what it feels like and if comfortable sleep with it and see what happens in terms of aerophagia reduction....will worry about the AHI later.

Pugsy wrote: ↑

Tue Nov 12, 2019 5:48 pm

Okay....how about a total about face just to see if we can get you some therapy without the aerophagia monster coming for a visit?

One night experiment.....Change over to S mode on the AirCurve 10 VAuto
EPAP 3 (yes it will go down to 3)
IPAP 7
this will give you PS of 4
See what it feels like and if comfortable sleep with it and see what happens in terms of aerophagia reduction....will worry about the AHI later.

Ok, thanks, I'll try that and report back.

Also, in answer to your earlier questions, I didn't feel, subjectively, like I was waking up any more than usual, but there were more CAs than usual which says otherwise. I occasionally have nights where I lay awake for long periods, but mostly I fall right back to sleep, and did so last night. I'm finding the AirCurve to be subtly more comfortable to breathe with than the Airsense. I do have PLM/restless legs which tend to get worse when I'm uncomfortable, plus I skipped my trigger-point therapy work that I usually do before bed to help control it.

I'm excited, no aerophagia this morning! I did wake up with a massive headache from clenching my teeth, but it's worth it to know there's a light at the end of the aerophagia tunnel.

I was pretty restless--the CAs mark most of my arousals, but I don't remember them much. The absence of Flow Limitations looks really strange, but I gather from the manual that they're not tracked in S Mode--am I right?

I couldn't get to sleep again after the 6:20 pee break even though I was still tired (I hid the morning hourlong session where I lay awake with the mask on). Now that I'm aware of the sleep-onset CA events I sometimes feel them happen and then my brain kicks in and wants to watch the process--very counterproductive to sleep. Did I mention I'm a big nerd? A while back I video-recorded 3 nights of me sleeping so I could make sense of the Flow Rate charts and it's kinda freaky watching a 40-second CA happen.

I should mention, too, that's it's very rare for me to have OA events show up when I'm on cPap. My sleep study overall AHI was 7 in 4.5 hours, but I had 27 OAs during the one 45-minute REM session that finally happened at the end of the night. I know something's happening because I wake up with a really thick head/hit-by-a-truck feeling if I don't wear the mask, even for an hour in the morning.

S mode apparently does not record flow limitations. I didn't realize that until the other day when someone mentioned it.
It's common on Respironics machines in modes where the machine doesn't auto adjust but I had always thought ResMed did do flow limitations in all fixed modes because it shows them on the Elite machines which are fixed mode machines.
Apparently not though...oh well. Minor annoyance.

My whole idea with this experiment was to figure out where the line is for triggering a visit from the aerophagia monster and then see if keeping pressures below that line allowed too many OAs to happen.
EPAP and IPAP both play a part in triggering the aerophagia monster.
I didn't know if your EPAP was playing a bigger part or your IPAP was the bigger factor.

I am concerned about the centrals or arousals. Even if they aren't real asleep centrals that would mean way too many arousals messing with your sleep architecture. Is the central causing the arousal or are the arousals causing the centrals?????
Do you see evidence of arousals prior to the central flagging or mainly after the central flagging?
I wonder about PS itself triggering centrals...it's rare but not impossible. I have another experiment in mind for figuring that out but right now I am only trying to sort out pressures and aerophagia.

It's fairly common for some people to have OSA mainly during REM stage sleep or to have it worsen during REM.
With so many arousals from whatever.....you may not be getting much REM sleep which might explain the lack of OAs/hyponeas.

When in auto mode the machine will want to kill off the flow limitations with more pressure but sometimes the pressures needed to kill off those FLs cause more problems than the FLs themselves cause.....in your situation the higher pressures cause a visit from the aerophagia monster. When that happens I feel that the aerophagia (when really bad) is a worse problem and I would limit the max so that I don't cross that line where aerophagia gets triggered.

How about another experiment but this time in auto mode? EPAP 4 PS3 max IPAP 7. I know it won't auto adjust but I want to see if 4 EPAP triggers aerophagia or not. We could do this experiment in S mode but in auto mode we get the FL graph back.
I am just curious as to what the FL graph looks like. At this point I am only trying to figure out if EPAP is much of a factor in your aerophagia.
One change at a time so we can better isolate which change might do something or how much.

Pugsy wrote: ↑

Wed Nov 13, 2019 11:22 am

My whole idea with this experiment was to figure out where the line is for triggering a visit from the aerophagia monster and then see if keeping pressures below that line allowed too many OAs to happen.
EPAP and IPAP both play a part in triggering the aerophagia monster.
I didn't know if your EPAP was playing a bigger part or your IPAP was the bigger factor.

Yes, that'll be interesting to learn. I can feel when the aerophagia is happening, but can't tell exactly how it's happening (inhale, exhale, top of the inhale?).

Pugsy wrote: ↑

Wed Nov 13, 2019 11:22 am

I am concerned about the centrals or arousals. Even if they aren't real asleep centrals that would mean way too many arousals messing with your sleep architecture. Is the central causing the arousal or are the arousals causing the centrals?????
Do you see evidence of arousals prior to the central flagging or mainly after the central flagging?

I usually have a cluster of Centrals right when I first fall asleep, and then they almost always follow an arousal, as I transition from conscious breathing back to--would you call it autonomic breathing? I'm sure sometimes it's just me holding my breath as I wake up, but I have seen the transition thing on video.

I get these automatic, sudden, deep breaths at regular intervals during deeper sleep, and sometimes they cause an immediate arousal, sometimes not. Don't know if my body is trying to get more oxygen or it's just a reflex.

Pugsy wrote: ↑

Wed Nov 13, 2019 11:22 am

It's fairly common for some people to have OSA mainly during REM stage sleep or to have it worsen during REM.
With so many arousals from whatever.....you may not be getting much REM sleep which might explain the lack of OAs/hyponeas.

Interesting. That fits with a theory I have that some of the weird sleep things I do are survival mechanisms I've developed to keep me in a sort of twilight state or jolt me out of my sleep paralysis so I don't obstruct. Things like teeth clenching, hand spasms (I wake up with my fists clenched and fingers aching sometimes), neck spasms (keeping my head pressed all the way to the right if I'm on my back), etc. One of the weird things for me when I started sleeping longer with cPap was how I wasn't aware of the passage of time through the night--I'd wake up and suddenly it's 6 hours later!

Pugsy wrote: ↑

Wed Nov 13, 2019 11:22 am

How about another experiment but this time in auto mode? EPAP 4 PS3 max IPAP 7. I know it won't auto adjust but I want to see if 4 EPAP triggers aerophagia or not. We could do this experiment in S mode but in auto mode we get the FL graph back.
I am just curious as to what the FL graph looks like. At this point I am only trying to figure out if EPAP is much of a factor in your aerophagia.
One change at a time so we can better isolate which change might do something or how much.

I'm on it! Did I mention how nice it is to not be all bloated and gassy today?

"transition apnea". it's a term, google it for more info.