setting to reduce stomach bloating

Hello All,
I'm fairly new to the bpap usage, about 6 months, and I seem to get a lot of stomach bloating. I've talked to the doctor about it and he kind of dismissed it as a standard side effect. He said try some Beano. I did, and it didn't help.....

In the reading I've done, it seems like users are making adjustments to try and reduce it a bit. In reading the newbies page, I guess I'm supposed to provide the type of equipment I used.

It's a RedMed AirCurver 10 Vauto and I'm using a full face AirFit F20.

The settings are
Mode = s
ipap = 20
epap = 10
Ti Max = 2.0
Ti min = .3
Ramp = 30
Start epap = 5

Located in Michigan.

Based on the report I get from the MyAir app, it says my AHI are usually around 2. My understanding is that this is pretty good. The problem is, the bloating is so bad I wake up around 4 am and can't get back to sleep, so overall net gain on sleep hours is not that good.

I've also read that making changes to the settings might result in an increase in AHI. My thought iss, why not try to make some changes. If the AHI increases significantly, then change it back. I might be willing to live with a little higher AHI, if I can control the bloating.

I've tried changing my sleeping position from side to side and back, but the bloating is about the same.

The other issue, and maybe it's related and maybe not, I've really got to strap the mask tight to prevent leaks, which is getting uncomfortable. I hoping that lowering the ipap some, might help with that as well.

thought or suggestions? Is there anything else I should try?

Thanks in advance.
Andy

It would help us greatly if you could download OSCAR and post a daily graph the machine settings on their own don’t tell us much


Please read this thread and read how we like the graphs presented.


viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

Get a mask liner from Padacheek.com to help with leaking... don't overtighten your mask as you're defeating the purpose - the silicone needs to inflate to work properly. If the liner still isn't enough, look at readjusting the straps, get a diff. size altogether or a diff. mask... there are so many out there.

Mode S ????? Should be AUTO !

LSAT wrote: ↑

Tue Jun 25, 2019 4:46 am

Mode S ????? Should be AUTO !

And that EPAP of 10 with IPAP of 20 equals PS of 10....WOW....no wonder major aerophagia is happening.

My question to the OP would be is there some special reason the doctor decided on PS of 10....special lung or respiratory problems needing extra ventilation or something??? That's not a common PS (pressure support or difference between EPAP and IPAP).

Pugsy wrote: ↑

Tue Jun 25, 2019 6:23 am

LSAT wrote: ↑

Tue Jun 25, 2019 4:46 am

Mode S ????? Should be AUTO !

And that EPAP of 10 with IPAP of 20 equals PS of 10....WOW....no wonder major aerophagia is happening.

My question to the OP would be is there some special reason the doctor decided on PS of 10....special lung or respiratory problems needing extra ventilation or something??? That's not a common PS (pressure support or difference between EPAP and IPAP).

Would not be surprised if the CA’s are also through the roof due to over ventilation

Jas_williams wrote: ↑

Tue Jun 25, 2019 7:44 am

Pugsy wrote: ↑

Tue Jun 25, 2019 6:23 am

LSAT wrote: ↑

Tue Jun 25, 2019 4:46 am

Mode S ????? Should be AUTO !

And that EPAP of 10 with IPAP of 20 equals PS of 10....WOW....no wonder major aerophagia is happening.

My question to the OP would be is there some special reason the doctor decided on PS of 10....special lung or respiratory problems needing extra ventilation or something??? That's not a common PS (pressure support or difference between EPAP and IPAP).

Would not be surprised if the CA’s are also through the roof due to over ventilation

That was my first thought also but he is reporting an AHI of 2 so I guess that's not happening.

Hello All - Thanks for the replies so far. I'm still pretty new to this, so I don't know what some of the acronyms means. Someone referenced CA's. I'm not sure what that is. Also about the mode, I'm not sure what S is verses Auto. I'm looking for the clinical manual to do some reading.

As for the settings, these are what the doctor said where needed to get my AHI's where they wanted them. Before starting to do some reading, I had no idea of what PS is. I'm still unsure how having a higher or lower PS will affect me. Compared to what a lot of others have posted, it does seem high. It seems like many others try to have a PS around 5.

I am working on install OSCAR or SleepyTime (sp?) to get more detailed report. Hopefully that will enlighten me some more.

Thanks,
Andy

You can request the clinical/provider manual here via email attachment.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

CAs...clear airway...SleepyHead/Oscar term for central apnea. Airway is open but no air is moving. Hold your breath for 10 seconds...that's essentially a 10 second central apnea
OA...obstructive apnea...flow reduction of at least 80% to 100 % because airway tissues are sagging and blocking the airway so air can't move from a physical blockage.
Hyponea...flow reduction that doesn't quite meet OA criteria...most of the time is from a physical blockage like OAs. On occasion they can be central in nature but that's not very common.

Aerophagia...the stomach bloating....The pressure pushes on the LES (lower esophageal sphincter usually but can be the Upper sphincter) and the air enters the stomach. The LES is often damaged or scarred from past GERD (heart burn stuff) so it can't stay closed well enough to prevent the air from entering the stomach. Obviously more pressure means more stress being put on that sphincter.
There are some things you can do to help reduce the symptoms
wiki/index.php/Aerophagia

I suspect the biggest culprit is the PS of 10 going on all the time....all night long.

ASV machines offer auto adjusting PS values....the VAuto only offers fixed PS in either S mode or Auto bilevel mode.

Most people using ASV machines will be using a lower PS and have the machine only go higher when it needs to when a central apnea happens...so they aren't having that 20 cm pressure with every inhale. Usually for centrals the minimum PS is around 4 or 5 with the maximum being up around 15...and the machine only increases the PS when needed and not with every breath...so the pressure on the sphincter isn't always so high...less chance of the air sneaking into the belly.

So your doctor is using the high fixed PS to keep you breathing all night long whether you need it or not...Not ideal or common way to treat central apneas at all.

Beano won't help much as you have found out. To be honest...the doctor doesn't sound like he knows the mechanics behind all this and doesn't want to learn.

Just how bad was your central apnea index during your sleep study? Do you have a copy of your sleep study report? If not, request it.
If your central apnea was so bad you need for the machine to give you a 10 cm burst of air with every breath....you got the wrong machine...ASV or even the ST model would have been more appropriate.

You could try a lower PS and see what happens in terms of AHI and your belly issues....you can change the settings yourself (it's easy) if you are comfortable making changes like that yourself.
I would try PS of 5 if it were me...but you have to decide what you want to do.

wow, you guys are a wealth of information. Let me try to give you everything you have asked for. I had to take a picture of the sleep study results and I can't stop it from rotating. Sorry about that.
Then reading the newbie section, i think these are the OSCAR reports that you recommend inserting.
Events
Flow rate
Pressure (ResMed users..you have 2 pressure graphs...we don't need both..pick one and use it...doesn't matter which one if we want the other we will ask)
Leak
Flow Limitation (this is only for ResMed users...Respironics users won't have this graph but instead the FLs are shown in the Events graph)

When I looked through some of the settings, I didn't see one specifically for PS. I only saw the EPAP of 10 with IPAP of 20. So should i try to slowly reduce the IPAP and try to get to a PS around 5 while keeping an eye on my AHI? I'll try to get the manual and do some more reading.

Thanks again,
Andy

We want the *daily* chart, not the overview.

You'll find "flow rate" on the daily. Respiration Rate isn't the same thing.

Ok. Let me try this again. I hope this is correct.
I did some additional reading and it looks like you can only set the PS when your in Auto mode. Does that sound correct?

Thanks,
Andy

Read this thread please...compare your image to the examples I posted.
viewtopic/t158560/How-to-post-images-for-review.html

PS is pressure support...in the auto mode it's a setting available.
In the fixed S mode it's just there by inference but no special setting choice.

PS is nothing but the difference between inhale and exhale.

In S fixed mode....EPAP 10 and IPAP of 14 means PS is 4. It's there you just don't see a separate setting because you don't really need it.
In Auto mode EPAP 10 with PS of 4 means IPAP of 14.....same thing only everything can go higher if the parameters set allow it.

I noticed when reviewing the charts, it seems like a lot of nights I turn the machine off pretty early in the AM. I knew I was doing that, but I'm kind of surprised how often. I tend to wake up around 2 - 3 am, and due to my stomach hurting, I can't fall back to sleep and then just turn it off.

I've attached another set of daily charts for a different day where I slept longer.

furno wrote: ↑

Fri Jun 28, 2019 11:31 am

I noticed when reviewing the charts, it seems like a lot of nights I turn the machine off pretty early in the AM. I knew I was doing that, but I'm kind of surprised how often. I tend to wake up around 2 - 3 am, and due to my stomach hurting, I can't fall back to sleep and then just turn it off.

I've attached another set of daily charts for a different day where I slept longer.

oscar_daily2.JPG

Post your charts correctly, as Pugsy asked you to.

If you don't like that example, then try this one: wiki/index.php/Sleepyhead:Organize

Otherwise, you're just wasting your time, and ours.