Major weight loss and high pressure issues

Soonerdude11 · Post by **Soonerdude11** » Fri Sep 18, 2020 11:25 pm

Pugsy, do any advice on how to proceed with lowering the bottom number? I don’t want to choke myself like I did in those 18 minutes again lol. Is my median pressure being so close to my starting pressure an indication that I could drop down still?
So far 11 down to 9 has been ok but I want to see if dropping a little more will make the air problem better but I don’t want to have anything happen like above in that 18 min. window. So far I’ve had 3 days at the 9-13 range.

Pugsy · Post by **Pugsy** » Sat Sep 19, 2020 7:03 am

I am not so sure that the 18 minutes you didn't like had anything to do with the pressure being at 8 minimum
I think something off beat or weird happened.
But what you can do is go down in smaller increments instead of 1 cm increments.

Soonerdude11 · Post by **Soonerdude11** » Sat Sep 19, 2020 11:28 am

This was last night at 8.6-12. I felt the best so far and less stomach issues and minimal burping. Leak dropped down some more but I also know that can be different from day to day. I didn't have any dry mouth and my eyes weren't dry this morning from what I could tell. Can you tell me how the median pressure vs 95 percent pressure works? In your opinion do you think the median pressure should be hugging so close to the minimum? Could that possibly mean I have more room to lower?

zonker · Post by **zonker** » Sat Sep 19, 2020 11:36 am

Soonerdude11 wrote: ↑
Fri Sep 18, 2020 11:25 pm
Pugsy, do any advice on how to proceed with lowering the bottom number? I don’t want to choke myself like I did in those 18 minutes again lol. Is my median pressure being so close to my starting pressure an indication that I could drop down still?
So far 11 down to 9 has been ok but I want to see if dropping a little more will make the air problem better but I don’t want to have anything happen like above in that 18 min. window. So far I’ve had 3 days at the 9-13 range.

sounds like it's time to mention the zonker protocol. i, too, have issues with aerophagia. what i did to start is find a minimum pressure where i could not suffer from gas. i paid NO ATTENTION to my ahi. it went up. i knew it would.

but i needed to get sleep. what good is a low ahi if i can't sleep for the pain? so i turned my min down, i think to 6 or 7. once the aerophagia monster was tamed, i started to slowly(and i mean SLOWLY) to raise that min pressure. i would go up by .2 and if i felt the gas pains, i'd back off. then try again. btw, i left the max at 20.

this took me months! but i did it. i'm now currently at a min of 18 and max of 20. for reasons having nothing to do with this discussion, i'm going to start raising that min again. and i'm not having any aerophagia.

if you want to go through the whole boring routine, read it here-

viewtopic/t173195/zonkers-cribsomewhere ... r%27s+crib

it's a long ass post so you may want to jump to page ten or so.

hope this helps!

Soonerdude11 · Post by **Soonerdude11** » Sat Sep 19, 2020 11:43 am

Another couple random questions. Why is there a discrepancy between how high it really got in pressure on the graph and what the max pressure stat says? Also, I noticed it says its guessing what the settings were for the night sometimes. What's that about? I feel like I've noticed both of these things before.

Soonerdude11 · Post by **Soonerdude11** » Sat Sep 19, 2020 11:46 am

Thank you to everyone who has been replying. I appreciate all the great advice.

Pugsy · Post by **Pugsy** » Sat Sep 19, 2020 12:52 pm

I don't see any discrepancy in the maximum pressure statistic and the pressure graph. The pressure line stops short (just barely) of the 11 cm line. If you changed the scale you could see if more clearly. Plus I think the max stat is based on 99% or something weird. I forget exactly how it is figured.

As for the note about the settings. That's mainly for when people make a change mid session reporting and there is data there from different settings within a 24 hour reporting period.. The settings notations don't have a way to separate the settings reported in that statistical area when you change something. I think it picks the earliest setting as to what it says.
Like if you started the night with 6 minimum and later in the night increased it to 8 minimum..say after an hour or so...the settings would say 6 minimum to whatever. Same thing if you change the max during the night or change EPR or whatever.

As for 95% stats vs median pressure stats. Sometimes they are close and sometimes not. I see it myself all the time. Doesn't mean much except some nights I need more pressure for short periods of time than I do other nights.

I don't worry so much about the numbers or the differences in numbers or if the median is close to the 95% number or not. They are just numbers.
Now looking at your median number and your AHI which is nice and low and the fact that your median number is also pretty much your minimum pressure setting....that tells me that your minimum pressure could be lower and not allow the airway to collapse.
Remember the definitions of median and 95% numbers.
http://adventures-in-hosehead-land.blog ... de-to.html

Since you are having aerophagia issues and the constant minimum pressure is contributing to the aerophagia issues then it makes sense to reduce the minimum pressure in an effort to reduce that constant pressure on the LES which is letting air sneak into the stomach.
You have room to reduce the minimum pressure and not have the reduction cause a lot of apneas to happen and maybe reduce the belly issues. If your AHI was high...then we would be having a different discussion about the minimum.
From the looks of your AHI and the non movement much of the pressure line I wouldn't be surprised if 6 cm minimum was more than enough to adequately deal with the bulk of the holding of the airway open and then let the machine go higher only when needed....but you aren't comfortable with a lower minimum at this time and that's okay too.
It hurts nothing to use more minimum than you might technically need to hold the airway open well enough as long as that minimum isn't causing a problem.

billbolton · Post by **billbolton** » Sat Sep 19, 2020 2:34 pm

Soonerdude11 wrote: ↑
Mon Sep 14, 2020 4:10 pm
The last three nights. Tried changing EPR each time to help.

Just as a general comment, if you make a change to your xPAP therapy, you should really run it for 5 days, or longer, to evaluate what the impact is.... a single night is simply not long enough to isolate the impact of any change.

Soonerdude11 · Post by **Soonerdude11** » Sat Sep 19, 2020 2:43 pm

Thanks Pugsy. Yeah it must be an average pressure thing. I thought it was the max it hit for any amount of time. I put the cursor over where it said 10.9 to show the difference. I think it’s the averaging like you said.
Now as for the settings thing, I think I only changed it right before I went to bed (at least this time) to 10.6 but maybe it just didn’t register or something. I have also experienced it like you said when you change it midway through the night. If I select all the sessions from a day ago when I did change it from 8.0 after choking, it did show a different starting pressure at the top right below the orange ahi stripe and the machine setting part and then lower starting on the statistics thing on the setting so there’s one way I noticed it and then also it sometimes says “settings are guessed” in addition to the differences but not every time. I guess it just depends and honestly it doesn’t matter. I’m just rambling....lol.
Thank you for your advice on the minimum pressure. I’m trying to obviously keep it as low as needed just wasn’t sure how slow to go. It’s so strange to be in this lower pressure territory. I’m sure you are right that I may just have overall lower pressure needs. I have a regular doctors appointment on Monday to discuss the symptoms so they can show documentation to get me a titration study. I want to make sure I’ve lost most all the weight before I get the study done since those aren’t typically covered more than once in a while. I’m going through the Choctaw Nation for the sleep study, so not like regular health insurance. Honestly it would be great not to have to do a sleep study at all, but I know that may not be in my best interest if when I’m ready, I could get it done and not have to pay out of pocket.

Pugsy · Post by **Pugsy** » Sat Sep 19, 2020 7:35 pm

Going down in pressure when someone has been used to a higher pressure for a long time isn't easy sometimes.
I once did an experiment where I went from my normal minimum of 10 cm starting pressure up to a minimum of 13. I took 6 weeks to complete the experiment with a 0.5 cm increase every 7 days. So I gradually went up to 13 and used it for a week.
I was experimenting to see if the AHI changed...or how I slept or felt changed...nothing changed so I aborted the experiment and immediately dropped it to the prior 10 cm minimum. I actually was uncomfortable at 10 cm for 2 or 3 nights because I felt a bit air starved or suffocating even at 10 because I had been using a higher minimum. Now I knew what it was so I was able to just bull through it but sudden changes either up or down can be uncomfortable just from an overall sensation kind of thing.

Now in your situation...we have a known goal....aerophagia relief so we want to reduce the pressure rather quickly in an effort to reduce aerophagia but you still have to be comfortable with the change. Sort of damned if you do and damned if you don't kind of thing.
It hurts nothing to go down slowly but it does increase the potential for aerophagia if you are still above the line in the sand where below a certain pressure there is no aerophagia and just above it you have aerophagia.
If you were brand new to cpap therapy and not used to the higher pressures...we just tell you to drop the minimum way low and we work our way up but in your case it's best to work our way down.

Soonerdude11 · Post by **Soonerdude11** » Sat Sep 19, 2020 7:50 pm

Great advice! Thank you!

Soonerdude11 · Post by **Soonerdude11** » Sun Sep 20, 2020 5:02 pm

Here is last night's data. I had a few burps throughout the day but I don't think my stomach hurt from what I could tell. I had some dry mouth from my mouth occasionally dropping open but its so much better than it was. My leak rate looks pretty good too. Looks like I only had one little central apnea compared to the multiple I was having before at higher pressures, and I'm not even sure it was a real one. Where do I go from here? Hold steady tonight or drop maybe to 7.6?

Pugsy · Post by **Pugsy** » Sun Sep 20, 2020 5:53 pm

You zoomed in a little too close to really evaluate the one central apnea. Can't see enough of the flow rate breaths preceding it.
Needs to be approx a 3 minute segment with the central to the right side so the flow rate preceding it can be seen better to get an idea if you were awake or not.

It's your choice what to do. If it were me I could continue to reduce the pressure and see what happens.
And try to get to a point where I didn't even burp much during the day unless I know it was from eating or drinking something that caused the burp.

Soonerdude11 · Post by **Soonerdude11** » Sun Sep 20, 2020 6:28 pm

Is that better? I don't tend to fall asleep too quickly so not sure.

Pugsy · Post by **Pugsy** » Sun Sep 20, 2020 8:32 pm

Yes, that is much better. Thank you.
You weren't asleep during that segment.

I am leaning towards those prior centrals you had show up at the higher pressures being more awake related than pressure related.
I am thinking that the higher pressures caused the belly issues which caused most likely awake/arousal issues and then the centrals got flagged like the one above.

Major weight loss and high pressure issues

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