Aerophagia

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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ozij
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Re: Aerophagia

Post by ozij » Thu Oct 13, 2022 11:10 pm

Rubicon wrote:
Thu Oct 13, 2022 12:39 pm
ejbpesca wrote:
Thu Oct 13, 2022 7:34 am
If the max pressure setting is hit on a repeated basis as per a daily report from OSCAR etc., would that indicate that more head room is needed for the APAP machine to climb higher?
I am going to go with absolutely maybe.

If the max pressure represents a REM period and events are causing you to get bumped out of REM, and the REM period is lost, that's an issue that needs to be addressed.
Would you describe flow limitations as "events" too?
And it's not just the max pressure plateau either. There's events all along driving the pressure up.
I'm guess you would.
If significant desats are occurring during max pressure, really shouldn't let those slide.
Given the aerophagia, and acid reflux, I personally would go for a pulse oximeter before driving the max pressure further up
Especially so since it seems that the OA's occur at pressures lower than the max.
Which brings me back to my previous thoughts:
  • Enlist a gastroenterlogist's help with the acid reflux
  • Consider bringing the lower pressure up closer to your median, but be very careful about the acid reflux.
  • And if you still want to raise your max, without oxygenation info, do it in 0.2 increments, as Zonker suggested.

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Re: Aerophagia

Post by Rubicon » Fri Oct 14, 2022 4:07 am

ozij wrote:
Thu Oct 13, 2022 11:10 pm
Would you describe flow limitations as "events" too?
Especially if they cause arousals.

BTW OP, is the head of your bed jacked up?
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Re: Aerophagia

Post by ejbpesca » Fri Oct 14, 2022 9:24 am

https://sleephq.com/public/8b647fd9-567 ... d717f92a52

Bed gets jacked up periodically when tolerated. I have a very jacked up spine.
Gastroenterologist has been consulted for acid reflux. Out of suggestions.
I must investigate how to get oxygenation information.

I fell asleep without APAP, woke around 4am and got it going for a 5 hour sleep session. Acid down so far today at 10:30am and feeling that therapy worked. Prior to sleep yesterday I consumed mass quantities of antacid products to get the burn down.

I see that the pressure graph is not repeatedly reaching for the new max setting of 11. Possibly the new 7.6 min does a better job at preventing apneas so the machine does not go into "more power," mode.

No apparent aerophagia today.

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Re: Aerophagia

Post by robysue1 » Fri Oct 14, 2022 9:34 am

ejbpesca wrote:
Fri Oct 14, 2022 9:24 am
I see that the pressure graph is not repeatedly reaching for the new max setting of 11. Possibly the new 7.6 min does a better job at preventing apneas so the machine does not go into "more power," mode.

No apparent aerophagia today.
I would leave the machine at these settings for at least 4-5 days as long as the aerophagia doesn't come back.

In other words, if one night is "bad", I would not automatically jump to increasing the settings right away. But if you've got a string of bad nights at 7.7-11 and there's no aerophagia, then you can see about bumping either the min or the max pressure up a bit more.

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Re: Aerophagia

Post by Rubicon » Sat Oct 15, 2022 2:36 am

ejbpesca wrote:
Fri Oct 14, 2022 9:24 am
Bed gets jacked up periodically when tolerated. I have a very jacked up spine.
Explain those things further.

Do you sleep on your left side?
I must investigate how to get oxygenation information.
Buy an oximeter and upload data to Oscar.

I'd also get a sleep position app as this could (should, actually) go a long way in explaining both of your issues.
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Re: Aerophagia

Post by ejbpesca » Sat Oct 15, 2022 8:18 am

Rubicon wrote:
Sat Oct 15, 2022 2:36 am
ejbpesca wrote:
Fri Oct 14, 2022 9:24 am
Bed gets jacked up periodically when tolerated. I have a very jacked up spine.
Explain those things further.

Do you sleep on your left side?
I must investigate how to get oxygenation information.
Buy an oximeter and upload data to Oscar.

I'd also get a sleep position app as this could (should, actually) go a long way in explaining both of your issues.
I have an adjustable bed. I raise the head section to replicate having the entire bed on an incline, as prescribed for acid reflux, when my spine will tolerate it. I cannot raise the entire head of the bed by placing it on supports. It is very heavy and vibration from the motors would work it off supports like bricks.

I sleep mostly on my left side. At times I will wake to find myself on my back. Lately I have placed pillows to my back hoping to prevent a roll to my back while sleeping.

https://sleephq.com/public/2a3ea170-359 ... a9223aacd7

I see the pressure is on the move all night. My machine is reaching the end of its service life. I wonder if the APAP is working okay.

Breathing through the APAP mask is easier with the EPR set to 3. I cannot tell if the 3 setting is negatively effecting the therapy.

Aerophagia is not detectable upon waking on 10/15.

Not rested, fatigued.

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Re: Aerophagia

Post by robysue1 » Sat Oct 15, 2022 3:26 pm

ejbpesca wrote:
Sat Oct 15, 2022 8:18 am
I have an adjustable bed. I raise the head section to replicate having the entire bed on an incline, as prescribed for acid reflux, when my spine will tolerate it.
How often are you able to raise the head section of your bed?
I sleep mostly on my left side. At times I will wake to find myself on my back. Lately I have placed pillows to my back hoping to prevent a roll to my back while sleeping.
Is the acid reflux and/or aerophagia better when you manage to stay on your left side?
I see the pressure is on the move all night. My machine is reaching the end of its service life. I wonder if the APAP is working okay.
The pressure is "on the move all night" because that's what Resmed APAPs do: They are constantly increasing/decreasing the pressure based on an algorithm.

Pressure goes up when the machine detects flow limitations and snores. The machine also goes up after the machine detects obstructive events that are close together. Note, however, that it waits until after the event is over before increasing the pressure: Even at maximum pressure, a PAP machine can't force your collapsed airway to open; so it waits until your body responds, arouses, and opens the airway. Then the machine increases the pressure in an effort to make it more difficult for the airway to collapse again. And the machine keeps increasing the pressure until the machine thinks the flow limitations have been smoothed out, the snoring has stopped, there are no obstructive events being detected, and the machine is certain that your breathing has stabilized into nice regular sleep breathing OR the max pressure setting is reached. Then the machine is programmed to start decreasing the pressure until either the minimum pressure is reached or more flow limitations, more snoring, or more obstructive events are detected and the next pressure increase starts.

It's important to note that Resmed's Auto algorithm is pretty aggressive in terms of responding to flow limitations, snoring, and events. In other words, once a Resmed Auto decides to increase the pressure, it can increase the pressure by quite a bit over a fairly short period of time. That's why the front (increasing) sides of "waves" in the pressure curve are so steep.

And while the Resmed Auto algorithm is aggressive in its pressure increases, it's also important to note that just as soon as the machine is "happy" with your breathing, it immediately starts to reduce the pressure. That's what causes the characteristic sharp "peaks" in the pressure curve graph for a Resmed Auto.

Finally, it's also worth noting that the Resmed Auto algorithm is much slower (and more cautious) about lowering the pressure than it is about increasing the pressure. That's why the back sides of the "waves" in the pressure curve are so much more "gentle" than the front sides are.

In other words, there's nothing fishy about how your pressure curve looks given that you are using a Resmed APAP.

Breathing through the APAP mask is easier with the EPR set to 3. I cannot tell if the 3 setting is negatively effecting the therapy.
It will take several days of using EPR = 3 to tell whether there is any serious effect on your therapy.

But if the data you posted at https://sleephq.com/public/2a3ea170-359 ... a9223aacd7 turns out to be typical, then I'd say EPR is not really affecting your therapy all that much.

Yes, there is one cluster of events that starts around 2:50 AM (EDT since I'm in Buffalo, NY) that has 6 OAs scored in a 6-7 minute period. It would be really useful if someone like Rubicon or Pugsy looked at those OAs. To my eyes, it's not clear whether there was an arousal before the cluster started. It is clear that just before the cluster starts, your pressure was at 8.3cm. And it's clear that the machine increases the pressure from 8.3 to 11cm in a 1-minute long period between 2:50 and 2:51 EDT. The pressure increase is in response to the first two apneas being scored along with a flow limitation being scored. But the machine can't go any higher in response to the 3rd, 4th, 5th, and 6th OAs nor the continuing flow limitations that occur between 2:51 and 2:57 EDT.

Regular sleep breathing is established by around 2:57 EDT and continues 3:22:30 EDT. During this time the machine goes through a long pressure decrease specifically because there is nothing to "respond" to and your minimum pressure setting of 7.6 is not reached.

I don't think EPR = 3 is connected to that one cluster of events.
Aerophagia is not detectable upon waking on 10/15.

Not rested, fatigued.
No aerophagia is good. But waking up not rested and feeling fatigued is not good.

How many days have you been using a pressure range of 7.6--11? And was this the first night with EPR = 3?

Have you woken up feeling rested or not fatigued on any day that you've used 7.6--11?

Finally, your median pressure for this night is about 8.6. In the long run, you might need to increase your min pressure up to something in the 8.4-8.8 range, as well as bumping your max pressure up to something in the 11.4--11.6 range. But it's important to change only one variable at a time when you're trying to figure out what does and what does not trigger the aerophagia.

My advice would be to use the current settings (Min = 7.6, Max = 11, EPR =3) for at least a couple more nights. And then post three days worth of data at the same settings so we can figure out what to recommend as the next step.

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Re: Aerophagia

Post by Pugsy » Sat Oct 15, 2022 3:50 pm

robysue1 wrote:
Sat Oct 15, 2022 3:26 pm
It would be really useful if someone like Rubicon or Pugsy looked at those OAs. To my eyes, it's not clear whether there was an arousal before the cluster started.
It is a bit iffy but right before the first OA flag during that first little cluster is evidence of some increased respiration and irregular breaths which makes me wonder if even the first one was a real asleep event and if it isn't then it makes me question the rest of the flagged events as well.

That segment of breathing doesn't look like asleep breathing to me. It's not clear cut but I am leaning towards "not asleep".
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Re: Aerophagia

Post by ozij » Sun Oct 16, 2022 3:01 am

I posted the following on another thread, it's relevant here too:
The newer Resmed machines, of which yours is one, have two "response" options when set to APAP.
You're running on the Standard resopne. They also have a Soft response.

Your machine is set on Standard. Soft may be better. Note that once again, the events triggering a pressure raise occur when you're at the minimum.
A slower pressure change may help with aerophagia. Worth checking.

https://www.resmed.com.au/healthcare-pr ... technology
AutoSet Response mode
ResMed’s AutoSet algorithm now allows for additional customisation of therapy with the new AutoSet Response mode, which offers all the benefits of the enhanced AutoSet algorithm with gentler pressure increases for additional comfort.

For patients who are sensitive to faster changes in pressure during therapy, AutoSet Response can be set to either Standard or Soft. If set to soft, patients will receive gentler pressure rises during therapy.

Available in the AirSense 10 AutoSet and AirSense 10 AutoSet for Her devices.

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ejbpesca
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Re: Aerophagia

Post by ejbpesca » Sun Oct 16, 2022 4:40 am

robysue1 wrote:
Sat Oct 15, 2022 3:26 pm

1.
How often are you able to raise the head section of your bed?
2.[/quote]Is the acid reflux and/or aerophagia better when you manage to stay on your left side?

1. Not often. Raising the head section of the adjustable bed lifts about 1/3 of it. This an awkward and irritating position and I have not found it beneficial.

2. It is appearing to me I now sleep all night, each night, on my left side. If I attempt to go right side, acid increases. I rarely find myself on my back at any waking time. Left side seems best side to reduce acid. Aerophagia will occur sleeping on left side.

Questions on down the reply:

3. How many days have you been using a pressure range of 7.6--11? And was this the first night with EPR = 3?

4. Have you woken up feeling rested or not fatigued on any day that you've used 7.6--11?

Answers:
3. 3 nights. Yes EPR = 3

4. I have not been rested by sleep in many days with 7.6-11 or any setting. Aerophagia/acid woke me around 4 am today Oct 16. Oct 15 report looks good, but I am waking with headache, aerophagia and acid. The headache is fairly new. I will reduce min pressure to 6.8 yet I want to go lower since aerophagia and acid are acute this day.

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Re: Aerophagia

Post by Rubicon » Sun Oct 16, 2022 4:57 am

ejbpesca wrote:
Sun Oct 16, 2022 4:40 am
Left side seems best side to reduce acid.
As a million studies have shown.
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Re: Aerophagia

Post by ejbpesca » Sun Oct 16, 2022 5:00 am

ozij wrote:
Sun Oct 16, 2022 3:01 am
I posted the following on another thread, it's relevant here too:
The newer Resmed machines, of which yours is one, have two "response" options when set to APAP.
You're running on the Standard resopne. They also have a Soft response.

Your machine is set on Standard. Soft may be better.

Machine is now set to soft response.

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Re: Aerophagia

Post by ejbpesca » Sun Oct 16, 2022 5:17 am

Frustrating wake today. Yet another day I need to get things done, but I am so tired I remain in bed all day/night for days now.

Aerophagia and acid woke me. I am reducing the min pressure to 6.8. I think I am realizing I've had this aerophagia going on for a long time, but it took the acid reflux with it and accidentally seeing a video on it to realize my APAP was causing it.

Therapy looks like its happening so now, how to get it with least pressure in hopes of ridding myself of aerophagia and maybe acid with it.

https://sleephq.com/public/8176ae94-a8f ... 72988a7988

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Re: Aerophagia

Post by ejbpesca » Sun Oct 16, 2022 1:07 pm

It has been suggested my now daily headaches may be from lack of O2. I may need to add O2 to my APAP machine and quick if these headaches are about low oxygen during sleep.

Does anyone have an opinion on the Lookee Wellue brand? The oval shaped ring version looks like it would be easiest to use.

I also wonder since I have small fingers if the Lookee O2 ring child version would be best. It seems basically the same as the adult version but smaller. It is advertised as having cell phone and computer data gathering capability like adult versions. Reviews are sketchy but at least Lookee claims to have a US based operation.

Thank you so much for your help online. I asked for oxygen years ago and was ignored by my clinic. (that doctor left and new one does not respond) My doctor is a pulmonologist not an apnea therapy person. Thanks to this forum I know way more now than the clinic I visit once a year for my APAP prescription.

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Re: Aerophagia

Post by ejbpesca » Mon Oct 17, 2022 12:34 pm

Acid/aerophagia not as severe today. It again woke me from pressure and pain from acid. Starting another round of Prilosec. Fear that weak sphincter is causing the acid reflux along with aerophagia. This daily report's last hour or two is me trying to get back to sleep with no success.

https://sleephq.com/public/3cd959bc-8f7 ... dd3b1c42a1

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