Aerophagia

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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robysue1
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Re: Aerophagia

Post by robysue1 » Tue Oct 18, 2022 12:03 pm

ejbpesca wrote:
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.
Hopefully this round of Prilosec will help.
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
This may sound crazy, but ...

It may help to go ahead and get out of bed when you've been trying unsuccessfully to get back to sleep for 20 minutes or so.

In my case lying in bed trying unsuccessfully to get back to sleep often aggravates the aerophagia issues.

I don't wake up and find myself unable to get back to sleep in 10-15 minutes very often anymore, but I do remember a time when I simply had to get out of bed (sometimes multiple times) during the course of the night for 15 minutes or so before going back to bed and putting the mask back on. I would usually get sleepy enough in 15 minutes out of bed to make it easier to fall back asleep when I did go back to bed.

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Rubicon
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Re: Aerophagia

Post by Rubicon » Tue Oct 18, 2022 3:31 pm

robysue1 wrote:
Sat Oct 15, 2022 3:26 pm
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.
IMO at least 2 of those events are unambiguous respiratory events. Given the time of night, duration of disturbed breathing, machine response and sudden appearance and disappearance, that could very have been a REM period. The thing to remember about REM periods, they don't like being jostled. Poke 'em a couple times and the body will simply stop trying to REM and that period will be lost. Indeed, in severe severe OSA there may be no REM whatsoever. Put on them on xPAP and they REM till the cows. Massive REM rebound.
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Re: Aerophagia

Post by Rubicon » Tue Oct 18, 2022 3:36 pm

Supine position could also do that, but it's my understanding that the OP is doing stuff to insure side sleeping and there doesn't appear to be motion artifact pre- and post- events indicating 2 position changes (my WAG anyway).
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Re: Aerophagia

Post by robysue1 » Tue Oct 18, 2022 6:40 pm

Rubicon wrote:
Tue Oct 18, 2022 3:31 pm
robysue1 wrote:
Sat Oct 15, 2022 3:26 pm
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.
IMO at least 2 of those events are unambiguous respiratory events. Given the time of night, duration of disturbed breathing, machine response and sudden appearance and disappearance, that could very have been a REM period. The thing to remember about REM periods, they don't like being jostled. Poke 'em a couple times and the body will simply stop trying to REM and that period will be lost. Indeed, in severe severe OSA there may be no REM whatsoever. Put on them on xPAP and they REM till the cows. Massive REM rebound.
Thanks for looking at this Rubicon. As I said, this was not at all clear to me.

Which of the events are most unambiguously respiratory events? I want to learn from your expertise.

I would like to know what you are looking at when you say, "Given the time of night, duration of disturbed breathing, machine response and sudden appearance and disappearance, that could very have been a REM period."

Time of night I understand. I even understand that this cluster and the associated disturbed breathing lasts about 7 or 8 minutes and that some REM cycles are about that long and if a person's OSA is worse in REM that would explain the sudden start at the beginning of the REM cycle and end at the end of the REM cycle. But what do you mean by "machine response"?

The thing to remember about REM periods, they don't like being jostled.
Other than obstructive events, what else can jostle a REM period?

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Re: Aerophagia

Post by Rubicon » Tue Oct 18, 2022 7:03 pm

robysue1 wrote:
Tue Oct 18, 2022 6:40 pm
Which of the events are most unambiguously respiratory events?
In this block I would call these 3 unambiguous:

Image

#2 is a spectacular example of normal breathing > severe flow limitation > apnea > resuscitative breathing > repeat
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Re: Aerophagia

Post by Rubicon » Tue Oct 18, 2022 7:08 pm

robysue1 wrote:
Tue Oct 18, 2022 6:40 pm
Other than obstructive events, what else can jostle a REM period?
Excessive alcohol. Go to bed drunk and your REM can be suppressed/disrupted until it wears off, resulting in a rebound at the end of the night.
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Re: Aerophagia

Post by Rubicon » Tue Oct 18, 2022 7:27 pm

robysue1 wrote:
Tue Oct 18, 2022 6:40 pm

Time of night I understand. I even understand that this cluster and the associated disturbed breathing lasts about 7 or 8 minutes and that some REM cycles are about that long and if a person's OSA is worse in REM that would explain the sudden start at the beginning of the REM cycle and end at the end of the REM cycle. But what do you mean by "machine response"?
Simply, when his pressure peaks out. If these pressure peaks occurred at 90 minute intervals and were repeatable on a nightly basis we'd have an open and shut case that this is purely REM-related. Nonetheless, IMO the incidence of these bursts are due to body position, REM, neck position (the trendy "chin tucking") or a combination.
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Re: Aerophagia

Post by robysue1 » Tue Oct 18, 2022 9:26 pm

Rubicon wrote:
Tue Oct 18, 2022 7:03 pm
robysue1 wrote:
Tue Oct 18, 2022 6:40 pm
Which of the events are most unambiguously respiratory events?
In this block I would call these 3 unambiguous:

Image

#2 is a spectacular example of normal breathing > severe flow limitation > apnea > resuscitative breathing > repeat
Thank you for this! It's very useful for those of us who look at lots of wave form data. And #2 is one of the ones in this cluster that made me so unsure about the idea of what was going on in the first place. It's great to learn something useful.

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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 3:33 am

IMO the "open airway" identification techniques are pretty accurate if one is asleep. SWJ often screws everything up, so without EEG/EMG/EOG what we're doing might appropriately be termed "WAG Scoring" (although there is a guide to event scoring looking only at breathing waveforms. I posted it somewhere, forgot where).

For the remaining events:

Image

#1 blue aCA
#2 blue aOA (that might be a little FL in the breath before the apnea)
#3 blue aCH
#4 blue aOA (that might be a little FL in the breath before the apnea)
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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 3:49 am

How about WAG Scoring Rules?

Ignore sleep onset CAs.
Ignore post-arousal CAs.
Ignore everything in SWJ.
Maintain a little skepticism about machine identification (especially OAs could really be CAs).
Look for stuff in Epoch-by-Epoch review that may be important (especially FL patterns).
Look for stuff that could be sleep stage-related (now that's REALLY WAGging).
Look for stuff that could be body position-related.
Use oximetry to help identify significant events.
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ejbpesca
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Re: Aerophagia

Post by ejbpesca » Wed Oct 19, 2022 5:34 am

During this sleep session I do not think I moved from left side position. I am waking without acid pain (I guess Prilosec is kicking in), no acidy gas being belched up, no headache, and actually alert/rested feeling. Went to sleep with little to no pain from spinal problems. Bed was not elevated. Left arm was still under chin at waking (my built in cervical collar).

Even with >5 AHI and such a defined cluster of OAs, I would call this about as successful a night's sleep as I'm going to get.

Do all the steady low line graphs represent good sleep until the cluster? Was therapy working during this time or was I just not having apneas with no need for therapy? Does the cluster show about an hour of failed therapy?

Searching for oximeter. Waiting on opinion on Lokee/Wellue oval ring sleep meter.

https://sleephq.com/public/2934e15f-68f ... 86f6e2fbdc

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Re: Aerophagia

Post by ejbpesca » Wed Oct 19, 2022 5:42 am

Test for upload space available.
OSCAR 10 19 22.png
OSCAR 10 19 22.png (315.58 KiB) Viewed 218 times

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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 6:24 am

ejbpesca wrote:
Wed Oct 19, 2022 5:34 am
During this sleep session I do not think I moved from left side position.
That block is supine sleeping. I'd bet your life on it.
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Re: Aerophagia

Post by ozij » Wed Oct 19, 2022 7:09 am

Rubicon wrote:
Wed Oct 19, 2022 6:24 am
ejbpesca wrote:
Wed Oct 19, 2022 5:34 am
During this sleep session I do not think I moved from left side position.
That block is supine sleeping. I'd bet your life on it.
Why? Because it's so utterly dramatically sudden? Accompanied by snore and flow limitations - the works?

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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 7:22 am

ozij wrote:
Wed Oct 19, 2022 7:09 am
Rubicon wrote:
Wed Oct 19, 2022 6:24 am
ejbpesca wrote:
Wed Oct 19, 2022 5:34 am
During this sleep session I do not think I moved from left side position.
That block is supine sleeping. I'd bet your life on it.
Why? Because it's so utterly dramatically sudden? Accompanied by snore and flow limitations - the works?
And long-- an hour.
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.