Aerophagia

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

Post by ejbpesca » Wed Oct 19, 2022 9:07 am

Welp, I guess my Great Wall of pillows may have not blocked a roll to back. I know staying in one position is not usual for me. I develop pain and have to move, sometimes with force and rapidity. I guess I cannot control that and if APAP therapy does not work for it, and that is the time I need the therapy, I wonder why I have put on that mask for 15 years.

Or, is it back to raising the max pressure enough so the therapy will work for a cluster of events triggered by supine position sleep?

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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 9:34 am

ejbpesca wrote:
Wed Oct 19, 2022 9:07 am
Or, is it back to raising the max pressure enough so the therapy will work for a cluster of events triggered by supine position sleep?
Yeah, you're chaining in there, crank it up to at least what happens. May have to make some trade-offs or get a Plan B, but you'll have hard data to help make the decision.

Those are nasty uOAs, might take a bunch to clobber them.
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Re: Aerophagia

Post by ozij » Wed Oct 19, 2022 9:40 am

ejbpesca wrote:
Wed Oct 19, 2022 5:34 am
[...] 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?
Yes
Was therapy working during this time
Yes. Look at the way pressure went up to 7.76 or so - and you could continue sleeping.
or was I just not having apneas with no need for therapy?

You were not having outright apnea because the APAP responded appropriately to their precursors and could prevent the total collapse of your airway.
Does the cluster show about an hour of failed therapy?
It shows that your maximum pressure of 9.6 isn't enough when you're (presumably) lying on your back. You could call it failed for at that pressure for that position.
It's a trade-off between your stomach and your apnea therapy.

[edit: I see Rubicon and I were posting simultaneously...]
If I remember correctly, things looked better - apnea-wise - when your max pressure was 10.
You need to see how badly you desaturate when such a cluster occurs.

As for handling the trade off: all I can do is to remind you once again of Zonker's suggestion of how to get your body gradually used to higher pressures.

Although if Rubicon says a "bunch" (a punch, I presume) I trust him. OTOH, I had acid burping into my nose when my aerophagia / reflux was bad - so the layperson in me cringes as the thought of punch of pressure. But Rubicon is the real (real life, honest to God) pro around here.

Question for Rubicon: Which is better, a punch and then lowering gradually if things are intolerable, or raising by 0.2 each time, backing off if necessary and trying again till it works (this is what worked for Zonker - I have no idea what his breathing looked like).

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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 10:18 am

ozij wrote:
Wed Oct 19, 2022 9:40 am
Although if Rubicon says a "bunch" (a punch, I presume) I trust him. OTOH, I had acid burping into my nose when my aerophagia / reflux was bad - so the layperson in me cringes as the thought of punch of pressure. But Rubicon is the real (real life, honest to God) pro around here.

Question for Rubicon: Which is better, a punch and then lowering gradually if things are intolerable, or raising by 0.2 each time, backing off if necessary and trying again till it works (this is what worked for Zonker - I have no idea what his breathing looked like).
I meant bunch, but punch works too.

I'm answering from the selfish point of view. Crank it up to see what target is.

Of course, I'm not the cranky (get it?).
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Re: Aerophagia

Post by Rubicon » Wed Oct 19, 2022 11:11 am

OK let's review OSA 101:

1. It takes 25-28 cmH2O to open the esophageal sphincter.

2. Therefore, any concerns that going up 1.0 cmH2O will blow the patient up like a dirigible and end up flying around the room when he takes off his mask are absurd.

3. Aerophagia, by definition, is not "blowing air past the esophageal sphincter'". It's air swallowing. Really. Look it up. Now if increasing pressure is making him drool, or try to swallow breaths or whatever, then fine. But it's not pressure per se.

4. And most important, the negative pressure generated during an obstructive event can easily hit -60 cH2O standing on one foot. So doing our adds and subtracts, what do you think the weak link is?

OSA causes GERD! Crank the MF thing up!
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Re: Aerophagia

Post by robysue1 » Wed Oct 19, 2022 2:51 pm

Rubicon wrote:
Wed Oct 19, 2022 11:11 am
3. Aerophagia, by definition, is not "blowing air past the esophageal sphincter'". It's air swallowing. Really. Look it up. Now if increasing pressure is making him drool, or try to swallow breaths or whatever, then fine. But it's not pressure per se.
I grant you that aerophagia is caused by air swallowing.

But that can still make you pretty miserable. And if you already have GERD, the air swallowing can make the GERD worse: All that excess air has to get out of the digestive system in one way or another. And if it increases burping, that can increase the acid reflux.

In my case, once the IPAP gets much above 9 or the EPAP gets much above 5.5, I start swallowing the air. I don't know why, but it clearly happens and I'll wake up with what looks like a basketball in my stomach. And yes, it's painful.

Fortunately for me, a max IPAP = 9 with the PR Bilevel auto algorithm's ability to leave the EPAP at 4 when increasing the IPAP seems to take care of the apnea while not triggering the air swallowing.
OSA causes GERD! Crank the MF thing up!
Again, I know in principle that OSA can cause GERD.

But for me, I never had GERD symptoms before starting xPAP. And people both here and at my horrid sleep doc #1's office kept telling me that I must have GERD given how bad my aeropagia was when I was starting out with a Resmed S9 Autoset running in CPAP mode with pressure = 9cm and EPR = 3.

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Re: Aerophagia

Post by Rubicon » Thu Oct 20, 2022 2:38 am

robysue1 wrote:
Wed Oct 19, 2022 2:51 pm
But for me, I never had GERD symptoms before starting xPAP.
At the risk of stating the obvious, you and the OP are 2 different people. Looking at your very first post, you mainly had hypopneas with 14 apneas, and in another you noted NO desaturations even with the apneas:
robysue wrote:
Wed Nov 03, 2010 12:22 pm
Since I currently am NOT having desaturations with my apneas and "hypopneas with arousal", is the OSA actually doing damage NOW to my body? And if so, what's the mechanism? How do the arousals themselves cause the damage?
In the OP's October 18th SleepHQ data he's running chain uOAs for hour with lengths up to 45 seconds! I wish he had an oximeter and you both had/have Pes but you don't. We're stuck with WAG Scoring, but I'm going to add another rule:

Fix the knowns first:

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Re: Aerophagia

Post by ejbpesca » Thu Oct 20, 2022 9:52 am

Waking again as if my apnea was treated. No head ache, no acid (3rd day Prilosec), aerophagia present. Even with a special effort to prevent rolling from my left side to my back, I failed to stay on side. I was awakened in the night, probably by my own snoring or multiple OAs, finding myself on my back. I did not check the time to see if being on my back coincided with the cluster of OAs. I returned to left side. If the hour long clusters are from back sleeping, I may have to choose between aerophagia and apnea since higher max PAP pressure could cause me to swallow more air. If swallowing air is causing the acidic condition, I would stop PAP therapy to stop the hyperacidity if that's what it takes. Why after many years of PAP treatment the aerophagia came on a few months ago is a mystery unless coinciding weight loss has something to do with it. (5' 7" 178lbs. to 162lbs.) Even with AHI up I am feeling better upon waking two nights in a row possibly due to the burn of acid being down and chronic pain level down.

I hope to have an oximeter soon. I am not sure if the cheaper ring types are accurate, but I guess worth a try. If oxy levels are not dangerous even with AHI up, I will opt for less aerophagia and more AHI's if indeed higher pressure causes aerophagia.

Thank you Rubicon for the explanation of pressure and the sphincter. I have yet to take a ride around the room like the villain in Dune, but as a young child I thought I could out of body travel at will, after falling asleep.

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Re: Aerophagia

Post by Rubicon » Fri Oct 21, 2022 2:42 am

ejbpesca wrote:
Thu Oct 20, 2022 9:52 am
Thank you Rubicon for the explanation of pressure and the sphincter.
Yeah well apparently I didn't explain it well enough. Those long uOAs (58 last night), generating significant negative intrathoracic pressure, are probably sucking gastric acid into your esophagus, and perhaps even upper airway, creating swelling and making the OSA worse.

When's the last time you had a GI workup (like endoscopy)? With ineffectively treated GERD for all these years perhaps by now you've got an incompetent esophageal sphincter and now you're really ****ed.

Don't know what else to tell ya. There's gotta be some pithy saying regarding this, something like (and RS should appreciate this):

If you have 2 conditions, and treat neither effectively, the two negatives will not create a positive.
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Re: Aerophagia

Post by robysue1 » Fri Oct 21, 2022 10:48 am

Rubicon wrote:
Fri Oct 21, 2022 2:42 am
ejbpesca wrote:
Thu Oct 20, 2022 9:52 am
Thank you Rubicon for the explanation of pressure and the sphincter.
Yeah well apparently I didn't explain it well enough. Those long uOAs (58 last night), generating significant negative intrathoracic pressure, are probably sucking gastric acid into your esophagus, and perhaps even upper airway, creating swelling and making the OSA worse.

When's the last time you had a GI workup (like endoscopy)? With ineffectively treated GERD for all these years perhaps by now you've got an incompetent esophageal sphincter and now you're really ****ed.

Don't know what else to tell ya. There's gotta be some pithy saying regarding this, something like (and RS should appreciate this):

If you have 2 conditions, and treat neither effectively, the two negatives will not create a positive.
:)

Medical conditions are definitely additive rather than logical or multiplicative.

And adding two negatives results in a negative that is further away from 0.

Meaning: Both conditions have to be effectively treated before the patient feels better---particularly when one condition can make the other worse.

That was a lesson I had to learn the hard way back when I was new at xPAP: Until my migraines, my insomnia, and my OSA were all effectively treated, I was miserable. And teasing apart the moving parts and which conditions affected the other conditions and how took time and effort.

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Re: Aerophagia

Post by ejbpesca » Fri Oct 21, 2022 12:27 pm

Rubicon wrote:
Fri Oct 21, 2022 2:42 am

When's the last time you had a GI workup (like endoscopy)?
I had an endoscopy about three months ago. Only diagnosis given was an irritated esophagus and sphincter. I think an endoscopy can damage the sphincter.

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Re: Aerophagia

Post by ejbpesca » Mon Oct 24, 2022 5:44 am

https://sleephq.com/public/3ce12f82-014 ... 2404067da5

I will take a night as above anytime. Waking with no acid pain, zero aerophagia, and feeling rested. Prilosec may be helping me to heal up a bit after months of GERD.

The OSCAR report (that will not upload here) has a grayed out area. Is the gray area OSCAR recognizing that area as junk?

It is looking to me as if the current pressure settings are doing well.

Oximeter is on the way.

Tried AirFit F20 night before. Not good. For the first time I woke (within 3 hours) to find a ring of rash where the mask touches my face that was also swollen. The mask fitted well, no leaks, and was comfortable. Back to F10.

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Re: Aerophagia

Post by ozij » Mon Oct 24, 2022 7:09 am

Glad to hear you're feeling better.
I don't know - and am not asking - if you're taking Prilosec accompanied by a doctor's advice. But here's what I know about PPI's, of which Prilosec is one:
They're not like antibiotics in the sense of "getting rid of the disease".
They're also not like antacids.
They're important in reducing the amount of acid produced, and thus reducing the irritation to your esophagus and LES.
There was a time in my life in which I had to take an admittedly miniscule dose of a PPI every evening before I went to sleep.
Some people have to take maintenance doses -- and check the newest research about that.

Reduce the amount gradually (I know I said that), and when that time to reduce comes (I do hope you have a physician advising you on that), you can even try a period of "one day X one day less than X but not nothing". You don't want a rebound of acid irritating that LES again.

Gray areas on OSCAR indicate large leaks.
OSCAR only presents what the machines report. And the machines are incapable of distinguishing "SWJ" from real sleep.

:o :? Your ramp is on 7, your minimum at 6.8 ?

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Re: Aerophagia

Post by robysue1 » Mon Oct 24, 2022 7:45 am

ozij wrote:
Mon Oct 24, 2022 7:09 am
:o :? Your ramp is on 7, your minimum at 6.8 ?
The data posted by ejbjpesca seems to indicate that the starting ramp pressure is about 6.8 and the min pressure is 7.

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Re: Aerophagia

Post by ozij » Mon Oct 24, 2022 10:01 am

robysue1 wrote:
Mon Oct 24, 2022 7:45 am
ozij wrote:
Mon Oct 24, 2022 7:09 am
:o :? Your ramp is on 7, your minimum at 6.8 ?
The data posted by ejbjpesca seems to indicate that the starting ramp pressure is about 6.8 and the min pressure is 7.
Not if you click on the SleepHq link https://sleephq.com/public/3ce12f82-014 ... 2404067da5
"Machine settings"
Click on "More" to see all the settings.
On the screen, it is as I wrote.

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