Aerophagia

Mask Seal: I will have mask leaks. The only way I can bring them down is to tighten the mask to the point it hurts. I change out the mask each month. I attempt to rid my face and mask cushion from oil each day with a wet wipe. I was using witch hazel on the wipe till I discovered it was exasperating my rosacea acne. I will be ordering an Airfit 20 as opposed to my current Airfit 10, next order. I've tried 4 mask types.

I have awakened at times due to major leaks. I adjust the mask and try to return to sleep. Once awake, even if just after one hour sleep, I fail to return to sleep for 3-6 hours. I don't think I have a circadian rhythm, and sleep for me is difficult to achieve without meds to calm my ailments. And, those meds effect breathing while sleeping.

ejbpesca wrote: ↑

Tue Oct 04, 2022 8:31 am

This link will show an example of a night's sleep with meds onboard: Losartan, muscle relaxer, nerve pain med, double dose of acid reducer, and an anti anxiety med. Upon waking: No aerophagia, state of groggy for 1 hour, blood pressure 171/95. Current state: Feeling more rested, groggy down by applying caffeine. Various pains down to level 1 (that will change shortly). Cognitive function impaired.

That sounds like the BP is not very well controlled. What does your PB usually run?

I think the meds allowed for a continuous 8 hours of sleep. While a bit wobbly, I am up and at em, trying to hard to get some things done for a change. The change in AHI is impressive on this report.

What the heck was happening between 1:00AM and 3:00AM Alabama time last night?

Here is a slightly zoomed in shot of your data (time stamps in the screen shot are EDT since I'm in Buffalo, NY.):

Lots of events, lots of flow limitations, and lots of snoring are all being scored. And the machine can't raise the pressure any more in an attempt to "normalize" the breathing since you've capped the max pressure at 9cm.

But the big question is: Were you sound asleep during this period? Or were you dozing and going in and out of sleep during this period?

I ask because you also write:

Beginning sleep position: left side to left side with rotation towards being belly down. Other positions acquired during sleep: supine. Restless attempts at sleep positions are a continuous roll from left to right side, supine, on stomach then get up and forget trying to sleep.

Furthermore, if we zoom in further on your data, we see this right at the beginning of that horrible stretch. (The timestamps in the screen shot are for my local Eastern Time Zone, since I'm in Buffalo.)

Now there are several things I want to point out about this part of your data:

1) You obviously had turned the machine off and back on just before this stretch starts. When your machine starts, it activates a ramp and your pressure ramps up from 4cm to your current minimum setting of 5cm. And your machine does not record events during the ramp period. That's why those things that look like apneas/hypopneas in this stretch have not been flagged as apneas/hypopneas.

2) Because we know you were awake right at the beginning of this stretch, it's reasonable to assume that this breathing pattern right at the start of this stretch is what's often referred to around here as sleep-wake-junk breathing, or SWJ for short. The transition to sleep is not always smooth and sometimes that is reflected in the breathing: The handoff of control of breathing from the voluntary to automatic (involuntary) nervous systems sometimes involves glitches that can look like apneas. On an in-lab sleep test, the tech has the EEG data and the data from the belts to properly figure out if ragged breathing right as you are trying to go to sleep is actually sleep disrupted breathing or just a normal variation on transition to sleep breathing. And if it's just a normal variation on transition to sleep breathing, these kinds of stretches of "not breathing" don't get scored as a sleep disordered breathing event--i.e. a hypopnea or an apnea.

3) The problem here is that the SWJ-type breathing pattern that we see right after you turn the machine on continues for a very, very long time--as in it continues for the next 2 hours pretty much non-stop. You never really transition to a normal, regular sleep breathing pattern during this whole 2 hour time period where the huge number of OAs are scored. And what happens after the ramp period is over? The machine starts scoring events every few minutes because the machine's programming now assumes you are in fact asleep and those stretches where your respiration is significantly reduced now match the machine's criteria for being scored as events. But the machine has no EEG data, so it cannot tell when you finally fall asleep. So, as I said before, the question becomes: Were you sound asleep during most of this 2-hour period? Or were you dozing in and out of sleep during this 2-hour period?

4) Notably right around 3:00 AM Alabama time (4:00 AM on the screen shot since I'm in Buffalo, NY), your breathing does settle down into normal, regular sleep breathing. And no events are being scored and the machine finally starts to lower the pressure. Here's what your normal, regular sleep breathing looks like:

So we can definitely conclude that you were in fact sound asleep by 3:00 AM your time and that the machine's pressure was doing its job of preventing obstructive events from occurring.

ejbpesca wrote: ↑

Tue Oct 04, 2022 8:46 am

Mask Seal: I will have mask leaks. The only way I can bring them down is to tighten the mask to the point it hurts. I change out the mask each month. I attempt to rid my face and mask cushion from oil each day with a wet wipe. I was using witch hazel on the wipe till I discovered it was exasperating my rosacea acne. I will be ordering an Airfit 20 as opposed to my current Airfit 10, next order. I've tried 4 mask types.

Have you tried using a mask liner to help increase your comfort and decrease the skin irritation? The mask liner can also help absorb some of the facial oils.

Also---over-tightening the headgear can actually lead to more leaks: Your mask uses an air cushion to form the seal. If the air cushion cannot inflate fully because the headgear is too tight, you will get more leaks.

I have awakened at times due to major leaks. I adjust the mask and try to return to sleep. Once awake, even if just after one hour sleep, I fail to return to sleep for 3-6 hours.

Is it possible you were fighting mask leak problems during the whole bad stretch between 1:00 AM and 3:00 AM Alabama time last night? Notably your breathing and your leaks both settle down right around 3:00 AM. So if you know you were fighting the mask for an extended period of time after you turned the machine at roughly 1:00 AM your time, then I'd be inclined to write the whole horrid stretch between 1:00 and 3:00 as SWJ because you weren't really asleep.

It's also worth noting that while the leaks feel like they are major leaks to you---probably because it feels like air is blowing in your eyes or on your arms or whatever, from the machine's point of view, even the worst of your leaks on this night don't reach into "Large Leak" territory: Resmed defines a Large Leak as a leak that is over 24 L/min. And from the machine's point of view, Large Leaks are not really problematic unless you are in Large Leak territory for at least 30% of the night.

So the leaks need to be addressed specifically because they are waking you up or keeping you from getting into sound sleep. But you don't need to worry about the actual size of the leaks affecting your therapy.

I don't think I have a circadian rhythm, and sleep for me is difficult to achieve without meds to calm my ailments. And, those meds effect breathing while sleeping.

There's nothing wrong with taking the meds you need to calm your various ailments enough for you to fall asleep.

But which meds are you worried about affecting your breathing while sleeping? And why do you think they affect your sleep breathing? Finally, did you take any medication around 1:00 AM Alabama time when you woke up, turned the machine off, and then turned the machine back on and had the 2 hours-from-heck?

OMG, I just answered questions in a thoughtful edited reply with quoted questions. I hit submit and it disappeared. Noooo. Next is maybe preferred, short statements.

I was asleep during the off/on period. Must have been a power failure.

No aerophagia symptoms today.

More rested and fully alert today than have been in a long while even though AHI over 10.

Some of my meds relax muscles and decrease nerve function = effect on breathing, but they help to stay asleep and keep my pain level down. (I have many permanent injuries and get new ones easily.)

After a week of use, new masks begin to have major leaks at the top. I tighten up the head gear to stop those leaks.

I have used a Snugzzz liner. Leak report went way up. I will try one again.

I am having a long awake day/night. I may be up for 36 hours before I sleep again. These long wake days happen once a month or so when I have a rare rested night of sleep.

My blood pressure goes above normal and back down regularly for no apparent reason. I took BP reading this morning after seeing AHI over 10. Sys. was 172. I took a med that is to be taken once on a day with a Sys. reading over 150.

Thank y'all sooo much for your help. Your expertise is amazing. I will post a link as soon as I can get some sleep. It is Oct 5th now. I may be able, with med help, to get to sleep before dawn.

As per advised, no adjustment will be made today to machine pressure, but I do understand my max setting is not enough to treat the over ten AHI of last night. Not raising the max right away is to see if it may work on another night?

ejbpesca wrote: ↑

Tue Oct 04, 2022 11:17 pm

I was asleep during the off/on period. Must have been a power failure.

Was there any other evidence of a power such as the proverbial blinking clocks everywhere in the house?

If not, then I suspect you actually did wake up just enough to turn the machine off and back on, but the wake was so short you don't remember it. When I was really battling the aerophagia monster I got into the habit of turning my machine off and back on (to reset the pressure down to its minimum setting) every single time I woke up. One sign that I was slowly adjusting to PAP was when I would look at the data in the morning and realize that I was surprised that I did not remember all of the wakes. I still tend to turn my machine off and back on when I briefly wake up at night, but now I seldom remember doing it and the number of times I do it during the night has decreased quite a bit. Most of the time those off/on breaks occur at times I would expect a normal, brief post-REM wake that is short enough for me to not remember when I get up for the day.

On the other hand, if you did wake up to blinking clocks somewhere else in the house, it could be that the power failure woke you up enough to trigger a long period of not very deep sleep with you tossing and turning and dozing in and out of a light sleep for 2 hours while unconsciously worrying about another power failure.

In other words, most of us wake up almost as soon as a power failure happens specifically because there's no air being blown into the mask and breathing with the mask on immediately gets much harder.

No aerophagia symptoms today.

More rested and fully alert today than have been in a long while even though AHI over 10.

Can you post a link to the data?

Some of my meds relax muscles and decrease nerve function = effect on breathing, but they help to stay asleep and keep my pain level down. (I have many permanent injuries and get new ones easily.)

Unless the effect on your breathing is really and truly astounding, I'd say you need to take the meds to keep the pain level down, which helps you stay asleep.

But it is worth keeping track of when you take the meds that "relax muscles and decrease nerve function" to see whether there is some correlation between the med and the bad apnea episodes recorded by your machine.

After a week of use, new masks begin to have major leaks at the top. I tighten up the head gear to stop those leaks.

I have used a Snugzzz liner. Leak report went way up. I will try one again.

Again, post some data links so we can see how bad the leaks are.

You should not need to tighten the head gear too much in an effort to stop the leaks. The air cushion has to be able to fully inflate in order to properly seal the mask, and over-tightening the headgear can prevent that from happening.

Sometimes you can get the mask to reseal by simply pulling the mask away from your face just a bit and then letting it go so it can resettle on the face. Have you tried that trick?

Also, are you fitting the mask while sitting up? Or are you lying down in your usual sleep position? That also can make a big difference. Finally, you need to fit the mask at full pressure if possible.

Or it may help to have at least two mask cushions for your mask and swap them out every couple of days.

I am having a long awake day/night. I may be up for 36 hours before I sleep again. These long wake days happen once a month or so when I have a rare rested night of sleep.

What typically happens after a long wake day? Do you usually have a really bad sleep (subjectively speaking, not in terms of data)? Do you usually sleep much longer than is normal for you?

My blood pressure goes above normal and back down regularly for no apparent reason. I took BP reading this morning after seeing AHI over 10. Sys. was 172. I took a med that is to be taken once on a day with a Sys. reading over 150.

Subjectively how were you feeling before you looked at the data?

Did you half-expect that the AHI would be on the high side? Or was the AHI > 10 a total surprise?

ejbpesca wrote: ↑

Tue Oct 04, 2022 11:23 pm

As per advised, no adjustment will be made today to machine pressure, but I do understand my max setting is not enough to treat the over ten AHI of last night. Not raising the max right away is to see if it may work on another night?

Until you can tease out more about whether you are actually asleep rather than dozing during those bad episodes, I would be reluctant to increase either pressure setting just yet. In other words, I'd be inclined to leave the settings alone for at least one, maybe two more nights just to gather more data at a setting that is not triggering the aerophagia.

It's also not entirely clear if you will need to increase the maximum pressure, the minimum pressure, or both. Increasing the max will allow the machine to raise the pressure to a higher level during those clusters in an effort to break them up. But increasing the min will help the machine prevent the cluster from starting in the first place. Unfortunately, however, we don't yet know which of the following is triggering the aerophagia:

• It could be your stomach really needs a low median pressure, but can handle some periods where the pressure is high enough to try to prevent/break up a nasty cluster. In this case, raising the max should help.
• It could be your stomach really needs the pressure to stay below 10cm regardless of the median pressure. In this case, raising the minimum pressure should help.
• It could be your stomach reacts poorly to steep increases in pressure more than it reacts to the overall pressure. In this case, it may be necessary to raise both your min and max pressures in order to keep the difference between them somewhat small.
• It is likely that some combination of these three things is triggering the aerophagia. And in that case, it may take some controlled experiments to figure out your best compromise between making the stomach happy and keeping the AHI low enough for you to feel like you are getting as good of a night's sleep as is possible with your other medical conditions factored in.

When you do decide to increase the pressure settings, you need to do so very, very slowly. Your machine allows you to increase either pressure setting by a mere 0.2cm and you need to take advantage of that. I also think that it's important to try to only change one variable at a time. In other words, during the dial-winging, I think you need to focus on increasing only one of the two pressure settings at a time.

Because the aerophagia came back when you bumped the pressures up to 6-11, here is my suggested strategy for cautiously working on increasing the pressures until you find ones that work for you:

Step 1: Identify a potential maximum for the minimum pressure setting while leaving the maximum pressure at its current setting.
In other words, we need to see how high you can set the minimum pressure setting without it triggering the aerophagia. So when you're really eager to try something new, I'd suggest raising your minimum pressure by 0.2 cm to see if that's enough to trigger the aerophagia. If raising the minimum pressure by 0.2cm doesn't trigger aerophagia for about 3 days in a row, then increase the minimum pressure by 0.2cm again and keep it at the new setting for at least 3 days in a row if there's no aerophagia. Keep repeating the experiment until the aerophagia returns OR until the clusters are not happening.

If the aerophagia returns, then lower the pressure back down by 0.2 cm and see if the aerophagia goes away again. If it does, you've identified the highest pressure you can use for your minimum pressure setting without triggering aerophagia at your current max pressure of 9cm.

Step 2: Once you have increased the minimum setting as far as you can without triggering the aerophagia, start working on figuring out what you need for the maximum pressure setting.
Again, you will have to go slowly. Increase the max pressure by 0.2 cm and see if the aerophagia comes back. If the aerophagia does not come back for about 3 days in a row, then increase the maximum pressure by 0.2 cm and keep it there for at least 3 days in a row if there no aerophagia. Keep repeating this experiment until either the aerophagia returns OR until the clusters are not happening.

Now if you can find max and min pressures that keep your stomach happy and prevent those clusters from happening on most days, you've found your optimal settings. But if the clusters are still happening and you don't feel you can increase the pressures any more without triggering the aerophagia, you go back to step 1 to see if the stomach can now tolerate any additional minimum pressure.

As I said, this is going to be a slow process. So you are going to have to be patient. You might want to keep a short log that tracks when you increase one of the pressure settings, how bad the aerophagia is each night, a subjective sense of how well you slept and how rested you feel when you wake up before you look at the data.

::raises hand:::

quick questions/comments

I noticed the OP had a ramp time of 10 minutes and wondered if it takes too long to get up to pressure if he/she gets up in the middle of the night and turns off the machine? Maybe laying back down and dozing right off and not having enough pressure or even laying back down and feeling like they can't breath and thus further disturbances?

I had the power go out a few weeks ago, thankfully it was only 12 minutes and surprisingly did not seem to disrupt my sleep too much. But I only have a 5 minute ramp. Even though I am still usually fiddling about/fixing mask it doesnt seem to register events during the period immediately after I turn the machine back on and get out of ramp and into normal pressure. I think if I woke to go to the bathroom and laid back down and started dozing off right away, if my ramp time were much longer I would likely be having more events.

Just a thought.

Here we go. Now I'm taking meds to help sleep, as expected, OA's are up. 18.8 AHI today. I was on a campaign to stop meds, I lost, meds won. Waking: No detection of aerophagia, acid symptoms down but rising, BP 111/62 (yay), pain level low, no brain fog/groggy/dizzies. Started sleep in side position, woke supine. 3 hours now up, energy is draining fast. This may be a nod out day. I have a long record of a good day awake, then a worn out day requiring bed rest. (I was declared disabled about 18 years ago due to my spinal problems)

I have no blinking anything that will give an indication of a power outage that could have caused the off/on of my machine. Yes, there is a possibility that I could have removed the mask then put it back on while asleep. I have sleepwalked, so I could have sleep mask removed then put back on, with no recollection of doing so. Mask off = auto shut down, mask on = auto start. Please remark on the following:

Reading your questions, should I answer them in a reply or just ask them to myself and ponder the answer?

I raised Min Pressure to 5.6 I am tempted to take it on up to 6.5... More power Scotty. This is actually fun for me in a way. I was telecommunicating with microcomputers by 1979, via a modem and land line.) We had bulletin boards back then. Only one caller could be on the host's server at a time. The was only one host in the city of Mobile, AL at the time. All others would require a long distant call with charges. Not fun being so sick, but having purpose for my laptops and fiddling with data takes me back to computer teacher days.) If CPAPtalk would clean out the upload space I could send snips from OSCAR.

My current concept of therapy: (please check for accuracy)
Min pressure is to maintain a steady flow to prevent apneas. If an event occurs during Min pressure, pressure will rise in attempt to prevent more events, but immediate rise in pressure does not jump up fast to stop an event in progress. With more events pressure keeps rising until it hits Max setting. If Max is not high enough, events will continue to occur until, for some reason, events stop anyway. Is that correct?

So the goal is to have a Min pressure setting that prevents apnea all night but does not cause aerophagia. That Min is now challenged by me resuming medications. Meds, I've taken for 30 years may be a major factor of OA events. I believe OA's are up due to meds resumed. I think I could bump up that min to 8 as was the original one pressure setting from my first sleep test and bring AHI down. That may trigger aerophagia, maybe not. The culprit that causes the aerophagia may be the Max setting. Due to some change in my organism, 10/20 cm blew my guts up which aggravated my current acid problem. I think the 10/20 setting was excessive and caused my major leaks problem. It took aerophagia to call my attention to the setting and realize I have never had ANYONE give any attention to how my CPAP therapy is going till you kind people stepped up to the plate. You are heroes.



https://sleephq.com/public/3ed8518c-052 ... 0fa5042f92

lynninnj wrote: ↑

Wed Oct 05, 2022 10:12 am

::raises hand:::

quick questions/comments

I noticed the OP had a ramp time of 10 minutes and wondered if it takes too long to get up to pressure if he/she gets up in the middle of the night and turns off the machine? Maybe laying back down and dozing right off and not having enough pressure or even laying back down and feeling like they can't breath and thus further disturbances?

I had the power go out a few weeks ago, thankfully it was only 12 minutes and surprisingly did not seem to disrupt my sleep too much. But I only have a 5 minute ramp. Even though I am still usually fiddling about/fixing mask it doesnt seem to register events during the period immediately after I turn the machine back on and get out of ramp and into normal pressure. I think if I woke to go to the bathroom and laid back down and started dozing off right away, if my ramp time were much longer I would likely be having more events.

Just a thought.

I just set ramp time back to 5 min. where it has been for years. Do you know what "Smart Start" is on a ResMed AirSense 10 and if that, in my case would be best on or off?

It may be appropriated to let y'all know that I have a bunch of nerve damage causing impaired transmission between brain and the rest of my body. The full extent of it will never be known, but from top to bottom, my spine is damaged and diseased. Impingement of nerves and trauma to the spine causes much of my body to not function properly. It is a miracle I walk and have a bit of life left. (5 doctors over the years declared me a walking miracle after seeing MRI's that read "quadriplegic.") Long story of a long list of injuries. jb

ejbpesca wrote: ↑

Tue Oct 04, 2022 11:02 pm

OMG, I just answered questions in a thoughtful edited reply with quoted questions. I hit submit and it disappeared. Noooo. Next is maybe preferred, short statements.

i laugh because it's happened to me. too many times to count!

i suggest hitting the preview button, then hit submit. doesn't always work for me, but at least it slows me down.

mostly.

ejbpesca wrote: ↑

Wed Oct 05, 2022 10:39 am

lynninnj wrote: ↑

Wed Oct 05, 2022 10:12 am

::raises hand:::

quick questions/comments

I noticed the OP had a ramp time of 10 minutes and wondered if it takes too long to get up to pressure if he/she gets up in the middle of the night and turns off the machine? Maybe laying back down and dozing right off and not having enough pressure or even laying back down and feeling like they can't breath and thus further disturbances?

I had the power go out a few weeks ago, thankfully it was only 12 minutes and surprisingly did not seem to disrupt my sleep too much. But I only have a 5 minute ramp. Even though I am still usually fiddling about/fixing mask it doesnt seem to register events during the period immediately after I turn the machine back on and get out of ramp and into normal pressure. I think if I woke to go to the bathroom and laid back down and started dozing off right away, if my ramp time were much longer I would likely be having more events.

Just a thought.

I just set ramp time back to 5 min. where it has been for years. Do you know what "Smart Start" is on a ResMed AirSense 10 and if that, in my case would be best on or off?

I like the smart start. It allows me to get into position, cover the short hose and blow out to test for mask leaks, and then when mask is where I want it I plug into the longer hose coming from the machine. When you start to breathe, it senses it and turns the machine on which is great so I dont have to reach and maybe cause mask to shift position. I like it a lot. I do take a big deep breath when I first plug in to get the air moving so I don't know how sensitive it is but it does seem beneficial IMO if only for the reasons above.

It really helps to get the "full pressure into the mask" as Robysue mentioned when you cover the short end of the hose with your hand and blow out, without having the machine shifting at the same time (prior to plugging in.)

I do not however trust the auto off feature. It might be dandy but I just don't want it.

Edit: fast forward to 5:55 and that is around the spot where he shows how to check mask for leaks. THIS is what I am referring to, with whatever mask you use. https://youtu.be/L-pRVlAo6Ic

What does the 95% on the Dashboard of SleepHQ represent for a pressure score?

I see my rough night of 18.8 events did not make the machine reach the max of my max pressure setting, I think, so setting the max higher would not have helped? I moved to being on my back in my sleep. I will border my back with a pillow tonight to try and stop a roll to supine position. My pains prompt me to move around in my sleep at times.