Aerophagia

Pugsy wrote: ↑

Mon Oct 03, 2022 12:23 pm

In most situations when faced with a big leak and time...these machines will actually reduce the pressure in an effort to get leaks under better control.

In support of your education moment, here's an image showing a machine lowering pressure to try and get the mask to seal:

ejbpesca,

Pugsy is correct that what's driving the pressure increases is the flow limitation graph.

Here are some zoomed in shots of the last data you posted with some editing to make it quite clear what is going on in terms of pressure increases at certain times of the night:

The beginning of the night:


A bit later in the night:


And even later in the night:


Note: Times in the screenshots are EDT, not CDT because I'm in Buffalo. You'll need to subtract an hour to get Alabama time.

Pugsy wrote: ↑

Mon Oct 03, 2022 1:54 pm

BTW....I am not convinced that the cluster of events on Oct 1 that everyone is so worried about is a real asleep cluster.
The breathing prior to the onset of the cluster....very irregular to my eye which makes me suspect the validity of those flagged events and the machine's response.

This is possible. But at 4-10, ejbpesca had a cluster like this on every night. So it's worth investigating further.

Pugsy wrote: ↑

Mon Oct 03, 2022 1:54 pm

So....someone went trying to kill some maybe arousal flagged events with more pressure....and that opened the door for the aeophagia monster to sneak in. Just because a machine might want to go higher doesn't always mean that the reason it wants to go higher is a valid reason and even if a valid reason it doesn't mean that it won't create a problem going higher.

I agree 100%. That's why I've been trying to get ejbpesca to understand the need to keep the same settings for several nights to gather data, as long as the aerophagia is not an issue. And at this point, ejbpesca needs to also learn the lesson of "Change one thing at a time."

Pugsy wrote: ↑

Mon Oct 03, 2022 1:54 pm

]If it had been me I wouldn't have changed anything based on that one night with some maybe not so asleep flagged events driving the pressure up. If not asleep....doesn't count.

I agree. I had said that if those nasty clusters continue while using 4-10cm, then it would worth considering a modest increase in pressure. Jumping from 4-10 to 6-11 is not a huge leap, but with aerophagia in the driver seat, it's too big of a leap.

I would have waited and got more concrete data and looked for trends and patterns.
I am not so sure that more pressure was the way to go because I am not so sure that the flow rate points to for sure asleep breathing.

I would have waited as well.

At this point, I would suggest going back to 4-10 for at least 4 days, and a week would be better. Then look at the daily data for each day to see if there is always a nasty cluster at roughly the same time. If so, then some adjustments may be in order.

But it could also be the case where the sweet spot (so to speak) for ejbpesca is to cap that max pressure at 10cm and tolerate more activity in the flow limitation chart and some clustering of events in order to be able to get some decent quality sleep without triggering the aerophagia.

robysue1 wrote: ↑

Mon Oct 03, 2022 2:30 pm

I would have waited as well.

At this point, I would suggest going back to 4-10 for at least 4 days, and a week would be better. Then look at the daily data for each day to see if there is always a nasty cluster at roughly the same time. If so, then some adjustments may be in order.

In total agreement and would add in doing some self education as to arousal breathing irregularities and how IF there are again some ugly clusters that some investigation into "are those real asleep flags or are they arousal related flags" because if someone isn't really asleep then they don't need more pressure to try to fix whatever problem is causing the arousal breathing.....if we see arousal related flags and not asleep related flags on a consistent basis.

Goes back to a common sense thought we have always gone by.....don't go trying more pressure (when more pressure is causing a problem like aerophagia) until we are damn sure that more pressure is for sure needed. Now I am still on the fence with this one. I haven't seen clustering with for sure asleep breathing....what I have seen is clustering and not for sure asleep breathing.

Hmmm ok....so, no crystal ball. Gotcha.

I realized after you corrected me that the Flow limit had risen BEFORE the events all went down. I hadnt looked that closely at it, so it made sense when you said pressure goes up for several reasons and increased FL was one of them.

That said, my comments came from noting my own pressure increases after I make a mask adjustment and thought maybe that was the culprit.

I too look forward to hearing what Robysue has to say. I had a case about a week ago where I got up and did my usual cat/camel stretch and nearly vomited on my pillow because of all that acid shaking loose. It was awful. Normally the stretch corrects my reflux problem to some degree so I was not expecting it.

It is for that reason I hope the OP really can get answers, and I follow along.

palerider wrote: ↑

Mon Oct 03, 2022 2:12 pm

Pugsy wrote: ↑

Mon Oct 03, 2022 12:23 pm

In most situations when faced with a big leak and time...these machines will actually reduce the pressure in an effort to get leaks under better control.

In support of your education moment, here's an image showing a machine lowering pressure to try and get the mask to seal:

Holy cow! ok.

I appreciate that. I often feel like as I am dozing off and my mask shifts a bit with my head it feels as though the pressure increases with the leak but I guess something that large would give the algorithm a different path to take.

Thanks for sharing that. ( cannot even IMAGINE 60 AHI and feel lucky not to experience it.)

lynninnj wrote: ↑

Mon Oct 03, 2022 2:52 pm

I appreciate that. I often feel like as I am dozing off and my mask shifts a bit with my head it feels as though the pressure increases with the leak but I guess something that large would give the algorithm a different path to take.

Thanks for sharing that. ( cannot even IMAGINE 60 AHI and feel lucky not to experience it.)

The way our machines maintain the current pressure setting in the presence of a (large) leak is to blow more air into the leaky system. That additional air flow can feel like a pressure increase even though the pressure is either being maintained or even being allowed to decrease in order to see if the mask will reseal itself.

Here's one way to try to make this idea of how the machine blowing more air into the leaking system is not the same as increasing the pressure:

Think about blowing up a balloon with a very small leak in it. Once you get the balloon to its full inflated size, you still have to keep blowing air into the balloon at at same rate that the balloon is losing air. Now if the leak gets larger, you have to blow harder to keep the balloon fully inflated: The rate the air is escaping has increased, so to keep the size constant, you have to increase the amount of air you are blowing into the ballon to match the new leak rate if you want the balloon to stay fully inflated.

That's basically what our CPAPs do all night: They blow air down our throats at a rate that is the same as the amount of air being lost through the exhaust vents of our masks---our airway, the mask, the hose, and the CPAP make up the leaky balloon: To keep the pressure constant, you have to replace the air that is lost due to the leaks.

Now if we spring an extra leak---our mask unseals or we open our mouth---the machine will attempt to keep the pressure constant by blowing additional air into the leaky system. The amount of additional air blown into leaky system will equal the size of the additional leak.

Our machines are quite capable of maintaining the needed pressure as long as the extra (unintentional) leaks are kept to around 25-30L/min. If a leak gets to be bigger than that and lasts for any length of time, the machine may have trouble compensating for the additional leaking. Some machines are then programmed to intentionally allow the pressure setting to go down in order to help reseal the mask.

Pugsy wrote: ↑

Mon Oct 03, 2022 2:45 pm

Goes back to a common sense thought we have always gone by.....don't go trying more pressure (when more pressure is causing a problem like aerophagia) until we are damn sure that more pressure is for sure needed. Now I am still on the fence with this one. I haven't seen clustering with for sure asleep breathing....what I have seen is clustering and not for sure asleep breathing.

I'd have to go back through the Oct. 1 data to see whether I think it looks like SWJ or not.

But I agree that being on the fence is a reasonable place to be with this one. And the only way you and I get off that fence is with more data at the same pressure settings.

In this case, we know the problem that has to be fixed: The aerophagia that has badly affected the serious acid reflux problems and interfered with the amount and quality of sleep ejbpesca is getting with the mask on his/her face. And we know that reducing the pressure all the way to 4-10 seems to fix that problem.

What we don't know is whether 4-10 is enough pressure to prevent the development of real clusters of events that have the potential to create problems. What we need to figure out whether those clusters are a real problem is more data that is generated by running the machine at 4-10 with keeping the aerophagia under control.

lynninnj wrote: ↑

Mon Oct 03, 2022 2:52 pm

I appreciate that. I often feel like as I am dozing off and my mask shifts a bit with my head it feels as though the pressure increases with the leak

Pressure NEVER EVER increases due to leaks. NEVER.

The blower will go faster in order to provide more air *FLOW* to compensate for the pressure that is lost because of the leak, people think that the higher air FLOW means higher air PRESSURE, but it doesn't.

Pressure is the result of resistance to a flow. You can't have pressure without resistance. If you turn on the machine without a mask attached, you get the maximum air flow (probably a couple hundred liters per minute of air), but near enough to zero pressure, because all the fan in the unit can do is create air flow. Pressure happens when your face blocks the air flow.

A leak causes the pressure to drop, which makes the blower speed up to compensate for the reduced pressure, by providing more airflow.

So, please, do what Pugsy said and get that whole idea out of your head.

robysue1 wrote: ↑

Mon Oct 03, 2022 3:19 pm

That's basically what our CPAPs do all night: They blow air down our throats

Please don't use that terminology, CPAPs don't, and *can't* "blow air down" anybodies throat. That confuses newbies and is just another thing that freaks them out.

The only machines that can actually blow air down people's throats and into their lungs are NIV machines, like the ST, ASV and iVAPS type machines, that do actually breathe for people.

robysue1 wrote: ↑

Mon Oct 03, 2022 3:19 pm

at a rate that is the same as the amount of air being lost through the exhaust vents of our masks

and added leaks.

palerider wrote: ↑

Mon Oct 03, 2022 3:33 pm

robysue1 wrote: ↑

Mon Oct 03, 2022 3:19 pm

That's basically what our CPAPs do all night: They blow air down our throats

Please don't use that terminology, CPAPs don't, and *can't* "blow air down" anybodies throat. That confuses newbies and is just another thing that freaks them out.

Ok. Fine. But when I was a newbie it sure felt like air was being forced down my throat all night long. And the tickle in the back of my throat was real.

robysue1 wrote: ↑

Mon Oct 03, 2022 3:19 pm

at a rate that is the same as the amount of air being lost through the exhaust vents of our masks

and added leaks.

You only quoted part of what I said:

robysue1 wrote: ↑

Mon Oct 03, 2022 3:19 pm

That's basically what our CPAPs do all night: They blow air down our throats at a rate that is the same as the amount of air being lost through the exhaust vents of our masks---our airway, the mask, the hose, and the CPAP make up the leaky balloon: To keep the pressure constant, you have to replace the air that is lost due to the leaks.

Now if we spring an extra leak---our mask unseals or we open our mouth---the machine will attempt to keep the pressure constant by blowing additional air into the leaky system. The amount of additional air blown into leaky system will equal the size of the additional leak. (emphasis added)

We are in agreement that when there is an added leak, the machine blows more air into the system in an effort to maintain the pressure in the system.

robysue1 wrote: ↑

Mon Oct 03, 2022 3:38 pm

palerider wrote: ↑

Mon Oct 03, 2022 3:33 pm

robysue1 wrote: ↑

Mon Oct 03, 2022 3:19 pm

That's basically what our CPAPs do all night: They blow air down our throats

Please don't use that terminology, CPAPs don't, and *can't* "blow air down" anybodies throat. That confuses newbies and is just another thing that freaks them out.

Ok. Fine. But when I was a newbie it sure felt like air was being forced down my throat all night long. And the tickle in the back of my throat was real.

I'm pretty sure there's no air being shoved down people's throats if they don't have gills to vent that air.

robysue1 wrote: ↑

Mon Oct 03, 2022 3:38 pm

You only quoted part of what I said:

Because I was agreeing with you.

Please keep in mind that Resmed machines let you change your pressure in 0.2 increments.
No need to make changes in large steps ones if you're trying to train aerophagia.

ozij wrote: ↑

Mon Oct 03, 2022 8:33 pm

Please keep in mind that Resmed machines let you change your pressure in 0.2 increments.
No need to make changes in large steps ones if you're trying to train aerophagia.

THANK you.

this is what saved me from aerophagia. it took me literally two months. go up .2, hate it, go back. wait a few nights. go up .2, works.

rinse. lather. repeat.

patience was absolutely key.

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.

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.

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.

Note: You folks are incredible. I have never in my life seen people willing to give so much knowledgeable attention to an apnea patient. I can't thank you enough.

https://sleephq.com/public/27b528a0-648 ... 1a4b332af7