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 » Sat Oct 08, 2022 11:06 am

ejbpesca wrote:
Sat Oct 08, 2022 9:33 am
Waking 10/6: No aerophagia. Acid is rising after a day with zero acid.
I took a break from the CPAP the night before. Had the first acid free day in a very long time. I was extremely tired all day with no CPAP. Today I do not feel well rested and here comes the acid, but no aerophagia.
If you had to take a break from CPAP after the night with the mask liner, because of acid, and today (after almost all night at 9) the acid is returning then I don't think raising the min to 9 is a good idea just now. because if possible, we don't want to irritate that stomach sphincter.
The night before the break, your median pressure was lower - and yet you needed that break.

If we agree that 9 isn't cutting it - as max - and some night(s) you have events snores and flow limitations driving your pressure to the max, but some nights less, but still have acid reflux then I would be more conservative about upping the min, in the hope you may have some relief from the pressure when your breathing is better, and the pressure drops. But I would try upping the max - slowly and carefully.

Try to look at your data and track median pressure and its relation not only to your AHI, but also to your acid reflux.

Also think about the EPR.
With your EPR at 2, your effective EPAP (Exhale Positive Airway Pressure) last night (and during your obstructive clusters) is 7.

What happens to you if you turn EPR off? Or drop it to 1? It's a way of raising the minimum pressure when you exhale and maybe make obstructions less likely.
I realise that's counter to what a bi level does, but then, we're not even close to where your minimum EPAP pressure handles obstructions, let alone near your necessary maximum.

Basically, EPR subtracts 1 or 2 or 3 from the exhale pressure from whatever minimum pressure you've defined.

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Re: Aerophagia

Post by ejbpesca » Sun Oct 09, 2022 3:47 pm

https://sleephq.com/public/1bb7cf97-6ec ... c859571d15

AHI down, acid up. Had a two part sleep today. Looks like at least 10 max is required to keep AHI <5. That's better than the 12 min. I had.

EPR 1 made exhaling a bit difficult.

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Re: Aerophagia

Post by lynninnj » Sun Oct 09, 2022 4:22 pm

ejbpesca wrote:
Sun Oct 09, 2022 3:47 pm
https://sleephq.com/public/1bb7cf97-6ec ... c859571d15

AHI down, acid up. Had a two part sleep today. Looks like at least 10 max is required to keep AHI <5. That's better than the 12 min. I had.

EPR 1 made exhaling a bit difficult.
How are you feeling otherwise?

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Re: Aerophagia

Post by ejbpesca » Mon Oct 10, 2022 4:56 am

https://sleephq.com/public/8c737fdb-0bd ... d61c92fb7c

Well the above report sure is different.

Waking with pain level 3, no apparent aerophagia, fairly alert.

Breathing was comfortable at EPR =3. Min/Max = 6.6/10

Great Wall of pillows prevented roll to back. Left arm served as cervical collar. How I did not seem to move for six hours sleep is not understood and I'm sure will not last.

To lynninnj: Overall I do not feel well. No energy, and sticky feeling has been my norm for a long time. I had Covid last January. It is like I never really got fully over it.

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Re: Aerophagia

Post by ejbpesca » Mon Oct 10, 2022 5:19 am

Could someone please explain this from SleepHQ:

Dashboard (a daily report I take it)

Statistics shows pressure 10 @ 99.5%

Graph shows pressure 10 was reached for less than an hour over 6 hours sleep period.

Should the percent of pressure 10 not be more like 17% for this one day? Or, is that 99.5% a running total of past days showing that 99.5% of the time the machine is at pressure 10? Or, totally something different?

I have been lethargic for quite a few days. It is time to do some maintenance here at my old house tomorrow. That means pain. Movement = pain. I am betting that when I treat the pain, my daily report for sleep therapy will go back to looking a mess.

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Re: Aerophagia

Post by Pugsy » Mon Oct 10, 2022 5:36 am

ejbpesca wrote:
Mon Oct 10, 2022 5:19 am
Should the percent of pressure 10 not be more like 17% for this one day? Or, is that 99.5% a running total of past days showing that 99.5% of the time the machine is at pressure 10? Or, totally something different?
95% numbers of either leak or pressure just means that for 95% of the time the machine was at OR BELOW that number.
It is NOT where someone spent 95% of the night. It is not an overall average.
The "or below" part of the definition is critical.

The 99.5% number is nothing more than a reflection of the max number reached. Doesn't matter how long you might have been up there.

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Re: Aerophagia

Post by lynninnj » Mon Oct 10, 2022 8:54 am

ejbpesca wrote:
Mon Oct 10, 2022 5:19 am
Could someone please explain this from SleepHQ:

Dashboard (a daily report I take it)

Statistics shows pressure 10 @ 99.5%

Graph shows pressure 10 was reached for less than an hour over 6 hours sleep period.

Should the percent of pressure 10 not be more like 17% for this one day? Or, is that 99.5% a running total of past days showing that 99.5% of the time the machine is at pressure 10? Or, totally something different?

I have been lethargic for quite a few days. It is time to do some maintenance here at my old house tomorrow. That means pain. Movement = pain. I am betting that when I treat the pain, my daily report for sleep therapy will go back to looking a mess.
Dashboard will give you daily report of whatever day you want.

Pugsy explained the 95% thing well.

Its hard to know if the lethargy is happening because of uncontrolled apnea. Maybe someone else can chime in. But looking purely at the numbers it seems you should be on the mend and maybe you are finding your groove with the PAP.

I am hoping someone chimes in here with suggestions.

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Re: Aerophagia

Post by ozij » Tue Oct 11, 2022 5:14 am

ejbpesca wrote:
Mon Oct 10, 2022 4:56 am
https://sleephq.com/public/8c737fdb-0bd ... d61c92fb7c

Well the above report sure is different.

Waking with pain level 3, no apparent aerophagia, fairly alert.

Breathing was comfortable at EPR =3. Min/Max = 6.6/10

Great Wall of pillows prevented roll to back. Left arm served as cervical collar. How I did not seem to move for six hours sleep is not understood and I'm sure will not last.

To lynninnj: Overall I do not feel well. No energy, and sticky feeling has been my norm for a long time. I had Covid last January. It is like I never really got fully over it.
It seems that these settings are worth sticking to for a week or two - at least.
Do try to get a consultation with a gastroenterologist about your acid reflux. Yes, I know you've been suffering from it for 50 years, but the CPAP therapy at too high pressures post weight loss may have made thing worse -- and maybe something can / should be done to give you relief. And then, there's always the possibility that it isn't even CPAP causing it, and a doctor should be the one to diagnose the reason(s).

Keep us updated about how thing are working out for you!

By the way, you probably know the following, but just in case: when using proton pump inhibitors, if you feel you can / want to stop them there has to be a gradual weaning off.
I'm no physician - simply a person who had experience with APAP induced aerophagia and the exacerbation of acid reflux, and these types of meds.

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Re: Aerophagia

Post by ejbpesca » Tue Oct 11, 2022 12:16 pm

ozij wrote:
Tue Oct 11, 2022 5:14 am


By the way, you probably know the following, but just in case: when using proton pump inhibitors, if you feel you can / want to stop them there has to be a gradual weaning off.
I'm no physician - simply a person who had experience with APAP induced aerophagia and the exacerbation of acid reflux, and these types of meds.
I did not know one had to ween off long term proton pump inhibitors. My severe acid condition was fixed by the invention of drugs like Zantac. The banned one was the only brand that would work for me. I only had to take it maybe 1 a day for 3 days and I was good to go for many months. This go round I have tried the max dose of every counter brand, no luck. Protonix prescription double dosed..acid remains. Aerophagia came on and acid has gotten worse even with aerophagia down. I'm eating way too man TUMS. Two will help for about 15 minutes.

Today I'm going old country medicine. I am drinking a quarter shot of apple cider vinegar, a mild acid every couple of hours. It seems to be working (maybe psychocematic or just psycho), but it at least for the past few hours acid is down. Theory is that with mild acid ingested, the body will produce less hydrochloric acid. Some say we need that to digest. A doc once told me we do not. He seemed to think it is a left over from cave man days when we ate carrion therefore needed to disinfect rotten meat with acid like other scavengers.

Been feeling alert today and actually getting things done. I may have had some sort of flu like illness the past few days and did not realize it. Headache, nauseated, fatigue, all that. Those are gone today.

Feeling hopeful today. First time in a long time.

Thank you for your wonderful help in educating me to read and adjust my machine. I have never had help till now and none is available from my doctor nor a cpap tech here. All doc wants to know is if I use the machine 4+ hours a day...that's it. They do not even check my oxy level each year when I visit that pulmonologist.

I am up for new gear and new machine soon. I am thinking I may try the Airfit 20, and I am open for suggestions on a newer model CPAP. This will be my 4th machine.

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Re: Aerophagia

Post by ozij » Tue Oct 11, 2022 7:34 pm

ejbpesca wrote:
Tue Oct 11, 2022 12:16 pm
Today I'm going old country medicine. I am drinking a quarter shot of apple cider vinegar, a mild acid every couple of hours. It seems to be working (maybe psychocematic or just psycho), but it at least for the past few hours acid is down. Theory is that with mild acid ingested, the body will produce less hydrochloric acid.
I've read about that in this forum, years ago - never tried it though.
Very glad you're feeling better!

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Re: Aerophagia

Post by ejbpesca » Thu Oct 13, 2022 7:34 am

CPAP dot com home test, here I come.

But until then. 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?

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Re: Aerophagia

Post by robysue1 » Thu Oct 13, 2022 9:59 am

ejbpesca wrote:
Thu Oct 13, 2022 7:34 am
CPAP dot com home test, here I come.

But until then. 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?
Not necessarily.

If your AHI is below 5 and your aerophagia is not acting up too much, there is no good reason to increase your max pressure just because you're machine is at that pressure for a good chunk of the night.

Think of it this way: A lot of people (most of who are NOT on this board) do just fine with fixed pressure machines that are set just high enough to prevent most of their apneas from occurring. APAPs can be used to titrate patients who are then prescribed a fixed pressure machine with the pressure set to the 95% pressure that the APAP reached during the titration.

Of course those of us here at cpaptalk.com tend to steer people away from accepting fixed pressure machines, but the fact is there are people who do better without pressure changes all night long. The real question is whether the pressure is high enough to keep the AHI low enough for you to feel decent. And in your case, the second, equally important question is whether the over all pressure is low enough to keep the aerophagia and acid reflux problems from spiraling out of control and making you miserable.

In other words, because of the acid reflux and aerophagia, you need to be extra cautious about any pressure increases. And if there's not a problem to fix, it's best to leave the pressure range alone for a while.
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Re: Aerophagia

Post by ozij » Thu Oct 13, 2022 10:31 am

robysue1 wrote:
Thu Oct 13, 2022 9:59 am
Not necessarily.

If your AHI is below 5 and your aerophagia is not acting up too much, there is no good reason to increase your max pressure just because you're machine is at that pressure for a good chunk of the night.
Absolutely. Unless you find yourself snoring badly.
robysue1 wrote:
Thu Oct 13, 2022 9:59 am
The real question is whether the pressure is high enough to keep the AHI low enough for you to feel decent. And in your case, the second, equally important question is whether the over all pressure is low enough to keep the aerophagia and acid reflux problems from spiraling out of control and making you miserable.
Agree.
robysue1 wrote:
Thu Oct 13, 2022 9:59 am
In other words, because of the acid reflux and aerophagia, you need to be extra cautious about any pressure increases. And if there's not a problem to fix, it's best to leave the pressure range alone for a while.
Once again - absolutely.

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Re: Aerophagia

Post by Rubicon » 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.

If significant desats are occurring during max pressure, really shouldn't let those slide.

If the events during max pressure cause an awakening, and especially if resuming sleep is difficult...

And it's not just the max pressure plateau either. There's events all along driving the pressure up.
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Re: Aerophagia

Post by ejbpesca » Thu Oct 13, 2022 1:23 pm

This report seems to tell me the APAP is reaching for more power Scotty. Acid is up today. That is probably due to me finding it hard to stick to the high acid person protocol. I will try to do better on that.

https://sleephq.com/public/175d79a0-5a6 ... bba9d6d190

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