Setting CPAP mode instead of APAP Question

So my numbers are constantly around 9.6 each night. I’ve noticed I can go to sleep fine around 7.4 starting ramping to 8. The problem is, if my pressure stays close to 9 I get aerophagia. I want to eventually get to the 9.8 pressure all night without any pain in the morning. I have EPR to 3.

I saw the SleepHQ guy analyze someone’s charts, and he told him to use lower pressure fixed and move up. If I start with a fixed pressure of 7.2 and work my way up to 9.8, would that be an OK strategy? It might not prevent every apnea, but it would get my body used to a pressure that could, 9.8. Is there any harm with this? The guy he helped started at 8 and worked up to 14 in a few weeks.

As long as you have an apap, use it to find your pressure.
Some "experts" prefer single pressure.
Some of us consider that counter-intuitive.
Set your range from comfortable to 20, and sneak the lower number up
a little at a time, until you have a goldilocks combination of comfort and efficacy.
If you choose to ignore the sleephq guy, you are not alone.

That could work.

But another strategy to consider is:

• Keep it in APAP mode
• Set your minimum pressure to 7.2
• Set you maximum pressure to 7.4
• Try it for a few nights.
• If you experience aerophagia lower the maximum pressure by 0.2, and leave it there for a few more days
• If you don't experience any aerophagia increase your maximum pressure by 0.2 and leave it there for a few more days.
• Repeat

This way , you can still benefit from APAP. Don't be afraid to leave the pressures alone for a while as you approach the range where you experience problems.

dog slobber's advice above is what i used to overcome aerophagia. bear in mind, it took a very long time to conquer it, but i did.

when i say "long", i mean weeks.

Dog Slobber wrote: ↑

Sun Dec 04, 2022 1:40 pm

That could work.

But another strategy to consider is:

• Keep it in APAP mode
• Set your minimum pressure to 7.2
• Set you maximum pressure to 7.4
• Try it for a few nights.
• If you experience aerophagia lower the maximum pressure by 0.2, and leave it there for a few more days
• If you don't experience any aerophagia increase your maximum pressure by 0.2 and leave it there for a few more days.
• Repeat

This way , you can still benefit from APAP. Don't be afraid to leave the pressures alone for a while as you approach the range where you experience problems.

Would I eventually be raising the minimum as well, like if this pressure is fine, I would raise it to 7.6, then the min to 7.4 and so on?

Edit: I just tried the 7.2-7.4 and it felt like I wasn't drawing enough air. Changed it to 8.0-8.2. For the past year, and I've used my machine all but maybe 6 days total, my 95% pressure rate has been at or below 9.68. I think my pressure is between 8.0-9.6, so I'm going to continue working up to that. Thank you!

jlsmithseven wrote: ↑

Sun Dec 04, 2022 3:12 pm

Would I eventually be raising the minimum as well, like if this pressure is fine, I would raise it to 7.6, then the min to 7.4 and so on?

No, at least not automatically.

But the minimum pressure might need to be increased to address optimizing therapy needs. For that, it's a good idea to provide graphs.

Just saw your Edit: Yes, set your minimum to a comfortable level and then set maximum to slightly above that and then increase maximum dependent on Aerophagia.

https://imgur.com/kzQ6c7X
This night looks good in the graphs and I probably felt OK in the morning.

https://imgur.com/ZvRR5hI
This night, I made a note that I felt pretty darn good in the morning. Which with a higher AHI does not make sense, but that's how it goes.

I have also been trying to tape my mouth to prevent leaks, I've found that it has worked pretty well. Some nights I don't feel like doing it because I'm not sure how much its helping. I also have a 7 week old so my nights aren't exactly slept through, so it's kind of hard to juggle if I want to tape or don't tape, etc while trying to figure out this pressure game.
I do remember Dog Slobber you helped me in the past by creating some settings to work with and I was using that for a long while. They weren't perfect but I woke up feeling OK. I think I gained a little weight since then so I think it's becoming less than great so that's why I've been trying different things. I've been at this for a year now, but I have come a long way since they gave me a machine and said here use 4-20cm of pressure with a full face mask.

OK looking at those graphs, let's start you off:

• In APAP mode
  minimum presure at 8.2
• maximum pressure at 8.4
• Leave EPR at 3
• leave it for 3 days
• if no aerophagia, keep bumping the max and repeat increasing 0.2.
• If you experience aerophagia go back down by 0.2

As you get closer to your aerophagia tolerance level, be prepared to stay at that maximum longer.

Be prepared for your AHI to take a tittle bot of a hit. That usually gets fixed by increasing minimum pressure, but we don't want to be trying to fix two things at once.

Ok thank you it makes sense. From the looks of Oscar though, it looks like half of my events aren’t even flagged. Looking at my flow rate charts I see many events near 10 seconds where I’m not breathing in. Thanks again for the tips I will post my results as I go.

Sad to say last night was not good at all. I woke up severely dehydrated and have been struggling with a giant headache all morning. I checked my charts and the interesting thing I found was that after having a hypopnea, the machine didn’t really ramp up and it resolved itself. On the auto algorithm, it would have jumped like 2cm probably. So that was exciting news, but I can’t try these settings tonight again because I did have some large leaks and it couldn’t address them because the pressure max 8.4. Have any other suggestions? I think I might do the 8 starting ramp to 9.0 again that seemed ok for the most part. Should I limit it to 10? That’s been working ok for me. I also tried the n20 mask last night , I guess I should stick with my dreamports until I have this down?

You seem to be attributing every observation to the changes] we made last night. Many of which would, had nothing to do with it.

jlsmithseven wrote: ↑

Mon Dec 05, 2022 7:08 am

I woke up severely dehydrated

Likely not related.

jlsmithseven wrote: ↑

Mon Dec 05, 2022 7:08 am

have been struggling with a giant headache all morning

Maybe unrelated, what was your AHI?

jlsmithseven wrote: ↑

Mon Dec 05, 2022 7:08 am

but I can’t try these settings tonight again because I did have some large leaks and it couldn’t address them because the pressure max 8.4.

Not related at all, pressure doesn't fix leaks.

jlsmithseven wrote: ↑

Mon Dec 05, 2022 7:08 am

I think I might do the 8 starting ramp to 9.0 again that seemed ok for the most part. Should I limit it to 10?

The reason the max pressure is at 8.4 is because you stated you experience aerophagia at around 9.

Sorry, it was just a long night. I understand your observations. And thanks for the information. Would taping my mouth lead to more aerophagia? Should I try the same settings tonight with the same mask I’ve been using and am comfortable with, tape or no tape? Sorry I just need very clear instructions because there are so many factors to this that I don’t understand what they do yet. Thank you

Edit- my Ahi was like 1.6 I think, not terrible. It didn’t flag half the events that were hyponeas or obstructive though, but I did recover from them very quickly which was great because the pressure would have easily risen on all the occasions, I can share later I’m at work now. Won’t be until 7 tonight est though.

jlsmithseven wrote: ↑

Mon Dec 05, 2022 7:46 am

Sorry, it was just a long night. I understand your observations. And thanks for the information. Would taping my mouth lead to more aerophagia?

It could.

Aerophagia is caused by swallowing air. In the most typical scenario, excess air from the xPAP gets into your mouth because the tongue is not in the "right" place to block the oral cavity off from the nasal cavity. Enough air builds up in the mouth for it to be uncomfortable, and the body wants to get rid of it.

There are two ways to try to get rid of the excess air: Swallow it (which leads to aerophagia) or open the mouth and let it out (which leads to mouth leaks). The thing about mouth leaks, however, is that as soon as you close your mouth again, if the tongue is out of place, more air rushes in from the nasal cavity and the xPAP.

Taping prevents you from opening your mouth, and that increases the chances of swallowing the air once it is trapped in the mouth.

Should I try the same settings tonight with the same mask I’ve been using and am comfortable with, tape or no tape? Sorry I just need very clear instructions because there are so many factors to this that I don’t understand what they do yet. Thank you

I'm of the opinion that you really need to change only one thing at a time. If you are going to experiment with taping, then nothing else should be changed. But, as I indicated above, taping could lead to more aerophagia.

Since aerophagia is your problem, I think I'd be less inclined to tape right now. My own advice is to go back to a min pressure of 8cm (ramp up from 7cm only if you need to), and for the time being cap the max pressure at 8.6 for several days since you say that aerophagia is an issue when the pressure gets above 9cm. Yes, your AHI is going to take a hit for a while. But you need to identify how much pressure your stomach can take and then make some decisions about finding a working compromise between the pressure needed to keep the OSA under control and the pressure needed to keep the stomach happy. It may well be the case that you will feel and function better with an AHI that is usually between 2 and 3 and no aerophagia instead of an AHI < 2 and lots of aerophagia.

If you can train your tongue to stay in the correct position, even when you open your mouth, the oral cavity is essentially blocked off from the nasal cavity. The "correct position" for the tongue is the normal resting position for people who naturally breathe through their nose when they're not using their mouth to talk or eat. The tip of the tongue is at or near the gum line behind the top front teeth. The hump of the tongue is parked touching the roof of the mouth.

Edit- my Ahi was like 1.6 I think, not terrible. It didn’t flag half the events that were hyponeas or obstructive though, but I did recover from them very quickly which was great because the pressure would have easily risen on all the occasions, I can share later I’m at work now. Won’t be until 7 tonight est though.

When you post the data, it would help us help you if you posted at least two screen shots:

One of the full night's data---the flow, pressure, flow limitation, and leak curves are the most important to get into the shot.

A second screenshot that zooms in on one of the events that you believe should have been flagged as an H or OA, but wasn't. In this shot, we need to be able to see a minute or so of breaths before the "event" as well as a few breaths after it. We also need to see the flow limitation graph. The other graphs are not as important for helping us teach you why the event was not flagged in the first place.

zoomed out:


zoomed in first one:


zoomed in second one:


the second one shows how the marked one is similar to the other one but wasn't marked...but normal breathing continued afterwards. normally that unmarked event would make pressure go up by 1 at least. but in this instance it did not, and i still resumed good breathing.

EDIT: ignore the first half of the night, that was during the day when I took a much needed nap. 7 week old baby .

Last night, with the settings RobySue1 provided, 7 ramp to 8, max 8.6, Slept amazing. I feel so good this morning.

https://sleephq.com/public/5b226301-d1e ... 2d5f37ed7c

Although I'm not a huge fan of sleepHQ it's very nice you can see this data and zoom in. Can you see what happened this night that made it good?