Aerophagia and bievel machine

first, the question then i'll blither on about details.

i've fought and defeated aerophagia on my apap by using a method that dogslobber dubbed the zonker protocol. i dialed my min pressure way down until i found the level at which no aerophagia appeared. i then slowly over the course of weeks raised the minimum by .2 until i got good therapeutic pressure while getting rid of the gas.

my question is-will this same method that worked on apap work with my bilevel? or should i look to tweak other settings instead or in conjunction?
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now on to aforementioned blithering! this time 'round, the aerophagia is significantly different. what i had before presented more as a tight ball in my stomach, threatening to burst. or so it felt like to me. very miserable and very much in the way of therapy.

this time, it's different. this presents as mainly belching. also, this didn't come upon me all of a sudden. it's been creeping up since last fall. at first, it was minor small burps. they sort of rolled up from mid-chest and escaped my lips. but over the course of time, it's gotten to the point where it's full tilt!

this generally happens after my first sleep cycle. for me, lights off at 11PM then awake at about 5AM to pee. come back to bed and that's when it really takes off.

seems like i had something more, but damned if i can remember.

anyway, thanks for reading and for any advice!

zonker wrote: ↑

Sun Apr 23, 2023 2:00 pm

first, the question then i'll blither on about details.

i've fought and defeated aerophagia on my apap by using a method that dogslobber dubbed the zonker protocol. i dialed my min pressure way down until i found the level at which no aerophagia appeared. i then slowly over the course of weeks raised the minimum by .2 until i got good therapeutic pressure while getting rid of the gas.

my question is-will this same method that worked on apap work with my bilevel? or should i look to tweak other settings instead or in conjunction?

The same method, with modifications, will work with a bilevel. The thing is, however, that now there are in essence three variables (two independent, and one dependent on a Resmed Vauto) that can affect aerophagia: EPAP, IPAP, and PS. So you'll have to decide which of Min EPAP, PS, and Max IPAP to increase slowly.

What are your current settings?

In my case, I'm more comfortable with a PS between 3 and 5 (from my days of using a PR BiPAP, where EPAP, IPAP, and PS are all independent variables), but I also know that if EPAP > 6 for extended periods of time, I'll wind up with a lot of aerophagia. And in the past I've also had real problems with aerophagia if my IPAP > 9 for extended periods of time. Since I prefer a PS = 4 over PS = 3, I am currently using Min EPAP = 4, PS = 4, Max IPAP = 9. That effectively gives both EPAP and IPAP an extremely tight range: My EPAP is allowed to vary between 4 and 5 and my IPAP can vary between 8 and 9.

robysue1 wrote: ↑

Sun Apr 23, 2023 2:30 pm

The same method, with modifications, will work with a bilevel. The thing is, however, that now there are in essence three variables (two independent, and one dependent on a Resmed Vauto) that can affect aerophagia: EPAP, IPAP, and PS. So you'll have to decide which of Min EPAP, PS, and Max IPAP to increase slowly.

of course! with a more "complicated" machine comes more complication!

robysue1 wrote: ↑

Sun Apr 23, 2023 2:30 pm

What are your current settings?

i've been lowering my min epap for a few days now, without finding the bottom. i didn't write down where i started. anyway-

Max Ipap 25

Min Epap 11.4

ps 4

Ti max 2.0s

Ti min 0.3s

Trigger very high

cycle med

thanks for the response!

Zonker,

What's your 95% IPAP these days?

Because if the problem is high IPAP triggering the aerophagia, lowering the min EPAP might not actually give you much of a benefit.

Nothing to add.

Just wanna say, Thanks for doing what you can to fix Zonker, Robysue.

And now back to our regularly scheduled program (which is, helping Zonker in this thread, not me thanking people for doing it).

robysue1 wrote: ↑

Sun Apr 23, 2023 7:23 pm

Zonker,

What's your 95% IPAP these days?

Because if the problem is high IPAP triggering the aerophagia, lowering the min EPAP might not actually give you much of a benefit.

groovy, now the forum is bombing out on me. let's see how many times i can post my response.

having trouble find 95% IPAP in oscar. is this the same as what oscar reports as Pressure?

zonker wrote: ↑

Mon Apr 24, 2023 1:42 pm

robysue1 wrote: ↑

Sun Apr 23, 2023 7:23 pm

Zonker,

What's your 95% IPAP these days?

Because if the problem is high IPAP triggering the aerophagia, lowering the min EPAP might not actually give you much of a benefit.

groovy, now the forum is bombing out on me. let's see how many times i can post my response.

having trouble find 95% IPAP in oscar. is this the same as what oscar reports as Pressure?

Yep. Oscar calls IPAP on a Resmed VAuto "Pressure". (SleepyHead used to call it IPAP. Which makes you wonder why it changed.)

robysue1 wrote: ↑

Mon Apr 24, 2023 2:31 pm

zonker wrote: ↑

Mon Apr 24, 2023 1:42 pm

robysue1 wrote: ↑

Sun Apr 23, 2023 7:23 pm

Zonker,

What's your 95% IPAP these days?

Because if the problem is high IPAP triggering the aerophagia, lowering the min EPAP might not actually give you much of a benefit.

groovy, now the forum is bombing out on me. let's see how many times i can post my response.

having trouble find 95% IPAP in oscar. is this the same as what oscar reports as Pressure?

Yep. Oscar calls IPAP on a Resmed VAuto "Pressure". (SleepyHead used to call it IPAP. Which makes you wonder why it changed.)

the name changed because it could! (now palerider will come in and explain the why of it. )

okay for three nights, 95% pressure at 15.82 16.14 and 17.00. to my untrained eye, that looks fairly similar, no?

and armed with this info, what would you suggest?

does anyone have a suggestion?

I am scratching my head because I don't know if EPAP is the troublemaker or if IPAP is.

Toss a coin...reduce max IPAP to 17 or reduce EPAP by 2 cm to 9 whatever.

Do you ever hit IPAP at 20??????

Pugsy wrote: ↑

Mon Apr 24, 2023 9:46 pm

I am scratching my head because I don't know if EPAP is the troublemaker or if IPAP is.

Toss a coin...reduce max IPAP to 17 or reduce EPAP by 2 cm to 9 whatever.

Do you ever hit IPAP at 20??????

over the course of the last 3 weeks, i've hit 20 2x.

will try reducing to 17 tonight.

thanks! will report back.

Zonker,

I want to synopsize your settings and your 95% levels.

Here are the settings you have been using:

Max Ipap 25
Min Epap 11.4
Ps 4
Ti max 2.0s
Ti min 0.3s
Trigger very high
Cycle med

Your 95% IPAP (pressure in Oscar) for the last few days are 15.82 16.14 and 17.00, but you have hit 20cm a couple of times.

Also, one more question: You said that you had found settings on the APAP that did not trigger the aerophagia. But you've now been switched to bilevel and the aerophagia is back. If you remember them, what were the pressure settings on the APAP that did not trigger the aerophagia? And why have you switched to bilevel?

I agree with Pugsy that reducing the Max IPAP to 17 is a decent idea. This is one case, however, that I think changing both Max IPAP and Min EPAP at the same time might be warranted. If aerophagia has continued to be an issue while you've been decreasing Min EPAP, then I'd be inclined at this point to do a pretty drastic pressure decrease of both Max IPAP and Min EPAP. In other words, if I were fed up with the aerophagia, I'd drop Max IPAP to 17 and Min EPAP to 9 for a few days. And for the first 3 or 4 days, I would solely focused on the aerophagia issues rather than worrying about any resulting increase in AHI.

As to what I'd do after 3 or 4 days at Min EPAP = 9, Max IPAP = 17, that would depend not only on the machine data (i.e. the AHI), but also whether the aerophagia has been brought under control. Keep us posted on what's happening on the aerophagia as well as the AHI and the 95% pressure levels.

reducing IPAP to 17 significantly reduced the aerophagia. so, huzzah!

robysue1, didn't see your reply until today. will come back later to read it more fully.

robysue1 wrote: ↑

Mon Apr 24, 2023 10:14 pm

In other words, if I were fed up with the aerophagia, I'd drop Max IPAP to 17 and Min EPAP to 9 for a few days. And for the first 3 or 4 days, I would solely focused on the aerophagia issues rather than worrying about any resulting increase in AHI.

i just went over to the machine and set min epap to 9.

will report back. and certainly won't pay any attention to ahi during this process. i KNOW it's going to go nuts.

min epap of 9 didn't work for me. couldn't breathe against the reduced pressure.

funny thing is, i slept fine for 4 hours before i woke up gasping. set epap to 10 and tried to work with that, but it too was too little. finally set epap to 11 and that pressure was fine.

the aerophagia returned, of course, as that was where i began. so my thinking is, i need to continue lowering the ipap to see what that does.

unless i hear differently from my betters, i plan to reduce ipap from current 17 to 16. and leave epap at 11.