I need some advice with my sleep apnea situation.

Hello, first would like to apologize for my english I know won't be the best but hopefully you guy's can understand and give me some advice.
I been having problems with apnea I did my test and I got an 75 (AHI) events per hour, my oxygen level goes down to 64% at night, I'm 29 / 290 pounds / 5'7 / I'm starting on a journey to lose weight too because is obviously necessary.

They send me home with a Resmed Airsense 10 for a month at min 4 / max 10 , but still most of the day's AHI are between 60 up to 80, I went to the Dr. and he told me to keep using it like that and to keep doing medicine ( antihistamine / and some nose spray's) he doesn't change any configuration, and to visit him in 6 months... I feel is too much time, so looking about it I found this forum, I decide to create an account to post my case to see if I can get some advice.

I change the config for what I read to try at least, and here is the results on OSCAR. Yesterday and Today I wake up full of air (farting a lot), yesterday was worse and my mouth was totally dry, today my mouth was just a bit dry I bought Oracoat Xylimelts a few weeks ago because first month I have problems with dry mouth too, that give me a big big headache every morning, even when I'm using the water tank for humidity but doesn't really make any difference I breathed all my life by mouth or almost all my life so I suppose that's why using these pills will be necessary, I didn't use the Oracoat Xylimelts last few day's because with config 4-10 I wasn't having problems anymore so I stop using it, but with 7-20 and 7-14 I had this problem again with the dry mouth but don't have headache.

Here in the image's you can see the difference, but not sure what I should do now, my idea was to try to change the config on my own and then go to the Dr. and show him (the problem is that this Dr. is the "best" one where I live, so is almost impossible to get a consult for atleast two months, so my idea is to try getting the config by myself and then talk with him again to see, he probably it's going to be angry because I'm not a "Dr". But is my life at risk, not sure if I want to wait 6 month's having 77 AHI, maybe is not dangerous if I'm using the machine but I'm not sure about this.

If you guy's can give me advice on the min/max I should be using- I'm using a F20 Resmed mask / Resmed Airsense 10.

If you guy's think I'm "crazy" and should stay with 4/10 for the 6 months let me know too please, I just think doing that can be dangerous for myself that's why I'm trying, but maybe is worse to change the config like this, so please let me know. Thanks in advance.

Those are the results with 4-10 / 7-20 / 7-14 (With 7-14 and 7-20 I wake up full of air, farting and feel like I swallow a lot of air) - yesterday that I did 7-20 was my first time in a year or more that I didn't fall asleep while working on my computer as I work from home.

I think you may need more than 20 cm to be available to you and that means a different machine.

How's the aerophagia with the 7 to 20 range? The machine obviously maxes out at 20 cm which makes me think it wants to go even higher but can't.

How much nasal congestion at night are you having?

Pugsy wrote: ↑

Sat May 13, 2023 7:05 am

I think you may need more than 20 cm to be available to you and that means a different machine.

How's the aerophagia with the 7 to 20 range? The machine obviously maxes out at 20 cm which makes me think it wants to go even higher but can't.

How much nasal congestion at night are you having?

Hello, thank you for the answer, the aerophagia was kinda bad, I wake up feeling bloated, and I farted a lot like just air for a long time never had this kind of "fart" before. and burping too. it latest like a hour or two after I was feeling "normal" today I feel a bit bloated too, but not burping and just one long fart in the morning as soon as I wake up, but today I sleep on 7 to 14 range. but the AHI was 22.76

The nasal congestion is not that bad in my opinion, but it's hard to breath only by nose because I feel is not enough air, I been using spray's and antihistamines the Dr. send me for the nasal congestion so is way better than before, I haven't breath this good from my nose in years.

What is your primary sleeping position?
Did you have a sleep study done in a lab or at home?

Your machine wants to go higher but it's going to make the aerophagia worse if it does.
Maybe a change in sleeping position will change your pressure needs.

Like....are you sleeping on your back now and have you tried side sleeping? Though I will be the first to admit that altering sleeping position consistently is easier said than done.

Is your nose open enough now that maybe you could use a regular nasal or nasal pillow mask instead of the full face mask??
Sometime pressure needs will be less with a nasal mask of some sort.

Pugsy wrote: ↑

Sat May 13, 2023 7:41 am

What is your primary sleeping position?
Did you have a sleep study done in a lab or at home?

Your machine wants to go higher but it's going to make the aerophagia worse if it does.
Maybe a change in sleeping position will change your pressure needs.

Like....are you sleeping on your back now and have you tried side sleeping? Though I will be the first to admit that altering sleeping position consistently is easier said than done.

Is your nose open enough now that maybe you could use a regular nasal or nasal pillow mask instead of the full face mask??
Sometime pressure needs will be less with a nasal mask of some sort.

At my back.
I did a lab study, I went there and sleep a full night on it.

I sleep on my back, but I can change position to side sleeping without problem, I usually just put on a position when I go to bed and wake up in the same position, so I can do that.

I have a nasal mask they give me the first day with the machine "Resmed mirage FX" I can try using it tonight, I believe using a lower min and max pressure at first ? maybe 7-12 with the nasal mask? I tried this nasal mask the first night of treatment but I was having a difficult time because I feel air wasn't enough, so I change it to the full mask to be able to breath.

I do believe the problem was the min on 4 tho, now that I'm "learning" a bit more about this, and that I change the min pressure to 7 I feel the difference even with the full mask, when it was at 4 I had to make a effort to breath even by mouth, with 7 it's more "natural".

A lot of people have difficulty with a minimum of 4 cm pressure. Just not enough air movement to be comfortable.
Your machine is essentially setting a new minimum for you. Once you go to sleep the machine climbs significantly in response to the airway either collapsing or trying to collapse and pretty much stays up there.

Try side sleeping and see if that changes the pressure any in terms of how high it wants to go.
I know one person who needs 19 cm when on their back but only 9 cm when on their side. Can't guarantee that will be the same for you but there's a chance and sure worth at least trying.

Go ahead and leave the max at 20...the machine won't go there unless it has a good reason. You can use whatever minimum you wish for right now. The machine is likely going to set you a new minimum anyway.

The Mirage FX nasal mask....old school...that was available when I started cpap therapy back in 2009. There are many newer and better nasal masks available now. You can give it a try if you wish but if you sort of like it and can use it without much mouth breathing just be aware that there are potentially "better" choices out there.

Pugsy wrote: ↑

Sat May 13, 2023 8:16 am

A lot of people have difficulty with a minimum of 4 cm pressure. Just not enough air movement to be comfortable.
Your machine is essentially setting a new minimum for you. Once you go to sleep the machine climbs significantly in response to the airway either collapsing or trying to collapse and pretty much stays up there.

Try side sleeping and see if that changes the pressure any in terms of how high it wants to go.
I know one person who needs 19 cm when on their back but only 9 cm when on their side. Can't guarantee that will be the same for you but there's a chance and sure worth at least trying.

Go ahead and leave the max at 20...the machine won't go there unless it has a good reason. You can use whatever minimum you wish for right now. The machine is likely going to set you a new minimum anyway.

The Mirage FX nasal mask....old school...that was available when I started cpap therapy back in 2009. There are many newer and better nasal masks available now. You can give it a try if you wish but if you sort of like it and can use it without much mouth breathing just be aware that there are potentially "better" choices out there.

Thank you so much for the advice, I will try doing it then like that, tonight will keep the face mask but sleep on my side, with 7-20 and tomorrow I update the thread with the OSCAR results, I suppose if this doesn't work would need to try with the nose mask and if doesn't work either I will visit another Dr. to see if I can get the machine updated to a different one no?

Because staying like this Dr. want me for 6 months with 4-10 when the results everynight was 75+ AHI I suppose is dangerous no? and I should look to get a different machine.

I think the side sleeping will make a big difference - let us know in this thread tomorrow.

cpap2994 wrote: ↑

Sat May 13, 2023 9:29 am

Because staying like this Dr. want me for 6 months with 4-10 when the results everynight was 75+ AHI I suppose is dangerous no? and I should look to get a different machine.

Yes.
A different doctor and possibly a different machine - but trying to sleep on your side is an excellent idea.

Lets see how much, if any, difference simply sleeping on your side will give you then worry about changing masks if you need to or simply want to try something else.

I wouldn't try both at one time...side sleeping and changing masks...because if you do get marked different results you won't know which change caused any result (if you got a result).

Science experimentation 101...keep your variables to a minimum if at all possible.

You do need a different doctor, if current one is fine with what looks like inadequate treatment. For issues with aerophagia, a VPAP could be a better option with larger pressure support between inhale/exhale pressures since your current machine limits EPR at 3.

Hello here is an update about my situation...

So I sleep on my side, first hours was on a config of min 5 - max 12 it was supposed to be max 20 not sure why I put it like that honestly, I reduce the min to 5 because when I try to sleep on my side at the start on 7 was a bit uncomfortable because I didn't use the ramp and was having a hard time to fall asleep yesterday thinking about personal issues, when I realize the machine was already on 10 or something like that and was a bit weird to sleep like that so I reduce it to 5, but seems like I reduce the max to 12 or something...

I wake up after around 6 hours and check and there was like 60 AHI's can't remember the exact amount, so I check the config and realized the mistake on the max so I turn it to max 20 and move the min to 8 as I was going to continue sleeping, so I did for almost 2 more hours sleeping on my side.

On the Oscar Image I separate it with a red line, so you guy's can see, the problem is when I wake up after 2 hours of using it with the max on 20 I feel really bloated, worse than the last 2 day's, I didn't measure it but I probably fart for like 10 minutes in total, and had a pain on my lower right side, now I'm okay and don't feel this pain and haven't fart in a while but still feel a bit weird like with air on my stomach

I suppose the only solution is to look for another Dr. to get another kind of machine, and in the meantime keep using it but with a more "moderate" config even when I will have AHI's because I suppose using it with the max at 20 when I wake up feeling this "inflated" can be dangerous too, no? If aerophagia is not dangerous at all, I don't mind the discomfort at all, just not sure if can be dangerous to swallow this much air and wake up like that or not at all, if is not dangerous, I will do maybe 8 to 20 because is the way I don't have AHI's I do but a "small" amount, while I wait to see a different Dr. to change the machine.
Thank you guy's all for the advice really appreciate it!.

NOT meaning to be funny or anything, but have you had your appendix out? The pain you had plus aerophagia might just be trying to tell you something, but of course only a doctor could say.

Julie wrote: ↑

Sun May 14, 2023 7:16 am

NOT meaning to be funny or anything, but have you had your appendix out?

Yes November last year I got my appendix out.

A machine that will go higher than 20 cm isn't going to do your aerophagia issues any favors. It is not a magic miracle worker.
Yes it will allow a greater pressure support than your EPR can offer but it's a long shot that will resolve your issues with the aerophagia just because you can use 4 or 5 PS....you are still going to need the higher pressures that cause the belly issues.

How much...if any...nasal congestion did you have last night?