Pressure settings and comfort

I sleep on my back and side. I need a lower pressure for side sleep vs back. I'm at a 6.8 on back put when I switch to my side it's too high pressure and I wake up with bad aerophagia. I don't like using my CPAP in auto mode so I use my one set pressure. I try to stay on my back but switch back and forth from back to side throughout the night. I'm waking up all night when on side due to the too high pressure. Would a bi level be better for me?

Why don't you like using Auto mode on your current CPAP?

Auto mode was designed specifically for the scenario you describe: More pressure is needed in one sleep position than another. Or more pressure is needed in REM than in non-REM.

As for bilevel: What do you hope to accomplish by having one pressure for inhalation (IPAP) and a different pressure for exhalation (EPAP)?

Yes, sometimes bilevel machines are prescribed when a CPAPer is dealing with excessive painful aerophagia that interferes with the ability to get to sleep and stay asleep and other things have been tried to address the aerophagia. (I'm someone who wound up on bilevel for this reason.) But before being moved to bilevel the sleep doc's PA had me try all the following things:

• Changing the EPR setting. (What is your EPR setting?)
• Changing from CPAP to APAP
• Narrowing the APAP range to prevent the machine from increasing pressure to the point of triggering the aerophagia regardless of my sleeping position
• Change of mask

Bilevel machines are roughly twice as expensive as APAPs are. And insurance companies are not going to simply replace an APAP with a bilevel unless a doctor is willing to write a letter of medical necessity that explains why APAP is not being tolerated, but why a bilevel machine might be tolerated.

Hi thank you for the advice. I'm just at my wits end. I've had my CPAP since March and still haven't gotten a good night's sleep despite trying many different things. I watch the Lanky Lefty on u tube and he dislikes auto mode. I have my EPR on 2. I think I am going to try your advice and set a small range on my auto 5.2 to 6.8. I'm just desperate for some good sleep!

Holly P wrote: ↑

Thu Oct 17, 2024 12:10 pm

Hi thank you for the advice. I'm just at my wits end. I've had my CPAP since March and still haven't gotten a good night's sleep despite trying many different things.

What "many different things" have you tried?

I ask because I am someone who had a very long, very hard, very arduous adjustment period to xPAP way back in 2010 when I started PAPing. My biggest adjustment problems involved severe aerophagia and super-severe insomnia that set in right after I started CPAPing, most likely as a result of the aerophagia and my nightly anxiety about the aerophagia. (Dreaming of being a goose being force-fed air and swelling up like a balloon will do that to you.)

I watch the Lanky Lefty on u tube and he dislikes auto mode.

While there are some people around here who respect some of the things that Lanky Lefty says on his youtube channel, not many of us agree with his views on Auto mode. And the reason why we disagree is pretty simple: Our own experiences night after night say that we personally sleep better using Auto mode (with an intelligent range) than we do on fixed pressures. This is particularly true of people who can document the need for more pressure in certain sleep positions or in REM versus non-REM sleep.

Since you say that sleeping on your side at 6.8cm of pressure triggers aerophagia, but that you need that much pressure for your back, you ought to try auto mode.

I have my EPR on 2.

Given your low pressure setting, leaving EPR = 2 is reasonable.

I think I am going to try your advice and set a small range on my auto 5.2 to 6.8.

This is a reasonable range to try if sleeping n your side at 5.2cm of pressure doesn't trigger the aerophagia. Personally I would consider using an even lower minimum pressure if you need to in order to be able to sleep comfortably on your side. But whatever pressure range you choose, keep the same pressure range for at least a week before changing the settings again.

I'm just desperate for some good sleep!

Been there, done that, and have the scars to prove it.

Some unsolicited advice: It is quite possible that your continued bad sleep is being caused by something other than "just the CPAP". What I mean by that is this: There are many causes of bad sleep and not all of them are related to OSA and CPAP issues. And you have to sometimes work hard to identify those other issues and address them before your sleep will actually improve. Sometimes keeping a simple sleep log can help identify some of the non-OSA/non-CPAP related issues that you need to deal with. A simple sleep log can also help you keep track of subtle, modest improvements that can occur over several weeks and that you don't tend to notice as an improvement simply because they are so subtle.

In my own case, I had to deal with finding a fix to my really awful aerophagia AND I had to work hard on reining in the insomnia monster that moved into my bedroom. Along the way I also had to deal with wrangling my chronic migraines under control, finding a better management scheme for my chronic TMJ problems, and doing some cognitive behavior therapy to deal with my resentment of being diagnosed with OSA when I only went for the sleep test to satisfy my husband who was tired of witnessing me stop breathing at night. And for what it's worth, the first signs that CPAP was doing me some some good was when I noticed the phrase "woke up without hand/foot pain" appearing in my sleep log appearing 2 or 3 times a week; about a month later I was waking up with. no hand/foot pain most days and was only noting when I woke up in pain. That's when I knew for certain CPAP was doing something positive for me even though my sleep was still far more fragile and messed up than I wanted it to be.