EPR and aerophagia

Just wondering if anyone could give me some suggestions as to how EPR could help my aerophagia. Will it reduce the amount of air going into my digestive system? How? What should I put my EPR setting on?? The few times I have tried to use EPR my AI went above 5 and my HI was higher too. What should I set my pressures on if the EPR will reduce the effectiveness of the CPAP pressure? For example if I normally have my pressure set at 12 I would have to raise it even higher to compensate for the EPR and I hate to think what that might do for my GERD and aerophagia. Is this logic correct?? THANKS for any help!!

Not an expert here but have read on several threads, where some people do get relief by using their exhale relief. Quite a few of users do end up having to increase their pressures by the same 1-2-3 exhale you choose to start out with. With less force exhaling you problably don't end up swallowing that extra air.
That makes sense to me but you will get some more answers as you get more responses from this board.

Good luck!

It would help to know what your cpap pressure was on those few times you tried EPR, and what EPR level it was that you tried.

O.

Theoretically, if you require 12 cm pressure on CPAP and use EPR=3, then the machine has 2 pressures, one for Inhale (IPAP) and one for Exhale (EPAP).

SO using it at 12 cm and EPR=3 you should see:

IPAP=12 cm
EPAP=9 cm

That 3 cm drop should be quite noticeable. Next question comes in how it increases AHI?

EPR is SUPPOSED to reduce its exhale relieve in the presence of SDB, that would be Flow Limitation, Apnea & Snore. This would mean
if you were using setting 3 and machine detected an event where it needed to increase pressure by 1 cm to eliminate it, it would lower EPR from 3 to 2, if the event persisted it would drop it from 2 to 1, if they continued, it would disable EPR entirely until events seen subsided.

However, it would seem the machine is a bit slow in doing this if you compare your AHI averages on CPAP w/EPR disabled. That is the only logical explanation I can come up with why AHI would climb.

As mentioned in the other treads, YOU need to decide what you want to fix. If you want to resolve the aerophagia you are going to have to lower pressure. But that has its disadvantages in allowing a higher AHI. With aerophagia you want to avoid frank apnea, as that will only make your aerophagia worse or prolonged. When you recover from a frank apnea, you gasp for breath, that sucks stomach acid up into the esophagus which further erodes the LES.

But the machine you have is generally pretty good at preventing frank apnea when in AutoSet mode. I am pretty confident that in the AutoSet mode it will prevent frank apnea up to 10 cm pressure. The problem you are experiencing is your pressure requirement is 12 cm. That is 2 cm higher than the machine will respond. So if you use it in AutoSet mode it won't respond once your pressure is at 10 cm.

Now as I indicated before, if you want to relieve your aerophagia, you need to use the AutoSet mode, drop the Minimum pressure down as low as possible and hope you don't have that many apnea above 10 cm. Because if the machine goes back up above 10 cm in response to Flow Limitation or Snore, you are where you are at with CPAP pressure and you know how well that works.

You can try EPR but not many have reported success using it, most have gone to other machines that have a more limited response to FL and snore.

The machine you should have is the 420e or the Sandman Auto. With these machines you could adjust parameters not found on any other machine to lower pressure faster, to respond to frank apnea above 10 cm pressure. You could change the Command on Apnea default setting from 10 cm to 13 cm. You could also turn off aggressive response to Flow Limitation. However, there is not much you can do with snoring, if it drives up pressure on a Resmed it will on these as well, but I found this machine is not as sensitive or aggressive when it comes to snore.

So I see your options as:

1. When you use the AutoSet mode you don't feel rested, this is because you need 12 cm pressure and the machine is designed not to respond to apnea above 10 cm. When you set it to CPAP mode or set the Minimum pressure up to address those apnea it aggravates your aerophagia condition.

2. You could use a different machine to address those apnea above 10 cm but there is no guarantee that your SDB may just cause this machine to also drive up and remain at 12 cm.

3. Your only other option is to see a GI Specialist about your dysfunctional LES. There are patients using CPAP with a lot higher pressure that 12 cm and they don't report aerophagia problems (some do, some don't). So if it was just a pressure thing everyone should be having problems with aerophagia. IF they examine your LES with an endoscopy, they usually fix anything seen. You need to however have a GI specialist that understands what the problem is and takes steps to resolve it. IF they feel you have GERD they will prescribe PrevAcid for probably 12 weeks or more. Once you stop the stomach acid it will take at least that long for things to heal, if you have already tried Prilosec or other acid pump inhibitor then tell them. That means they need to fish down the scope and have a looksie. OSA, GERD and a dysfunctional LES are all related which one comes first depends if you are the chicken or the egg.
But if your aerophagia is as bad as you indicate, you better get your butt down to the GI specialist and let them check it out, that is also the leading cause of stomach cancer if left untreated, if that is the case I'd say screw the CPAP machine.

Apart from all theories, I found EPR to be nearly as good as my Bilevel (PB330 knightstar) - I set the PB330 to
ipap = 13 & epap = 10 & it worked very well. For travel I use an S8 Vantage set in Cpap mode with EPR = 3.
The rise & fall of the pressure is not exactly the same as the PB330 but close enough that I enjoy using the
machine that way.

The data extracted from the machine showed similar ventilation results to other Bilevels I have used except as
with most Resmed machines the HI number is usually higher than other brands will show.

My opinion of EPR after using the machine over the past 18 months on travel is that it is 2nd best to a bilevel
itself in regard to exhalation relief.

The EPR feature that reduces EPR if obstructions are detected is an outstanding aspect of how it works - very
innovative.

DSM

Snoredog- I am so grateful for your detailed info. My one remaining question is this: if the APAP does not respond to apnea over 10cm why does my morning data report a pressure of 11.2? I may be stupid but this confuses me completely!! Tonight I am going to set my machine in CPAP mode with a lower pressure to see how I feel in the a.m. I have had GERD for many years it just seems that CPAP has kicked it up a notch. I have a hiatal hernia that before apnea did not bother me too much except when I was under stress. I took meds off and on during those times but had not needed it for years until apnea and CPAP. THANKS!!!

Forgot to say that even when my machine is in APAP mode and my pressures are 9-13 my AHI and HI are fairly low(like less than 3.0) so if the machine does not respond to events above 10cm why are my results as good as they are? Seems to me the AHI and HI would be much higher if it wasn't "catching" my 12cm necessary apneas. Does that make sense?? Most days my results are less than 2.0 sometimes AI= 0.1. Those results are just about the same as when on CPAP, so I don't understand why I feel less rested. Could it just be that the sudden rise in pressure is messing up my REM sleep or something like that??

grumpygirl wrote: Those results are just about the same as when on CPAP, so I don't understand why I feel less rested. Could it just be that the sudden rise in pressure is messing up my REM sleep or something like that??

August 3 :
Why so sluggish on APAP????

Sept 5:
Still Tired with APAP, any help???

O.

grumpygirl wrote:Snoredog- I am so grateful for your detailed info. My one remaining question is this: if the APAP does not respond to apnea over 10cm why does my morning data report a pressure of 11.2? I may be stupid but this confuses me completely!! Tonight I am going to set my machine in CPAP mode with a lower pressure to see how I feel in the a.m. I have had GERD for many years it just seems that CPAP has kicked it up a notch. I have a hiatal hernia that before apnea did not bother me too much except when I was under stress. I took meds off and on during those times but had not needed it for years until apnea and CPAP. THANKS!!!

For your pressure to climb above 10 cm with that machine, it can only be the events it responds to above 10 cm, that would be:

- Flow limitation
- Snore

Hiatal Hernia: DID you have the hernia fixed? That can easily be WHY you are having so much trouble with aerophagia. Why not see a GI specialist and have that fixed? It is a easy laparoscopic procedure and you are done with it, it will most likely resolve your GERD and aerophagia.

Thanks again for ALL the info. Last night I put my machine in CPAP mode with a 25min. ramp at 8.0 with a fixed pressure of 11.4. This morning I feel much better than yesterday. I do have some "gas" issues and a little GERD but nothing major yet. No. I have not had the hernia fixed- with some other medical issues in my family and my apnea expenses over the last year I have not had the $$$$$ to do that. Will give it some thought after paying off some of these mounting medical bills!! Am hoping I have found a good spot to leave my CPAP on for a while. Will try to keep it there for a few days to really get a good picture of what my responses will be. My AHI was 2.8, AI was 0.0 with HI 2.8, so I think that is pretty darn good!!

Pretty darn good it sure is, GrumpyGirl!
I hope you'll keep feeling better.

O.

grumpygirl wrote:Thanks again for ALL the info. Last night I put my machine in CPAP mode with a 25min. ramp at 8.0 with a fixed pressure of 11.4. This morning I feel much better than yesterday. I do have some "gas" issues and a little GERD but nothing major yet. No. I have not had the hernia fixed- with some other medical issues in my family and my apnea expenses over the last year I have not had the $$$$$ to do that. Will give it some thought after paying off some of these mounting medical bills!! Am hoping I have found a good spot to leave my CPAP on for a while. Will try to keep it there for a few days to really get a good picture of what my responses will be. My AHI was 2.8, AI was 0.0 with HI 2.8, so I think that is pretty darn good!!

I'd say that is pretty good, can't get much better AI, it will probably fluctuate from night to night, if it goes up don't worry about it.