Melatonin-My Hero

Esther, I've used several different types of machines - just for the heck of it. Normally I use a pressure of 8 - 14 and never have any aerophagia problem at all on autopap.

However, in trying 3 different bi-level machines, if I set the IPAP (inhalation pressure) at 12 or higher I had aerophagia - painfully. I'm really a wimp about pain!

Even though there are sometimes brief periods during an occasional night when my autopap has to use 12 or 13, it's for such a short time -- no problem. Since most of every night is spent down at pressures that do not cause aerophagia for me, treatment with autopap is very comfortable for me.

The only time I had aerophagia on autopap was in my early days experimenting with some rather high pressures. 11 gives me a little bit of aerophagia, 12 gets painful, and it gets increasingly painful with each step up....for me.

IF a person is going to have aerophagia at all, the threshold pressure where it can start happening for them varies from person to person. 12 causes it for me; 7 is causing it for you. The solution in just about any case of aerophagia is LESS pressure.

I don't think many doctors or DME's take "comfort" issues with this kind of treatment as seriously as they should. Too often their answer to the myriad problems cpap users face is, "Keep trying." "You'll get used to it." "Well, you really need to use it, but it's your choice." Whether they are too busy to take an interest in figuring it out, or think they already know the answer, they drop the ball too much. And people drop out.

Some can eventually get used to a pressure that starts out giving them aerophagia. I, for one, would not put up with enduring the "getting used to it." Not where real pain is concerned. Pain can be quite a sleep disrupter.

I had the luxury of knowing how to change the pressure settings on every machine I've used. I can tell you that two hours into the night on the bi-level inhale pressure of 12 that woke me up with bloated belly pain, I was out of that bed in a heartbeat and was punching the necessary buttons to bring that pressure down a couple of notches.

If aerophagia is beyond burping and passing air...is actually causing abdominal pain, I personally think it's much better to lower the pressure down to whatever it takes to relieve it. I'd go about it by using a non-pain-causing pressure for awhile, even if it's not a good therapeutic pressure. Raise it a cm, get used to that one. Raise it another cm, get used to that one. And so on. The process might take days or weeks to get up to the titrated pressure.

Certainly the person might not be getting "real" treatment for their OSA during the days of gradually working up to the prescribed pressure. But better that than to quit entirely due to pain! I think a lot of doctors just "don't get it" when they wave aside comfort issues. The very issues that can make it or break it as far as whether the cpap user is going to be able to stick with the treatment or not.

I don't know if an autopap would make any difference for you, Esther. Especially since you are using a relatively low pressure anyway, yet are getting quite a bit of aerophagia. It may simply be that you are breathing through your mouth at some times during the night and gulping air inadvertently when you get roused enough to try to make the transition back to nasal breathing.

Or, there may be a physical problem with your esophagus that just is going to let air push its way through the wrong way. That's the kind of thing it would take a good doctor to figure out for you. But MORE pressure, as your current doctor advises, is not what I'd go for at all. No way, no how.

As long as that doctor has blinders on about autopaps in general, and thinks "more" straight pressure is the answer to aerophagia, you're up a creek,unfortunately. You're going to have to consult another doctor, or.... make your own treatment decisions.

If it were me suffering from painful aerophagia, I know what I'd do. I'd decide for myself what pressure I can "take" and what machine I want to use. But I'm not a doctor. Each person has to decide for himself/herself just how involved to be in the treatment process.

RG,
Thanks soooo much for taking the time to answer my question! Very thorough and helpful. I've always gotten a lot from reading your posts and really appreciate your help. There are lots of great people on this forum.

I will try going a little lower to see at what level there is no aerophagia and then gradually increase the pressure. (Should be talking with my Dr. tomorrow and will discuss this with her--she does seem to care. Just hope she agrees. ) Since this problem actually seems to be more prevalent now, I was wondering if the sphincter at the end of the esophagus is too weak. I will try to see if there is any medication that helps with that--although I really don't want to take any medicine that is not necessary.

At this point I am not in a position to purchase another machine out of pocket so hopefully just slowly working my way back up will do the trick.

Thanks to all for the great comments and encouragement,
Esther

Hey Lori and Rested Gal as well as others on other threads,
Thanks for the help. I shared with my Dr. what you shared with me about the auto helping with aerophagia (even if you don't have high pressures). She agreed and is sending me a rx for an auto. She even said she is glad that I was willing to research this and take an active roll in my treatment--she wishes more patients would do this. She should meet all of you. My Dr. has always been willing to sit and talk about things--I'm also thankful she is willing to listen.
Hoping the auto will really help!
Thanks to all,
Esther

Esther,

You make sure you follow this doctor anywhere she moves, out of state, out of country, off the planet, wherever! It is so wonderful that you have found someone who actually takes the time to sit, listen and discuss your situation with an open mind. She is a gem, for sure.

And GREAT about the fact that she is going to put you on an auto. I just went back to it because of the same problem and set mine lower than I normally do. It really does help. I'm sure you'll see a difference, too. I also find the lesser the pressure you stay at, the quieter the masks are, too.

Which machine do you plan on getting? If you have a DME like mine was, he said what your doctor said and was thrilled to be working with someone who was proactive in their treatment. He also said he wished more people were. I had explained to him that I wanted to be able to monitor my own treatment and not depend on the DME to read my information every month. So he and I researched the options together and both came up with the two same machines, the Remstar Auto and the BP420e. I chose the Remstar for two reasons: A) The Cflex option, which now I don't use, and B) The fact that I could just upload my information every day via a card and not have to carry my whole CPAP machine upstairs to my computer.

I'm sure whichever way you go, you will be happy to have the option of using it in auto mode or cpap. Let us know when you get the machine and how you're doing on it. Good luck! I'm so happy for you!!!

Hi Lori,
Thanks.
Right now I have the Remstar Pro with Cflex and heated humidifier. The only info it records is how compliant you are, but I have no problems with the machine and like the Cflex! Since I already have the heated humidifier I thought I'd just get the Remstar Auto with Cfex. I haven't had as good fortune with my DME as you, and since they charge so much more, I thought I'd try to save my ins. some money and go online. I'm glad you like your Remstar Auto.
Did your DME help you get the software or just suggest what to get? I didn't discuss getting software with my Dr.--didn't want to push my luck , but whenever I can afford it, I would like to get it. What's the best way to get all you need to monitor youself?
Esther
By the way, the last time I was in for a visit (to my Dr.) I told her about the Aura. She had never heard of it. I suggested that I call Aeomed to see if they would let me have one for free to try and then give my review to my Dr. She liked that idea and said to tell them she has 800 patients/year that she could recommend the Aura to if it is good. The company wouldn't send it to me but sent one to my Dr. She is letting me have it so I can report on it to her.

Esther,

What a great idea for getting an Aura to try. Hope you like it. I actually used my Swift last night, with the hose attached to the top, like Tridens came up with, and have to say I had a really good night with it. It's still one of my favorites along with the Aura.

I had to purchase the software and card reader out-of-pocket, the only thing that my insurance company doesn't cover. But I can understand that and it was fine by me. My insurance company has also been great so far with everything OSA-related. I've been blessed in that regard, too. As far as the DME, he didn't really know too much about the machines that would allow me to be in charge so we both learned all about them together. He wasn't the one to suggest it at all. As a matter of fact, when I told him that I wanted to be able to read my own data, he acted as if he didn't know it was possible, but told me I could get a machine that has a card in it and all I'd have to do is bring it in to them like once a month and they could tell me what was going on. Then I explained to him that I didn't want to be at anyone's mercy and wanted to be able to view the data at my own choosing. So he said he would look into it, and I said I would do the same, and we both came up with the same results. I really love this RT at my DME. He's a great guy.

Anyway, I see it as you going with the Remstar Auto with CFlex if you like the CFlex and plan on continuing with it. The 420e doesn't have that option, although some feel it is more sensitive than the Remstar. I would love to be able to try the 420e and see if it is any different for me than my Remstar. But I did get the Remstar purchased for me, so it's a done deal whether I liked the 420e better or not. I think it's a matter of being happy with something that works just fine for me. No complaints here.

Good luck, Esther. Keep me posted, please!

Born Tired

I just noticed your reply about the twitching and melatonin.

I only tried the melatonin for 2 weeks but found I stayed awake more, so I am back on 1 clonazapam a night. My doctor put me on extra calcium/magnesium supplements since a blood test showed I was fairly low. The doctor thought this might have to do with my involuntary muscle movement. I have taken the calcium/magnesium supplements for a month and the twitching seems to have gone. (it wasn't really twitching, more like every so often an arm or leg would jerk which is very unusual for me)

About the issue with air in the abdominal area. When I first started CPAP nine months ago I did not have an auto machine. My pressure was set at 9 and a lot of air went in my tummy which was very uncomfortable by the morning, besides the fact that I could barely sleep with a pressure of 9. I constantly took my mask off.

Since I now use the auto at 5/10 I believe I stay around 6 and have no problem with the abdominal air and I can keep my mask on all night now.

Good luck to you.

Lisa

Stunned,
Glad the jerking is better.
Looking forward to getting an auto soon.
Esther

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Listening to a Dr Andrew Weil CD of a torum on alternative medicine he gave a different dose (the 2-3 mg range) for jet lag/occasional use and the much lower dose for ongoing use. You might check into his web site to verify the dosage for continued use.

I loooove melatonin!!! I discovered it way before I had to be on a CPAP and I have always said that it gave me the most peaceful,restful sleep I ever had and often pleasant dreams also.
Another natural way you can really relax before bedtime that will litrally ''knock you out'' naturally is with Chamomile tea.My boyfriend has battled insomnia for years and I got him using it instead of Excedrin PM's or Nytol to help him get to sleep.Both melatonin and Chamomile tea are natural ocmpounds,which minimizes your risk of side effects.
For safety's sake though,if you are on prescription meds,or you have any serious health related concerns,always talk to your doctor before using.Oh yeah,and don't combine these with alcohol,which increases the sedative effect,and don't use before driving a car or other heavy machinery.

I think you are right guys!

Hi all and especially dkeat--My husband uses melatonin when he travels internationally and it helps him a great deal. He does not use it routinely. I asked my doctor about using it and his answer for me is no. I have several forms of auto-immune disease and take 11 medications. For me I am not able to add melatonin to the mix. So, while it is a great thing for many people, I suggest for those with health problems, at least, ask your doctor! It's not a bad idea for healthy people, too

Swanson vita has a time release Melatonin 1 1/2 at first then 1 1/2 mg later in night. any form of med /supplement takes time to act one week with a cold is way to short a time to evaluate. also start taking note of what you feel when you are aroused at middle of night times. ?dry nose , gassy tummy ,leg stiffness etc. these may help treat root cause of arousals. God Bless GENE