Posted: Sat Oct 08, 2005 9:50 pm
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.
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.
