Resmed auto:can you use EPR ??

WELL, I had the worst night in my entire life of cpap usage last night. I woke up with aerophagia so bad that I couldn't stand up straight for almost an hour and a half. Couldn't eat breakfast or drink anything because that made everything worse. Took Gas-X---nothing worked. Finally after getting down on the floor and holding my knees to my chest several times over the hour and a half and putting a heating pad on my tummy-I "passed" enough gas to feel somewhat more comfortable and then things began to get a little better. I eventually ate breakfast(a small one) about 2 hrs. later than normal.
So, what should I do?? I had my machine set to straight cpap with a pressure of 11 with the EPR at 1. Any EPR higher than that and I feel like I can't breathe correctly-can't sleep that way. My titrated pressure was 12 but I can't stand that-my poor tummy looks and feels like the Goodyear blimp every day and it makes my GERD much worse.
Can I set the machine on APAP and use the EPR? What pressures should I try? I have used the APAP before with pressure in a very narrow range like: 8.8-10.2 because I tend to get "inflated" with the sudden rise in pressure too.
So what's a gal to do?? I am beginning to feel after almost 3 yrs. on cpap that I will never get this thing right and I will never feel rested-- EVER!! Sorry for the graphic description of my morning problem!
Didn't sleep very well last night either-woke up at 2 and never fully went back to sleep. My morning stats looked good with: Leak: .04, AHI: 0.8, AI: 0.0, HI:0.8 .
HELP- GG

Your equipment profile says your machine is this one:
Resmed S8 Vantage™ EPR™ Auto CPAP Machine

The S8 Vantage has EPR only when being used in CPAP mode.

EPR can't be turned on when the S8 Vantage is being used in autotitrating mode.

If it were me, and if the aerophagia was painful, I'd probably use the machine in straight CPAP mode at whatever pressure and whatever level of EPR (or with EPR "off") that could accomplish these two goals:

1. Not give me aerophagia (or give a "not painful" amount.)
and
2. Keep my AI (apnea index) under 1.0. I'm talking about just the AI, not the "AHI." Using a ResMed S8 machine, it wouldn't matter to me how high the overall AHI was each morning -- if the bulk of the AHI was made up of "hypopneas."

Could be a trial and error trade-off kind of thing. Lowering the treatment pressure some, in order to trade off painful aerophagia for (possibly) allowing a few apneas to happen.

If allowing a few apneas to sneak through keeps a person able to use their machine... and the alternative is, "I've got to stop using CPAP because I can't stand the pain from bloating." I'd vote for using a little less pressure.

If pain from aerophagia is driving a person toward stopping CPAP, that person has to decide which is better...
Using less pressure than ideal and allowing a few apneas through?
or
Using no pressure (stopping CPAP completely) and allowing a LOT of apneas through?

One thing that has helped me to keep my AI below 1 at slightly less pressure is my using an oral appliance in conjunction with (at the same time as) my PAP therapy.

do you happen to know if your apnea is positional?

I was told I had a pressure of about ten, turns out four cm does the trick if I sleep on my side or stomach!

I use my apap on cpap four now! unbelievable! (I just make sure I stay off my back)

So last night I set my machine to straight cpap with a pressure of 10.8 (down from 11) with an EPR of 1. The EPR seemed to have been helping with the aerophagia until recently. Anyway, my stats look like this: PRess: 10.8, Leak: .00, AHI: 2.4 (high for me), AI: 0.2, HI: 2.2. Those numbers seem to be acceptable however, I woke with the WORST GERD symptoms I have had in a long time. Even now after Pepcid (20mg) and two doses of Mylanta I am still feeling like the back of my throat is on fire. Those hypopneas must have been enough to bring up the stomach acid. As I said the AHI is high for me since I usually get numbers at 1.0 or even lower. This seems to be a never ending battle of trying to find the right spot to set my pressure. I go through times when I think I 've got it right and then BAM-it just doesn't seem to work any more.

I guess I don't have to say that I am frustrated and tired! I have been using cpap almost 3 yrs. and still do not feel like I am getting the proper treatment results. The titrated pressure was influenced (I think) by the fact that I was taking an antidepressant and Xanax at the time and I slept on my back most of the time. I still sleep on my back all night long due to shoulder & hip bursitits issues.

I've tried all kinds of settings, changing my machine from cpap to apap and still do not get consistent results that help me feel rested . Every once in a while I will feel pretty good but I cannot find any concrete reason for it.

I appreciate all the help I get at this site and if it were not for the fact that I am unemployed I would consider another sleep study. I was also titrated using a FFM but I have not found one that fits well or is comfortable so I use the Opus and tape my mouth. Seems sometimes like I am going in circles with the whole thing. THANKS again for the posts-GG

rested gal wrote:Using a ResMed S8 machine, it wouldn't matter to me how high the overall AHI was each morning -- if the bulk of the AHI was made up of "hypopneas."

Why is that? I have an AI of zero most of the time on my S7 machine, but my hypopneas are dragging my oxygen level down into the low 80's. Are you sure hypopneas don't matter? My oxygen levels improve when my HI gets smaller. Seems to me like hypopneas DO matter.



grumpygirl, I'm struggling with aerophagia, too. Just had a sleep study which showed that I have persistent REM hypopneas and oxygen levels in the low 80's because of these hypopneas. New pressure intended to clear the hypopneas, which I think matter, is 19, but I can't handle it. I'm having projectile burping, very, very violent belching, with severe stomach pain.

grumpygirl wrote:This seems to be a never ending battle of trying to find the right spot to set my pressure.

Ditto.

grumpygirl wrote:I've tried all kinds of settings, changing my machine from cpap to apap and still do not get consistent results that help me feel rested .

Ditto. If you find an answer, I would love to hear what it is.

LoQ wrote:

rested gal wrote:Using a ResMed S8 machine, it wouldn't matter to me how high the overall AHI was each morning -- if the bulk of the AHI was made up of "hypopneas."

Why is that? I have an AI of zero most of the time on my S7 machine, but my hypopneas are dragging my oxygen level down into the low 80's. Are you sure hypopneas don't matter? My oxygen levels improve when my HI gets smaller. Seems to me like hypopneas DO matter.

I don't think RG is at all implying that 'hypopneas don't matter.' She even put the word "hypopneas" in quotes, which highlights that some of the changes in breathing that a machine scores as "hypopneas" might not be scored as hypopneas during a PSG.

That information is not meant to discount the fact that going for lower numbers is a logical thing to do, within reason. And obviously O2 levels do matter. But if a person is feeling well, has good O2, and an AI below 1.0 on a pre-S9 ResMed, many would recommend that the person not become discouraged or obsessed or overly concerned about the number given as "HI" by his or her machine, since many of the changes in breathing being estimated to be "hypopneas" may not be significant as far as efficacy of treatment.

As the clinical manual for my machine states: "The AHI values reported by the VPAP Auto should be viewed as trending information only, that may suggest the need to further investigate the patient's
condition with a polygraphy study. . . . The AHI reported by the VPAP Auto may be higher than the AHI determined by polygraphy scoring since the VPAP Auto cannot detect the sleep state or the presence of arousals, nor does it incorporate SpO2 measurements into the AHI calculation."

If you haven't already, have a look at your food and drink intake, especially in the evening. When I did a google search, there is a huge variety of foods that can trigger GERD or gas. To alleviate my aerophagia, I had to cut out: all caffeine, soy milk (with carageenan), tomatoes, spicy foods, orange juice. I go to bed at 10 pm, so have a very light dinner and--no later than 6 pm. I was taking Gas X and Maalox before bedtime, but now don't need to.

If you sleep on your back, can you raise the head of your bed?

I use a very narrow range on apap 11-12, or cpap at my 95 percentile of 11.8, both with EPR of 2. On my one night of using the FX, I had worse aerophagia, though can't be sure it was related.

jnk wrote:I don't think RG is at all implying that 'hypopneas don't matter.'

She said:

it wouldn't matter to me how high the overall AHI was each morning -- if the bulk of the AHI was made up of "hypopneas."

Maybe I am misunderstanding that, but it sounds like she is saying that as long as the bulk of the AHI is made up of "hypopneas," it doesn't matter to her how high the overall AHI is each morning. Am I misunderstanding that?

jnk wrote:But if a person is feeling well, has good O2, and an AI below 1.0 on a pre-S9 ResMed, many would recommend that the person not become discouraged or obsessed or overly concerned about the number given as "HI" by his or her machine, since many of the changes in breathing being estimated to be "hypopneas" may not be significant as far as efficacy of treatment.

Most people don't know what their O2 numbers are. I don't think you should be discounting hypopneas as long as the full picture is not available, and it almost never is for people on pre-S9 machines.

jnk wrote:The AHI reported by the VPAP Auto may be higher than the AHI determined by polygraphy scoring

That little word "may" is critical. We don't know for any individual whether they are having the kinds of hypopneas that would be scored by polygraphy or not. For any individual, they might all be valid hypopneas, or none of them might be valid, or maybe 27% of them might be valid. We simply don't know.

LoQ, I think ResMed's own words "the AHI values reported . . . should be viewed as trending information only" says it very well. And I appreciate that RG is particularly good at helping people understand the significance of those words. But some will still find ways to manage to misunderstand them, regardless. But, hey, that's cool!

GrumpyGirl, if you think you were that badly titrated, why not have another PSG? Or if that is impossible, how about a slow drop on pressure, to see if you can get good therapy with less Aerophagia?

For me, many hypopneas on the ResMed are orrelated with oxygen desats.... also with period of being awake and tossing.

The ResMed VPAP manual is being careful, knowing full well that the algorithm planners never assumed a hypopnea on that algorithm was necessarily an indication of obstruction. (Berthon Jones...) they're simply saying "don't assume those are necessarily the hypopneas the you know from the sleep lab".

O.

jnk wrote:LoQ, I think ResMed's own words "the AHI values reported . . . should be viewed as trending information only" says it very well. And I appreciate that RG is particularly good at helping people understand the significance of those words. But some will still find ways to manage to misunderstand them, regardless. But, hey, that's cool!

I agree with the ResMed words. I seriously doubt that I am misunderstanding those words.

What I think is misleading is the discounting of hypopneas on this forum simply because they were measured by a pre-S9 ResMed machine. Sometimes it is appropriate to discount those, sometimes it is not. The cases where it is NOT appropriate almost never get high-lighted, except by the people who don't have apneas. That right there should tell you something about the bias of the knowledge in this forum.

LoQ wrote:

jnk wrote:LoQ, I think ResMed's own words "the AHI values reported . . . should be viewed as trending information only" says it very well. And I appreciate that RG is particularly good at helping people understand the significance of those words. But some will still find ways to manage to misunderstand them, regardless. But, hey, that's cool!

I agree with the ResMed words. I seriously doubt that I am misunderstanding those words.

What I think is misleading is the discounting of hypopneas on this forum simply because they were measured by a pre-S9 ResMed machine. Sometimes it is appropriate to discount those, sometimes it is not. The cases where it is NOT appropriate almost never get high-lighted, except by the people who don't have apneas. That right there should tell you something about the bias of the knowledge in this forum.

My understanding of ResMed's words, as I read them, is that THEY are honestly and factually "discounting" the AHI values of ALL home machines by pointing out, rightfully so, that it is only useful for trending.

But hey, no one has ever accused me of being very bright, so maybe I have no idea what ResMed is talking about at all. I'm just the guitar player, after all.

LoQ wrote:

jnk wrote:LoQ, I think ResMed's own words "the AHI values reported . . . should be viewed as trending information only" says it very well. And I appreciate that RG is particularly good at helping people understand the significance of those words. But some will still find ways to manage to misunderstand them, regardless. But, hey, that's cool!

I agree with the ResMed words. I seriously doubt that I am misunderstanding those words.

What I think is misleading is the discounting of hypopneas on this forum simply because they were measured by a pre-S9 ResMed machine. Sometimes it is appropriate to discount those, sometimes it is not. The cases where it is NOT appropriate almost never get high-lighted, except by the people who don't have apneas. That right there should tell you something about the bias of the knowledge in this forum.

LoQ, I wonder how do you account for the fact that the ResMed Autoset algorithm doed not respong to hyponeas? In either the S8 version or the S9 version? No pressure change at all.