In Agony please help me

I have been using APAP for about 6 years . I have the RESMED Autoset Spirit II with the H4i Humidifier, heated tube and a Swift LT or Swift FX nasal pillows. Since autumn of 2012 I have started having major issues when life up to this point and my love of APAP was unblemished. For some bizarre reason I started mouth breathing or releasing air from my mouth (like a phut phut) . The major issue from this is now I am suffering with gastric insufflation (or aerophagia). The gas then becomes trapped and I am in agony to a point where I have gone to the hospital and been prescribed Oral Morphine.

When I first had episodes of this agony they were happening late in the day so I am going through diagnosis with endoscopy for suspected gall stones /pancreatitis. Now its first thing in the morning and linked to feedback from my partner that I was mouth breathing or letting gas escape through my mouth and feeling EXTREMELY bloated. (maybe I have both and the bloating triggers a pancreatitis event) I feel this could all be linked to my APAP treatment and the way its going awry.

Either way it takes most of the day to recover. So its severely impacting my life and work. I cant work with Morphine in my system, as being spaced out in meetings or driving is not a good idea.

My first suspicion was that in August my machine was "serviced" and this had done something to the setup or algorithms (e.g. did they do a SW update - no idea. Did they reset the settings - no idea) . So I decided to start changing the min and max pressures . Stupidly I did not note down what they were initially.

My thinking was
- as I was moth breathing maybe I wasn't getting enough air. So I upped the Max pressure.
- still mouth breathing so upped the Min

So as of today Min = 7.0 and Max = 18.0

Messing around in this area had zero effect on the symptoms of taking in in or expelling air through my mouth. I now think my understanding of what is happening is floored. I think my actions have led to the air being forced into my stomach and causing this sever pain episode and escalation of more serious issues. (little knowledge is dangerous)

Reading other posts seems both upper and lower pressures can result in air being either swallowed or forced into the gut. Its made me narrow the band my machine works in so now set at min 8.0 max 14.0 so will try this. I have a memory in my early use of bloating and the max pressure was reduced. The bloating then didn't cause this severity of pain.

My AHI in now in the 11-13 range (I cant see the history had to record on a daily basis) . My AI seem to always around 2 . Leak last night was at 0.62

I have never been to a sleep clinic for a tit-ration, I was prescribed APAP on the basis of oximeter analysis.

So first an formost if anyone knows how to release the gas bloating me more quickly I would be hugely grateful ?>
Can anyone suggest better min max settings and a method to determine the best range ? What should I look for in the results to see if I'm going in the right direction ?
Is it true that the HI value reported by Resmed products is normally higher than other machines ?

Hi,

The S8 series of machines over report hypos by a factor of 2. Respironics and Resmed S9 machines don't have that particular issue.

I have a working theory...if you didn't have a titration, you were probably given a prescription for having the machine set with a wide open pressure range. Then when you had air ingestion issues at the start, the pressure was probably changed by your respiratory tech. If that change didn't make it to your prescription, then when you machine was serviced, they probably set it back to the original wide-open range. Just a theory.

If you AHI is high, that is a medical issue. I think it is a good time to schedule a visit with a sleep doctor. I think I'd suggest finding a different doctor or clinic. For example, you don't need a doctor that takes a guess at the pressures based on oximeter readings. That is like measuring how much rain we get by counting how fast your windshield wipers move--it isn't accurate or scientific.

You airway and the tube leading down to your stomach are exactly next to each other. It doesn't take a very large physical change to end up having air go down into your stomach. Sometimes, a weight change of just a few pounds can do that. A new pillow or simply changing your sleeping position by an inch or two can trigger this. Do you have any new aches or pains that are causing you to sleep differently?

For a period of time when I was losing weight, I was in a catch-22 situation like this. I needed a pressure of at least 16 to feel good, but anything over 14 caused me to inflate like a balloon. It was awful. This condition is surprisingly painful. I was able to pass the air as gas within 2 hours of waking up, but I'd toot like a stream train. Fortunately, the condition passed within 8 weeks as I was losing weight.

If you are computer savvy, it would be helpful for you to download the treatment data from your machine and post the graphs. That might allow folks here to offer guesses as to a way you can survive until you are able to get lined up with a new sleep doctor.

-john-

I am computer savy but my understanding is to get data out of an S8 you need special software and a cable to go into the card slot on the device. Have I missed a trick here ? Thanks for your thoughts very appreciated.

The S8 requires a special card reader that is hard to find. I have seen them on the internet for about $80.

After six years with the same machine; you may qualify for a new machine.
If you can, read this first.
http://maskarrayed.wordpress.com/

From a planet in a galaxy far, far, away...

If you can withstand a little discomfort you may find that you can keep your mouth closed by wedging a pillow under your chin while you sleep. It takes some fiddling around to "get it right" but once it is in place it serves as a muscle memory device to keep your mouth closed.

The problem with this comes when you roll over. To keep the pillow in place you can use something like a beach towel. Just don't make it so tight that you cut off your ability to breathe. Sometimes you can do this by simply adjusting the way you lay your head on your pillow. If you lay down with your head back, your jaw tends to fall open. Too far forward and you wake up with a stiff neck. You need to find the sweet spot.

I have to agree with the others. Without data it is difficult to adjust pressure. A new machine may be the best way to go.

plug_it_in wrote:So I decided to start changing the min and max pressures . Stupidly I did not note down what they were initially.
My thinking was
- as I was moth breathing maybe I wasn't getting enough air. So I upped the Max pressure.
- still mouth breathing so upped the Min

So as of today Min = 7.0 and Max = 18.0

Whatever was causing your mouth breathing, it is very highly unlikely to have anything to do with not getting enough air.

IMO, you need to go back to your DME and find out what the settings should be, restore your S8 II to those settings and start working through the mouth breathing issue from there

Cheers,

Bill

IMO, you need to go back to your DME and find out what the settings should be, restore your S8 II to those settings and start working through the mouth breathing issue from there

For God's sake, one lucid man.

Yes and get a new machine soon - compatible with software.

Better, get a proper titration at a good sleep lab. Altho I do understand money problems. You might benefit from a bi -level machine, or as Respironics calls it, a Bi-Pap.. although a bi-level machine is not of much help if you do not know the correct pressures to treat your apnea.

If you have mouth leaks, you need to fix them. Have you tried using a chin strap? You might also need to switch to a full face mask if you can't fix your mouth leak.

You may help aerophagia if you tilt your head forward and point your chin at your chest. I haven't tried it, but here's a YouTube video. https://www.youtube.com/watch?v=-65JWNBttnE

Some people think that various body positions can help you release trapped gas. This is often referred to as a "yoga" technique, but it's a mechanical thing. You don't necessarily have to believe in new age BS, just maneuver your body to get the gas out. Google "gas relieving positions" or some other terms. Gas-x may help by reducing bubble and letting you burp it out more easily.

Higher air pressure will tend to make both aerophagia and mouth breathing worse.

Do you have EPR turned on on your AutoSpirit II? Many people find that helps with gas.

archangle wrote:
You may help aerophagia if you tilt your head forward and point your chin at your chest. I haven't tried it, but here's a YouTube video. https://www.youtube.com/watch?v=-65JWNBttnE

That LankyLefty is an absolute idiot. Telling people to sleep with their head propped up at a 45-degree angle.

Any spine doctor will tell you this is setting you up for disaster. Everyone of them strictly recommends sleeping with the head in a neutral position.

The same for awake posture - head should be in neutral position.

I thought I would report back. I set my min pressure to 6.8 and max to 12 (min set for comfort) . What a MAJOR improvement. Also spoke with my partner in more detail and she has clearly pointed out that my "mouth breathing" is exhalation and not inhalation . So the whole chin strap taping up my mouth that I tried was compounding the problem .

So I created my own problem by gradually increasing to a Max pressure at 18 . I thought I was breathing in through my mouth so I taped it shut . To the point where the night before one of my worst bloating the pressure was finally set to 18 and double taped my mouth. My partner said I was whistling like a boiling kettle past the tape. So my poor stomach didn't stand a chance.

So now my AHI has increased slightly at max pressure 12 but no surprise here (and the reported pressure the machine actually went up to was 10, so not even hitting 12 anyway). I am not bloated and had the best night sleep for a long time. AND I didn't mouth breath . What a lesson learnt.

Now I am going to let my poor battered stomach recover and stay still settings wise for a week or so. Then I will gently increase the pressure and see if it has any impact on the AHI . I have also ordered the card reader and software so I can get more detail from my machine.

I think the suggestion that the service reset my machine to the default setting was 100% correct (i.e. 4/20).

Thanks for all your input