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Help! I am really struggling to find a good Sleep Doctor in Manhattan. Currently, my Cardiologist is trying to help , however, I need someone who specializes in this field of medicine. Currently my pressure is set to 18/15 and I am experiencing severe Aerophagia. Not every night, but most nights, making it impossible to use my BiPap machine, which I have been using for more than 10 years without any problems. Thanks
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Hi LSSNYC. Welcome to the Apnea Board. Lots of members well see your request for help. One of the first things that we will ask for is more information from you. The best way to fill this request is to install the Sleepyhead software. We would like to see what a typical night looks like in terms of pressures and waveforms. The next thing we ask for is information from your original sleep study. Your pressure settings seem pretty high. You might benefit from lowering pressures to reduce the aerophagia but it would help us to make suggestions if we can see what is going on. Keep in mind that few sleep doctors actually want to look at your pressure and flow waveforms. We have lots of people here who can share their own experience and also share suggestions that have worked for others. You have some work to do but I am pretty sure we can help. We can also offer Dr upgrade suggestions. Keep us posted.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post images

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Welcome to the forum and good luck in finding a high quality sleep specialist.

You write:
Quote:Currently my pressure is set to 18/15 and I am experiencing severe Aerophagia. Not every night, but most nights, making it impossible to use my BiPap machine, which I have been using for more than 10 years without any problems.

Was your pressure recently changed? Or have you been using 18/15 for a long time?

When did the aerophagia start? And were there any other changes in your health or sleep patterns at the same time?

Do you have any issues with GERD or acid reflux?

And do you wake up a lot on the nights where the aerophagia is at its worst?

The usual first thing they tell people with aerophagia problems to do is to start doing a lot of the self-help for GERD stuff as well as a couple of CPAP things:
  • Elevate the head of the bed
  • Don't eat too late
  • Pay attention to what you eat at supper time, and if certain foods are correlated with increased aerophagia, try to eliminate them from the diet, or at least supper.
  • If there's a chance you are mouth breathing, switching to a FFM may help. Or not.
  • If you wake up with chipmunk cheeks while using a nasal mask or a nasal pillows mask, then air is getting into your mouth, but it's not leaking out the mouth, and you're probably swallowing when the mouth gets "too full" of air; in this case working on retraining the tongue to stay up on the roof of your mouth can help. Or, when it does not increase the treated AHI, a small reduction in pressure can help. On a bilevel auto, it can help to reduce the min EPAP more than the max IPAP.
Questions about SleepyHead?  
See my Guide to SleepyHead
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Thank you so much for your quick reply, it is greatly appreciated. Yes, I recently had a sleep study this past July. The recommendation was to increase the BiPap pressure from 18/14 cm of water to 18/15. This has proven to be a little too much. Unfortunately, a mask fitting was not possible since they did not have anything for me to try. The mask that I am currently using, needs to be secured very tightly to mitigate leakage. At times this proves to be very painful, especially at the back of my neck. As an alternative, I have discuss this matter with my dentist (who I will see next week) and he has proposed an appliance that could be customized for me. Also, I often wake up with a very dry mouth.
With regards to GERD. I have been treated for that condition for several years now by my Gastroenterologist. Not sure if this is relevant, but I was diagnosed, as a child, with Crohn's/Colitis.
Yes, when sleeping, I am a mouth breather, which is why I use a full face mask.
Thank you again and for any suggestions you may have.
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It would be very helpful if you could post data from SleepyHead. It may be preferable to move back to your former slightly lower pressure and accept some additional apnea events, rather than suffer the overly tight mask and discomfort of aerophagia. This therapy is sometimes a bit of an art to find the compromise between good sleep and the optimum apnea reduction.

Given the severity of your problem, and pressures required, I would recommend you be very skeptical that a dental device can be effective. If used with your bilevel, it may even make aerophagia worse. It is extremely rare that a MAD (mandibular advancement device) can have a positive effect on OSA that requires the pressures you are using, and they have their own set of potential complications.

You are in good hands with robysue whom has dealt with these problems personally for many years. Her solution is a compromise between full treatment of OSA and respecting her needs to avoid aerophagia. So I'll let her continue her advise here without my interference. If you can download SleepyHead, and post the chart images as shown in these tutorials, we can probably help you more than a dental device.

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Thanks again. I have to say that I am very impressed with the feedback, etc that I am receiving here. I will download Sleepyhead as requested and purchase the necessary peripheral to download the data from my BiPap machine. You also requested my latest sleep study. What is the best way to do that? Also, is this data protected in anyway? Not to get too personal, but if you do not mind me asking, are you Robysue and Richb in the medical field or people with sleep apnea wanting to share your knowledge to help others? Either way, your response seem to make a lot of sense and is greatly appreciated.
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We may or may not need to see your latest sleep study. That is up to you if you have questions. The record is very important for you to have in your files, because future equipment authorizations will be based on it, it can save you from another study, and gives you a permanent record. You are entitled to any record, test result or prescription under HIPAA. Just submit a request for the record(s) you want, and you should receive it.

Neither robysue or richb are professionals, and you should consider advise and responses on this forum as coming from experience and compassion. Often that advise is better than the medical advise, but I think most of us know our limits, and readily admit when we're uncertain and you should ask your doctor.
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From my own experience, I can tell you that the advice and education I got from this Board allowed me to find a qualified Dr and have an intelligent discussion with her. The Dr I started with had no idea what he was doing and it took me a while to figure that out (with the help of this Board). By the time I went to my new Dr I was able to provide her with detailed information and data so that she could confirm my diagnosis and write a proper prescription for the correct machine. Your case might be a lot simpler. Information from your sleep study should not include any identifying information. We just want to know what they found e.g. AHI, types of apneas and hypopneas, desaturations etc. Then from Sleepyhead we would like to see some detail from a typical nights sleep and your machines settings. We want you to remain anonymous. Remember that from what you posted your Dr made some changes in your settings with a lot less information than we are asking for. I hope this helps you.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post images

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Thank you for the clarification. It has given me confidence as well as encouragement to work with you. When I am ready to post my study as well as the data from my machine, I will reach out again. Have a good weekend.
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WELCOME! to the forum.!
, I wish you good luck as you continue your CPAP therapy, hang in there for more responses to your post.
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