Bloating with Aircurve 10 VAuto

[trish6hundred]

Hi John Turner,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy,and getting it adjusted to meet your needs.

[John Turner]

Third night since changing settings from S to Vauto due to bloating. Settings are: Max Ipap 18; Min Epap 8; PS 4; Trigger Med.[attachment=2685]

[Sleeprider]

This is looking okay, but you're still getting obstructive events in clusters. I would suggest this is likely due to sleep position at those times. The machine probably needs a higher EPAP minimum pressure to prevent these, and the way to get there, is to increase EPAP Min 1.0 cm at a time, starting at 9.0. Do this slowly over time and you should eventually find these clusters are prevented. Alternatively, you may need to stay off your back, or use a soft cervical collar to prevent "chin tucking", depending on how your apnea are triggered. Good luck!

On future graphs, please show the pressure graph rather than the time at pressure. That will let us see where the machine is at the time events occur.

[Sleepster]

John, I would ask the RT why your machine mode was changed from VAuto to S back on May 18. Based on what you've told us so far there seems to be no reason for that change, so perhaps we're missing something about your health that we need to know.

You are suffering from aerophagia, your AHI is elevated due to obstructive apneas and hypopneas. The remedy for the aerophagia is lower pressure, but the remedy for the obstructive apneas and hypopneas is higher pressure. When you're in VAuto mode you can spend more time at lower pressures because the machine raises the pressure only when it needs to do so to prevent the obstructive apneas and hypopneas. You didn't have this advantage when you were in S mode which is likely why your aerophagia was worse then.

So, here's the way your machine works when it's in VAuto mode. You have three pressure settings: minEPAP, Pressure Support (PS), and maxIPAP. EPAP is the pressure when you exhale, IPAP is the pressure when you inhale, and PS is the difference between the two.

I'll use my settings as an example. You can see by looking at the panel on the left that I have a minEPAP of 5.2, a PS of 4.4, and maxIPAP of 13.6. So, when the machine starts up the EPAP is 5.2 and since the PS is 4.4, the IPAP is 9.6. As the night progresses the EPAP and IPAP will automatically rise up when necessary, fall back down when necessary, and so on. The largest they'll ever be is a IPAP of 13.6, and since the PS is 4.4, the EPAP will be 9.2.

In your case you need a higher maxIPAP to prevent your obstructive apneas and hypopneas, but a lower min EPAP and higher PS to prevent aerophagia. Others in this thread have given you some good suggestions on what those settings could be.

When you post SleepyHead screen shots here are some good guidelines on what you should do to show us what we need to see:
http://www.apneaboard.com/wiki/index.php...ganization

[John Turner]

Thanks for the link...hope this attachment includes all info needed. As far as why machine was changed from Vauto to S MD seemed concerned my AHI wasn't very good and was still having a fair number of apneas and hypopneas. OOOPS when trying to send attachment I'm told I've exceeded my 512 kb limit. How do I delete past attachments so I can send this new one?

[Sleepster]

As far as why machine was changed from Vauto to S MD seemed concerned my AHI wasn't very good and was still having a fair number of apneas and hypopneas.

Were you suffering from aerophagia at that time, or did you complain at that time about it?

Careful monitoring of the data and adjustment of the pressures in VAuto mode is really your only hope of both lowering your AHI and treating your aerophagia. To some extent it's a trade-off between the two, but the good news is that aerophagia tends to subside and that AHI tends to go down as we adapt to the therapy.

For help with attachments look here:
http://www.apneaboard.com/forums/Thread-...4#pid65514

[John Turner]

Thanks for all the help navigating the board...here's a new attachment that will hopefully provide needed info. [attachment=2691]

[John Turner]

Changed my minEPAP from 8 to 9 last night and woke up around 2 a.m. with bloating....decreased minEPAP to 8.6 which helped with remainder of night. Had 4.6 events per hour BUT AHI was still 13.4. Total AI were 8.6 and Centrals 0.8. Thought AHI would drop with this few events/hour. This mean that therapy is not that effective even with this drop in hourly events?

[Sleepster]

Changed my minEPAP from 8 to 9 last night and woke up around 2 a.m. with bloating....decreased minEPAP to 8.6 which helped with remainder of night. Had 4.6 events per hour BUT AHI was still 13.4. Total AI were 8.6 and Centrals 0.8. Thought AHI would drop with this few events/hour. This mean that therapy is not that effective even with this drop in hourly events?

I understand what you're going through, John, because I went through the same thing.

First of all, resist the temptation to draw conclusions from such a small amount of data. AHI can change if you do nothing, so concluding that it changed because of a few hours spent at a different pressure is not meaningful.

I would suggest that as you lower the minEPAP you increase the PS. Keep in mind that the starting IPAP is the sum of the minEPAP and the PS. You need the higher PS to fight the aerophagia, but you need the higher IPAP to fight the obstructive apneas and hypopneas.

Another thing I suggest you explore is your sleeping position. Sewing a tennis ball into the back of your shirt can prevent you from sleeping on your back and can help alleviate obstructions allowing you to spend more time at lower pressures helping to alleviate the aerophagia. When sleeping on your side tucking your chin against your chest might alleviate some of the aerophagia.

On the other hand a wedge may be needed instead of the tennis ball to force you to sleep on your back with your head elevated to prevent both the obstructions and the aerophagia.

You just have to experiment to find out what works for you. Don't be discouraged because once you figure it out you'll be rewarded. Both aerophagia and obstructive events tend to subside as we adapt to the therapy, so that is another reason to persevere and not give up.

[John Turner]

Still seeing much relief from bloating since I changed settings to VAUTO. Will see RT tomorrow to discuss changes. Another question...last night my AHI was 2.6 BUT my machine showed 2.6 events per hour (see attachment) with an AHI of 13. Sleepyhead and my Aircurve don't agree...machine shows 2.5 events/hour with total AI of 8.3 and Centrals of 0.9. Why the big discrepancy. If my RT sees AHI of 13, he's going to make changes based on that. I'll show him a screenshot from Sleepyhead but I don't think he's familiar with the software. Any suggestions?[attachment=2712]