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[Diagnosis] Aerophagia causing breathing difficulty?
#1
Sad
Am now a week into auto use set at 6/9.  The pressure pattern over the week seems to have settled down to a fairly even pattern.

Last night I had my best AHI result to date ( over 3 weeks of machine use) of 0.52 but was also my worst night to date.

Basically I slept fine until early morning (around 5:30am) when things went downhill.  

I have attached a screenshot from Sleepyhead showing the notes I made this  morning & would appreciate comments from those more knowledgeable than myself.  Please feel free to request specific enlargements from sleepyhead if required.

I am aware that others have previously posted similar & the comments have been around anxiety issues. I did not feel especially anxious (& as a retired psychiatric nurse therapist consider I possess the  self awareness to make that statement), or scared as I was aware I could remove the mask. I persisted however for a while to re-establish a normal breathing pattern, but eventually admitted defeat.  


[Image: 33675191290_2b7ef6cf4a_o.png]
 
Below are expanded copies of the flow rate wave pattern, showing my normal breathing pattern, & the breathing pattern when I felt I was struggling to get sufficient air. To my untrained eye the two don't look hugely different, but they sure felt different!

[Image: 33217587314_6e02201b35_o.png]

EDIT: Now a couple of hours or more since I got up I feel fine.
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#2
You are breathing deeper in the 2nd set, I wouldn't be surprised to see a higher Tidal Volume.
Look at your pressures, it's not much but this period is also the highest pressure part of your night, not by much but it's there.  It looks like a couple of snores and some flow limits put it there.  

It would be possible that your swallowing air caused four distress.   Is this the first, the only time this has occurred?
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#3
Yes tidal volume was up.
I'm not clear on what 'flow limits' are, but I suspect you are suggesting that changes in this (& snores) are 'markers' for the machine to increase pressure? (Btw.... Is it actually possible to snore when connected to the machine?).

Of course I am not aware of swallowing air because I'm asleep, but certainly I can feel the pressure in my guts. Also just before this morning's 'incident' I was aware of needing to keep my mouth closed because I was getting occasional small leaks out through my lips.

My wife suggested that the internal air pressure from swallowing air might be a bit like the effect of heavy pregnancy on women when it affects their lung capacity because of the internal pressure pushing up against the lungs.

I'm going to lift up the end of the bed tonight.

This was the second time I've experienced this in the 3 weeks I've been on the machine, but can't find it on sleepyhead, so am not sure if it was on fixed pressure (8) or since I switched to auto (6/9) or even the first night where the machine supplier incorrectly put me on 10. Certainly 10 was by far the worst night for aerophagia.
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#4
Cuppa, you are using auto CPAP at 6-9 pressure. What is EPR set at? Just to be clear, you sensed a need to breath deeper, and did not have any issues with aerophasia, correct?

On the wave forms, the second example has higher volume per breath and higher respiration rate, and appears to be awake breathing, while the first looks more like sleep.
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#5
(04-15-2017, 10:17 PM)Sleeprider Wrote: Cuppa, you are using auto CPAP at 6-9 pressure. What is EPR set at?  Just to be clear, you sensed a need to breath deeper, and did not have any issues with aerophasia, correct?

On the wave forms, the second example has higher volume per breath and higher respiration rate, and appears to be awake breathing, while the first looks more like sleep.

Auto CPAP @ 6 to 9 pressure
EPR on 2
DID have issues with aerophagia. 
I was awake for much, if not all that period of heavier breathing.

Just looked up Aerophagia on wikipedia  https://en.wikipedia.org/wiki/Aerophagia  where it lists symptoms which I experienced bloating, chest tightness, & shortness of breath. In addition last evening we had pigged out a bit on easter chocolate, & I was suffering from heartburn when I went to bed & had been belching excessively. That’s 5 of the listed symptoms. 
Following the link on ‘Shortness of breath’ takes you to another wikipedia page https://en.wikipedia.org/wiki/Shortness_of_breath  where a descriptive sentence describes precisely what I experienced. “Distinct sensations include effort/work, chest tightness, and air hunger (the feeling of not enough oxygen)’.
I have no reason to think that any of the other causes of Dyspnea listed are applicable to me. I have been out swinging an axe splitting firewood all morning without a problem.

I guess the concern I have is about getting aerophagia at what are extremely moderate pressures compared to what others use. It’d be really nice if I could just be happy about an AHI under 1.
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#6
Your pressures are not overly high, and you seem to be getting good control of AHI at 6-9 pressure. It could be your aerophagia was a transient problem from a large meal and reflux. If it is persistently a problem, then compromising between pressure and comfort is a reasonable course of actions. You may find a pressure range of 6-8.5 or 6-8 may alleviate air ingestion, while controlling apnea. An AHI less than one is exceptional. I think managing it at a level under 3/hour is more than satisfactory. Remember to look at the long-term, not one night at a time.
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#7
Have now had a further 2 nights on 7 to 9, with 95% under 8.5 pressure & median pressure of 7.2. AHI under 1 still both nights. Bed raised a bit at the head end, plus an extra pillow.  Also not eating too much in the couple of hours before bed.   No repeat of the dyspnea, & aerophagia whilst still an issue has been relatively mild.

Another step forward I think.
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