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EPR, Centrals and Aerphagia
#1
4 months ago, a wise forum member suggested I turn off my EPR to reduce my centrals. I did, and it worked.

A couple of weeks ago, I realized via another forum member that the aerophagia I was experiencing could possibly be relieved by turning on my EPR. So I set it at 2. It kind of worked--gas is down significantly. (I am also trying to sleep on my right side, use a wedge pillow and plan to decrease my Ipap pressures a bit)

Please note that my AHI average for the last three months is a very boring 1.2.

BUT, the centrals came back as the EPR went on, and last night they came back in spades.
I have been at the EPR #2 setting for 6 nights, and before last night the average AHI of the other 5 days was 1.79. (Range .37 - 4.54)

What is the cause and effect between the EPR settings and Centrals? Does lowering the exhalation pressure via EPR somehow indicate to my body to stop breathing? What is going on? Are these centrals real and significant or some kind of artifact?

I would really like to get rid of the gas and bloating, but I don't want my AHI to increase so dramatically.

Any advice would be appreciated.
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Began APAP 11/28/17
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#2
Are you symptomatic from the clear airway events? If not, they probably don’t matter.
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#3
Currently you are at 7-11 EPR 2 and previously I assume the same setting without EPR. It would help to know the median and 95% pressure for the period before you turned on EPR. My thought is that we can reduce your overall pressure, set EPR to 1 and get better results all around. What if we could set your pressure to 7.6 to 9.0 with EPR 1 or off?
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#4
Yes I am still at 7-11.
According to Sleepyhead, for the last 30 days, my Average pressure was 8.88 and the 90% pressure was 10.52
The average pressure in the last week (with the EPR on @2) was a little lower, 8.52 with the 90% @ 9.92.

Do you think your suggestion would still help the aerophagia? I can always go back the EPR off and the AHI will be fine. But I want to get rid of the excessive flatulence so I can go places again (with people).

Also Rider, do you understand why this is happening?
Began APAP 11/28/17
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#5
(06-04-2018, 02:33 PM)Coffee Man Wrote: Are you symptomatic from the clear airway events? If not, they probably don’t matter.

I can't tell a difference yet in symptoms. I was sleepy in the day before the change and still am. My sleep doc is trying a med on me now, but that is a different issue.

Also the 1st 5 days of EPR @2 were not problematic as far as AHI and centrals go....a little higher, but nothing like last night.
Began APAP 11/28/17
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#6
(06-04-2018, 03:50 PM)Allessio77 Wrote: Yes I am still at 7-11.
According to Sleepyhead, for the last 30 days, my Average pressure was 8.88 and the 90% pressure was 10.52
The average pressure in the last week (with the EPR on @2) was a little lower, 8.52 with the 90% @ 9.92.

Do you think your suggestion would still help the aerophagia? I can always go back the EPR off and the AHI will be fine. But I want to get rid of the excessive flatulence so I can go places again (with people).

Also Rider, do you understand why this is happening?

I have coached a lot of people through settings that compromise AHI and aerophagia, and all I know is it's not a very predictable process.  I know your machine tends to over-react to OA and H events and can increase pressure very quickly on flow limitation.  Most people can control obstructive events at pressures considerably below the 95%.  OA is mostly controlled with the exhale pressure, and during the time you were at 7 to 11 with EPR 2, your EPAP pressure was 5 to 9.  So I am confident that with EPR set at 1, you can still control obstructive events with lower pressure.  Based on your recent results with EPR 2, I think a pressure range of 6 to 9 will still deliver EPAP at 5 to 8, and should reduce CA events.  Let's take a look at it after a trial run.
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#7
(06-04-2018, 04:40 PM)Sleeprider Wrote:
(06-04-2018, 03:50 PM)Allessio77 Wrote: Yes I am still at 7-11.
According to Sleepyhead, for the last 30 days, my Average pressure was 8.88 and the 90% pressure was 10.52
The average pressure in the last week (with the EPR on @2) was a little lower, 8.52 with the 90% @ 9.92.

Do you think your suggestion would still help the aerophagia? I can always go back the EPR off and the AHI will be fine. But I want to get rid of the excessive flatulence so I can go places again (with people).

Also Rider, do you understand why this is happening?

I have coached a lot of people through settings that compromise AHI and aerophagia, and all I know is it's not a very predictable process.  I know your machine tends to over-react to OA and H events and can increase pressure very quickly on flow limitation.  Most people can control obstructive events at pressures considerably below the 95%.  OA is mostly controlled with the exhale pressure, and during the time you were at 7 to 11 with EPR 2, your EPAP pressure was 5 to 9.  So I am confident that with EPR set at 1, you can still control obstructive events with lower pressure.  Based on your recent results with EPR 2, I think a pressure range of 6 to 9 will still deliver EPAP at 5 to 8, and should reduce CA events.  Let's take a look at it after a trial run.

Sounds like a plan...I think I will turn EPR to 1 tonight, and then if all goes well, drop my pressure to 6/9. Hoping it will also continue to help the excess gas!!
Began APAP 11/28/17
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#8
Coffee man asked a good question about the impact of the CA events on how you feel. A lot of people don't feel particularly bothered by them because they tend to result from over-ventilation in cases like this, so there is no hypoxia, respiratory effort or other physical stress. So if you weren't looking at all the pretty purple stripes on your results, maybe you'd still feel okay. I think its a fair comment, and sometimes we have to evaluate the quality of our therapy before looking at the numbers and graphs.
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#9
(06-04-2018, 05:48 PM)Sleeprider Wrote: Coffee man asked a good question about the impact of the CA events on how you feel.  A lot of people don't feel particularly bothered by them because they tend to result from over-ventilation in cases like this, so there is no hypoxia, respiratory effort or other physical stress.  So if you weren't looking at all the pretty purple stripes on your results, maybe you'd still feel okay.  I think its a fair comment, and sometimes we have to evaluate the quality of our therapy before looking at the numbers and graphs.

It's true, the whole SH experience can put my OCD in overdrive!  But since I have only one really bad night so far, I really don't feel much different. The AHI surprised me when I saw it....I did not expect such a radical increase. I guess I should go back to wearing my Spo2 device while this experiment is on. I stopped wearing it when my data stayed about the same for 3 months. (It wasn't particularly good then ((ODI=5.5 on ave))..but the really bad days were outliers). The doc didn't seem too concerned. The only thing I can mention is that I have some headaches today that are stronger than normal.
Began APAP 11/28/17
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#10
A trial in any change deserves more than one night to establish whether it is better, worse or neutral in effect. I don't want to jump to conclusions on the basis of one single trial that helped your aerophagia but gave you bad numbers. CA can settle down in time, and like the first time we dealt with this, it's kind of predictable that CA rises with EPR, especially as a sudden change. So EPR 1, or EPR 2, you need to be the one that decides what is most comfortable. I think you already know I don't really give much priority to the "numbers".

Do what you think is best. If this trial deserves more time on the merits of resolving aerophagia, give it a go. If you feel dazed by the increase in AHI, then move to the EPR 1 experiment. Thanks again to Coffee Man for the sensible post.
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