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Kiwii's Search for Restful Sleep
#1
Kiwii's Search for Restful Sleep
Hi. Some background and a question about aerophagia to start my thread. I'm very sleep deprived since starting xPAP last week; still coming up to speed on what needs to be done to post SleepyHead charts, but they will be following in a day or so (it has been installed and data successfully imported).

The initial Rx was for "BIPAP Auto 5-20 cm PSV 4 Resmed Air Curve" - AHI 70, ODI 63.1, lowest O2 60%; at home test due to insurance constraints; the choice of machine was mine, sleep doctor would have chosen APAP; equipment is being paid out of pocket.

Initially I was setup with a Swift FX. Now (as of yesterday) using F&P Simplus.

XPAP went okay, other than the occasional forceful blast of air from the vent, and the swallowing of large amounts of air (judging by the volume that was exiting my body from the other end throughout the night).

The mask unexpectedly turned out to be a poor choice for me, possibly due to reconstructive surgery and rhinoplasty that was done as a teen (movement to the tip of my nose, caused by the hose, made something inside of my nose painful - and translated pressure upwards, against the sensitive area where some bone was removed). Not happy that it took so long to get an exchange made, and the new Simplus was the wrong size, but my husband picked up a new one during lunch so tonight ought to be great! (wish me luck)

Things I am wondering about:

1. I thought a bi-level is supposed to reduce aerophagia.

2. Sleep doctor's solution to aerophagia was to have me sleep on my back. I prefer to sleep halfway between stomach and side (obliquely). Snoring has historically been worse on my back (and, sure enough, AHI has gone up since following his advice, although admittedly the aerophagia is better). I saw comments in the aerophagia thread against back sleeping, but did not see mention of the rationale behind that advice. So what is the rationale? Any ideas on why my doctor would recommend something that would increase AHI? (maybe read #3 before answering)

3. Sleep doctor at first refused to alter settings, insisting that I must first have an in-house bipap titration study before any adjustments could be made. I questioned the need for that, considering the machine that I have. Once I assured him that I could also provide him with oximeter data, and asked if he couldn't in the interim do something to 'take the edge off', he agreed to change the settings. Looking at my machine, the settings as of 9/11 are:

Mode: VAuto
Max IPAP: 10.0
Min EPAP: 4.0
PS: 4.0
Ti Max: 2.0s
Ti Min: 0.3s
Trigger: Med
Cycle: Med

SleepyHead data will be coming once I can understand what I need to include and how to post it, etc. I'm sorry to be so slow in figuring it all out. The learning curve (and search/research for a workable mask) is starting to ease some, so hopefully progress on this will speed up. Thank you for your patience.

I'll be sleeping obliquely on my side for the next few nights. I'm curious to see if the aerophagia occurs again and how the data will compare.

Thank you. I'm looking forward to your comments/observations.

eta: btw, I am scheduled to see a new sleep doctor next month, referred by my neurologist. I'm feel uneasy at this sleep office.
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#2
RE: Kiwii's Search for Restful Sleep
Hi Kiwii, great first post to introduce us to the issues. Welcome to the forum. I'll look forward to seeing the charts from your current settings, as we don't know what your AHI or pressure results are. Your pressure support could be reduced if your issues are not hypopnea or flow limitations, and that might help with some of the air ingestion. Sleeping on your side, especially left, should not be a problem and most people with this issue find elevation of the shoulders and head using a wedge or bed that can elevate the upper body is more effective than sleep position. Your starting pressures are low at 8/4 with maximum 10/4, but what we do with that really depends on the data.

Good luck with your therapy, and hopefully we can help you get as comfortable as possible. There are many members here that share your issues with aerophagia.
Sleeprider
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#3
RE: Kiwii's Search for Restful Sleep
Thank you Sleeprider!

Could you tell me please, are these the correct graphs for a screenshot of the Daily View?

Event Flags
Flow Rate
Pressure
Leak Rate
Snore

Any others? I've disabled the Calendar and Right Sidebar.
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#4
RE: Kiwii's Search for Restful Sleep
Sounds perfect. If you show flow limitations, even better.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Kiwii's Search for Restful Sleep
Gotcha! Thanks! So glad you have a link to instructions for imgur. With any luck, I'll have something up tonight (or in the morning).

I had to laugh though when I saw the Flow Rate for my first night sleeping on my back. Looked like a forest of blue pins. Smile
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#6
RE: Kiwii's Search for Restful Sleep
Okay. I think I've got this... it is organized so that you can view whatever you think is pertinent.

Home Test Results

First few days: lying on left side, using Swift FX
Day 1, 9/6
Day 2, 9/7
Day 3, 9/8

At this point, I was in a lot of pain from the mask (also experienced strong blasts of air from vent & lots of air swallowing/gas passing) and figured sleep was more important than using the machine. The doctor was out of the office on 9/8 and was due to return on 9/11.

9/9 - did not use at all
9/10

New pressure settings: lying on back, still using Swift FX (but not so painful in this position); recording oximeter strapped to left wrist
9/11
9/12
9/13

Still on back, changed to Simplus (clinician incorrectly 'sized' me as small; should have been medium). Leaks at corner of mouth as my jaw relaxed in sleep. Jaw did not 'drop open', but rather relaxed backward into an undershot jaw position.
9/14

Tonight I will be using size Medium Simplus... and will be sleeping on my left side.
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#7
RE: Kiwii's Search for Restful Sleep
Wow! That Simplus is soooo nice! I was completely comfortable the entire night. Slept obliquely on my left side. Woke up feeling refreshed - not sure what time - but just relaxed and reveled in the feeling of having gotten sleep until the alarm went off at 5am. Fisher & Paykel, you've got yourself a fangirl.

The RemZzz's mask liner added to the comfort. Very soft against my skin. Loved it! My report says there were air leakages, but I was not aware of any and slept like a baby (as far as I know).


Day 1 of Simplus, size Medium, lying on left side - no aerophagia
Last night
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#8
RE: Kiwii's Search for Restful Sleep
Kiwii, you are using PS 4 over 10/4 and you're getting a large number of centrals in some cases and clusters of OA. In order to resolve the OA, we really need higher EPAP pressure. Reducing CA may respond to lower pressure support. Based on what I'm seeing here, I recommend you move EPAP min to 6.0, IPAP max to 12 and PS to 3.0. So PS 3.0 over 12/6. I really think you will see difference.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Kiwii's Search for Restful Sleep
Looking at your chart, I'd suggest raising the min to 5 (could be more later) to try and cut down on your OA events, and keep an eye on your CA events for now. Maybe reduce your PS in the future.

edit: I was taking a more conservative approach and was looking a ending up about where SR suggested>
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#10
RE: Kiwii's Search for Restful Sleep
Thank you both!

bonjour: When I looked at my charts, it seemed that the minimum was originally set to 5. Two days later, if I remember right, it shows 4. Am I correct in thinking that someone must have reduced the setting remotely? (or am I misinterpreting the data, and perhaps I'm seeing something that the machine is doing on its own?) Ramp had been fine, initially, but I've since turned it off because it is too low.

Sleeprider: Thank you so much, I am looking forward to making those changes - and to know what an appropriate setting for me actually is. I am going to hold off until Monday though. I will be sending the data from this weekend to my doctor as a direct comparison to the back sleeping data, and I want to see what he has to say - an opportunity to test his trustworthiness. Hopefully he will respond with something that makes sense to me, because right now I am feeling wary and that tendency to be on high-alert for danger is something I'm trying to overcome (wariness taken too far is not healthy).

I am so happy, looking forward to Monday to change the settings. It felt so good to get some sleep last night; I can only imagine how wonderful it will be once I'm on the right settings. I cannot thank you enough. Seriously. I'm overwhelmed with gratitude. Thank you.
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