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Need help with Aerophagia
#11
RE: Need help with Aerophagia
An update ... next night same setup except without the pillow ...
   

Great reduction in events, eh?!!  Positional obstructive.

Unfortunately I was up still had to get up for awhile due to the aerophagia. Aaaargh!

Thanks for feedback everyone.
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#12
RE: Need help with Aerophagia
what an improvement. whatever you're doing is working great! wait for the more-experienced members but here's what I think.

I don't know how you arrived at fixed epap 11 but that's bordering on high imo. if you can get away with lower it will help reduce aerophagia. have you tried asvauto mode, say epap min 8 or 9, max 12? your last few hypopnea are still largely clustered so more of what resulted in this latest chart is in order. if it were me, I'd try the auto range epap and also nudge min pressure support up 0.2 every other night to see if the remaining H can be clipped. idk but it might also increase your tidal volume.

edit after seeing your flow limitation thread: nudging up ps should also help the FLs, which do seem to be fairly significant in the chart in that other thread.

also, fyi, they tell us it's best to keep our inquiries to one thread so history is easily found, at least for those questions related to optimizing one's own therapy.
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#13
RE: Need help with Aerophagia
Kally, have you ever tried ASVauto mode with a lower minimum of EPAP pressure? With variable EPAP pressure, you might be able to relieve aerophagia, and the machine would increase EPAP as needed for obstruction. Perhaps ASV auto with EPAP min 8.0 EPAP max 11.0 and your PS 3-14.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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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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#14
RE: Need help with Aerophagia
Thank you for your responses. I'm on hold for any changes until I see the Dr. on Monday.
As for sticking to one thread, if I change subject it seems like its useful to start a new thread. yes, no?
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#15
RE: Need help with Aerophagia
If it has to do with your therapy keep it to one thread.
I have given advice that wasnt the best for the user because I didn't think to check for a second thread.
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#16
RE: Need help with Aerophagia
OK. My bad Bonjour. Your comment confirms how caring you are and eager to be of real help. Thank you for that. I will get a more detailed profile up when I can.  At this point I have to rely on Dr. to change settings. He is adamant I not "mess with his therapy." He doesn't explain things though and I really want to learn, so I will keep reading the posts and asking questions. So glad you are here!
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#17
RE: Need help with Aerophagia
I saw my doctor yesterday and thought I would share what he told me and what he did about all this in case it is of use to anyone else.
Dr noted that I had good luck with the cervical collar in stopping the large leaks over the past couple of weeks.
He also noted that stopping the leakage meant the air that previously was escaping during leakage, now has nowhere to go except into me, which causes more aerophagia. He said that reducing the EPAP (from 11 to 10) was not a good idea as my apneas and hypopneas were not controlled during the sleep study at that level and in fact they were best controlled at 12. I told him I thought the excessive pressure was from the PS setting (3-14) as it was topping out at 25 (EPAP 11 + PS 14 = 25), which seemed to be too much for my poor LES (yes, I have severe GERD). He said he couldn't touch the PS as the ASV would only go as high as was needed and if it went that high it was because I needed that much pressure to control the A/Hs. After having told me all that, he agreed to change the settings anyway, just a little. As it turned out, he changed the EPAP to 10, as he indicated AND the PS to 3-10. So now it is topping out at 20 instead of 25. I have only had one night at this level. Here are the charts--full night, first part, last part. These are divided according to the sessions in the software. I was up for 45 min in between them, dealing with the aerophagia.
   
   
   
This is one of the worst nights I have had. Apneas skyrocketed (50) and hypopneas were also quite high (46) during the first part of the night. For the second part of the night, I made a change which I was hoping might reduce the aerophagia (returning to my old setup of having a cotton pad across the Amara mask nose hole) that caused some leakage (mostly under 24lpm). This resulted in NO apneas and only 16 hypopneas for the rest of the night. It looks to me like I'm better off with a few leaks. When I called the sleep center to report the results of all this, I was told to leave the settings as they are for a week and doctor would review them then... that one night's data was not enough to know if the settings should be changed. I asked what was the "danger zone" in terms of apneas, if they went up some more at what level did they want me to call them? I got no answer on that, but I was told to ditch the cotton pad to reduce all leakage as much as possible.

So it appears the doctor was right about the settings--maxing the EPAP/PS at 25 was reducing apneas. It appears they don't care if I have to live with increased AHI for a week and that I will still be suffering with the aerophagia. So I have gone to a lot of trouble to take some personal responsibility to stop the large leaks only to increase my own suffering with aerophagia, and having taken the trouble to see the doctor about it, the consequence is inadequate therapy as well. Aaaargh!
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#18
RE: Need help with Aerophagia
I know this must be getting frustrating for you. The better the treatment works, the worse your Aerophagia is. I still think it's positional and mask leak. You may need to get your head back more, to open your throat. you need a mask that will seal. When you have max 20 and you are still obstructing. Probably micro-arousing from sleep to breathe again. It really isn't working.
The only thing I can think of is to use a pool noodle under your neck to keep the head back. I Just tried it and it does work, not that comfortable, but the body will get use to anything over time.

The heat and bite mouthpiece is still an option and may in fact be one thing, that is easy to add. It may be enough to stop the jaw dropping back and keep the tongue forward, if that works you can get a MAD. If it turns out this is an issue.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#19
RE: Need help with Aerophagia
Kally you need to access the setings and try PS 3-14. Doing so will allow you to determine whether the worse results are related to EPAP or PS. This distinction cannot be made when more than one change has been made at once. We cannot tell if the UA and H events are obstructive or central using the machine data (Oscar). If those events are central and pressure support is insufficient to trigger a breath then pressure support needs to be higher, and it's possible you can tolerate lower EPAP. Similarly, if pressure support does not improve the result, then perhaps you need the EPAP to be restored to 11.0 and the PS can remain low.

You cannot obtain optimized therapy without making some on-the-fly experiments to determine cause and effect. While we rely on our doctors for their input and expertise, many of us have to work within a narrow range of parameters to better define what is going on and to provide insights for proper optimization. It is clearly your choice whether you do this, or fully rely on the doctor and supplier to make adjustments, however it is going to take considerably longer to arrive at a solution. Without knowing whether we should focus on EPAP or PS, it is a random approach, rather than a disciplined optimization of titration.
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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#20
RE: Need help with Aerophagia
Thanks, Ajack. I agree it's not working. I have the leakage pretty well stopped with the cervical collar. Not enough pressure support at this time to control the apneas. I am debating whether to rattle some more cages at the sleep clinic today or try to get through another week like this. An hour in apneas seems completely unacceptable. Here is my chart from last night and a close up, and one that shows changes in the flow pattern. I was told five years ago that I had Cheyne-stokes breathing (periodic breathing) and high loop gain, which is when they added the oxygen. I have not seen much of it until the last two nights since Dr reduced the pressures. I'm kinda bummed, but trying to get a better attitude. On a high note, the aerophagia seems somewhat improved! Thanks you for your support. Nice to feel someone understands!

   
   
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