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Need help with Aerophagia
#21
RE: Need help with Aerophagia
I'd rattle cages at the doctors and get a titration at a specialist lab with a very experienced tech. You shouldn't have been sent home like that in the first place and should have been booked for another night. It just depends on copays and such. They can put a scope down your throat while asleep and see exactly what is happening.

I also agree that auto with as low as possible epap without oa and min PS would be worth doing. Repeating what is happening is going nowhere.
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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#22
RE: Need help with Aerophagia
Your event closeups look central. This means the problem is not EPAP but PS to resolve the lack of breathing effort. I am convinced my original suggestion to try ASVauto mode with EPAP 8.0, PS 2.0 to 14.0 is the ticket, however, my last suggestion to return PS to 3-14, and keep EPAP at 10 is a very conservative recommendation that will start to tell us whether the problem is EPAP or PS.

I really hope your doctor's last changes were not to "teach you a lesson" in questioning his settings, but it sure looks like it.  This is untreated central, and needs higher PS. EPAP can go lower:

[Image: attachment.php?aid=12118]
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#23
RE: Need help with Aerophagia
Ha! We were both writing posts at the same time, Ajack! I didn't see your last post as I was writing.
I am so very much in agreement with you about making two changes at once. Why would Dr do that?!! Especially after he said he shouldn't?
As for changing settings myself, I have been told by my doctor not to do that and I want very much to have a good working relationship with him. He does have knowledge about sleep apnea that I don't have and he has access to all my data. My main problem is just getting his time and getting the reassurance that he actually is making good choices for me. If changes need to be made, I would rather he correct the issues, if possible, to restore my faith in him. My onlly question right now is whether it's safe enough to continue with the charts the way they are the last two nights or whether to camp out in his office hoping to get some attention today.
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#24
RE: Need help with Aerophagia
I'm not disagreeing to be disagreeable. And more thinking out loud. It would be good to have the mask pressure to show the pulses, instead of the pressure chart.

The PS is going up to the max 10, but there isn't any flow rate. As you would expect if they were CA being treated with ASV. PS10 on a normal unobstructed lung should inflate it or at least see a reduced flow rate and see the breaths. This one just isn't there and a flat line.

The respiration rate also drop to nothing. while this is happening. The breaths when taken, are running at minute vent near 20l/min. It just looks a shocker.

If it's not some sort of obstructive thing from whatever cause, then I'm at a loss. I'd be jumping up and down at the doctors saying you want the reason found and not get fobbed off. They can even put a scope down the throat to see what is happening when asleep.

@KallyA, it's probably not rock up to ER bad. But it does need sorting. If you are unable to change pressure, it's back to the doctor to show him it isn't working. It's something that he can't ignore or pacify you about.
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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#25
RE: Need help with Aerophagia
Hi Ajack, I wrote back this morning but my internet went down, so I just copied it to send later (now). Again be aware this is addressing the post before your last one. 

ha ha. crossed you again. Can't keep up!
Yes, at this point the PS definitely needs to go up. And I was actually wondering that myself .. whether Dr was "teaching me a lesson" ..to trust him and not meddle with his therapy. He is always pressed for time and does not see it as his job to educate me about sleep apnea. I feel lucky to get a straight answer out of him when I ask a direct question. But in fairness to him, until I know what he knows, my questions will always be a little ignorant and the answers will always be too long for the amount of time we have together.
 
I hate that I am suffering from having asked for more help from Dr. I always feel best when I can trust my own judgement and make my own choices in life. I feel worst when my hands are tied by ignorance. Until I know what Dr knows, I have to trust his judgement and hope he is not making bad choices for me. I certainly have learned through 11 operations over my lifetime that doctors are not gods and they can be petty and just as human as we "uneducated folk." Beyond all this, my doctor is Indian (from India) and I suspect there might be cultural differences in how Indian men treat women.
 
Again, many thanks Ajack. I know you get me and I appreciate it.

------so picking up from there. . .
Hubby and I decided to go to the doctor's office and camp out all day if need be to get the problem addressed. I actually felt too sick to eat this morning and my resting pulse was mostly over 100. The visit went fairly well and hubby didn't have to give any ultimatums. I brought the all night chart and the one showing the Cheyne-stokes breathing.. Dr listened to my heart and told me he was pushing all the settings on my ASV back up (EPAP 11, PS 3-14). He said these were centrals and he wants me to push my oxygen up from three to four liters until I see him again on Wednesday. He said to forget wearing the cervical collar and not even try to stop the leaks, big or little. Not sure about his reasoning on this, but it should help the aerophagia. I am impressed with how the machine responds even during large leaks, so I expect good results.

It is shocking just how fast things can go bad with sleep apnea. I wish the clinic would have given me better guidelines about what constitutes an emergency, but I know having Addison's disease (adrenal dysfunction) may have made things more critical for me ... I doubt that my sleep doctor could forsee that not addressing it now could have led to an adrenal crisis and a frantic trip to the emergency room tonight or the next.

Thanks again for your support Ajack. I have taken to heart many of the ideas you have presented and your comments helped me to decide to get myself to the doctor's office uninvited today. Much appreciated.

I hope posting this helps someone else in the future not to hesitate if they know in their heart that they need more help immediately. It's  hard to be assertive when you're worn out. An advocate helps.
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#26
RE: Need help with Aerophagia
We have all seen the response charts of what is supposed to happen. Possibly why the machine isn't responding as much, is because it can't because of obstruction and the machine can't put out enough PS to overcome it. Or that there is enough minute vent with the PB, between the CA, to give adequate minute vent ventilation overall and reach target. It may just be going to be a feature of your treatment.

https://www.resmed.com/us/dam/documents/...er_eng.pdf
[Image: 09ygsjy.png]
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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#27
RE: Need help with Aerophagia
In your notes you have listed a “spray tan nose plug” what is this being used for?


GuppyDRV
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#28
RE: Need help with Aerophagia
I guess there are exceptions to every rule but I've been reading for several years that asv resolves pb/csr and ca automatically and ua is obstructive. it's a major shift to think otherwise. I can see signs of pb in the beginning minute or two of my session flows but it evens out very quickly. afaik, I don't get any ca anymore with asv. the only way KallyA's machine is not auto is epap so maybe that's the difference; I sure don't know. but I'm inclined to think ajack is right that there's something else going on here. I also think that while KallyA needs to work things out with the doc for now, eventually she should try the autoasv with lower min epap as sleeprider suggested in post #13 and I mentioned in the post #12. and incrementally nudge up ps. it'll be interesting to see how this all works out.
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#29
RE: Need help with Aerophagia
Thank you to all for your support and comments. I have seen the chart that Ajack put up. It is quite helpful in understanding how the AirCurve 10 ASV works. Not all my events are central, but the sample I put up was definitely central---of the form Cheyne-Stokes, also called periodic breathing. I think the caveat about this machine working for centrals is that the settings have to be appropriate for the patient. The lowered EPAP and PS were obviously not appropriate in this case. There may be more adjustments necessary from here on. I will post again for interested readers.

I was first put on ASV 5-6 years ago, a ResMed S9 Adapt. There was no resolution of the centrals even on the ASV until they added the oxygen. It had something to do with high loop gain. I don't really know what that is, but maybe that will add clarification for those who do know. If you can explain it to me in simple terms, I'd appreciate it.

I don't know anyone personally who has succeeded in sticking with their treatment for sleep apnea. My hubby and I have three friends who threw away their masks and gave up, and another who died because hospital personnel did not hook her back up to her CPAP after surgery. Her death motivated me a great deal. I have not missed a night of treatment since I began over a decade ago. It has been a long, hard journey at times. I think the suggestions and encouragement you all provide here makes a significant difference for those determined to make it work.

We will see what the night brings. 
Again, many thanks.
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#30
RE: Need help with Aerophagia
spray tan nose plug (kind that fits in the nostrils to keep you from inhaling spray tan chemicals)

It stops the full blast of air from going up my nose. I breathe through my mouth.

I was on a hybrid mask for while. I just plugged the nose holes with silicone putty.

I was also on an Oracle (oral) mask for awhile. Oddly I never had to block my nose then as no air escaped that way.

However, I did have air moving out my tear ducts and across my (closed) eyes. Eye doc caught that one. It was with a FF mask.

Ahh, the fun of finding the perfect mask.
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