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Need help with Aerophagia
#31
RE: Need help with Aerophagia
Kind of thought that might be the reason. I’m not sure how it effects other aspects of your treatment with regard to centrals (it would be interesting to hear from some other more experienced members) but I found a huge improvement with my Aerophagia by switching to a nasal pillow. I’m now using a Resmed P30I with the cushion. I’ve also found that a form of GERD called LPR or silent GERD was a contributing factor. Dietary changes, not eating or drinking 4 hours prior to bed and the old sleeping on my left side worked great.

GuppyDRV
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#32
RE: Need help with Aerophagia
(05-22-2019, 10:50 PM)KallyA Wrote: 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.example of end stage pallitiative

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.

I wouldn't try to explain loop gain, I still don't understand what it means. It's to do with your chemoreceptors being very sensitive and high arousal to co2 change, that worsen CA, slide 21. Someone would have written an entire book and did his thesis on it. It was just in a powerpoint doc. I reread and posted a few days ago. To a new ASV user who wanted more info on them and how they worked. It was a term that stuck in my mind, because radio has similar terms of high gain and loop antenna .
http://www.masm.wildapricot.org/resource...Morgan.pdf

I forgot you were on o2, I went back and saw what I said from resmed. That the autoASV will handle 4lt and the fixed ASV will handle more, 15lt. The main takeaway from the thread, was how there was a big change in your AHI and the charts didn't look as cluttered. They seem like the good old days now Smile 

Hope you have a better night tonight.
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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#33
RE: Need help with Aerophagia
Much better night last night ...
   
Note the beginning of the night with large leaks I was using nose plugs and sealing the mask to my face in the normal fashion.
The rest of the night was laying the cotton pad over the nose hole of the Amara mask between my nose and the mask. This allowed for some leakage, but the leakage was mostly below the upper limit of 24lpm.
no cervical collar as Dr said don't worry about the leaks.
Still miserable with the aerophagia. Hoping for better over the next few nights.
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#34
RE: Need help with Aerophagia
Update ... 5-23-19 data --Lower AHI, duration and number of apneas so much better than the two nights from hell!
No periodic breathing on 4LPM oxygen. Aerophagia is somewhat improved.
   

I am attaching another showing my notes for the night --looser straps causing all the leakage
And the graphs are close up to show how well the AirCurve 10 ASV does even with large leaks
Notice how close the pressure follows the flow pattern breath by breath in spite of the extremely large leak and how it continues to respond appropriately even during the transition to low leak. It is able to sense when minute volume drops below target in spite of large leak. It is able to separate what is leak from what is your breathing even during large leak to do all this. Truly amazing machine. Hope this provides some reassurance to those struggling to stop mask leakage who are using an ASV.
   
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#35
RE: Need help with Aerophagia
They do recommend low leak on ASV, for feed back for the algorithm. At the end of the day, we do the best we can. I'm glad you had a better night.

My dad has CSR with CHF, he is able to maintain his o2 level above 90. So we let it go. He also has COPD. He's treatment resistant and won't wear the mask. Unless he is really sick with fluid or too high a resp rate, into the resp failure numbers and he's getting exhausted. He normally sits in the high 20's
He had some fluid and crackles and laboured breathing. So he was Ok for the ST for a few hours. Even a few hours helps with fluid. Pulmonary oedema. So I thought I would show you his chart on 10, ps 8, min Ti 0.7, backup of 6 and out of the way. Some pretty impressive PB

[Image: s3bo78W.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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#36
RE: Need help with Aerophagia
thanks for your reply Ajack and for sharing the chart. It reminds me things can always be worse and that they can still be brought under control. I am sad for your father and happy too. For sure, we just do the best we can.

No chart for me for last night...I forgot to put the chip back in my machine!
But it is showing an AHI of 4.8 and I woke up feeling a lot better, so I am a happy camper.

Many thanks for your support
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#37
RE: Need help with Aerophagia
Good night last night. I'm giving credit to the 4 L/min oxygen and higher pressures.
Hugh leaks, but Dr. said let it leak. Still up during the night with aerophagia.
Seeing Dr again on Wed. I'm really curious why stopping leakage brings on more events and allowing leakage reduces events...or whether that is just coincidence???

   
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#38
RE: Need help with Aerophagia
the machine can't function properly with leaks over the 24 L/m threshold so it misses events that it recognizes when leaks are under the red line.
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#39
RE: Need help with Aerophagia
From 0030 on I'll agree with your doctor, barely over the limit.  2200 to 2315 IMHO Leak IS too high.  2315 to 0030, I'm not at all comfortable with the leak rate as it approaches nearly double the normally accepted standard of 24 l/m.

Higher leak rates interfere with the machines ability to determine what is happening, resulting in both incorrect data and incorrect therapy compared to therapy with no excessive leaks.  At higher pressures expected leak rates climb.  This means unexpected leak rates also climb.  Here is a chart for PR masks illustrating this,

PR Leak_Rate_Graph

ResMed only reports Excess Leaks. Total Leak = Excess Leak + Intentional Leak.  Based on the PR data Ill assign an intentional leak of 40 l/m to the mask 

Total Leak = Excess Leak       + Intentional Leak
 112 l/m    = 72 (95% value)  + 40 (high mask leak at 20 cmw)

IMHO 112 l/m leak is definitely excessive
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#40
RE: Need help with Aerophagia
Having the machine auto-adjust the pressure is what finally reduced my aerophagia. It enables me to spend more time at lower pressures.

I urge you to take the advice given to you by Sleeprider. He knows what he's talking about.
Sleepster

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