(05-13-2016, 02:59 PM)filo4u Wrote: I have been on the CPAP for almost 2 years now and initially I owned the ResMed Autoset S9. I had issues having a ton of gas in the mornings and so about a year ago my doctor switched me to a VPAP ResMed AirCurve 10,
The gas problem is called aerophagia
When I was first diagnosed back in 2010, I had a Resmed S9 AutoSet and within 2 weeks I was experiencing severe aerophagia, which in turn led to severe insomnia problems and a precipitous decrease in my daytime functioning. I was switched to bilevel after 3 months of misery. But I also wound up with a PR System One BiPAP rather than the S9 VPAP Auto. The switch to BiPAP took the edge off the aerophagia right away, but it took another couple of months of using the BiPAP along with a couple of changes in pressure settings before I could really say that the aerophagia was completely under control. I still have some problems with aerophagia now and then even after 5 years of using the BiPAP: But it's not chronic any more and most of the time I can go a week or two (or more) between times when I wake up with serious pain.
I tell you this bit of background so that you know you're not the only one who has been in this position. And to let you know that bilevel can help with the gas problem.
Quote:I'm not sure if this is just because my body wasn't use to the machine yet. I have been messing around with the settings to find out the best setting for me and even tried a couple CPAP only settings and was surprised that the best record was from a set CPAP setting. I wish I could link my statistics but since I am new I can't.
Here's the thing about aerophagia: The AHI stats in particular are useless for figuring out how to handle the aerophagia. In other words, a near perfect AHI (such as your data shows) that is accompanied by severe aerophagia usually means that the aerophagia is keeping you from getting really good, solid sleep. And, of course, there's the misery of the aerophagia itself to deal with. In my case the aerophagia would last most of the day and it wasn't just an issue of "fart/burp it out" for an hour or so after waking up.
I learned that in my case, I have to tolerate a slightly higher treated AHI (mine is usually in the 1.5-3.0 range) and more flow limitations and a bit more snoring in exchange for significantly less air in the stomach. And less air in the stomach usually means better overall sleep for me.
As a result of this, I've learned that I have to keep my max IPAP setting at the highest level my stomach
can handle. I've experimented with increasing the max IPAP by 1-2cm for a week or two at a time. That usually reduces the AHI to the 0.5-1.5 range, but it also increases the aerophagia and decreases the overall quality of my sleep.
Quote:I was wondering if someone could tell me what I should be looking for in finding out if VPAP or CPAP is best for me. Thanks in advance!
Here's my advice on what you need to do at this point:
1) Track how bad is the aerophagia?
and how do you feel?
rather than worrying about the AHI stats. Focus on whether a give set of test settings makes the aerophagia more bearable and whether less aerophagia leads to you feeling better overall. If you can find settings that reduce the aerophagia down to what you can easily
tolerate, but the AHI goes from the 0.5-1.5 range up to the 2.5-3.5 range, you're better off with the higher AHI and better sleep due to less aerophagia.
2) Do check up on your leak rate: If you are doing a lot of things in an effort to prevent mouth leaks, that may be leading to your swallowing a lot of air. You may be better off either switching to a full face mask OR tolerating a slightly higher than desired leak rate while using a nasal mask or a nasal pillows mask. It's important to remember that if your largest leaks are only in the 10-15 L/min range with the Resmed AirCurve, that's fine. It's also important to remember that if you only have one 15 minute long official large leak that you sleep through, that's also something that you can tolerate in terms of your therapy----provided of course you sleep through the leaks and wake up feeling decent in the morning.
3) Based on the one night's data that you posted, it's not clear why the AirCurve is increasing the pressure so high at times. My guess is that the AirCurve is responding to activity in the Flow Limitation graph or the Snore graph. In either case, it's worth seeing if reducing the Max IPAP from 19cm to (say) 17cm might reduce the aerophagia without increasing the AHI too much. (That would reduce your max EPAP to 13cm)
4) Finally I'll throw this idea out, even though it is most likely not practical. You might want to see if you can switch from a Resmed AirCurve 10 VPAP Auto to a PR DreamStation BiPAP Auto. Yes, it's an expensive gamble. But the reason I suggest this is because the PR BiPAP Auto algorithm does NOT increase the EPAP everytime it increases the IPAP. And keeping the EPAP as low as possible can also help with aerophagia problems. If the AirCurve is increasing both the IPAP and EPAP in response to a lot of activity in the Flow Limitation graph, the PR DreamStation would only increase the IPAP in response to that same activity. It could also be the case that the very rapid and aggressive pressure increases made by the Auto algorithms used by the AirCurve and the S9 AutoSet are aggravating your aerophagia. And if that's a factor, the more gentle and slower pressure increases by the PR DreamStation BiPAP's Auto algorithm may also trigger less aerophagia.
Good luck in figuring out a workable solution.