New Guy Now On CPAP

[Mike208]

Well, the general consensus is that I am one of those people who can not adapt to cpap. I spoke to the sleep center today and was told there would be absolutely no point in trying to push for bipap. At the pressures I need I get air in the gut. At lower pressures I can not breathe well and my AHI's go up. Their feeling is that I continue using the dental appliance and use supplemental oxygen. I will be scheduled to have an overnight test here shortly and then another a little later on.

[Sleepster]

Well, the general consensus is that I am one of those people who can not adapt to cpap. I spoke to the sleep center today and was told there would be absolutely no point in trying to push for bipap.

I totally disagree. I suggest you get a second opinion from either a different doctor, a different DME, or both.

Bi-level therapy is the gold standard for the treatment of aerophagia. It worked for me and it worked for many many others who have posted here in this forum.

[Mike208]

Well, the general consensus is that I am one of those people who can not adapt to cpap. I spoke to the sleep center today and was told there would be absolutely no point in trying to push for bipap.

I totally disagree. I suggest you get a second opinion from either a different doctor, a different DME, or both.

Bi-level therapy is the gold standard for the treatment of aerophagia. It worked for me and it worked for many many others who have posted here in this forum.

I go to see them Wednesday. I plan to speak to her on all of this because there's a lot I don't understand. Number one on the hit parade is: If bilevel is the gold standard therapy then I fail to see why won't Medicare cover it? They absolutely will not.

[Sleeprider]

Your EPR is set to 3.0 and you are still getting aerophagia problems. From the data, I see your machine is set to fixed CPAP pressure with EPR 3.0. A fixed pressure of 10.0 seems to give you therapeutically acceptable treatment, but when pressure is dropped to 7.0, your OA index is extremely high. Using EPR your pressures have been effectively 10/7.0 and 7.0/4.0. At the lower pressure you are not treated. The solution then will lie in preventing Aerophagia at a pressure that resolves CA. FWIW, I agree with the "pros" that bilevel would not likely resolve this dilemma.

There are therapeutic exercises for minimizing aerophagia, and the use of a soft cervical collar has been effective for a number of people with this problem. Body position and other factors may help to mitigate air ingestion. Sleep apnea is a serious problem and needs to remain a priority for you to resolve, however you need to find out the root cause for your air ingestion. This may be anything from a lower esophogeal sphincter problem to something called tongue thrusting which leads to improper swallowing that takes in air, rather than a smooth paristaltic swallow reflex. You need some help you're not getting, and I don't know where to send you, but you might want to start researching aerophagia and similar conditions to see what specialists you need on your side.

[Mike208]

Your EPR is set to 3.0 and you are still getting aerophagia problems. From the data, I see your machine is set to fixed CPAP pressure with EPR 3.0. A fixed pressure of 10.0 seems to give you therapeutically acceptable treatment, but when pressure is dropped to 7.0, your OA index is extremely high. Using EPR your pressures have been effectively 10/7.0 and 7.0/4.0. At the lower pressure you are not treated. The solution then will lie in preventing Aerophagia at a pressure that resolves CA. FWIW, I agree with the "pros" that bilevel would not likely resolve this dilemma.

There are therapeutic exercises for minimizing aerophagia, and the use of a soft cervical collar has been effective for a number of people with this problem. Body position and other factors may help to mitigate air ingestion. Sleep apnea is a serious problem and needs to remain a priority for you to resolve, however you need to find out the root cause for your air ingestion. This may be anything from a lower esophogeal sphincter problem to something called tongue thrusting which leads to improper swallowing that takes in air, rather than a smooth paristaltic swallow reflex. You need some help you're not getting, and I don't know where to send you, but you might want to start researching aerophagia and similar conditions to see what specialists you need on your side.

Wow, I really appreciate your reply. I agree that the apnea is a serious issue. I wish that I had the answers. I have no idea what to do. But I do know that cpap just doesn't work for me. Using the dental appliance helps but obviously not enough. Since I have a bad case of GERD I was thinking the air swallowing is somehow related but I don't know. I recall my EMT training and knowledge of the airway. I can't see how the air gets past the epiglottis. I guess I need to get in to see the Gastroenterologist on that.
I believe that I happen to be one of those people that have combined issues making treatment difficult. I have the GERD. I have very small throat and nasal passages. The shape of my palate is prime for the tongue slipping down where it shouldn't be. All these things set me up for this. The only other resort I have is surgery which we all know is not pleasant and does not offer more than a 50% chance of any success.

[Sleepster]

A fixed pressure of 10.0 seems to give you therapeutically acceptable treatment, but when pressure is dropped to 7.0, your OA index is extremely high.

Then why not put the machine in auto mode with a range of 7 to 10?

With a Respironics BiPAP you would also have the freedom of setting the pressure support to a range of 3 to 6, instead of the essentially fixed pressure support of 3 that you have now with EPR set to 3.

[Mike208]

A fixed pressure of 10.0 seems to give you therapeutically acceptable treatment, but when pressure is dropped to 7.0, your OA index is extremely high.

Then why not put the machine in auto mode with a range of 7 to 10?

With a Respironics BiPAP you would also have the freedom of setting the pressure support to a range of 3 to 6, instead of the essentially fixed pressure support of 3 that you have now with EPR set to 3.

According to the sleep center the previous trials have included that. As far as bipap it's not going to happen. I trust the people I'm working with. They've seen all of this before. If they say it will not work it's not going to work. I have seen two doctors and two other sleep specialists and they are all of the same opinion. I am told that it isn't often they run across someone like me but it does happen. For whatever reason, my anatomy or whatever, I am difficult to treat.

[Sleepster]

What I see happening is that you were unable to tolerate a fixed pressure of 7 with EPR set to 3. I agree that if you can't tolerate that, bi-level therapy would be of no use to you. The reason is because 7 minus 3 equals 4, and 4 is the lowest possible pressure for any PAP machine.

But as I recall, you said you tried that for only a couple of hours and couldn't tolerate it because you felt it wasn't delivering enough air. That is different from not being able to tolerate it because it's pumping air into your stomach. The aerophagia is a matter of anatomy, but the feeling that you're not getting enough air is not.

There are still options available to you that involve CPAP therapy, and we have discussed them here in this thread. Most of them do not involve bi-level therapy but instead involve the use of other things in conjunction with CPAP therapy. Setting the CPAP machine to auto mode, wearing the collar, sleeping with a wedge, using the dental appliance, IIRC. many of these strategies are temporary and are needed just to get you to adapt to the therapy. You don't have to do them for the rest of your life.

In my opinion you are giving up too soon, but the decision is yours to make. We are here to offer suggestions and provide support.