(09-30-2014 10:33 AM)PhyllisBalboa Wrote:
(09-30-2014 08:16 AM)Buckeyedog Wrote: So you guys have one set EPAP plus PS and I have an EPAP huge range of 4-15. Wonder why?? Interesting.
I think it's that we have the same machine, but you have yours set to asv auto mode (which allows a range of EPAP), while I have mine set to asv mode (which allows only one EPAP setting).
So I'm wondering why our doctors set us on different modes. Maybe there's an advantage to one way or the other? Maybe I'd like a range of EPAP. Is that the only difference between the 2 modes?
I don't know how it would feel if my EPAP varied all the time. But then the IPAP does, so maybe that would be fine. And the fact that I have trouble breathing out against pressure might make that range more comfortable for me.
I was waiting and hoping for you to have no more air swallowing problems, so I could encourage you to start working your Max PS higher. But it looks like it would still be premature for you to start working your Max PS higher, since you are occasionally still having the problem of excessive air swallowing.
I think swallowing a little air does not hurt us at all, but swallowing so much air that it bothers us is swallowing too much.
Yes, the only difference between ASV mode and AutoASV mode is that EPAP would automatically adjust within a range. Instead of only Pressure Support (PS) varying automatically, EPAP and PS would (separately) vary automatically.
But I suggest staying in ASV mode at least until you have learned how to avoid excessive air swallowing, in case AutoASV mode may worsen the problem of air swallowing.
Just like in ASV mode, in AutoASV mode PS is the difference between EPAP and IPAP.
In AutoASV mode, changing PS does not change EPAP. Every time PS is automatically increased or decreased, EPAP is not changed, so changing PS only causes IPAP to change.
In AutoASV mode, changing EPAP does not change PS. So when EPAP is automatically increased or decreased, PS is not changed. When EPAP is changed, both EPAP and IPAP change together, each up or down the same amount, so that PS, the difference between EPAP and IPAP, remains unchanged.
When the difference between EPAP and IPAP changes, that means the PS has changed. If it looks like the machine has changed IPAP without changing EPAP this means that, actually, only the PS was changed.
Buckeyedog's doctor simply left the range for EPAP at the default settings, wide open, 4 (which is the machine's lowest possible setting for Min EPAP) to 15 (which is the machine's highest possible setting for Max EPAP). This causes Buckeyedog's EPAP to start extremely low (which might be okay if Buckeyedog seldom needs higher EPAP pressures to avoid obstructive events), and the machine can raise EPAP higher if needed.
PhyllisBalboa, in your case, since you are still having problems sometimes swallowing too much air, if you give EPAP a range, I would suggest a range that does not go higher than 8. For example, you might try a range such as Min EPAP=4, Max EPAP=6 or 7 or 8. But if you set EPAP or Min EPAP as low as 4 or 5, I would expect your previous feelings would continue, that you're not getting enough air when the pressure is so low.
This is a common experience after a few weeks or months of regular CPAP therapy, that we have become accustomed to the pressure making inhalation easier, and when the pressure is lowered too much it feels like it requires more work to breathe in through the mask, so it feels slightly hard to breathe in, which is bothersome. To help overcome this, you would perhaps need to increase Min PS from 1 to 2 or 3, meaning Max PS may need to be 7 or 8, because Max PS must be at least 5 higher than Min PS.
So you might end up lowering your EPAP but may find that, to be more comfortable, you may need to increase the PS.
One potential problem may be that lowering EPAP would tend to increase the frequency and severity of obstructive events. But, because you stay off your back, perhaps you won't have much of a problem from obstructive events.
(09-30-2014 08:37 PM)PhyllisBalboa Wrote:
(09-30-2014 06:32 PM)Whitewabit Wrote: It still seems hard for me to exhale against an EPAP of 5 and wonder if it I need it that high since 27 out of 29 events in my sleep study were centrals.
That's my same question. If we have centrals, why do we need extra pressure on the EPAP? Our airways are not closing up (OA's) and we're swallowing all that extra air or over inflating our lungs. Or maybe we can't empty our lungs enough with all that pressure during the exhale.
I wonder if doctors are too ingrained with the CPAP mode, and are not looking at the whole picture when it comes to centrals. It seems to me that we need enough pressure on IPAP to handle any OA's and enough ventilation to handle the centrals.
Usually it is EPAP which is raised to handle the OA's. (In AutoASV mode, when EPAP is raised both EPAP and IPAP are raised together, so that PS is not changed.)
When you say we need enough ventilation to handle the centrals, the way to think of this is we need higher PS to handle the centrals.
It is higher PS which which does for us some or all of the work of breathing, making it easier to breathe in and breathe out.
But higher PS also means higher IPAP which may cause more air swallowing.
(10-01-2014 01:16 PM)PhyllisBalboa Wrote: So for me, having the terrible air problem, I felt that air trapped throughout my abdomen and lasting for days was too dangerous to pussyfoot around about. And I was afraid of collapsing my lung. That's painful to have and to fix. My stomach was hard as a rock, so what was that doing to all my internal works? Forced air is not a natural occurrence for the body to deal with.
Since, like you, I couldn't use the machine, I lowered the pressures drastically within a month, making small changes every 3 days. Now I realize I could have made bigger changes and would have been fine. I'm still lowering. Why the doctors start out so high, I'll never know, especially with centrals. I think it's better to start low and work up as needed, than to start high and make us constantly call our doctors for permission to nudge it down.
In your case, you had already had a CPAP titration which showed you needed an EPAP of 8 to treat the obstructive events (but perhaps you were asked and required to sleep on your back during the CPAP titration, which would have increased the likelihood of having OA's, causing an EPAP of 8 to be needed to prevent the OA's?), and the doc was allowing the machine to automatically increase the PS as much as it needed to, to keep you ventilated when your breathing becomes irregular or stops.
The doc's approach makes sense; it is just that (1) it is causing too much air swallowing, and (2) apparently the algorithm for increasing PS may be more aggressive than needed, in your case, at least while you are still falling asleep.
I may be wrong, of course, but it sounds to me like your main problem is swallowing too much air, not collapsed lung, and the soreness in your chest may be just that your muscles are being stretched and exercised more than earlier, so you may just need more time to build strength. And of course you need to find some way to reduce air swallowing.
(10-02-2014 03:08 PM)PhyllisBalboa Wrote: Night before last I started gulping air blasts again before even falling asleep. I had to get up and pace a few times to move the air out, and was still full of air all during the next day. So before bed last time I lowered EPAP from 7.2 to 6.4, figuring I needed a bigger drop to take care of it. So my EPAP on my VPAP (kind of catchy) was 6.4, with PS at 1 to 6, max IPAP then should not go above 12 or so, instead of 13 or so.
That didn't work. Within 10 minutes my chest was hurting like mad, and I was filling up with air. I could feel large masses going down my throat, stomach was cramping up, and becoming nauseated. I was awake, on my side (I don't sleep on my back at all), with my mouth tightly shut and no mask leaks. So I've been thinking about some possible theories to account for this.
One, this seems to happen about every 4 days on therapy. So my idea is that after those days I'm pretty much filled with air throughout, and it takes several days to move and discharge. At the current settings I can't discharge air enough when I'm on the machine nightly. Maybe I need breaks. This is not promising, because I want to use my machine every night, so I must get the settings right.
Two, after being on VPAP for almost 4 months, my body has learned to swallow air for fear of over-inflating my lungs, which is probably more dangerous than air in the digestive track, so despite the lesser pressures these days, it keeps up this habit. This is not promising either, because I don't have a clue on how to do the untraining.
Three, the settings are still too high. I can drop the ps down from min 1 to min 0, and max 6 to max 5. I can drop the EPAP down in bigger chunks maybe closer to 5. I can switch from asv mode to asv auto mode, which allows me to set a range of EPAP.
Four, I can get a brilliant solution from one of these fine forum members.
I'm going for four, three if I have to.
One, I also occasionally swallow air, and when I get up I do tend to burp, and it may take take a short while after getting up in the morning to pass the air which during sleep had passed beyond my stomach. The air seems to do me no harm. I do take a probiotic (Garden of Life brand "Primal Defense Ultra") and time release Magnesium (Jigsaw brand sustained release Magnesium) to keep the digestive system working well and regular.
Two, swallowing air does not reduce the pressure or amount of air reaching the lungs, so your body would not "learn" to swallow air as a method of lowering the pressure or amount of air entering your lungs.
But how and where we hold our head can have a big effect on how easy it is for the pressure to push air into the esophagus, and we later end up swallowing the air into the stomach. When I feel myself having air forced into my esophagus, I try to burp it up right away (but if a little effort does not get the air out of my esophagus I try to ignore it) and then I tend to try lowering my chin to be a little closer to my chest, and often that will help reduce the tendency for air to get into my esophagus and swallowed. (For you it may be a different slight positional adjustment which helps.)
Three, if you lower your EPAP and PS too much, I would expect you'll find it harder to breathe and more uncomfortable.
Fourth, I suggest two things.
(1) try enabling the Ramp function so that you are asleep before the machine starts the regular algorithm and raises the pressure too much. Part of our problem is our breathing is sometimes irregular while we are still falling asleep, and the machine will ignore this if it is over by the time the Ramp period is over.
You, like many others, tend to breathe irregularly when falling asleep, and this is causing to machine to react too early and too aggressively. So I suggest using the Ramp function, adjusted to be longer than it takes for you to fall asleep.
(2) when you feel air slipping down your throat, try a little to burp it up right away but if the air doesn't come up easily then try to not let it annoy you, and also try moving your head a little to see if you swallow less air when your head is repositioned a little.
(10-02-2014 03:29 PM)PhyllisBalboa Wrote:
(10-02-2014 03:19 PM)jcarerra Wrote: Are you looking at your data to see what pressure the Adapt is trying to USE with the EPAP+min/maxPS? Does it frequently push it up near the max 12.4 on inhale?
Yes, the max IPAP of 13.2 seems to be where it's going most of the time, even when I'm still awake. My graph shows 2 hypopneas only, but still the pressure stays high. No obstructives for 4 months, rarely even get centrals, AHI's always below .3.
I wonder if I should take ps down from a net of 5. Is that a requirement in asv mode? Instead of 1-5, maybe I should have 1-3. Would that bring down max IPAP?
I think the only solution to air swallowing for me is to bring down those high pressures.
As discussed above, in your case, since you are still having problems sometimes swallowing too much air, if you give EPAP a range you should put the top end of the range fairly low. I would suggest a range that does not go higher than 8. For example, you might try a range such as Min EPAP=4, Max EPAP=5 or 6 or 7 or 8. But if you set EPAP or Min EPAP as low as 4 or 5, I would expect your previous feelings would continue, that you're not getting enough air when the pressure is so low.
To help overcome the feeling of not getting enough air, you would perhaps need to increase Min PS a little, meaning Max PS would also need to increase a little because Max PS must be at least 5 higher than Min PS.