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[Treatment] Flow Limitation and swallowing air
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Brian Rule Offline

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Joined: Nov 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Respironics Wisp
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CPAP Software: SleepyHead

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Sex: Male
Location: Ross on Wye, england

Post: #1
Flow Limitation and swallowing air
Hello all you Experienced people,

I need help again I'm afraid! After about 4 months with the S9 Autoset I am doing pretty well but I do have a couple of problems which continue to dog me and I can't get any clear view of why I have the problems or if I can do anything about them. Any advice would be welcome.

1. I now manage to get through the night OK and for the most part I get AHI scores of between 2 and 5 (with a few under 2 and a few over 5) though if I wake in the night and lie quietly for more than a few minutes before going back to sleep then the AHI goes shooting up. I have pretty low leakage in general but often my AHI goes up to 10 or 12 for 30 to 60 minutes. There is no significant leakage and the sleepyhead and Resscan software both show little of no Apnea activity during the period: they do however show a lot of "Flow Limitation" over that period. Any ideas why this is so and what can I do about it please? Flow limitation seems a bit difficult to grasp, for me anyway!

2 The second problem is that I wake most mornings absolutely blown up with air which, unless I can discharge it by burping soon after getting up causes me severe discomfort and chest pain throughout the day. I have tried sleeping with a higher pillow (not much improvement) and Gaviscon is of limited usefulness. Seems a minor problem which the doctors don't seem to take seriously, but it is pretty difficult to cope with all day every day to the extent that I wonder if it isn't worse than the S[/b][/size][/font]leep Apnea. I feel sure others must have to cope with this problem so any advice would be more than welcome - I am certainly not getting much from the medical world.

I look forward to all your collective wisdom which over the last few months has been my main prop.

Thanks.

Brian
04-05-2014 10:47 AM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
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CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #2
RE: Flow Limitation and swallowing air
Hang in there. I have no experience to help you with but there are plenty of people on the board that do and I am sure you will be getting plenty of help.

PaytonA
04-05-2014 11:13 AM
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Brian Rule Offline

Members

Posts: 17
Joined: Nov 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Respironics Wisp
Humidifier: ResMed H5i
CPAP Pressure: Auto Cpap "8 to 13
CPAP Software: SleepyHead

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Sex: Male
Location: Ross on Wye, england

Post: #3
RE: Flow Limitation and swallowing air
(04-05-2014 11:13 AM)PaytonA Wrote:  Hang in there. I have no experience to help you with but there are plenty of people on the board that do and I am sure you will be getting plenty of help.

PaytonA

Hi PaytonA

Thanks for the encouragement. Always good to have support, particularly from the other side of the world. The internet is wonderful and ApneaBoard is brilliant.

Have a nice day!!!

Regards

Brian
04-05-2014 11:31 AM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
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CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #4
RE: Flow Limitation and swallowing air
(04-05-2014 10:47 AM)Brian Rule Wrote:  1. if I wake in the night and lie quietly for more than a few minutes before going back to sleep then the AHI goes shooting up. I have pretty low leakage in general but often my AHI goes up to 10 or 12 for 30 to 60 minutes. There is no significant leakage and the sleepyhead and Resscan software both show little of no Apnea activity during the period:

I'm a bit confused: Your ahi goes up to 10 or 12, yet the software shows little or no activity? What are you looking at to know your ahi is increasing?

(04-05-2014 10:47 AM)Brian Rule Wrote:  2 The second problem is that I wake most mornings absolutely blown up with air which, unless I can discharge it by burping soon after getting up causes me severe discomfort and chest pain throughout the day. I have tried sleeping with a higher pillow (not much improvement) and Gaviscon is of limited usefulness. Seems a minor problem which the doctors don't seem to take seriously, but it is pretty difficult to cope with all day every day to the extent that I wonder if it isn't worse than the S[/b][/size][/font]leep Apnea. I feel sure others must have to cope with this problem so any advice would be more than welcome - I am certainly not getting much from the medical world.

That's generally from air in your mouth being swallowed rather than expelled through your lips. In other words, you're mouth breathing. You may need to use a chinstrap or other technique to help train your mouth to keep shut. I use my wife for that purpose.
04-05-2014 11:32 AM
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Brian Rule Offline

Members

Posts: 17
Joined: Nov 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Respironics Wisp
Humidifier: ResMed H5i
CPAP Pressure: Auto Cpap "8 to 13
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Ross on Wye, england

Post: #5
RE: Flow Limitation and swallowing air
(04-05-2014 11:32 AM)retired_guy Wrote:  
(04-05-2014 10:47 AM)Brian Rule Wrote:  1. if I wake in the night and lie quietly for more than a few minutes before going back to sleep then the AHI goes shooting up. I have pretty low leakage in general but often my AHI goes up to 10 or 12 for 30 to 60 minutes. There is no significant leakage and the sleepyhead and Resscan software both show little of no Apnea activity during the period:

I'm a bit confused: Your ahi goes up to 10 or 12, yet the software shows little or no activity? What are you looking at to know your ahi is increasing?

(04-05-2014 10:47 AM)Brian Rule Wrote:  2 The second problem is that I wake most mornings absolutely blown up with air which, unless I can discharge it by burping soon after getting up causes me severe discomfort and chest pain throughout the day. I have tried sleeping with a higher pillow (not much improvement) and Gaviscon is of limited usefulness. Seems a minor problem which the doctors don't seem to take seriously, but it is pretty difficult to cope with all day every day to the extent that I wonder if it isn't worse than the S[/b][/size][/font]leep Apnea. I feel sure others must have to cope with this problem so any advice would be more than welcome - I am certainly not getting much from the medical world.

That's generally from air in your mouth being swallowed rather than expelled through your lips. In other words, you're mouth breathing. You may need to use a chinstrap or other technique to help train your mouth to keep shut. I use my wife for that purpose.

Hi Retired Guy

I am looking at the graphs on both lots of software. The section which indicates what kind of events you have had is completely clear while the AHI graph by time shows the graph rising to 10or12 and staying there for quite a while. Hope that is a bit clearer.

Brian
04-05-2014 11:41 AM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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Post: #6
RE: Flow Limitation and swallowing air
There are two graphs of which you speak. There are the events. And there is the AHI graph. The second is of little use unless you understand the concept behind what the AHI graph shows. The graph shows the mathematical integral of the number of apnea event with respect to time divided by the total time. I'll see if I can cast it into an equation...

[Image: Slide1.jpg]

Flow limitation is a scoring of the inhalation waveform. If the waveform has a rounded shape, it scores low limitation. If it is flat on top, it scores higher flow limitation. It's an indication that OSA is possible. I wouldn't get too wrapped up in that graph; the scoring is somewhat subjective.

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(This post was last modified: 04-05-2014 03:20 PM by justMongo.)
04-05-2014 02:15 PM
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zonk Offline

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Machine: A10 AutoSet
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Sex: Male
Location: Australia

Post: #7
RE: Flow Limitation and swallowing air
Events while awake are meaningless and discarded for true AHI value

Flow limitation (FL) are minor obstruction events, don,t meet the 10 seconds or more criteria to be scored as an apnea.
The machine raise pressure in response to FL, whats pressure stats med, 95p, max


Bloating discomfort is called aerophagia, something you need see the doc to see whether CPAP related or GERD or bit of both

Two different conditions with different approaches, increase pressure to deal with FL and decrease pressure to deal with aerophagia
(chicken and egg syndrome)

Some people find bilevel machine helps with aerophagia, higher pressure when breathe-in and much lower pressure (comfortable) when breathe-out
04-05-2014 03:03 PM
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JimZZZ Offline

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Machine: ResMed S9 AutoSet
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Location: Western North Carolina

Post: #8
RE: Flow Limitation and swallowing air
(04-05-2014 10:47 AM)Brian Rule Wrote:  I wake most mornings absolutely blown up with air
There is an extensive thread entitled "Aerophagia" that may contain some useful information for you.
04-06-2014 07:19 AM
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Brian Rule Offline

Members

Posts: 17
Joined: Nov 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Respironics Wisp
Humidifier: ResMed H5i
CPAP Pressure: Auto Cpap "8 to 13
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Ross on Wye, england

Post: #9
RE: Flow Limitation and swallowing air
(04-05-2014 02:15 PM)justMongo Wrote:  There are two graphs of which you speak. There are the events. And there is the AHI graph. The second is of little use unless you understand the concept behind what the AHI graph shows. The graph shows the mathematical integral of the number of apnea event with respect to time divided by the total time. I'll see if I can cast it into an equation...

[Image: Slide1.jpg]

Flow limitation is a scoring of the inhalation waveform. If the waveform has a rounded shape, it scores low limitation. If it is flat on top, it scores higher flow limitation. It's an indication that OSA is possible. I wouldn't get too wrapped up in that graph; the scoring is somewhat subjective.
Hi justMongo

Thanks for the bit of calculus, with which, as a fellow engineer, I do empathise. However I'm not sure it gets me much further forward with doing anything to improve the situation and as you say maybe flow limitation is best left alone.

Thanks for the help anyway.

Regards

Brian
04-06-2014 10:00 AM
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Brian Rule Offline

Members

Posts: 17
Joined: Nov 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Respironics Wisp
Humidifier: ResMed H5i
CPAP Pressure: Auto Cpap "8 to 13
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Ross on Wye, england

Post: #10
RE: Flow Limitation and swallowing air
(04-05-2014 03:03 PM)zonk Wrote:  Events while awake are meaningless and discarded for true AHI value

Flow limitation (FL) are minor obstruction events, don,t meet the 10 seconds or more criteria to be scored as an apnea.
The machine raise pressure in response to FL, whats pressure stats med, 95p, max


Bloating discomfort is called aerophagia, something you need see the doc to see whether CPAP related or GERD or bit of both

Two different conditions with different approaches, increase pressure to deal with FL and decrease pressure to deal with aerophagia
(chicken and egg syndrome)

Some people find bilevel machine helps with aerophagia, higher pressure when breathe-in and much lower pressure (comfortable) when breathe-out

Hi Again Zonk

I am just getting to know a bit more about Flow limitation and it seems a bit academic to me. As far as I can understand flat topped is bad and round topped is good (but I don't understand the significance of tall and short yet - I guess tall is bad and short or none is good?). All of my Flow limitation seems to be flat topped whether it's tall or short - but it seems I can't do much about it anyway! - or have I got that wrong?

Regards

Brian
04-06-2014 10:12 AM
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