(10-20-2016, 07:51 AM)Ezil71 Wrote: It looks like I need to bump up more than a few cm since my ahi is still over 16. Even at 7 and only a few hours I can feel a bit of aerophasia, but not horrible at this level. Hard to say for sure since I didn't have it on all night.
Since you are still feeling the aerophagia at 7cm, I would be very reluctant to increase the pressure all the way up to 10cm and run the risk of the return of "horrible" aerophagia. Unless it is somehow part of a plan to get your doctor to advocate for a bilevel machine.
Unfortunately a lot of sleep docs minimize the problems some of us face with aerophagia. And if you wind up with really severe aerophagia, it can become a significant issue, even a deal breaker, when it comes to adjusting to PAP therapy.
Here's one thing you need to keep in mind about the aerophagia: There's a "chicken and egg" issue when it comes to aerophagia and arousals/wakes during the night. The aerophagia can trigger arousals and wakes, but lots of arousals and wakes can also trigger or aggravate the aerophagia because we often do swallow more when we're awake or semiawake than when we are asleep.
In my case the switch to bilevel took the edge off the aerophagia. But even now, six years into PAPing, if I have a restless night with a lot of wakes and arousals, I'm going to have more aerophagia to deal with. And that's in spite of cycling my machine off and back on at every wake to make sure my pressures go back to their minimum settings. So right now my sleep doc and I are working hard on figuring out ways to encourage me to both get soundly asleep and stay asleep during the night. PAP is not enough to do that for me, and if you're interested in what we're trying, just let me know and I'll write more about my PAP journey.
Quote:Here is last night's data, not good, but no surprise given the low pressures.
This is at 7/7 apap - but I turned flex completely off to see if that was any help.
It looks like I need to bump up more than a few cm since my ahi is still over 16.
Yes, the overall AHI is still too high at 7cm. But your events are clustered in three areas where the problem might be sleep instability, which can lead to "sleep-wake-junk" breathing which can artificially increase the AHI beyond what it really is. Mis-scored SWJ breathing can also lead to pressure increases if you are running in auto mode, which of course can then lead to more aerophagia.
In particular, there's a nasty cluster that starts around 0:05 and lasts until you turn the machine off at 0:18. My guess is that you woke up around 0:05 and tried to get back to sleep for about 15 minutes before deciding to turn the machine off. The timing of this cluster is a bit early for the first REM cycle, although it is possible that this cluster is REM-relateed rather than an arousal/wake followed by SWJ breathing causing the cluster.
Do you know if your REM AHI was much higher on your diagnostic sleep test than your non-REM AHI?
You turn the machine back on around 0:22, but your breathing doesn't really settle down into high quality sleep breathing until 1:10---right after the cluster of centrals and hypopneas. The close-up of the centrals you provide, along with the long stretch of no-event sleep breathing points to that 1:10 cluster being sleep transition related.
Do you remember being really restless for a
long time after the wake where you turned the machine off and then back on?
If you do remember being really restless between 0:22 and 1:10, then most of those events may be sleep transition events or SWJ "non-events" or a combination of the two. My guess is that this cluster may have also been fed by some aerophagia as well as triggering additional aerophagia.
The last cluster of events starts around 2:05 and it starts with a few CAs. More pressure doesn't help treat CAs. Those CAs may represent arousal-related SWJ breathing, or they could be CAs, or they could be CPAP-related CAs (that usually resolve as you finally get used to therapy). But it's also possible that this cluster might be REM related, which again begs the question: Is your untreated OSA documented to be much worse in REM than non-REM?
And finally it appears that you "woke up" around 2:30 and took the mask off and then presumably went back to sleep without the PAP. I put quotes around the "woke up" because it is not clear to me if you actually woke up during the 2:05-2:15 cluster of events (making them SWJ events) and then gave up when you couldn't get back to sleep or if you actually were asleep during the 2:05-2:15 cluster and then woke up after that cluster was actually over.
Quote:Should I keep going up by 1cm to 8/8? Or jump to 9 or 10 to see if my ahi comes down?
My own sensitive stomach urges extreme caution in increasing the pressure as long as you are dealing with aerophagia AND you're not able to keep the mask on all night because of the aerophagia.
In other words, I would encourage you to work on increasing your
comfort first in an effort to increase the usage time so that you can keep the mask on all night.
If you want to stick to fixed pressure, I'd use every setting (including the 7cm one) for several days before increasing the pressure. Sleep is a fickle thing and one bad night does not a trend make. If you have this kind of clustering for 3 or 4 nights in a row AND you're sure that you are
asleep when the clusters are happening, then it's time to increase the pressure. But with the history of aerophagia, you have to go extremely slowly in increasing the pressure: A 2 or 3 cm jump in pressure is going to increase the aerophagia, and the increase in aerophagia may wind up increasing the AHI by triggering a lot of SWJ events.
Quote:When I've had a wider range in the past my 95% has been 10.5 to 11.8, up to 13.5 - but up until recently I had never tested above 14.
To help me help you:
At what pressure settings has the aerophagia been "horrible" where you get to define what "horrible" means to you?
At what pressure settings has the aerophagia been "bad" but not "horrible"?
Quote:I've been reading up on flex settings and it seems that cflex + might be better for me than cflex since it gives relief at the end of an inhale vs at the beginning of an exhale with cflex.
I'm not sure the slight difference in timing of cflex vs. aflex/cflex+ will make a big difference. But then I have had to turn biflex totally OFF on my BiPAP because it was encouraging me to swallow when the pressure started to increase during my exhalations.
Quote:They really should rename the values from 1-3 to slow, medium and fast (if I am understanding how it really works, as a 2cm drop and a difference in speed).
The drop is also variable. Any one of the settings
can cause a 2cm drop in pressure---on a forceful exhalation. But on a gentle exhalation, the drop in pressure may be as little as 0.5 or 1.0 cm.
What may help you the most is to figure out
where in the exhalation the rise in pressure back up to full pressure feels most normal and triggers the least amount of air swallowing.