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the gas was so bad...
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plaidwandering Offline

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Post: #1
the gas was so bad...
That I'm not sure any of the air this thing was blowing actually went into my lungs!

Joking aside, I managed to sleep 6.5 hours on my machine. I remember waking up several times in the night with a brief thought of "I feel like I should burp" before conking back out.

I woke up at 5am, with severe gas bloating/cramps and nausea and a headache worse than my untreated bad nights. Took about 12 hours for the discomfort to resolve.

I searched on the whole aerophagia/gastric insufflation issue. Chin tucking not an option for me, I'm far too mobile a sleeper.

Had RT check data for mask leak and none found, so don't need a different mask or chin strap.

The pain and nausea are too severe for me to 'just do it' for a while to see if my esophagus learns to block out the air.

I asked if lowering the pressure range would help me get used to it for a while, and was told not only no, but that it would make the treatment worthless. They fail to grasp that not being able to do it is also worthless for treatment.

Is it really completely worthless if you aren't clearing your AHI down below 5? Is there any harm in a lower range for a trial period? It's not like I could be worse off than on my own right?
05-10-2016 02:06 PM
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surferdude2 Online

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Post: #2
RE: the gas was so bad...
I'd set the top limit to 10 cm H2O for a while and see how it goes. That's better than giving up on it. As others have noted, when on APAP, sometimes the machine goes higher than needed.

Dude
05-10-2016 02:18 PM
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plaidwandering Offline

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Post: #3
RE: the gas was so bad...
I'm actually not sure how the decision to set it to 7-20 was made, I just had an at home study and then was given a machine. I didn't do any titration one like some folks have.
05-10-2016 02:32 PM
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Sleeprider Online
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Post: #4
RE: the gas was so bad...
What was your average and 90% pressure and what kind of AHI results did you get?

Lots of people will choose to compromise pressure vs comfort and accept a slightly higher AHI. Another approach is to use a bilevel machine or settings that lower pressure during exhale.

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05-10-2016 03:02 PM
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plaidwandering Offline

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Post: #5
RE: the gas was so bad...
I think they told me that the pressure drops by 2 when I exhale?

The 90% pressure I think was 10 or 11 and AHI 3.4. Wouldn't that mean that a 10-11 is enough to blow me up with air?
(This post was last modified: 05-10-2016 03:18 PM by plaidwandering.)
05-10-2016 03:17 PM
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robysue Online
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Post: #6
RE: the gas was so bad...
(05-10-2016 02:06 PM)plaidwandering Wrote:  The pain and nausea are too severe for me to 'just do it' for a while to see if my esophagus learns to block out the air.

I asked if lowering the pressure range would help me get used to it for a while, and was told not only no, but that it would make the treatment worthless. They fail to grasp that not being able to do it is also worthless for treatment.
Yep. Been there, done that. It took the PA in my first sleep doc's office 3 "semi-emergency" meetings with me looking like something the cat dragged in before she was willing to admit that maybe, just maybe they'd over titrated me at the titration sleep study.

In terms of dealing with the idiots at the DME or sleep doc's office who just don't get it, I would suggest bugging them on a daily basis if need be. Every time you wake up feeling like you swallowed a basketball, call the doc's office. And I do mean every time.

OR get the clinical menu and reset the pressure setting yourself. Seriously: If they're not willing to help you, you might just need to get brave enough to help your self.

Quote:Is it really completely worthless if you aren't clearing your AHI down below 5? Is there any harm in a lower range for a trial period? It's not like I could be worse off than on my own right?
While long term you're likely not to feel much better if you are using a pressure that is too low to bring your AHI down to below 5, there's the very important issue which you raise: It's certainly NOT better to forgo therapy completely simply because the powers that be tell you there's no point in lowering the pressure.

Here's the thing: Aerophagia is often very pressure sensitive. As in dropping the pressure by 1 or 2cm may be enough to reduce the aerophagia down to where it is NOT an issue. And it is possible to be over titrated: Toward the end of the night on a titration study, the tech may jump the pressure up by 2cm in response to a couple of events rather than the more usual 1cm. (That's what happened to me.) And an APAP can also be used so that the pressure is at or just above what your stomach can tolerate for as little time as possible.

Here's my advice since you have a DreamStation Auto: Check your data and find out what the 90% pressure setting actually is. Also check the detailed daily data in SleepyHead to find out what is driving the pressure increases. If it's flow limitations instead of OAs and Hs, you may be much better off with capping the max pressure right below your 90% for a week or two to see if (a) it takes the edge off the aerophagia and (b) how much the AHI actually goes up.

There's just a chance that your AHI might stay below 5 even if you reduce the max pressure setting to something that your stomach can handle.

And if the AHI winds up increasing to something above 5, you still have the option of slowly increasing the max pressure (and the min pressure if need be) once your stomach starts to acclimate to PAP therapy.

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05-10-2016 05:25 PM
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robysue Online
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Post: #7
RE: the gas was so bad...
(05-10-2016 03:17 PM)plaidwandering Wrote:  I think they told me that the pressure drops by 2 when I exhale?
With Flex the pressure might drop by as much as 2cm---on a strong exhalation. On much more shallow exhalations, the drop will be less than 2cm even if your flex is set to 2 or 3.

Flex is also funny: It can help resolve some people's problems with aerophagia. But it can also make some people's aerophagia worse. In general if you wind up feeling like the machine is trying to make you inhale before you are ready to, you may need to turn the flex setting down or even off.

Quote:The 90% pressure I think was 10 or 11 and AHI 3.4. Wouldn't that mean that a 10-11 is enough to blow me up with air?
Without seeing the daily data, it's not completely clear how much pressure is "too much" pressure.

But if your 90% pressure is 10 or 11 and you're dealing with the kind of aerophagia you describe, then, yes, 10-11 cm of pressure may indeed be more than your stomach can handle right now.

If you are willing to experiment, I'd suggest setting the max setting to 9.5cm for a night or two. See if that's easier on the stomach. And see what happens to the AHI. If a max of 9.5 is still giving you severe aerophagia, see if you can tolerate 9cm.

In other words, your first task right now is to learn how to sleep with the machine. And that requires figuring out how much pressure your stomach can currently tolerate without too much aerophagia. Once you know that, you can then deal with whether that pressure is too low to treat the OSA, and if so, what kinds of things you can do to minimize the aerophagia as you slowly increase the pressure back up to what you need to get the AHI < 5

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05-10-2016 05:33 PM
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plaidwandering Offline

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Post: #8
RE: the gas was so bad...
well set max to 9.5 and put it on before an afternoon nap that I figured would be 15 minutes

woke up 50 minutes later super light-headed, swimming feeling like the first night that I didn't fall asleep with it on. Stomach is iffy too, still feels like it got pumped up. It isn't giving me an AHI for the nap, maybe it only does that for longer periods?
05-10-2016 07:41 PM
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green wings Online

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Post: #9
RE: the gas was so bad...
If it were me, I'd drop the pressure again, and again if necessary, until you find a pressure that lets you sleep comfortably without your stomach filling up with air.

I started off my CPAP therapy at 7.0 cm last winter. I had problems with swallowing air for about 3-4 nights. It was unpleasant, and it had a negative effect on my feelings about CPAP therapy.

I think it's important to work on comfort first. You may be at a sub-therapeutic pressure setting for a while, but almost everyone adjusts quickly to breathing with the machine and stops swallowing air. (Some people adjust quickly at higher pressures, but some of us need a lower pressure at first.)

I had a titration study and was given a CPAP machine set at 7.0 cm, which turned out to be way too low to control my apneas. I was very sensitive to pressure and to pressure increases, though, so it was probably for the best. It has taken me 3 months to increase from 7.0 to 11.0 cm. My AHI has gone from 5-6 to around 1 now.

I didn't go through a very long period of swallowing air, but it was extremely unpleasant and disorienting. I recommend walking around when it happens. Drinking fizzy water also helps.

It gets better. The mask stops feeling alien, you get used to breathing with the pressure, it all starts feeling familiar & comfortable after not all that long a time.

In the meantime, there's fizzy water and my second favorite yoga pose, Pawanmuktasana, aka "Wind-Relieving Pose". Smile

(05-10-2016 07:41 PM)plaidwandering Wrote:  well set max to 9.5 and put it on before an afternoon nap that I figured would be 15 minutes

woke up 50 minutes later super light-headed, swimming feeling like the first night that I didn't fall asleep with it on. Stomach is iffy too, still feels like it got pumped up. It isn't giving me an AHI for the nap, maybe it only does that for longer periods?
05-10-2016 08:29 PM
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Hmm888 Offline

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Post: #10
RE: the gas was so bad...
I had a major bout with aerophagia when first started CPAP. I took me a lot longer than most people to adapt to CPAP, but I toughed it out. I wonder if your body gets used to the pressure and adapts over time?
05-10-2016 09:33 PM
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