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Apnea / sleep / aerophagia? advice - Buonarroti - 03-10-2020
Hello to everyone in the community here and thank yous in advance
Around March of 2019 I was diagnosed with severe obstructive sleep apnoea (AHI 31/hr) and mild oxygen desaturation after a polysomnograph test and proceeded to trial CPAP for 30 days.
With some help from loved ones we acquired the Resmed Airsense 10 Autoset and I have been trying to acclimate to the therapy for the past year with little to no success; I still suffer tiredness, muscle weakness, poor memory & concentration etc. despite my efforts towards good sleep practices/hygiene/compliance.
Majority of sessions are under 4hrs which I have come to believe are due to nausea, bloating, abdominal pain, belching / flatulence with some shortness of breath and rarely a bit of vomit (yummy
s/). Saw posts about aerophagia; lowered pressure to minimum with a bit of improvement but still suffered symptoms, so I've returned to my usual 95% value of 6.2. Read about GERD correlations and have used antacids hoping for improvement but no such luck; opinions welcome. Found a better mask fit and noticed an improvement in the disturbances caused by air leaking onto face / into eyes. I am currently thinking to buy a neck brace in the hopes I can eliminate some of the OAs in the interim, though will defer to advice based on data / chin-tuck indicators etc.
I've attached OSCAR data for the sessions that were the longest uninterrupted (9hrs) and most recent, though the longest was immediately followed by another session which was only 3hrs with no change to settings. Included also is a page from the initial polysomnograph. I will post more screenshots of the report or OSCAR data if needed.
Thanks again everyone. Here's to hope.
~Buona notte Buonarroti~
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RE: Apnea / sleep / aerophagia? advice - Dormeo - 03-10-2020
Several thoughts.
First, the feeling of muscular weakness indicates to me it's possible some other medical problem is bothering you. Have you mentioned the feeling of weakness to you doctor? If not, that would be a good idea.
Second, have you tried repositioning your tongue? With the tip of your tongue behind your front teeth, put the middle and back of your tongue up on your palate, then swallow or suck a little to suction it in place. This may or may not address the aerophagia, but it's worth trying.
Third, you might want to try a fixed pressure of 7 with EPR of 3. For some people, getting the benefit of EPR consistently makes for easier, calmer breathing, and avoiding pressure changes might help too. You might shorten or eliminate the ramp period as well. -- Maybe this will just not be right for you, but you might experiment with it.
Fourth, there are other measures to consider in case GERD is part of your problem. Here is advice from the Mayo Clinic:
Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus.
Stop smoking. Smoking decreases the lower esophageal sphincter's ability to function properly.
Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. If you can't elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Raising your head with additional pillows isn't effective.
Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up again once you have chewed and swallowed that bite.
Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
RE: Apnea / sleep / aerophagia? advice - Sleeprider - 03-10-2020
I'd like to suggest stabilizing your pressure with CPAP mode at 6.0. Your obstructive sleep apnea has fully resolved, and what is left is some sporadic centrals. With a pressure range of 4 to 8.4, your pressure is bouncing along all night, mainly on flow limits. I think you may sleep better and still experience fewer events with fixed pressure at 6.0. Normally I would try some EPR which would drop exhale pressure by 1 to 3 cm, but it's likely to increase CA events. For now, let's try CPAP pressure at 6.0 and perhaps consider adding in EPR at 1 once we see how this works out.
The possibility of external factors affecting how you feel is something to consider. It is pretty common for people to start CPAP therapy, then relate everything about how they feel to that therapy. I see the possibility to stabilize your pressures and remove that disruption from your sleep, but it may not fully resolve the complaints you listed above.
RE: Apnea / sleep / aerophagia? advice - Dormeo - 03-10-2020
Definitely take Sleeprider's advice about pressure settings, not mine!
RE: Apnea / sleep / aerophagia? advice - Sleeprider - 03-10-2020
Dormeo, you were right on top of this with fixed pressure at 7.0, and we are definitely on the same page. No wrong answers, and you recognized the problem of fluctuating pressure. Some good thought and sleep hygiene advise in your post. Keep up the good work here.
RE: Apnea / sleep / aerophagia? advice - Dormeo - 03-10-2020
Glad I'm on the same page as you, Sleeprider. Buonarroti, keep us posted, would you?
RE: Apnea / sleep / aerophagia? advice - Buonarroti - 03-11-2020
Greatly appreciate the advice so far.
I've switched the machine from APAP to CPAP mode @ 6.0 and will report on that along with the OSCAR data.
Thanks for the tips Dormeo and for looking into the GERD stuff as well. I have an appointment booked with my GP later this month and will discuss the symptoms I've mentioned. The tongue position you mentioned is my default, but I'll keep it in mind to see if I lapse at any point. The bed elevation is an interesting idea, will definitely try that one out.
RE: Apnea / sleep / aerophagia? advice - Buonarroti - 03-12-2020
Here's the report from last night. Went and bought some blocks to elevate the bed but sadly do not think it helped - will keep trying and monitor. In any case I'm having a fun experience channeling my inner mountain goat.
Seems whilst preparing for the next evenings EPR test I forgot to turn it off, so will send that through next.
Any advice / reading material regarding OSCAR user flags / flow rate interpretation? Is the default 20% / 50% 8s decent for borderline event detection? I like to zoom in on the flow rate and try to understand what is happening; which changes in the pattern are normal / within tolerance versus not.
Will keep you updated. Kind regards.
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RE: Apnea / sleep / aerophagia? advice - Sleeprider - 03-12-2020
The Beginners Guide to Sleepyhead has probably some of the most extensive information on chart interpretation http://www.apneaboard.com/wiki/index.php/Beginner%27s_Guide_to_SleepyHead It's been a couple years since I edited and worked on the wiki, but it links out to other articles and good references.
RE: Apnea / sleep / aerophagia? advice - Dormeo - 03-12-2020
Aside from that one cluster of CAs, that looks like a fairly decent night, and you got in 7.5 hours, which is good. How do you feel? Any change in aerophagia or daytime tiredness? The subjective reports are as important in your case as the Oscar reports, given how well your apnea is being treated.
I like to zoom in to look at events, and I often see that CAs are preceded by arousal-type breathing (greater amplitude in flow rate, not much pause between breaths, irregular breaths, jagged flow rate). One theory is that this represents an arousal, either to a waking state or to a less deep sleep stage. Some people think the CA that follows represents you holding your breath as you turn over or move around in bed, though for me I think that is unlikely, since the CA follows an exhale and is usually too long to be plausible as a turning-over thing.
So for me, I think I have an arousal, the arousal breathing washes out some CO2, that reduces my urge to breath, I have a CA, then resume normal breathing. Nothing wrong with that except for the arousal part, I think. As I adapt to higher pressures, arousals are less likely to result in a CA, probably because my body becomes less on the hair-trigger edge of CO2 sensitivity.