18 yr old daughter with OSA

[GWam]

Hi! I am looking for guidance for my daughter. I am new to all this and not up on all lingo. She was diagnosed with severe OSA with about 32 events an hr. She had been dealing with fatigue for years and it was a relief to have a diagnosis. She was given a cpap machine a week before she went to her first year of college. Her sleep Dr gave her an automatic machine and set the air flow to 14-20 range. She started throwing up and/or being nauseated. She got frustrated and I just thought it would get better. I finally decided I needed to get more involved. I realized she was suffering from aerophagia.  I found her a new sleep specialist. He set the air pressure to 10. It starts at 4 and ramps to 10. She complained of feeling like she’s suffocating at 4 while she’s trying to fall asleep. She was still a little nauseous, but only able to use for 4hrs. To help with the suffocating he changed her setting to 8 and ramps to 10. She was still a little nauseated and and still can’t make it longer than 4 hrs. He lowered to 9. 

That brings us to today. She is able to make to 6hrs but not consistently. The she still is nauseated and has burping. I think she recently said she wakes up hiccuping and they won’t stop. She’s not as tired as the beginning of all this, but she’s still so fatigued and she has to take provigil to be alert enough to function. I should also say she has depression and anxiety and is on meds for all that. She does have a history of acid reflux and suffered from that most of her childhood. I’m wondering if the reflux might be an issue I need to tackle. Maybe put her on OTC for a while and see if that helps. She’s nearing the end of school and somehow she made it through. I want o help her but I just don’t know why this isn’t helping! She used the full mask.. her Dr said that after getting the air pressure right we can look at the mask next. I like this new Dr., I. Just impatient. Any advise?

[Rickyricardo]

Turn off ramping completely, which means she won't feel air starved at the low starting pressure, because she is being air starved for the ramp time. I can't understand why people are supposed to feel comfort with an air pressure too low to breathe properly.

And turn on EPR at 3. That makes exhaling less burdensome.

It's an APAP, and won't deliver any more pressure than she needs. Set the pressure along the line of 8-15 no ramp and EPR 3.

[Sleeprider]

GWam, make sure her machine has a SD card in the slot on the left side. It contains all the sleep data and settings we need to help. Download the free OSCAR program and upload her SD card data. If you post some charts we can definitively help guide you to optimized settings that don't trigger aerophagia and minimize apnea. There is so much information in the charts, it's hard to sit here and guess. I agree with the advice to turn on EPR full-time at setting 3, but pressure needs to be minimum 7.0 and maximum 10.0. That will give an automatic pressure range of 7/4 to 10/7 (inhale/exhale) and that should be a good start to give good therapy without triggering aerophagia. Post charts and we can definitively tell you what is going on.