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4 months in - Do I have to live with aerophagia?
#1
4 months in - Do I have to live with aerophagia?
First , I appreciate that many of you spend your time here helping others.   None of this sleep apnea journey is easy, but your support makes it less overwhelming.  I have learned so much here.

I’ve been using my ASV for 4 months after a split night sleep study with AHI 41 and diagnosis of CSA and OSA.  I have a mask that works for me (ResMed F30, plus a back up F20 that would be perfect if I wasn’t between sizes), I usually get 6 hours of unbroken sleep, and my AHI now averages less than 1.  BUT I can’t get away from the aerophagia.   

I don’t know if you can help without OSCAR data (I don’t use it yet because sometimes I obsess over data and it becomes counterproductive), but even general advice or a fresh perspective would be helpful.   At the moment, I have a sleep doctor who has changed my settings several times to address the aerophagia, even though he doesn’t seem too concerned about it because my results are good.  I started at EPAP 7, PS 3-15. That’s when the aerophagia pain woke me up at night and sometimes gave me nausea in the morning.  We cycled through some variations and ASV Auto before landing on ASV mode EPAP 7, PS 0-6.  I’m not in pain, but the bloating and flatulence aren’t great.    

I sleep wearing a soft c collar on a 7.5” foam wedge.  I’ve tried to teach myself to sleep on my left side but I think I tend to curl up which makes the aerophagia worse.  Back sleeping is better, and my preference, but AHI is sometimes higher (1-2, which I’m ok with).   AND YET, I can’t get the aerophagia to stop.  I’ll have a good night occasionally with almost no air swallowing but can’t consistently repeat it.   

I am not a mouth breather (I confirmed this with mouth taping) but  I do have chin drop, so I use the collar and it works.  The doctor also recommends it for the aerophagia.   I’ve learned to sleep on the wedge and not slide off, so my torso is elevated.  What am I missing?   Is there more leeway with my pressure settings?   Is there a psychological component?  Will it eventually go away?  Or do I accept the aerophagia and move on?
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#2
RE: 4 months in - Do I have to live with aerophagia?
Sounds like you're doing everything you can to maximize your therapy and aerophagia is tough to deal with. Do you have OSCAR and can you share screenshots of the last couple of nights so we can see what the pressure is doing?
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#3
RE: 4 months in - Do I have to live with aerophagia?
I'm no professional on this subject -- just a user of the same machine. Generally speaking, your pressure is too high somewhere. My understanding is that most people using this machine find it works better on ASVauto. Of course, your results could be different. My opinion, is to switch to ASVauto mode, set EPAP Min to 4, EPAP Max to 7, PS Min to 2, and PS Max to 6. I have found this to be a very 'trial and error' system to get it dialed in. Aerophagia was a problem for me also when I first started -- I just kept lowering pressure until it stopped. I assume you know how to change the settings.
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#4
RE: 4 months in - Do I have to live with aerophagia?
Thank you both for confirming that  1) aerophagia is not easy to fix and 2) my ASV settings will need tweaking, so this could take a while.    I had a fairly easy time adjusting to wearing a mask and using the machine, so the aerophagia has taken me by surprise.   

The doctor had me try ASV Auto but the nurse practitioner said it may have been causing my 5:30 a.m. wake ups so I’m back to ASV.  I do know how to change settings, I just haven’t done it.   I’m not using OSCAR yet, in part because I want my doctor to earn his keep and answer all my questions.  But I’m getting impatient.
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#5
RE: 4 months in - Do I have to live with aerophagia?
I've used the ResMed AirCurve 10 ASV. Yes it'll take some adjusting on your part.

A few suggestions/observations:

1. You're in the US meaning you can set the ASV yourself without a script change, you can tell doc or not

2. You're on Apnea Board so there's several to assist with number 1 above

3. Doc only cares about numbers (including $x.xx) so he probably can't/won't do any setting changes for aerophagia because there's no number data connected to it

4. I would suggest considering ASV Auto mode, it opens up the opportunity to run a bit lower base pressure via EPAP Min, which isn't available in ASV mode

ASV Auto mode makes EPAP 2 pressures running as a range. It will start therapy at EPAP Min for exhale, plus PS Min to get the inhale pressure (IPAP Min). From there, EPAP PS and IPAP are all 3 variable setting ranges. Conversely in ASV mode your EPAP is static and you're forced to set that probably higher than comfort and aerophagia threshold is for you.

Even a small EPAP range may be helpful like this...
ASV Auto
EPAP 6-9
PS 0-6 like you've got now if you want to keep it
IPAP is EPAP plus PS at that moment
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: 4 months in - Do I have to live with aerophagia?
Looking for info on EPR I came across your post concerning aerophagia.  A year ago or so I was having problems with aerophagia.  Over a period of time of many adjustments to my pressure settings on an AirSense 10 the aerophagia reduced then stopped.  In 15 years of CPAP therapy the problem of swallowing air has been intermittent and thankfully not happening at present.

By posting my OSCAR reports, I got help with adjusting my settings.  I found that small adjustments can make a big difference.  It took time and many nights of trying those settings to find what works well.  And, what settings are best can change with time. I recall taking pressures down until the aerophagia stopped, while monitoring my number of apneas.

The sleep study technicians, DME, and the doctor in charge of my CPAP therapy offer no help with settings, but on sites like this I have found great help from very knowledgeable folks willing to work to get those settings tweaked.  

Best of luck.
I only give suggestions from experience as a fellow CPAP user, not professional advice.
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#7
RE: 4 months in - Do I have to live with aerophagia?
Addressing how to adjust, if you choose to do it yourself in this ASV and again it's your choice to change this, no script change needed if you're doing you own:

From the home area of the screen when unit is off, push both Home and the Dial in together for about 5 seconds. You're now in the Clinical menu.

Example, suppose you wanted to change mode, scroll with the Dial to find the mode section and you'll see CPAP, ASV, and ASV Auto. Current has a dot next to it. To change from ASV to ASV Auto, turn the Dial to highlight ASV Auto and click the Dial to lock in the selection.

Next you'd need to scroll with the dial to EPAP, which now is 2 settings Min and Max. Dial in those numbers and click to lock in the number. These pressure settings should be a whole number and an even tenth decimal, as in 7.0, 7.2, 7.4, so on.

Last I think it's clicking home or moving to the exit selection. Upon exiting the clinical menu, those are now your therapy settings.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: 4 months in - Do I have to live with aerophagia?
Thank you for explaining the ASV settings!   I’m starting to understand how it works, which is a big deal, considering how lost I felt a few months ago.

My sleep was erratic this week, so I didn’t change anything.  I did what I always do, but had two bad nights.  One morning I felt so awful that I thought I had the flu.  AHI was 4.3, which is the highest it has been in 3 months.   I think I may have somehow tipped my head back, like maybe I fell off the top of the wedge.     I actually had to laugh about it:  Extremely sore throat like what I had with COVID, very tired, but minimal aerophagia!   And a 100 score on myAir, plus a star on my FitBit for meeting my sleep goal Too-funny      Anyway,  I will make some setting changes this week.
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#9
ASV - OSCAR interpretation help please! Why aerophagia one night & not the other?
       
After receiving help here with ASV settings a couple of weeks ago, I thought I was done with aerophagia.  Settings are now ASV auto,  EPAP 4.4/7,  PS 0/6
I have kept everything else the same:  sleeping supine, 7.5" foam wedge, soft c-collar, F30 mask, night guard for bruxism.

Aerophagia was gone for a few days.  I felt great on 11/7, better than I have in quite a while.   On 11/8, aerophagia came back and I don’t know why.   I installed OSCAR and I'm trying to understand what I'm looking at.   I don't know which information is most important to tell me if I'm getting what I need from the ASV.   AHI is good (less than 5 now vs. 41 during my sleep tests), but is there anything here that can tell me why the aerophagia came back on 11/8? 

Here are the first pages of my charts on 11/7 and 11/8.  Thanks for any insight you may have!
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#10
RE: ASV - OSCAR interpretation help please! Why aerophagia one night & not the other?
       
And here is page 2 for 11/7 and 11/8.
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