Can you recognize an aerophagia event in OSCAR?

[THEVGE]

Ow, a strange new issue I got when increasing my pressure (now at P 9.4 with PS 4) is that I wake up with pretty bad head aches that linger on the whole day. It is at the front of my head. There is nothing in my data that suggests I am doing something wrong, all relevant data is going in the right direction to treat my UARS.

This started when I introduced the Alaxo Xtreme nasal stents, that helped significantly, it improves my air flow and has clear therapeutic effect. I recently found that my left nostril is a big part, if not the main part, explaining my UARS.

Normally I treat "pain" as a clear message that something is wrong, but in this case I cannot think of anything. My head should be happy with the better supply of oxygen!

Note: data that improves is heart rate down, SpO2 up, flow limitations down, inspiratory flow rate shape more rounded, expiratory flow rate sharper and deeper, respiratory rate down ......really, finally, going into the right direction but still not good enough. With my previous setup my data looked perfect at P 13 PS 6 but aerophagia was killing me, it seems I will reach Valhalla at significant lower pressure and pressure support with my new setup. In a few weeks I have a ENT visit, he will probably tell me how bad the shape of my nose is.

[2SleepBetta]

First: I note that member Ferloft has started a thread, which I just glanced at, on this aerophagia topic. I post this without reading it closely, as I will. It's time for me to hit the hay after drafting this rambling post offline.

THEVEGE, I was fortunate that my miserable experience with PAP-induced aerophagia was brief when I started therapy using a FFM. But, unrelated to sleep, I have developed the same effects in the past year or so--lots of belching (and its accompaniments)-mostly associated with eating and drinking. It is a late-years development, I think, of swallowing problems that stem from my case of CMT and or aging.

Your FR curve is remarkably smooth and uniform, but a bit unusual without pauses before inspirations begin. That curve was all I found of yours upon checking several of your recent posts.

Reflecting UARS, your Work of Breathing, shown by your approximate Ti/Te and Ti/(Ti+Te) ratios is  high [1.8/1.0 and, for the latter, 1.8/(1.8+1.0) =  0.64  = duty cycle] without the usual questions about when expiration ends and inspiration begins. One study, for which I could only find one of its graphics, did depict a duty cycle of 0.52 as indication of severe airway obstruction. (That study found, see Fig. 3 here https://www.researchgate.net/publication...entilation ).

Given the near uniformity of your breath wave forms and sizes, I did a crude "covering triangles" check of a typical wave's areas and found, as expected, that the wave-enclosed areas above and below their zero-axis stretches were approximately equal for just one of the quite uniform breaths: there was no obvious swallowing of breath in that one-minute time span or elsewhere.  

My sense, quite possibly wrong, is that some air swallows might be seen in your FR curve. That idea stems from the middle inspiration wave on the first page of the linked ResMed patent document. See https://patentimages.storage.googleapis....2088A1.pdf   That illustration of a local inspiration wave disturbance suggests your lower esophageal sphincter (LES) may intermittently leak abrubtly, rather than seep air uniformly (which would tend to hide the upper GI intrusion). However, your leakage may be more extensive than is depicted.

Without seeing the usual desired OSCAR presentation of your, with two-minute zooms, I have no idea what is happening, not that I would have an idea if I did see the graphics.

You do mention low TV and (concurrent?) high RR—as high as 30 BPM. The former would reflect the latter given our high proportion of airway deadspace/dead-volume between our air intake and lung alveoli.  It's no wonder your high RR would cause some distress.
 
More links:

This link illustrates how individualized/ideosyncratic our breathing adaptations can be, for good (or for ill):   https://www.apneaboard.com/forums/Thread...w-limited?  See Post #63. Such makes difficult the prediction of a response to a significant change.  Can it be that you are having to go through an adaptation process?

https://my.clevelandclinic.org/health/di...aerophagia

https://www.webmd.com/balance/wim-hof-br...-technique

[THEVGE]

Hi 2SleepBetta,

Thanks for your elaborate reply, I will need some clarity and energy before I can dive in the information you give.

Please note this was a pretty rare incident that mainly happens if I combine 2 UARS therapies together, like bi-level with Velumount soft palate brace. With only bi-level this never happens. I have been on PAP for almost 4 years now, but as I still have no good therapy I do experiment a lot.

As stated, I will put time in your reply later, currently not able.

[THEVGE]

Yesterday evening I created this strange pattern again. For my UARS I need high pressure support, yesterday I tried PS 6 (on purpose very high to learn). My heart rate went up pretty fast which I noted when I woke up at some point. And the flow rate is not good in several ways, including this pattern that I now consider over-ventilation.

@2SleepBetta: just read the articles, interesting. I will check it out in more detail, want to grasp this work-of-breathing better as it sounds helpful.