Fragmented REM or Aerophagia on Bi-Level

[gainerfull]

How could you know when aerophagia occurs? Does it wake you up? That zoomed in view looks like a sleep transition / position change to me.

Trigger sensitivity is a setting that will start the next breath / inspiration based upon what you have it set to. If the setting is "high" or "very high" it essentially compels your to take a breath and avoid central apneas. Start with "high" and see if it gets rid of your residual central apneas.

If I were you the first thing I'd work on is solving your presumably leaky mouth as leaks can cause arousals and sleep fragmentation and you're leaking all night long which also makes your therapy less effective.

Next, I'd run you bipap in VAUTO mode so you can get flow limit data recorded. Set EPAP min to 4, IPAP max at 7 and PS 3 if those are your preferred settings.

[jrcifani5005]

           
Aerophagia wakes me up within a few hours - it's painful bloating; visceral pain from the stretching of GI tract from the air (it's not pain related to something else - it's definitely aerophagia).  Last night I lowered it down to 6 over 4 and had more horrible aerophagia.  I've used really well done mouth seals with Hypafix tape with awful aerophagia  (most of the worst aerophagia is with a really well-taped mouth) at a variety of pressures (12 over 8, 9 over 5, 7 over 5, 6 over 4) all at Easy Breath setting.  I've used a well-affixed chinstrap,  I've used a soft collar to keep jaw from dropping - and I've used all of those things at the same time.   I've been on CPAP for 17 years - and I've always had mouth leaks that made my therapy sub-optimal at 8 over 4, but never had aerophagia....and I just don't understand why in the last 3 months I now get aerophagia all of the time no matter what I do.

When you say "leaking all night" is a mouth leak or a mask leak?  

Thanks again so much for taking the time to work with me on this.

[gainerfull]

My intuition tells me that perhaps you're sleeping in a position that is conducive to allowing air into your stomach, even at low pressure. Top of mind, considering your persistent mouth leak is severe mouth drop / chin tucking. Back when you were on CPAP / APAP what did your data look like? Did you still experience aerophagia even without EPR turned on? Have you trialed any static pressures in CPAP mode? What about a soft cervical collar that will prevent your chin from tucking?

Does a full face mask like a Resmed F20 help?