Help with Aerophagia and treatment

[Gryffs]

Hello and greetings. I'm new here but have been using CPAP for just over three years now. I usually get treatment through the VA, but this past year has found me stranded in another country on the other side of the world (thanks COVID). With that, I have always encountered the occasional issue with Aerophagia since starting my treatment. This was mostly managed with the occasional painful morning, but it has gotten extremely bad over the past couple of months.

I believe the reason for getting worse has been weight loss (I've lost 40 pounds since the start of 2021). The issue wakes me in the night with lots of gas leaving the other end of the pipe and even wakes my significant other from time to time. I've spent a long time afraid to make any changes to my machine but then I found this forum. I've attached last night's OSCAR screenshot. I would appreciate help in getting this Aerophagia issue under control.

Thank you!

[sheepless]

the best initial strategy is to lower pressure. you want the highest setting that reduces aerophagia and the lowest setting that effectively reduces obstructive apnea. put another way, lower pressure to reduce aerophagia to the point obstructive apnea increases, then raise it a hair above that. later, incrementally raise pressure if necessary to allow acclimation. you might have to accept a few more obstructives to avoid the aerophagia.

while weight loss doesn't seem to cure us, it often results in fewer apnea which opens the possibility that your pressure needs are also reduced. weight loss may also affect mask fit.

another odd thought: some foods you may be eating more of in order to lose weight may cause gas.

[SarcasticDave94]

Welcome,

Yes sometimes lowering pressure can do it. A trick your AutoSet has is EPR, yours is off right now. Maybe turn that on to get exhale relief. I had to sleep on my left side for aerophagia & back pain. Maybe try that. Also try to elevate the head and torso area of your mattress or bed frame.

[Gryffs]

Thank you very much for your input! Unfortunately, you are correct about weight loss, after dropping the pounds I've tried sleeping a night without therapy and had issues.

I'm attaching my most recent night's report. I believe my current report shows some good numbers but I'm still working to understand the OSCAR report. Last night wasn't as bad for Aerophagia either because this morning was much lighter on the gas   The report on the original post had a higher AHI number so maybe more events equal more Aerophagia issues?

As for Foods, that one is interesting for my experience so far. I started "Healthy Keto" back in January, this included lots of vegetables and I noticed a high increase in pain from gas overnight. On February 24th I went zero carb, aka carnivore, and what I noticed is the gas from my treatment now flows much easier through my system, so less pain but not less gas. My hypothesis is that zero carb creates less blockage in my system for the air to pass through and that means less pain. But, the amount of gas is pretty intense. I joked with my wife that I was going to start timing some of these toots, some of them are pushing the 15-second mark (I'm 42 but have not outgrown fart humor).

I've noted the mask fit issues and adjusted the mask about 2 weeks ago and it still seems to fit well with these adjustments.

So, to start changing the pressure settings. I'm currently at 8 min and 16 max but it looks like my machine only went up to 12.22 last night and 12.39 the night before (is this correct?). What should I drop the max pressure to in order to reduce my Aerophagia issues? Any recommendations?

Thank you again for the help and this community. May you all sleep well through the night!

[Gryffs]

Welcome,

Yes sometimes lowering pressure can do it. A trick you AutoSet has is EPR, yours is off right now. Maybe turn that on to get exhale relief. I had to sleep on my left side for aerophagia & back pain. Maybe try that. Also try to elevate the head and torso area of your mattress or bed frame.

Thanks SarcasticDave94, I saw this just as I posted my last reply. If I turn on EPR, I assume I would use the FullTime setting but how about the number? I believe it has a range of 1-3. I have tried to elevate my head and torso through pillow use (I thought I would do this before buying maybe a wedge to sleep on), but the few nights I attempted this did not result in lower Aerophagia issues that I could tell.

[sheepless]

your flow limitations are high. median should be zero and the 95%tile column should be no higher than close to zero. Dave's suggestion is good: try epr full time at 2, 1 if you prefer to be conservative and work up incrementally. epr should help reduce aerophagia and flow limitations that drive pressure up. but watch for increasing central apnea. your max pressure is higher than it needs to be (your max in the last screenshot was just over 12) so you could lower it to 13 or just leave it as the current setting isn't hurting anything. post after trying epr and reevaluate.

[SarcasticDave94]

You have a slight amount of CA, just keep an eye on them as you edit the EPR. It might make the CA increase. If it's just a bit, that's likely OK but if it's drastically higher, not so good. Let's give EPR full-time 2 a go. If the CA don't jump, you can always go to 3 which is the top. But let's try it and see what you get. Go a full night unless it goes all out trainwreck. If it's goes badly, just drop it down ASAP.

Try EPR and follow-up with how you think it went and an OSCAR chart. One night should be good enough for an evaluation.

[Gryffs]

Hello everyone! First of all, thank you again for your help with this. Last night I feel like I slept fine and this morning I did not have any major Aerophagia issues, it didn't wake me in the middle of the night, and my wife didn't complain about the noise.

I've uploaded last night's sleep record. I think it looks good. What do you all think?

[OpalRose]

Looks good! Flow Limitations are down, and no increase in CA's. You can still try EPR 3 for more relief.
If you see an increase in Clear Airways, then set it back to 2.

[Gryffs]

Thank you all for the help here. I've attempted EPR at 3 and it looks like I had an increase in CA events. I've attached the reading from that night.

Am I correct in seeing that this is an increase in CA events and should move back to 2?