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Intestinal gas problems
#1
Intestinal gas problems
I am an old member coming back.   I have been using BiPap for more than a year.  The pressure settings are high.  I have the Resmed Auto Bipap set for 16 minimum and 5 for support.  I tried lowering to 14 minimum, but the machine always ramps up to an average of 16 anyway.  (It was at 18 to 23, but 16 to 21 seems OK.  Just nothing lower.)

For some number of months I have been having severe problems with excess intestinal gas at night.  I thought it was a digestion problem.  However,  after trying many things there with no success, I finally determined it seems to be the BiPap.  I am very sensitive to positioning.  I have to wear a soft collar, and even with the collar I have to position carefully on my pillow or I start to get events.   I noticed that the gas is worse when I am having problems with events.  It make me very uncomfortable.   I know this is a known issue, but I wondered if anyone here has any suggestions.

One change I have made over the last several months is to reduce the upper body elevation when I sleep.  I slept elevated for many years for back pain, and I have been gradually reducing the angle to see if I can get beyond the back pain.  The back pain is OK.  However, I tried raising the angle again, and it does seem to have some impact on the gas problem.  Actually, I have more trouble with the position sensitivity when I am raised, so I need to find a pillow and position where I don't have events when I am raised.  I am already taking GasX to try to pass the gas.

Any suggestions are very welcome.  I got great advice earlier to understand my position sensitivity.
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#2
RE: Intestinal gas problems
Marklang, give me a chart.  Pressure increases can be very aggressive on a Resmed Vauto when flow limitations are present, and your profile suggests a fixed pressure of 23/19 PS 4.  We can make comfort choices and maximum pressure limitations. It would help to see why your pressure are driving upward and giving you some alternatives.  Your last chart strongly suggests positional apnea, and we can fix that without high pressure.  Be sure to upgrade to the current version of OSCAR

[Image: attachment.php?aid=10395]
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Intestinal gas problems
I will get the new OSCAR and get you some charts. I was originally on 19-23 after my sleep test prescribed by my doctor. Later I tried using the auto mode and reducing the pressures to see if it would be OK. As I noted, the machine seemed to bring back to 16-21 whenever I try lower settings.
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#4
RE: Intestinal gas problems
I'm suggesting we can override the machine's program to increase pressure, particularly when that increase in pressure either does not result in an improved therapeutic endpoint or reduced discomfort. Sometimes, therapy is a compromise or judgement that works better than the machine's algorithm. It helps to look at the data when making those assessments.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Intestinal gas problems
Here is a start.  I have included a screen shot from last evening.  I had no incidents reported.  However, I notice that the machine increased the pressure to full scale at several points anyway.   I also included one from 2/28, where I was having trouble.  I woke up the first time with a very high AHI showing.  I adjusted and tried again -- better, but still issues.  I finally went back to my old pillow, which seemed to help.  Let me know what else I can provide.  Perhaps expanded views?


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#6
RE: Intestinal gas problems
The machine is rising on flow limitations. At peak pressure and PS 5.0 you are at 23/18 pressure. Flow limitation is incredibly high and I would really like to see the flow limits chart displayed. You will have to shrink down the events, flow rate and pressure charts to make it fit, the leak chart is near zero and doesn't help at this point. I'm going to take you way way down.

Mode: Vauto
EPAP min 9.0
PS 6.0
Max pressure 20.0

Need to know how this feels and works. Hypopnea are in clusters, and if you are using more than one pillow, toss the extras one on the floor. You are showing signs of positional apnea or chin-tucking. http://www.apneaboard.com/wiki/index.php...onal_Apnea I suspect this is the root cause of the problem.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Intestinal gas problems
I adjusted the graphs to get the Flow Limit graph displayed.  See attached.  I also added a screenshot from 3-3-2021. 

You are correct that I am very sensitive to position.  That is one thing you helped me with earlier.  Note that I have tried at least six different soft collars, some of them so stiff that I could hardly sleep.  However, none of them kept me from having events based on flow restriction issues when sleeping on any normal pillow.   For a while, I was using a collar with a special cervical pillow from Core Products.  This pillow has a pocket in the middle so the head sinks down a couple of inches below the neck.  It keeps the chin to chest gap open, and it also keeps the head facing straight up.  However, this caused me neck pain with the collar, as the collar adds additional height and makes the neck too high relative to the head.   After many trials, I finally found a pillow by COOP that is filled with shredded foam that can be added or removed to adjust the volume within the pillow.  I have most of the foam removed so the pillow is pretty flat.  Even at that, it caused me problems.  I finally found a pattern where I use the COOP flat pillow, but I position myself with my shoulders at about the middle of the pillow and my head hanging down off the top of the pillow onto the mattress below.  I have to be careful to get just the right position, but when I do I have been getting AHIs of zero or at least under 1 for a long time.   I had not reviewed the actual data from the machine for a while since I thought I was doing well.  I now know that even this arrangement still leaves some flow restriction that the machine is reacting to even though no events are sensed. 

On the screenshots, 3-4-2021 I was using the COOP flat pillow with my head off the top all night.  On 3-3-2021, which I added, I was experimenting.  I started the evening with the Core Products cervical pillow but no collar.  I woke up after about an hour, and the the machine showed an AHI of about 13.  I then added the collar.  I woke up after about another hour with the machine showing an AHI (total) of about 8.  (The machine, of course, only shows the AHI average over the total time slept.)  That seemed better, but after another hour or so the total AHI was still only at 6, so I switched back to the COOP flat pillow with my head hanging over the top.   I am confident that the Core Products cervical pillow kept me from tucking my chin down toward my chest.  Nevertheless, I was getting severe flow restrictions.  The combination of collar and pillow seemed to do the most good, but, again, does not remove all the flow restriction.  It is as if I have some issues of flow restriction beyond the normal neck tucked down problem.  Do you have any perspective on this?

Sunday is a very demanding day for me, so I prefer not to try anything radically new this evening.  I will try your setting probably Sunday or Monday evening and report back.  If the new screenshots change your recommendations, you can share the new ones and I will use them.

Again, I really appreciate the advice.  I got such good advice earlier that my sleep doctor did not even acknowledge when I shared with him.  (He discounted advice from any non-physician, and had nothing to offer relative to flow restriction.)  I have been having this gas problem for over a year, making me very uncomfortable at night and into the day until things settle down.  I have done many things for my digestion, even taking some medication costing me over $500 for 14 days to reorient the bacteria in my intestines.  This helped a little during the day, but I still had problems every night.  None of my doctors has even suggested my BiPap might be the issue.  I had some extensive pelvic floor physical therapy a month or so ago, and the therapist suggested part of my gas problem might be eating too fast.   She noted one can suck in gas if eating too fast.  It was this comment that later made me think it might be the BiPap, and I found several articles on the web confirming that when I did the research.  It is frustrating to have good doctors who still don't recognize these things.  Anyway, while the articles I found acknowledged the problem, they offered little advice to help.  Once again, the folks on this forum seem to be well ahead of the doctors.  I hope, with your help, I can make this much better.  Thanks again.


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#8
RE: Intestinal gas problems
When you start new threads, we lose the history, and in this case started all over with the positional apnea discussion and pressure history. It's better to keep therapy threads together.

Your ability to tolerate lower pressure is contingent on somehow getting control of the positional episodes. Between 4:00 and 6:00 in your chart above, and in several charts in the past, you have had long periods of low flow limitation. My suggestions for lower pressure are pretty aggressive, and the real objective needs to be to determine the maximum pressure you can tolerate without aerophagia, and setting that as a maximum, then using the collar and sleeping position to avoid trouble. We know that for you, the difference between a cluster of hypopnea and a cluster of OA is just the degree to which your airway is occluded by your sleep position. You know 23 cm results in air ingestion and a lot of discomfort. You have previously used lower maximum pressure, with good results other than an end of night episode, like in the graph below where maximum pressure was 20. You don't have central apnea, so a key part of my suggested settings is an increase in pressure support to 6.0. This can help mitigate the flow limitation to an extend, however, it doesn't matter how high you set your pressure, you will have obstructive clusters that cannot be controlled.

I think you can just stop using a sleep specialist or find one that listens. I have used my primary care doctor forever, and he is more receptive to my input. If you don't get any value from a doctor, there is really no point in paying him for his services. Your positional problems are real, and while there are surgical solutions, we try to avoid tracheostomy as a last-resort, although it is probably more effective than UPPP.

[Image: attachment.php?aid=10395]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Intestinal gas problems
I am looking back through my recent data.  I had the machine set for Epap of 14 with PS 5 and max of 23 for a while.  I see many days where I had no problems and the machine kept the pressure range very near 14 - 19.   I attached an example from 2/19/2021.  Since I have been having gas, I assume I was having gas at that time -- but I don't recall if it was a bit better than other days.  So I seem to be able to tolerate lower pressures if I can control the positional issues.  However, as you can probably tell, that has been very difficult for me.   It seems like it is more than just not tucking my chin, but perhaps I manage to reposition more than I think when I am asleep.   If you have more ideas there, let me know.   Otherwise, I will try your settings.  I will also continue to monitor my data and keep working to understand the position issues.  I had thought they were solved when I started getting AHI of 0 fairly consistently, but I now know that is not the case because of the aggressive action of the Resmed automatic algorithm. 

By the way, is there a way to change where Oscar stores the screenshots?  I have a directory under the Oscar_Data folder where I have screenshots saved from before, so it makes sense to put them there, instead.  I could not find a preference setting for that.

Thanks again.


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#10
RE: Intestinal gas problems
Here is my first evening with the new settings. 3-7-2021.   I did have a noticeably different feeling, especially on expiration.  It was like the pressure went away.  It seems like it started off OK, but gradually worked up the pressures during that initial roughly 4 hours of sleep.  There were still not many incidents.  However, I did have bad gas symptoms when I woke up the first time, and every time after that until well after I got up in the morning.  I was using my flat pillow with my heading hanging off the top.  It seems unlikely that I tucked my chin during that time.  Perhaps I was moving my head sideways or something else changing affected the flow restriction.  

For comparison, I included a screenshot of Saturday evening.  That evening I lowered the setting slightly to 14-23 cm, with PS of 5.  The pressures stayed right there at 14-21 for the whole evening.


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