OSCAR Data - Low AHI but still not feeling great, and are these real OA events?

[SeePak]

Hi Santino

Still same here, you need 8 cm, no EPR, give it a try.

Wondering if you have gas or acid in esophagus feeling? Hearburn?

Aerophagia can be caused by not relaxing during breathing as well.

Try some breathing exercises, check out Patrick McKeown.

I know you are close now with 8 cm, but keep EPR off otherwise we will not be able to see the effect of higher exhalation pressure on your obstructive events.

Need to get a handle on the obstructive.

Collar will give a good idea where to go next.....

agree?

Questions?

[G. Szabo]

... but I did experience some aerophagia again. My subjective feeling of restfulness feels about the same--not great. ... 

I might remember waking up gasping or something? 

Your gasping feeling is probably caused by your high flow limit, which can be mitigated by increasing your pressure. If you want to stick with CPAP, then you should raise your pressure to 9 cm. However, APAP (you have a more advanced device than CPAP) flexibly adjusts your pressure when you need more air and gasping. Therefore, APA would be a better choice.   
Higher EPR mitigates aerophagia. You can try EPR=2, full time.

[SeePak]

Santino

yes, preceded by irregular breathing, same for me, and i would think most obstructive.

If they come right out of the blue and long, possibly/probably positional, keep an eye on the flowrate, when it gets real LOW.

Sleep Hygiene
This cannot be overlooked....

A steady breathing state before putting mask on

no tv before bed, keep it to 1 hr, that's what i do, i fall asleep in seconds some time.

No food 2 hrs before bed, flexible time here, most say it matters

Alcohol, keep it minimum before sleep

Exercise, this is a big one!  Need to get into a state of CO2 creation, which allows oxygen to be transferred from air to blood, then from blood to cells in your body, including the Brain!

For me, its all about that balance, and then some sense can be made about the Charts .

Its hard, i know, sometimes, life is crazy really!
But we need to make time for ourselves, our bodies, our souls!

A Breathing Disorder got us into this apnea and CPAP world

Re-Learning to Breathe can get us out, or at least functioning much better while using CPAP.

[Santino]

SeePak - Thanks. I am hesitant to turn off EPR entirely just yet due to the aerophagia. I suspect my body may just need some more time to adjust to the higher average pressure. I woke up in the middle of the night feeling pain in my stomach and needing to burp and pass gas. In the morning, though, I was fine.

I agree that cervical collar is the logical next step to see if I can confirm or rule out positional apnea and then go from there. Another reason I’m hesitant to change my settings again yet is because I’m trying to just change one variable at a time to isolate the effect.

Thanks also for the tips on sleep hygiene, but I don’t think that’s the issue here as I’ve had that stuff dialed in long ago. Last night I think it was likely the aerophagia that caused me to have trouble falling back asleep for awhile.

G. Szabo - Sorry if I wasn’t clear—what I’m saying is that I DON’T ever remember waking up gasping, which is surprising to me given the occasional very long duration of some of the OAs.

[SeePak]

Another thing I don't know if I suggested  is oro functional therapy which includes swallowing and tongue exercises uvula raises and that will help with the swallow reflex which can be a very big contributor to aerophagia

[SeePak]

Sorry should have read Oro facial myofunctional therapy

[Santino]

Interesting, I will look into that. Thank you.

[SeePak]

I've had the same issue and I also have had trouble swallowing in the past I've also had burning sometimes in my esophagus and also I used to get like a lump in the throat type thing all these things were due to reduce sleep and other issues with muscles in my throat and neck.

Just a few exercises and you can make it a lot better I stopped doing them now for about a week but I'm going to be doing them again

But breath work breathing exercises that's number one

[Santino]

I tried the cervical collar (caldera releaf) and had an odd experience. On the one hand, I had a subjective feeling of having slept solidly through the night, probably as solidly as I have yet on CPAP. On the other hand, I still had quite a few OAs and the next day I actually felt WORSE than probably any day since starting CPAP. I'm not sure why that would be as my numbers didn't look substantially different than some other nights in terms of events (1.8 AHI), flow limits, etc.

In searching other posts on the board I can't really find anyone else having reported being negatively affected by a cervical collar so I assume some other factor was responsible for my feeling so crappy yesterday. I will probably give it a shot again perhaps even tonight, but I was scared off of wearing it again last night at least. If one night's data is any indication, my OAs might not be primarily a positional issue, though.

Other than the cervical collar question, I guess the only other thing to do to try and resolve the OAs is increase the pressure? Last night I tried a narrow APAP range of 8.8.-9.6, but I also took G. Szabo's suggestion to increase EPR back up to 2 as perhaps the slightly higher flow limits on EPR 1 are contributing to my feeling worse?

Unfortunately I slept terribly last night as I woke up an abnormally high number of times throughout the night. I sometimes start mouth breathing during the night (hence my FFM) and I think I was getting chipmunk cheeks from the higher pressure when I started mouth breathing and then that was waking me up. This is a frustrating setback as I had been doing better the last several nights in terms of sleeping through the night with CPAP.

I haven't had a chance to look at my OSCAR data from last night yet but tentatively perhaps I will set a slightly lower narrow pressure range tonight and see if I tolerate that better and then gradually try and increase that if I'm still getting OAs. But I am at a bit of a loss because it seems like I require higher pressures that I don't seem to tolerate very well (yet).

Please bear with my venting. I wasn't someone who had really bad symptoms before CPAP and one starts to feel discouraged and wonder whether the "cure" can be worse than the disease at times. I know that is a pessimistic take though probably borne of my poor mental state right now due to poor sleep, because there have been days where I've felt the improvement from CPAP. Sigh.

[G. Szabo]

The tightness setting of the cervical collar is important. When it is too loose, it is useless; when it is tight, it reduces blood flow and disturbs your sleep. It should only prevent your chin from moving down.

I looked up your previous OSCARs. You had negligible CAs. Hence, you can try EPR =3 to tolerate pressure better.