Newbie, gastric sufflation, setting pressure lower

[RocketScientist]

Thanks for this website -- it's great!

I've done some reading already, but am having trouble finding help for my particulars...

I got my CPAP machine the other day (REMStar 100M) and used it one night. It blew me up like a balloon (pressure set at 11). I was miserable for most of the day (I still have a little twinge in my side). I called the sleep doc who did my study and provided the machine. He dismissed it as aerophagia, and said just to give it time to get used to it. Based on what I've read here, I suggested an APAP machine to lower my average pressure and hopefully avoid what seems, pretty obviously, to be gastric insufflation, not aerophagia (thanks for the articles on this from OldLincoln and others.) I can't "get used to" being in pain for a day and very bloated every time I use the CPAP. He dismissed APAP's as over-rated, grudgingly suggested a lower pressure might help, but didn't provide any assistance in setting it lower.

I'm thinking of trying to discover my LES pressure by setting the fixed pressure on my machine lower and inching it up? My hope is that, if this works, it'll build my case for an APAP machine. Does this seem like a reasonable approach? If so, I'll need how to do the setup on my machine. Where do I find this? I found some directions on this forum, and can get into the setup menu, but there's several items in the setup menu and I want to make sure I get the settings right. Is a manual available somewhere?

Being a newbie, and given the discomfort from the gastric insufflation, I don't want to do something dangerous. Should I see another doc about my symptoms before I experiment with pressures?

Thanks for your help!

[Bob3000]

I've found my aerophagia (air swallowing) is worse when I sleep on my side, better on my back. Also, check out this guy's tips on resolving aerophagia.

[RocketScientist]

I admit to not being an expert on the difference between aerophagia and gastric insufflation, but I was not able to "relieve" the pressure/pain in the morning (I had experienced a little air in my stomach during the sleep study with CPAP, but this was gone shortly after waking up).

I think the difference between my sleep study and my first night at home on the CPAP was that they ramped the pressure up during the night of my sleep study. I only spent a couple hours at my titrated pressure (11). The rest of the night I was lower. Plus, my sleep study only lasted 5 hours, whereas my first night at home was 8 hours.

I could try a position change, but I'm really worried about another day lost to abdominal pain. Would rather try lower pressure if possible.

Thanks!

RS

[OldLincoln]

"I think the difference between my sleep study and my first night at home on the CPAP was that they ramped the pressure up during the night of my sleep study. I only spent a couple hours at my titrated pressure (11)."

You are spot on and just described the benefits of APAP. You can set your low side to below the threshold and the machine will only go past it to clear an event unless it needs to remain above. Even if your magic number is close, you will spend much of the night at lower pressure than with a CPAP. There's a big difference cruising along at 1 ccm above threshold and 5 ccm. As you discovered, pressure and the time spent there are the critical factors. I typically spend about 60% of the night below threshold and progressively less at each subsequent higher pressure, have no pain and a manageable amount of toots in the morning. I'm sure my LES is like a porch door with a spring so it only opens a little as pressure rises and progressively more as pressure increases. That's good news and perfect for APAP.

Doctors may be sensitive to the increased cost the DME must bear for APAP over CPAP. However you are their patient and supposed to be the primary concern. I've been around doctors a lot and learned how to discuss issues with them by asking them the hard questions. The theme is to discuss others experiences converting to APAP with improvement, and ask why they would resist writing your a script to do likewise. I told mine that I cannot tolerate the gastric insufflation and will be forced to discontinue treatment if he refuses to help me. He wrote it immediately.

[roster]

.... I got my CPAP machine the other day (REMStar 100M) and used it one night. It blew me up like a balloon (pressure set at 11). .... I can't "get used to" being in pain for a day and very bloated every time I use the CPAP. ..... He dismissed APAP's as over-rated, grudgingly suggested a lower pressure might help, but didn't provide any assistance in setting it lower.

First, let me say I also think the APAP is very overrated. What's missing in your posts and the followup posts is that you absolutely need a "fully data-capable machine" with software to monitor apneas, hypopneas, snores, flow limitations, pressure and excess mask leak. It is also best to have software that shows the event data minute-by-minute.

This is especially true in your case, since you need to do some self-titrating. If you try self-titrating without the software, you will only be able to titrate by how you feel and that is very subjective. The data can help you find an optimal CPAP pressure setting.

So before leaving this point, let me reiterate, you need tools that will give you data! Now that is typically an APAP machine because the straight CPAP machines do not usually provide all the data. (Note that an APAP machine can be set at straight CPAP if desired.)

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Second, regarding preventing aerophagia, the link Bob3000 provided is interesting, give it a try. It did not work for me but it seems credible that it has worked for others. What worked for me is sleeping in the Falcon position (viewtopic.php?f=1&t=36738&st=0&sk=t&sd=a&start=15 ). I also found that sleeping on my right side results in minimal aerophagia while sleeping on the left side results in the most. This undoubtedly is due to the orientation of the esophagus and the esophogeal sphincters. (I cannot sleep on my back due to very high CPAP pressure requirements.)

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Third, what to do when you arise in the morning badly bloated?

You need to have a BM every morning and all the gas will be gone. Here is how you can do it.

1. Eat a good breakfast every morning. Drink a hot beverage with or after breakfast. Those two things help stimulate the bowel.

2. Leave some time for the digestive system to stimulate your bowel. I find that by the time I shave after breakfast "things down there are ready".

3. Start eating three ounces of Bran Buds with your breakfast every morning. Measure them out in a three-ounce cup to make sure you are consistently eating the same quantity every day. After a few days you will be amazed at the very pleasant and thorough results achieved every morning.

The magic ingredient in Bran Buds is psyllium seed husks which are soluble fibers. Soluble fibers expand and become mucilaginous when wet.

4. Make sure you keep well hydrated by consuming 32 to 64 ounces of liquids each day. Just about any liquid (decaf coffee, tea or soft drinks - all preferably diet) is good but they say water is the best.

You should get advice from forum members on machine and software selection.

Good luck.

[OldLincoln]

APAP overrated? Let's see, the sleep lab results show she needs 11cm to clear apneas. 11cm blows her up like a balloon. The doc is now suggesting to lower the pressure below what she needs to clear apneas. Yeah, that's better than going to that crappy APAP machine, right?

Not everybody experiences gastric insufflation. Some of those who don't dismiss it as only a nuisance. If you remember, migraines, PMS, CIDP, Fibromyalgia, and many other diseases were poo-pooed by doctors for years. However, those doctors who experienced them knew they are real. I would wish that anybody who dismisses gastric insufflation as just a little gas actually experience a healthy dose for a few days.

As for BM's, farting, etc. When your colon is kinked back on itself you don't simply sit on the can and blow it all out. It takes hours to leak a little then more until pressure is relieved, then you still fart all day long. I know the gross meter is pegged but life is messy sometimes.

No my friend, APAP is not a waste for everybody. The very first night on mine was the very first night I did not have bloating. Also, you know the compliance numbers run 70% for APAP against 50% CPAP. My question is why do they still make CPAP? THEY are what's overrated!

[roster]

Yeah, that's better than going to that crappy APAP machine, right?

I would wish that anybody who dismisses gastric insufflation as just a little gas actually experience a healthy dose for a few days.

No my friend, APAP is not a waste for everybody.

OL, that is a tired political practice to invent an argument that someone did not make and then proceed to rail against it.

I did not say any of that and also it is not my opinion.

But I am certain that APAP is overrated. That is quite a different statement than "crappy APAP machine" or "APAP is a waste for everybody" or "dismisses gastric insufflation". Don't make stuff up and imply that I said it.

If RocketScientist follows the advice in my post, he will end up with an APAP.

Keep an even keel.

[OutaSync]

As for BM's, farting, etc. When your colon is kinked back on itself you don't simply sit on the can and blow it all out. It takes hours to leak a little then more until pressure is relieved, then you still fart all day long. I know the gross meter is pegged but life is messy sometimes.

That's exactly what happenes to me. The pressurized air goes through me all night and continues to leak out, under terrific pressure, all day. It's 24/7 and started my first night of CPAP therapy. I've tried Rooster's Bran Bud breakfast for a whole month and it did nothing to relieve the gas, or move things along any faster. I get plenty of fiber in my regular diet. What works for many people may not work for you. It absolutely is not true that you will be free from gas after a BM. But I'm glad it works for Rooster.

Bev

[roster]

.... It absolutely is not true that you will be free from gas after a BM. But I'm glad it works for Rooster.

Bev

If you had to ride from Virginia to Key West with me, you would be very glad it works.

[roster]

....I've tried Rooster's Bran Bud breakfast for a whole month and it did nothing to relieve the gas, or move things along any faster. .....

Are you discouraging RocketScience from trying it?

BTW, my gastoenterologist told me women who have had hysterectomies often have kinked up intestines. This is because of the extra space in the abdominal cavity. He said colonoscopies can be difficult for them.

[OutaSync]

[quote="roster
If you had to ride from Virginia to Key West with me, you would be very glad it works. [/quote]


If you had to ride from Virginia to Key West with me, you would be very sorry!!!!

[OutaSync]

....I've tried Rooster's Bran Bud breakfast for a whole month and it did nothing to relieve the gas, or move things along any faster. .....

Are you discouraging RocketScience from trying it?

BTW, my gastoenterologist told me women who have had hysterectomies often have kinked up intestines. This is because of the extra space in the abdominal cavity. He said colonoscopies can be difficult for them.

I would never discourage anyone from trying EVERYTHING they can to relieve the pressure. But I wanted him to know that if it didn't work for him, that he wouldn't be the lone ranger.

I have not had a hysterectomy, but I have had a ruptured ectopic pregnancy (30 years ago) and last September I had a large ovarian cyst removed along with one ovary and the fallopian tube. The doctor said he "knocked down" some adhesions from my old surgery while he was in there. He said that my intestines had become attached to the pelic wall. So, while I may, or may not have any intestinal problems, I never had any issues with gas until the first night on CPAP. I start to "toot" about 10 minutes after hosing up and it continues throughout the night and day. I also release huge amounts of stomach air when I first sit up in the morning and that continues throughout the day. While bloated and uncomfortable, it's rarely so painful that I can't funtion.

I'm always open to suggestions

Bev

[roster]

If you had to ride from Virginia to Key West with me, you would be very sorry!!!!

Pick a warm sunny week. I'll take the convertible.

[OutaSync]

If you had to ride from Virginia to Key West with me, you would be very sorry!!!!

Pick a warm sunny week. I'll take the convertible.

That's better than my last offer-the back of a pick-up truck!

[RocketScientist]

Well, thanks for the useful (and sometimes colorful) feedback. I had no idea my post would lead to offers of drives to Key West!

I think what I'm hearing is that a fully-data-capable APAP machine with software is what will help me get my average pressure down, allow peaks up to my titration pressure when I need them, and will let me know it's working because I can read out the data. Hopefully, I've summed it up correctly (minus that trip to Florida stuff!)

So, the next question is, how do I find such a machine and software? Are all fully-data-capable APAP's created equal? Is it a matter of preference, or are there ones that clearly emerge among the users here? Do all DME's carry a variety of machines, or do they tend to carry one particular line, etc. Are there some machines I should just outright avoid? Do all machines have software available for the end user? I'm guessing insurance won't pay for the software?

Since my first machine came from my sleep doc -- and he discouraged an APAP machine -- I'm thinking I'll shop for a DME who will work with me to get what I need. The doctor reluctantly gave me a CPAP prescription, which, I think, will allow me to get an APAP? Sound like reasonable next steps? Much newbie help needed!

After I get the new machine, I'll try the position and diet changes too, but I think I need to get the pressure down as a first priority. I haven't used the machine since that first night because I was in so much pain afterwards. I don't want to let this become more than a temporary setback!

Thanks and I look forward to your additional expert recommendations!