So I'm Still Struggling With

[rzw]

Aerophagia......its been about 45 to 60 days....in this process, I have at least found out what my sweet spot for air pressure is.....between 9.2 and 9.4 seems to be the range that I can get proper treatment......problem is, bad aerophagia.....I have tried reducing the pressure to see if I can beat it......gone down to 8.8, which I thought might work, but no, still having issues and my treatment at that pressure not so good.....waking up a little more.....now I can keep trying to go down, but I think treatment will start to suffer and then i'm no better off for sure.......Pugsy suggested try turning EPR on to see if you can get some relief.....while I don't like it on, as breathing positive and negative pressure seems to both be different, i'm pretty desperate at this point......so, if I turn epr on to 1 or 2 or 3, should I increase my pressure range a bit to compensate, or that probably doesn't make much sense either......just looking for a few more pointers..........I find myself using the machine for a bit and then once I wake up with aerophagia, I have take the mask off to allow time for the air to clear....I sometimes will go back to sleep only to wake up shortly having a moment because of no mask......this has now been happening a couple times a night.....so my sleep is quite fragmented....

Thanks for any tips....

[LSAT]

Setting an autoset machine to 9.2/9.4 range is essentially using the unit as a fixed pressure machine. What does your Sleepyhead look like?

[rzw]

Oops sorry....pressure settings are 6.6 to 9.2 or 9.4 range.....I just have found that the upper pressure range seem to be the mark that gave me effective treatment.....but have been backing down the upper range from that 9.2 to 8.8 to try and help the aerophagia is all.....if it wasn't for that, I would probably leave the upper pressure range to around the 10 mark, just to be safe....

[Pugsy]

The use of EPR allows some reduction of the pressure while exhale and sometimes that reduction gives people some relief of the aerophagia symptoms because there's not a constant pressure that is quite as high trying to sneak into the stomach.

Sometimes the use of EPR and that reduction during exhale can cause an increase in AHI because that drop during exhale allows some apnea events to sneak past the defenses during exhale where they wouldn't otherwise. It's not a given that it will always happen and it doesn't necessarily happen to everyone to the point that the IPAP pressure minimum has to be adjusted upwards to offset the drop.
Yes..sometimes some people do have to make that upwards adjustment but sometimes people don't have to make any offset adjustment.

What is it about using EPR that you don't like?

Does your machine have a setting option in the clinical setup menu call "Response"?

If you choose to revisit EPR....don't automatically up that pressure to try to offset the drop...it might not be needed and there's no sense in going looking for more problem fixes there until you for sure need to.

Also...what would your AHI be if you used a pressure that didn't cause the aerophagia issues?
How much worse is the AHI without the belly issues?
What is the AHI with the belly issues?
How much of a difference in AHI between the 9.6 max and maybe 8.0 max?

A nice low AHI is nice but an AHI of 4 and you can actually sleep through the night and use the machine all night and not have belly pain wouldn't be such a horrible compromise.
Just how "bad" or "good" is the AHI at the lower max settings?

[rzw]

Pugsy, I do have response in my menu....it offers soft or standard I believe.....what is this.....

Also, I guess call me carzy, but when epr is on, I can tell a difference on positive pressure......meaning it does not feel the same pressure output in positive pressure.....But your right, sleeping thru the night better with less stomach issues vs higher AHI....MY Ahi currently is .1 to .6 most nights......

Should I change the response setting? Also, I was thinking about turning epr to 2 and maybe bumping pressure max from 8.8 to 9.....thoughts

[Pugsy]

Try soft response instead of standard and try EPR at 2 and make no other changes and see what happens.
It affects the transition between inhale and exhale I think. It's minute...I played with it myself and I had to really pay close attention to feel the difference but you might like it. You might not...but worth trying.

Worst case...your AHI is really low and you have some room to let a few apneas slide by and not have horrible consequences.
Like if you reduced the max pressure limit just a little. Yeah the machine will probably want to go higher but going higher causes more problems than it fixes. Sometimes we just have to make compromises.

Don't increase max pressure just yet...see what EPR at 2 and changing the response does first.

[rzw]

yes mam...thank you again for the help as always

[Ron AKA]

You may find this document of some help.

https://www.sleepapnea.org/treat/cpap-t ... solutions/