Fragmented REM or Aerophagia on Bi-Level

[jrcifani5005]

I've been on CPAP/BiPaP since 2006. Was originally given a low CPAP pressure of 6. Many many changes since then trying to find something that worked. Have probably tried every type of approach out there (APAP, Auto Bi-Level, CPAP, Bi-Level, etc.), and every type of pressure (Pressure support of 1, 2, 3, 4 and even 5). I seem to be in a rare category of people that need some kind of pressure - but not too much. Some kind of pressure support, but not too much. I'm have the N20 Airfit nasal which has been really great, and use a chinstrap. My AHI is typically below 1.0 and often 0, but I can see many many awakenings in REM of less than 8 seconds in my Flow Data on OSCAR.

At 7 over 5 I have horribly fragmented REM sleep. At 9 over 5 I have slightly improved REM sleep but horrible horrible aerophagia that creates visceral pain from the distention in the intestines that lasts for days. Anything higher than that I start to get Centrals and more aerophagia. I feel like I have to choose between poor REM sleep, or extreme aerophagia in order to get better REM sleep. I recognize that the pressure needs are higher as we get into REM, and auto-adjusting algorithims (APAP, Auto Bi-Level) haven't worked for me (they don't adjust quickly enough up and down). If I wear Hypafix Mouth tape the aerophagia gets even worse (the air has no where to go if not out the mouth). Without some kind of CPAP therapy -- sleep is even worse.

I seem to have a high high sensitivity to wakefullness when in REM when the throat collapses slightly and have RERAs during REM that aren't tracked by the machine or reported as part of AHI.

I've been to 5 different sleep Drs in the Cincinnati area -- and always the same answer ("your AHI is great!....nothing needs to change here"). Fed up with the reluctance to look at OSCAR Flow data together and problem solve this.

The Lanky Lefty (AXG Diagnostics) has tried to help - but just can't find something to address this. Fragmented REM sleep over time is starting to create a mental health crisis (and yes I'm working with a psychiatrist to try drug therapy as well -- but that's not getting to the root cause of the RERAs during REM).

I'm fairly desparate here -- not sure what to do. I'm working on getting an oral appliance, but have been told that isn't going to solve the need for some kind of CPAP therapy in addition.

Does anyone have any thoughts about this situation? I've been told by several that this is rare to not be able to increase pressure enough to handle apnea events because of aerophagia being so severe.

Thanks all!
JR

[ChicagoGranny]

I can see many many awakenings in REM of less than 8 seconds in my Flow Data on OSCAR.

How are you observing this in the OSCAR flow chart? Can you post a chart of one of these segments?

aerophagia

Do you have any reflux? Have you had an upper digestive examination by a gastroenterologist?

Have you read the CPAP wiki? wiki/index.php/Aerophagia

[Julie]

Never mind - I goofed.

[zonker]

I've been on CPAP/BiPaP since 2006.

which brand of machine? when you get a chance, please fill out your equipment profile, so it shows up at the bottom of your posts, as mine does below.

and welcome to the zoo!

[Miss Emerita]

Could you post a typical daily chart, along with a zoomed-in view of what you're identifying as a wake-up during REM sleep? You'll need to use an image-hosting service, as this forum is out of attachment storage space.