Help required to reduce AHI and Aerophagia

Hi!

I'm new to the forum but been lurking the past few weeks to get a better understanding of sleep apnea. This is a great community and I'm hopeful you will be able to help me get to grips with my CPAP machine as I've been struggling. For the first 10 days I couldn't get to sleep with the machine on, but eventually overcame that and have been managing to sleep most nights since then. However, my sleep quality hasn't improved yet (AHI score seems to be averaging around 7 since I started getting to sleep with it on 16th Feb).

Also, for about the past month, Aerophagia has been a growing problem, and has gotten much worse over the past week or so. I've been using a chin strap for 3 weeks to close my mouth a bit (not completely as I struggle to breathe completely through my nose) and have now started using a travel pillow to keep my chin away from my chest. I've also been taking anti-bloating tablets the past few days which haven't made much difference. It has now got to the stage where for the past few days I've been wakening up after a few hours of sleep and then not being able to get back to sleep so reverting to taking my mask off as my stomach is just full of air and I'm struggling to breathe even when using the ramp button.

Does anyone have any suggestions of changes I should perhaps make to the pressure settings on my machine? My apneas seem to be mainly hypopneas and from what I can understand they seem to happen more when the pressure is higher. Could lowering the pressure settings maybe help both reduce hypopneas and aerophagia? Any advice would be much appreciated.

Here are some details regarding my equipment:
Machine - Dreamstation with heated humidifier
Mask - F&P Evora Full face mask
Settings - Min pressure 4 / Max pressure 20

Here is a link to last night's report and my overview - https://imgur.com/a/KDHlGAv
Just a quick note regarding last night - I woke up at 5.45am, so data after that is just me laying awake trying to sleep with the mask on until I decided to take it off.

Thanks in advance!

Sorry to hear... that will put a crimp in your style for sure. Hard to continue therapy when it hurts.

I found that sleeping on my right side helps... your stomach valve is at bottom, so the contents can help 'plug' the opening. This is opposite of what I used to do for reflux... you have to sleep with the valve *up*, on your left. Sleeping on your right side is better for your heart anyway, less pressure on it.

Another thing is your pressures... you are set wide open, factory default 4-20cm, just as if you'd bought one and never seen a doctor or tech. My guess is that you had a home study and were then handed an auto machine and told 'go for it'. The problem here is that pressures can actually do what the setting says... go to 20cm... this is way sky-high, especially if you haven't developed your CPAP muscles yet.

We'd need to see Oscar or SleepHQ graphs to determine what your pressures should be or even if they're going high... so that would help. Also, thanks for bringing the good info at the beginning... you might just go ahead and put your machine, mask, etc in your signature for future reference. You've been hanging out so you know about these programs, you upload your SD card into them, you get to see all the data, you post a link here, we get to see too.

In any case I can guarantee that 20cm is too high and 4cm is too low... post some graphs and we'll let you know a good range for the pressures. If you're still having AP problems you can start bringing the high pressure down even more. There's a device called V-COM, it's cheap, it's a flow restrictor for inhalation that helps with AP... here's some humorous Lanky Lefty videos describing it:

https://www.youtube.com/results?search_ ... ty27+v-com

As you can see there are quite a few of them, with viewer feedback... always read some comments with user feedback too. It looks like it could help you, it's only 20$.

Thank you so much for your quick reply.

I tend to sleep on my left side but since using CPAP I've mixed it up between left and right and have noticed no real difference in terms of my AHI or Aerophagia depending on side.

You are exactly right about how I got my machine. I had an at-home sleep study and was then given CPAP to use whilst waiting on my follow up sleep study (no idea how long that will take). I've had no real discussions with anyone about the machine despite trying to contact the clinic this week. Although the max pressure is 20, it has never really gone above 12. Would reducing the max pressure to say 15, actually make any difference if my pressure never gets that high anyway?

I did download OSCAR earlier this week and have spent time looking at the data. It's a great piece of software. I included an imgur link in my original post with last night's graph and an overview. Here's another link with 3 more graphs - https://imgur.com/a/0trEnRM

Please let me know if these work OK as I've never used imgur before. I also have my machine and mask in my sig. Hopefully these are showing OK too!

Thanks for the v-com recommendation. I watched one of the videos and is something I'm definitely interested in learning more about. I'll spend some time reading up on this for sure!

Jude92 wrote: ↑

Fri Mar 29, 2024 9:59 am

Please let me know if these work OK as I've never used imgur before. I also have my machine and mask in my sig. Hopefully these are showing OK too!

welcome to the zoo! yes, the images came through fine. and I would recommend you raise your minimum pressure from four (the factory default settings) to seven. see on your chart under the events tab where it shows "H"? that's hypopnea and it needs to be much lower than what is showing. raising the minimum will help fight those nasty buggers.

good luck!

and yes, everyone can see your equipment. that's important too so that we giving advice can see which machine you are using.

Thanks for your reply zonker. I can certainly try raising the minimum pressure to 7. Should I change the max pressure too? Also, do you think increasing the minimum pressure will affect my aerophagia?

Jude92 wrote: ↑

Fri Mar 29, 2024 12:11 pm

Thanks for your reply zonker. I can certainly try raising the minimum pressure to 7. Should I change the max pressure too? Also, do you think increasing the minimum pressure will affect my aerophagia?

prolly will. so try raising that pressure in increments rather than straight from 4 to 7. and allow each night of increased pressure a few nights to let your body get used to it. if it's intolerable, then back off at once!

this will probably take a long time and much patience.

oh and no, there's no reason to change max. it's not going to go to 20 unless it needs to and I don't think it will.

continued good luck.

+1 Zonker. One way raising your minimum to 7 might help is by giving you more consistent flex. (The lowest pressure the machine can generate is 4, so you get no flex at 4, just a little at 5, etc.) Flex can sometimes help with flow limitations and hypopneas.

After you try that for a few days, you could consider lowering your maximum to 7.5, just to see whether that helps with the aerophagia without affecting your AHI too much. Feel free to post more charts at any point along the way so we can all see how it's going.

One small request: could you close the calendar on Oscar so we can see more of the left-hand panel?

Thanks zonker and Miss Emerita for your posts. I will try increasing the minimum to 5 for the next few days and update you with the results.

Thanks for letting me know about the calendar. I've closed it and provided a link with updated graphs in case any one wants to see it - https://imgur.com/a/Iyqo6yX

One last question (for now!) - sometimes when I put my mask on and can't sleep, my AHI score can get extremely high even though I'm awake. Is this normal or is there any explanation for this? Here's a link to a graph from a night recently when I just couldn't get to sleep and my AHI score was 14.1 - https://imgur.com/a/dnTl0o8

Jude92 wrote: ↑

Fri Mar 29, 2024 1:38 pm

One last question (for now!) - sometimes when I put my mask on and can't sleep, my AHI score can get extremely high even though I'm awake. Is this normal or is there any explanation for this? Here's a link to a graph from a night recently when I just couldn't get to sleep and my AHI score was 14.1 - https://imgur.com/a/dnTl0o8

unlike Santa Claus, your machine doesn't know if you are a wake or asleep. it's just treating the apneas it perceives. so ozij just put it earlier-

"The machine does not know whether you're asleep or awake. It sees irregular breathing patterns (typical of wakefulness) and the if irregularity fits the definition of apnea or hypopnea, that what the machine reports. Totally independent of whether you're asleep or awake."

Brilliant, that's one less thing to worry about! Thank you all for your help. I'm much more positive about CPAP than I was this morning

Jude92 wrote: ↑

Fri Mar 29, 2024 3:21 pm

Brilliant, that's one less thing to worry about! Thank you all for your help. I'm much more positive about CPAP than I was this morning

when you come back in, bright eyed and bushy tailed, please continue the conversation right here in this thread. this is now your therapy thread.

just makes it easier for us old duffers to keep track.

Here's a link to last night's report where I upped the minimum pressure to 5 - https://imgur.com/a/WqWFn9b

One of my better AHI scores in the past couple of weeks with Hypopneas remaining the main issue. As in the past few days I woke up earlier than hoped (around 7.15am) and struggled to return to sleep even with keeping the mask on with the machine off. I ended up getting another hour or so with the mask off.

Do you think I should keep it at 5 for a couple more days or maybe increase to 5.5?

Thanks again for all your help!

Jude92 wrote: ↑

Sat Mar 30, 2024 4:01 pm

Here's a link to last night's report where I upped the minimum pressure to 5 - https://imgur.com/a/WqWFn9b

One of my better AHI scores in the past couple of weeks with Hypopneas remaining the main issue. As in the past few days I woke up earlier than hoped (around 7.15am) and struggled to return to sleep even with keeping the mask on with the machine off. I ended up getting another hour or so with the mask off.

Do you think I should keep it at 5 for a couple more days or maybe increase to 5.5?

Thanks again for all your help!

leave it for a few days. what time do you go to sleep?

and how's the aerophagia?

My usual sleep patterns is about 1.30am to 9am, but I’ve been wakening up much earlier the past few days, I think due to the aerophagia. I normally have a nap around 6pm too for about 30 minutes to an hour. The clocks in the Uk go forward tonight though plus I’m going on vacation on Wednesday to the US so my body clock will be all over the place for the next 10 days.

The aerophagia is pretty much the same as it has been all week.

Jude92 wrote: ↑

Fri Mar 29, 2024 1:38 pm

One last question (for now!) - sometimes when I put my mask on and can't sleep, my AHI score can get extremely high even though I'm awake. Is this normal or is there any explanation for this? Here's a link to a graph from a night recently when I just couldn't get to sleep and my AHI score was 14.1 - https://imgur.com/a/dnTl0o8

Absolutely normal. Wake breathing is irregular. The machine's assessment of breathing disturbances is based on the correct assumption that sleep breathing is regular. The irregular breathing when you're awake confuses the machine, and you can safely discount number on those nights.

I agree you need higher minimum pressure.