AHI looks good, but still feeling bad

[Deborah K.]

What if you set an Apap range of 8-11.  You are just barely under 8 now, and such a small range does not seem like it would be disturbing to your sleep, and it would not force you to go high.  Give it a try!  

[nh00]

Deborah, after another bout of painful trapped air this morning, I think that's my only option. I'll give that a try for a few nights and post back. Thanks for your advice!

[PeaceLoveAndPizza]

Based on your earlier charts, if you want to stay at a fixed pressure you need to raise it to 10 cmH2O. You could also go to a range and let the machine auto-adjust as needed.

Consider trying one of the following:

Mode CPAP
Pressure 10
EPR 3 full-time
No ramp

Or

Mode APAP
Min pressure 8
Max pressure 12
EPR 3 full-time
No ramp

The APAP mode may be more comfortable and help with the aerophagia, but the real thing to work on is keeping your tongue against the roof of your mouth and not swallowing air. If you do get the feeling of air in your mouth just puff it out as needed. It takes a while to get there with the tongue training, but it is worth it.

[nh00]

I tried a few more nights at a fixed pressure. My concern is this: I have an appointment in a month, and I can already imagine my doctor saying that I've switched settings too much, and maybe if I had just stayed with one setting, I'd be feeling better by now (I doubt this is true). Anyway, things are worse than ever. I've inched up to fixed 8.6.

My question is this: have I spent enough time at a fixed pressure to eliminate the possibility that it would solve my fatigue? Should I go back to the APAP mode as suggested above, or keep inching to a fixed pressure of 10? I've spent 2 months at a fixed pressure.

Also, as a reminder, I went a while with a pressure range of around 8-11: https://www.apneaboard.com/forums/Thread...#pid519211

[nh00]

I tried a static pressure of 8.8 and woke up writhing in pain. I can't ignore this anymore, the higher pressures are too painful for me. Here's a recap of my journey to this point:

• A pressure range of ~6-13 produced the lowest AHI numbers, and I didn't have frequent bouts of aerophagia. However, the changes in pressure were constantly waking me up, and the pressure was often not high enough to be therapeutic, leading to zero improvement in my feelings of fatigue. My 99.5% for this range was 10.
  
• I attempted to work up to a static pressure of 10. This was months and months of struggling, and I have never been able to push past 8.6. Although I was having fewer wakeups, the pressure was not high enough to be therapeutic, and I often had AHIs above 5. Mouth tape, elevated sleeping position, not eating before sleeping - nothing helped. The aerophagia is intolerable.
  

I don't think there's anywhere productive to go from here. I am not going to risk hurting myself with higher pressures. I have an appointment next month with my sleep doctor, and from my research, the only realistic option is a bilevel device, so I'll be pushing for that.

[quiescence at last]

i doubt the doctor will agree you have serious AHI problem. Theraputic is a word. You are getting some help from having even the medium pressure you are on. Hope you land with someone or something that can enlighten you and deal with breathing and non-breathing related disturbances.

QAL

[nh00]

My doctor is also an ENT and seems to take a much more holistic approach than "low AHI good," but you're right that a visit might not offer anything of use. I definitely wouldn't know where to go from there.

[PeaceLoveAndPizza]

Read this article on aerophagia. What you are experiencing is definitely not what we are used to seeing. It could be any number of things, but while the pressure may exacerbate it the root cause remains a mystery. 

https://www.sleepfoundation.org/cpap/aerophagia

Until you figure out the why, the best you can do is lower the pressure and live with the result whether it is therapeutic or not, or not use the CPAP until such time you understand why you keep getting such dramatic problems whilst using the CPAP machine.

[nh00]

I would say my symptoms definitely line up with what is typically described as aerophagia, but my severity seems unusual given how low my pressure is. Instead of discomfort, it's pain. I suspect it's related to my GERD.

I'll continue using the CPAP at a pressure that I can tolerate so that nobody can say I didn't try

[PeaceLoveAndPizza]

OThat is where I was going. GERD frequently causes loss of muscle tone in the lower esophageal sphincter. This allows air to enter the stomach. 

Worth getting checked out.