[CPAP] Just can't get this to work

[LeeWB3]

Hoping maybe some of you experts can give me some advice.

I've been using CPAP treatment for probably 15 years.  When they've tested me I have been in the 30-42 range for events.

About 4 years ago I lost an S9 that absolutely worked wonders.  I never had problems with it and felt it worked great.  They replaced it with an S10 and I've had problems ever since.  I'll start with saying I definitely believe I improved my experience somewhat by turning off the EPR, but it is still FAR from right....

I used to sleep on my back and did quite well with that with the S9.  With the S10 I cannot sleep on my back at all.  I am now sleeping on my side and Sleephead and the built-in analysis of events say I'm doing great - like over the last month: AHI-1.0, Obstructive-0.14, Hypopnea-0.43, CA-0.43 and RERA-0.22. 

However, I do NOT feel like it's working well at all!  I definitely think I'm swallowing a ton of air.  And this eventually leads me to stop breathing.  I.e. I get to where my throat is kinda locked up and I kinda have to reverse swallow to burp a bit to clear my throat and take a breath.  That goes on for a while, breath after breath until I can't quite clear my throat.  I've also woken up numerous times feeling like I cannot make myself take that next breath - not like things are obstructed but that I don't even know how to make my chest move to bring it in.  That feeling has lasted from seconds to well over a minute (AFTER waking up).  I've spoken with my supplier and even a sleep expert at a major Atlanta hospital about it, but everyone thinks my numbers are too good for there to be an actual problem, but I'm miserable with this.  I feel like I'm gonna suffocate every single night.

I've currently got the machine down at 7.6 and ramping it to 8 over 15 minutes.  No EPR with a max of 14 (the max it hit over the last month was 13.8).  When I first put the mask on it feels like barely enough pressure, like my breathing is VERY slightly restricted.  But, over a fairly short period of time, I get to feeling like it's pushing air into my stomach and I start fighting with it and the air swallowing starts.  Shortly after I manage to fall asleep I KNOW I'm continuing to fight it and burping and stuff, but the waveforms from those periods look like absolutely nothing's wrong and I've climbed out of bed when it was happening to go look.  During deeper sleep the machine varies as needed and my Average Pressure is 10.61 and 90% Pressure is 11.96.  I do believe I need those kinda pressures when I'm in deeper sleep, but the air swallowing before I reach those deeper levels is brutal.

What else can I do?!  I'm really getting afraid to go to sleep.

Any suggestions on a direction to go?

[Gideon]

From an aerophadia point of view EPR should help you. Since the EPAP is working for you, and EPAP is fundamental in treating OA, increase your min pressure by the amount of EPR applied. This is because your average pressure is typically lower.

If you think of this as a BiLevel where PS gives you a pressure boost on inhale. But with EPR you have to play with your settings a bit to get this.

so start small
EPR = 1 Fulltime
Min = Current Min + 1
Max = Current Max +1

Normally I would leave your Min and Max and set EPR = 1

Also please give us Screenshots as we really like to see the data.

[Sleeprider]

I assume you have tried EPR, but if not then, it has helped other members with aerophagia to better tolerate the therapy. Let's get a chart with OSCAR and see what your settings and results are on a daily details chart. We often work with members to find a compromise between lower pressure, AHI and aerophagia comfort. Show us a chart and perhaps we can help.

[LeeWB3]

I have tried EPR.  I think it makes it much worse.  I don't know if it's even possible, but it feels like a fair number of my apnea events occur when I am exhaling.  The pressure being lower during exhale seems to make my waking, gasping for air happen more often and there is no air in my lungs to exhale.  Other things I've tried:  Switching from a full-face mask to a nasal only mask, stopping using a prescribed bite guard that is supposed to help with sleep apnea, using Xylimelt tablets to keep mouth wetter, lowering max pressure from 17 to 14, adding melatonin, and adding nasal spray.  Note that going from a full-face mask to a nasal mask also necessitated lowering initial pressure from 9 down to 7 because the 9 was just WAY too strong.

Last night, after posting, I lowered my minimum pressure slightly, lowered my starting pressure (pre-ramp) slightly, extended the length of the ramp, and switched to the "Soft" response curve.  I did not experience nearly the issues I've been having and had a couple of dreams that I remembered for probably the first time in 3 months.  But, that's just one night so it's hardly certain I've done all I can/should.

I have attached the recommended OSCAR charts from last night and two previous nights that are pretty representative of what I've been doing for the last 3+ months.

On either the 5 or 6th I KNOW I had breathing problems (can't remember which of those two days).  Yet the charts don't seem to reflect it.  Even when zoomed in and looking at them immediately upon getting up (in the middle of the night while it was occurring) I don't see anomalies in the breathing patterns which I KNOW were going on.  That has caused me to wonder if the machine is working correctly because of this and because while using an older, full-face mask it would not turn itself off VERY often and even with the new nasal-only mask it occasionally just keeps blowing after I take it off....  That might not mean a thing, but KNOWING I'm having breathing problems and not seeing anything in the waveforms makes you look for other weird things...