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CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems
Hi everyone, I've been on CPAP since March 2022 and have been dealing with issues from it for the entire time. Mainly, I have pretty severe aerophagia, and will wake up very gassy, often at least 3 times a night. Usually my first wake up is after about 4-5 hours of sleep and I will wake up about every hour or two after. It definitely has a very bad effect on my sleep, and I will often sleep a total of 9+ hours a night without feeling rested at all. Trying to wake up earlier just causes bad headaches (rightsided) and I'll need a nap later. Even at low pressures, such as 6-7, I can still feel the air being forced into my esophagus while laying awake in bed, causing me to immediately burp it up. This issue in particular I've never heard or read about anywhere, aerophagia while awake, and I'm wondering if it's caused by something else or if anyone has any idea of why it's happening.
In addition, I wear an Apple watch during my sleep and the heart rate tracker will often show that my average heart rate actually increases in my sleep, going to ~90 bpm while sleeping even though my resting heart rate 50's-60's. So my three main issues are aerophagia, frequent wakings, and high heart rates and I'm not sure what the order of causality is or how to tackle these issues.
Over the past year, I've been experimenting with different CPAP settings, such as constant pressures ~6 or APAP between 5 and 10, but the problems remained. My initial prescription was 5-15 but those max pressures were much too high for me. I recently met with a new sleep doctor who suggested I do APAP from 5-7 but even that is still causing the same issues. I've attached the last few days of OSCAR data on these pressure settings if anyone can provide some advice. Even though my AHI values are apparently low there seems to be something going wrong for me. I also have an O2Ring though I haven't worn it in a few weeks.
RE: CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems
I think I came across a breakthrough recently with my therapy. I found a thread online about someone who had similar issues with very severe aerophagia even low pressures, with the same story of the air forcing open their esophagus. They were able to resolve it by simply applying external pressure to their throat just below their adam's apple. Apparently it may be due to a condition called silent reflux. As someone who gets sore throats and coughs after eating in addition to my CPAP troubles I wonder if I may have that myself. I tried applying pressure using a soft collar and for the past week my aerophagia is pretty much gone.
In addition, I am now able to raise my max pressures to my original prescription values (5-15) with no aerophagia problems, and my average sleeping hr's are within the 60's-70's, which is still slightly higher than my resting HR but much much better now. I've also found that sleeping on my right side works better than my left, which seems to contrast with others dealing with reflux/aerophagia. I still wake up once or twice a night but that's also a big improvement, and generally feel more energized during the day.
I'm always looking to make improvements and adjustments, and I've posted my last night's data with oximetry if anyone has advice. I was a bit concerned about those disturbances between 2-4 am and wonder what those could be in particular.
I wear it just tight enough to where I can feel it touching the bottom of my throat and it's enough to keep me from swallowing air. I actually wear mine upside down to what's recommended by the manufacturer as I find it conform with my neck better
There's also a device called the reflux band that is unfortunately no longer sold, but can be pretty simply improvised. I've seen people swear by it for aerophagia
08-13-2023, 04:15 PM (This post was last modified: 08-13-2023, 04:29 PM by manacles.)
RE: CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems
It seems that my aerophagia problems are still resolved for now, but I'm still having other issues, mainly with waking up multiple times a night and getting a strange feeling in my chest, like my heart was beating very fast. I've been wearing an o2ring and it does show some periods of elevated heart rate, though my averages are decently in the 60-70s range. However, I will have moments sometimes where I will wake up feeling very short of breath and be gasping for breath in the morning, I'll feel like I'm not breathing enough air and I have to really breathe very deeply. My mouth will also be hanging open and I'm unable to close it (even though i normally breathe through my nose). I don't know what's causing it and not sure how to address it, considering my SpO2 and AHI values are very good. Does anyone else have similar experiences or advice? Would increasing min pressure be of any help?
I have been tinkering with my therapy as well and started to see RERAs crop up here & there when I was on APAP min 10, max 16. Turns out, the CPAPs do not detect them well and aren't the best at compensating for them either. I switched to CPAP at 14 and titrated myself up to 16 based upon the results and so far have cut my pulse change events down considerably. Consider this, most of the heart rate spikes are arousals so your sleep is severely fragmented - for comparison, on my bad nights I was seeing 300 pulse change events in 8hrs and you're 4x that. Unfortunately aerophagia is more prevalent with CPAP so you're going to have to test & tune a bit but it's worth a shot. If I were you I'd start at 10cmH20 and review the results (or post them here) - if you run into aerophagia on constant pressure you can add EPR to lower the exhaust pressure making it easier to breathe out. Ideally you'd find the lowest constant pressure that keeps your obstructive events at bay and hopefully lowers your pulse change events as well.
08-16-2023, 02:10 PM (This post was last modified: 08-16-2023, 02:10 PM by manacles.)
RE: CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems
Been trying 10cm and it might be too high for me right now, I've gotten some pretty severe aerophagia and disturbed sleep. I'll try EPR 1-2 and see if it helps, or would it be better to just decrease my pressure?
08-16-2023, 05:14 PM (This post was last modified: 08-16-2023, 05:14 PM by manacles.)
RE: CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems
Just realized I posted the wrong chart. Also i just noticed that my pulse change events can be configured and I wasn't sure I should change the cutoff, and I was also wondering what pulse ox others were using.
RE: CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems
Unfortunately, the option you found in Preferences is not functional. This is a holdover from SleepyHead that as never implemented. The next OSCAR release will have text stating it is not operative. Since I haven't found any useful information using the Pulse Change (PC) and SpO2 Desaturation (SD) events, I turn them off to avoid clutter.
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