[Diagnosis] Reasons to BPAP, over CPAP

[WakeUpTime]

The decision to be in BPAP vs. CPAP seems to be a decision that's made by a doctor as a way of getting greater comfort and therefore more compliance with the PAP therapy.

Does anyone know of the specific factors that are considered to having a doctor recommend a BPAP machine over a regular CPAP machine?

[Sleepster]

Mine was prescribed for aerophagia. My son's was prescribed because, I presume, his pressure is so high.

The other reason is when patients can't tolerate breathing out against the CPAP pressure during their sleep study.

[WakeUpTime]

Mine was prescribed for aerophagia. My son's was prescribed because, I presume, his pressure is so high. The other reason is when patients can't tolerate breathing out against the CPAP pressure during their sleep study.

I read your use of the word "aerophagia". I'm wondering if I have something similar, or if it's just a byproduct of using CPAP.
[I awake each morning with a ballooned stretched out stomach and have painful stomach cramps (and exiting air). I don't have problems during the night, but only when getting out of bed.]

It would seem to make sense that BPAP might help if it helps the air exit the body too. Yes?

Regarding your son having apnea, I read a book on Kindle about CPAP recently. The author, a doctor, said there's a strong hereditary link of sleep apnea. I have a kid whose bedroom walls shake when she sleeps. I've read though that it's not just snoring but the silent periods that make for "sleep apnea". I just am having trouble in hearing whether they are silent (not breathing) or quietly breathing. Something else I'll have to look into. My kid has extreme difficulty concentrating, remembering and staying focused at school. (Sounds like possible results of sleep apnea.)

[me50]

The decision to be in BPAP vs. CPAP seems to be a decision that's made by a doctor as a way of getting greater comfort and therefore more compliance with the PAP therapy.

Does anyone know of the specific factors that are considered to having a doctor recommend a BPAP machine over a regular CPAP machine?

if you google medicare guidelines for cpap to bpap you can find the info that explains it. Also I think Resmed (whose website I have been getting errors on for 2 days when I try to access it) and Respironics has the info on their website

[me50]

Mine was prescribed for aerophagia. My son's was prescribed because, I presume, his pressure is so high. The other reason is when patients can't tolerate breathing out against the CPAP pressure during their sleep study.

I read your use of the word "aerophagia". I'm wondering if I have something similar, or if it's just a byproduct of using CPAP.
[I awake each morning with a ballooned stretched out stomach and have painful stomach cramps (and exiting air). I don't have problems during the night, but only when getting out of bed.]

It would seem to make sense that BPAP might help if it helps the air exit the body too. Yes?

Regarding your son having apnea, I read a book on Kindle about CPAP recently. The author, a doctor, said there's a strong hereditary link of sleep apnea. I have a kid whose bedroom walls shake when she sleeps. I've read though that it's not just snoring but the silent periods that make for "sleep apnea". I just am having trouble in hearing whether they are silent (not breathing) or quietly breathing. Something else I'll have to look into. My kid has extreme difficulty concentrating, remembering and staying focused at school. (Sounds like possible results of sleep apnea.)

record her while she sleeps

[Sleepster]

I read your use of the word "aerophagia". I'm wondering if I have something similar, or if it's just a byproduct of using CPAP.

Yup, that's aerophagia, and it is caused by the CPAP machine.

http://www.apneaboard.com/wiki/index.php...Aerophagia

It would seem to make sense that BPAP might help if it helps the air exit the body too. Yes?

It's the air pressure leaking into your stomach. A BiPAP lowers the pressure when you exhale, which helps. Lowering the pressure on a CPAP machine helps, too, but that can make your apnea worse.

Talk to your doctor about it.

My kid has extreme difficulty concentrating, remembering and staying focused at school. (Sounds like possible results of sleep apnea.)

Yes it does. I see a sleep study in his future. Many times this can be corrected with a tonsillectomy. Many times you can find a good ENT who also treats sleep apnea.

[WakeUpTime]

It's the air pressure leaking into your stomach. A BiPAP lowers the pressure when you exhale, which helps. Lowering the pressure on a CPAP machine helps, too, but that can make your apnea worse. Talk to your doctor about it.

Sleep Dr. is not so good. A month to get an appt. Seven minute meetings. A pat on the back with "stick with it and all those things may go away".

I read in your wiki link (many thanks) that Aerophagia may go away with changing sleeping positions. Did you try all those variations first, before settling on a BPAP machine? Lowering a CPAP pressure will probably just cause my OSA to come back. Need 12 to keep OSA away.

I've still got that persistent CSA issue. It's right on the line at 5/hour which just barely meets the requirements for an CSA style BPAP-SV machine. I'm hoping that goes away, in that I'm only two months into CPAP.

Didn't I read somewhere that even a regular BPAP (not BPAP-SV machine) does help in little bit with CSA too?

[Sleepster]

I read in your wiki link (many thanks) that Aerophagia may go away with changing sleeping positions. Did you try all those variations first, before settling on a BPAP machine?

Yes, and even after they switched me to a BiPAP the aerophagia persisted. It helped, but it's no magic bullet. It does subside as you adapt to CPAP therapy, though.

Lowering a CPAP pressure will probably just cause my OSA to come back. Need 12 to keep OSA away.

Lowering your pressure may raise your AHI because it may increase the number of OA's or hypopneas.

I've still got that persistent CSA issue. It's right on the line at 5/hour which just barely meets the requirements for an CSA style BPAP-SV machine. I'm hoping that goes away, in that I'm only two months into CPAP.

Didn't I read somewhere that even a regular BPAP (not BPAP-SV machine) does help in little bit with CSA too?

No. In fact, what happened to me was that my CA index went up when they switched me to BiPAP. It was up around 17! And there's more to it than just the AHI or the CA index. You need to look at how long the events last. You could have 5 episodes in an hour, each lasting only 10 seconds, and your index would be 5. Or you could have one episode lasting 2 minutes and you'd have an index of 1. I looked at mine and they lasted between 10 and 16 seconds, with most of them lasting barely more than 10 seconds. Keep in mind that if you stop breathing for 9 seconds it doesn't show up as an event. This business is more qualitative and less quantitative than many people realize. As they say, don't get too hung up on the numbers!

I later learned that an elevated CA index when switching to a BiPAP is a documented effect.

What my doctor did then was lower the pressure a bit, which helped lower the CA index and it helped with aerophagia.

I'll go over the whole history because it may help you get some perspective.

I started at a CPAP pressure of 13. Two weeks later the doctor switched me to a BiPAP at 13/8. That did help a little bit with the aerophagia, but it caused my AHI to go up around 17, mostly because of the CA index.

Then they lowered the lowered the pressure to 11/8, but because I still had a AHI over 5 on some nights at that pressure, I talked them into lowering it to 10/7. By this time the aerophagia had disappeared. Partly, I figure, because of the lower pressure, and partly because of the BiPAP.

It was at this point that I started tweaking the pressure settings on my own. I never changed it by more than 0.5, and I rarely changed it more often than once a month.

What I learned is that if I have the pressure too low my OA's and hyponeas increase, and if I have it too high I get aerophagia, although nowhere nearly as bad as when I was a newbie.

At one point I was at a CPAP pressure of 11 because I wanted to see if I really needed a BiPAP. I figured that if I ever had to buy a new machine it would be less expensive if all I really needed was a CPAP machine.

A CPAP pressure of 11 was ok for me in that it kept my AHI below 5, but my goal was to get it as low as possible. I found that if I raised it above 11 I started swallowing air again.

Now I have it in BiPAP mode at 12/9 and I stopped tinkering about 3 months ago. Last time I checked my AHI is averaging 1.2 for both the last month and the last week.

My advice to you is to leave your machine pressure where it is and look at the trends using SleepyHead. Your AHI is just barely above 5 and due mostly to CA's. Your aerophagia symptoms are not bothering you too much. If you see no change for a period of a month, try lowering your pressure by 0.5 and see what happens during the next month.

[herbm]

If your sleep doc is not good, try to find another one. You don't list your location so we can't know what stupid health care system you might be stuck with, and even in the US a lot might depend on your insurance carrier.

Aerophagia is COMMON but should not be considered NORMAL. It's common side effect of CPAP but you should not just have to tolerate it long term.

In addition to positions and changing machines, you might just work to train yourself to avoid it.

Although, I don't have a problem, it is quite easy for me to demonstrate myself how the situation occurs.

If I let pressurized air into my mouth and swallow under that increased pressure the air will go down my esophagus and if not burped up would eventually start distending my stomach etc.

It is sort of like swallow air (as kids due to burp) but MUCH easier since that increased pressure helps it along.

If you feel yourself swallowing air while asleep, try to burp it up.

Notice the feeling of that, and start training yourself to AVOID that while awake, e.g., to feel that this is "not good" so that your unconscious will try to maintain this protection while you are asleep as well.

Somethings just can't be controlled this way by some people, but many can with practice. These are NOT fully autonomic actions so we have some control while awake and MAY have some while sleeping.

When your cheeks are all puffed out with air from mouth breathing (or whatever), it might even FEEL NATURAL so swallow.

We are so used to a "full feeling in mouth means time to swallow" that is is almost automatic.

When you initiate a swallow, a complex series of related muscular activities happen in your throat to move the contents of your mouth into your stomach. (Wikipedia on Swallowing is far more complicated than most people would guess.)

One of the reasons that I don't have aerophagia might be that my nasal mask doesn't require air in my mouth and I don't allow air there much since I am able to keep my mouth closed and blocked even while sleeping.

On occasion, I will yawn or something and let air into my mouth and I notice a DISTINCT TENDENCY (not a requirement) to swallow that air when my cheeks were puffed out.

Consciously, I overrode this while awake and since my mouth stays closed off during sleep this effect just doesn't occur (much) *for me*. YMMV

[WakeUpTime]

One of the reasons that I don't have aerophagia might be that my nasal mask doesn't require air in my mouth and I don't allow air there much since I am able to keep my mouth closed and blocked even while sleeping.

I'm on a FFM now, and my mouth does open throughout the night -- hence, perhaps, the morning stomach cramps. (I can't burp to save my life; ironic because I came from a line of massive burpers.)

Previous to the full face mask, I had a nasal mask with a chin strap. The chin strap had to be on extremely tight to keep my mouth shut. My nostrils aren't so big and, at half the pressure that I'm at now, my nose massively dried out.

It was the Dr.'s idea to then use a FFM instead. A contributing problem could be a big overbite. I wonder, can a chin strap be worn along with a full face mask???

I'll always wonder if the bloated stomach is a short-term thing, given that I've only been on CPAP for 2 months. Or, should I get into a BPAP machine to solve that problem.