[Diagnosis] Reasons to BPAP, over CPAP

[WakeUpTime]

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.

I'll have to watch the duration of those CA events. From memory, they don't last that long. From Sleepyhead, I think they were 10-20 seconds.).

The aerophagia is pretty painful upon wakeup, but it goes away after 30 minutes or so. With a BPAP, isn't it still a good thing to help get rid of that "old air" more quickly anyway? Though with PR C+flex, I think that helps to get rid of air anyway.

That's crazy about CA events rising when going to a regular (non-SV) BPAP. Wow. I thought the opposite would be true.

[pdeli]

Initially my aerophagia was really disruptive and prolonged. Now not so much (when it occurs).

My question is whether this is an IPAP or and EPAP issue. Maybe both?

Does the mask make a difference? I'm now using a nasal mask, but still periodically get air in my stomach.

Phil

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I should add that it seems to be more of an IPAP issue, but if EPAP is too high, that could push air back,

[Sleepster]

My question is whether this is an IPAP or and EPAP issue. Maybe both?

Both. The higher the pressure the more likely it is you'll swallow air. Lowering the pressure (CPAP pressure, IPAP pressure, or EPAP pressure) will reduce that likelihood.

The problem with lowering the CPAP or IPAP pressure is that it will increase the number of obstructive events and hypopneas.

If you have exhalation pressure relief, set that at the highest possible setting.

[pdeli]

That was quite helpful, but EPAP - how does that impact things?

Phil

[Sleepster]

That was quite helpful, but EPAP - how does that impact things?

EPAP is simply the pressure during the exhale. If it's pressure that's causing your aerophagia (and it is) then any opportunity to lower the pressure will reduce that cause.

Unfortunately, it does induce in some patients CPAP-induced central apnea. Not really an issue as central apneas are no worse for you than obstructive apneas. Plus, like aerophagia, it tends to subside with time.

Lowering the pressure is the solution for CPAP-induced central apnea, but that's a tricky business because it also increases obstructive apneas and hypopneas. Lowering the pressure helps with the aerophagia, too.

By the way, it seems my aerophagia pattern is similar to yours. Like you, I had it much worse at first. Now it's just an occasional nuisance.

[APAAW]

<snip>
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've recently found myself awakening too often with my mouth about as wide open as it could get, at least while the FFM stayed on. Accompanying these wakes were dry mouth and increased aerophagia.

I tried a chin strap over my Quattro headgear. The chin strap seems to reduce these issues for me, and it also helps stabilize the FFM so leak rates over the course of the night are lower as well. Also, for whatever reason, when half-asleep it's harder for me to get the chin strap (a Respironics with Velcro at the top of my head) off than just the FFM, so it reduces my propensity to pull my FFM off in the middle of the night.

I'm sure not recommending the combination for initial comfort (or style!), but I do typically end up sleeping better and longer with it. Your Mileage Will Almost Certainly Vary

[pdeli]

I guess what I'm trying to determine is if min EPAP settings actually impact aerophagia.

I'm trying to get a picture here, and I think you're saying that increasing IPAP will likely increase likelihood on more stomach air. But does a change in min EPAP make any difference?

It seems to me that higher IPAP is more likely to push air into the mouth and subsequently into my stomach. Does a higher EPAP add to that problem? I'm just trying to understand the pressures at play here.

Or how about this: will an otherwise "normal" or "Safe" IPAP result in aerophagia if the EPAP is too high?

Phil

[eviltim]

Mine was prescribed because I slept very little during my study. Just as well as exhaling into higher pressure does seem to bother me.

[Sleepster]

But does a change in min EPAP make any difference?

The EPAP is lower than the IPAP, so if the IPAP is not high enough to cause aerophagia then the EPAP won't be, either.

Like I said, the magic CPAP pressure of 11 is all I can handle before I start swallowing air. Like, at 11.5 I get gassy at least some nights.

I was titrated at 13 cmH2O.

So, what a BiPAP does for me is allow me to run a IPAP of 12 and EPAP of 9. This has my AHI at 1.2, on average for the last week and month. That's a record low average for me!

My leak rate stays good as long as I keep my chin strap not-loose.

I feel like I'm in the groove after over 2 years of practice.

[WakeUpTime]

the magic CPAP pressure of 11 is all I can handle before I start swallowing air. Like, at 11.5 I get gassy at least some nights. I was titrated at 13 cmH2O. So, what a BiPAP does for me is allow me to run a IPAP of 12 and EPAP of 9.

If the IPAP is set to 12, doesn't it get to 12 many times (to prevent OSA) and therefore cause excessive air build-up for you?
Would it not be better for your EPAP to be set to 11.5 or 11?

Regarding the EPAP pressure of 9, wouldn't a lower # cause more exhaust air (we start to sound like car engines) to get out, reducing the chances of air entering the stomach?

But does a change in min EPAP make any difference? It seems to me that higher IPAP is more likely to push air into the mouth and subsequently into my stomach. Does a higher EPAP add to that

I'm not a BPAP user YET, but I would think definitely YES to your assumptions. Higher IPAP increases stomach air. Higher EPAP too increases stomach air because it's approaching a consistent pressure level like a regular CPAP machine.

What I'm really curious about (BPAP users, please weigh-in) why wouldn't one want the IPAP/EPAP spread to be GREATER, therefore causing as much exhaust air to get out of the body??? I.e. What is the downside of a much lower EPAP (exhaust air) number?