First night - aerophagia issues

[kanikami]

Hi all! I recently started with my first night of CPAP treatment using the AirSense 10 and the N30i mask.

I found I had terrible issues with swallowing air - just trying out the machine on the couch for an hour or so made me gassy. Similar things happened when I tried to sleep. I laid on my side with my head a bit elevated, but it felt like every time the pressure went up to a certain level the air was just going straight into my stomach. I ended up having some pain in the abdomen and even hours after waking up I'm still gassy. I also had some general psychological discomfort with the pressure but I'm sure that will get better over time - I'm mostly worried about the aerophagia.

Does anyone have any ideas of what to do here? I'll probably just try another night with the default settings for now, I suppose.

Attached are OSCAR screenshots of the little time I did spend with the machine. There's probably not much useful in there but I thought I'd attach them just in case.

Current settings are 6-14 for pressure, ramp off (it was originally auto but I turned it off partway through the night in an effort to help with the air swallowing). EPR is 3.

[Deborah K.]

Your pressure settings are not meeting your needs.  For now, I suggest you set your starting pressure at 8, as your median pressure is slightly over 8.  On your chart, you can see the quick, steep rise in pressure, showing that you need higher pressure.  For now leave your high-pressure setting where it is, although you will need more later, to allow you to adjust to the change and to avoid adding to the aerophagia.

Again, welcome, and good luck!  

[OpalRose]

I usually advise folk that experience painful Aerophagia to use Cpap mode.

Try a setting of 8cm with EPR set at 2. This should stabilize your breathing and still give you decent therapy.

Of course this is only one night we're looking at, but I don't see the need for higher pressures. Let's get the Aerophagia under control then take another look.

Summary:

Switch to CPAP Mode set at 8cm. The reason I suggest CPAP MODE is to limit the pressure swings. Although, there is also evidence that auto mode is preferable. If you stay with auto mode, a more narrow pressure range should be used.

Use EPR set at 2 for now. We may gauge your comfort and adjust accordingly.

I see Deb has responded. We're on the same page.

Question: Do you suffer with GERD? This can contribute greatly to Aerophagia. Also, try sleeping on your side with head slightly elevated.

[ArcherNeedsSleep]

Aerophagia is so challenging, and so painful!

You might play around with the algorithm on your PAP.  If it's a newer model, it should have a normal and a "for her" or "soft" response option, or something like that.  This setting doesn't impact the pressures - it just seems to change the sensitivity and speed of the pressure changes.  I found that they had an impact on aerophagia.

I also had success with the following things:

1) Mouth taping.  My aerophagia dropped in half, at least, when I started taping my mouth.  My breathing was also measurably better.  Basically, everything works better with mouth taping.

2) Getting the pressures right - too low is as bad (or worse than) too high.  When I felt air-starved, I gasped a lot, which caused more aerophagia.  When I got my lower pressure raised to the point where I always felt like I was getting enough in each breath, I relaxed and had fewer issues.  

3) Position.  On my left side I barely get any aerophagia.  On my right side, I'm almost guaranteed to wake up in pain from swallowing air.  On my back is 50/50.  So I sleep on my left side as much as possible.  How I lay on my pillow also has an impact, but it's harder to control, so I don't pay as much attention to it.

Unfortunately, it all comes down to experimentation as you go along.  But, it does seem to get better over time.  And the results are worth the effort.

[Sleepster]

I had aerophagia when I started CPAP therapy. The first thing they did was prescribe a BiPAP, which lowers the pressure on exhale. Your machine with EPR set at 3 is working as hard as it can to do this same thing, so I would recommend leaving it at 3 (sorry to be giving contradictory advice).

The next thing they did was lower the pressure.

Then I got myself an auto-adjusting BiPAP (actually it's a AirCurve, but that's just a different brand of bilevel, as is BiPAP). The auto-adjusting feature allows me to stay at a lower pressure until I fall into a deeper sleep level where more pressure is required.

Anyway, aerophagia tends to fade as you adapt, but meanwhile I would recommend lowering your pressure so that you don't have to suffer.

Lowering your pressure below what you need is far better than giving up because of the pain of aerophagia. Overwhelmingly, the chances are you will adapt and overcome this problem. Just don't give up because your life and your well being depend on it.

[kanikami]

Thanks everyone for your responses! Really appreciate the guidance.

I tried a few of the suggestions I received here - I went to 8cm min pressure, but it ended up feeling a bit uncomfortable so I brought it back down to 6, but with a lower maximum pressure of 12, and have been slowly ratcheting the minimum up since. I also switched to the For Her mode, and that seemed to help.

Last night it was at 6.8/12, and I was able to sleep with the machine on most of the night, but still with a decent amount of air swallowing. I've been sleeping on my side with my head a bit more elevated, and I'm going to try switching to the left side next. I will say that aerophagia aside the last night was pretty successful! I plan on trying a somewhat higher minimum pressure tonight, and possibly a lower maximum pressure, in order to get more of a handle on the aerophagia.

(Also, I don't have any particular issues with GERD that I am aware of.)

[Deborah K.]

Did you try OpalRose's suggestion to try Cpap mode, set at 8? That might help you. If you want to stay in Apap mode, try a small range of pressure, like 6.8 to 8, and see how that goes.

[Hmm888]

One thing I loved about the legacy Respironics Classic Remstar Pro APAP was it had a ramp setting as high as 4 hours. This was invaluable to me to get used to it and minimize my "challenges" with swallowing air.

[Sleepster]

I plan on trying a somewhat higher minimum pressure tonight, and possibly a lower maximum pressure, in order to get more of a handle on the aerophagia.

Comparing the chart from your first night to this one, note that your AHI is much reduced even at the lower pressure. This is why we never base decisions on a single night's data. This is especially true for a beginner because things change quickly at the beginning as your body and mind adapt to CPAP therapy. Lowering your pressure, even if it causes an increase in your AHI, is worth the trade off if you are suffering from aerophagia. Eventually the AHI will subside for the vast majority of us. Then you can slowly raise the pressure back up to lower your AHI, thus optimizing your therapy. Small adjustments and patience are the key to success. Congratulations to you, you seem to be getting off to a good start.

By the way, please read this article on how to organize your OSCAR charts here.