New diagnosis and new to CPAP

[PeaceLoveAndPizza]

If you look at the 02:36 zoom you can see the arousal breath, which likely is from movement (no reduction in air/flow limitation). It is then followed by a reduction in air volume, followed by a recovery breaths around 02:37:50 and 02:38:00. The first is nothing, the second are RERAs.

The one zoomed at 01:23ish is a RERA. Reduction in air volume with accompanying flow limitation, recovery breath, then resumption of normal breathing. 

What I see supports my thinking from yesterday that you need to use more pressure. I don’t think it is much, but you need to work on tolerating higher pressure to try and keep those RERA beasties at bay.

[obstructiveindividual]

Thank you that is really helpful

I am finding the aerophagia tough however and have gas and discomfort throughout the day plus some burping overnight

Am happy to drive up the pressure but am wondering:

1. Is aerophagia something that will likely pass with time?

2. I have read that APAP reactive increases in pressure can result in air swallowing so am wondering if I just try continuous pressures as I uptitrate

3. Equally have heard getting a bipap machine and increasing the difference between IPAP and EPAP can also help aerophagia

Would be grateful for some thoughts whilst I try and increase my pressures

Thanks

[PeaceLoveAndPizza]

Based on my understanding of aerophagia from personal experience and reading various articles and posts…

1. Yes, it passes in time assuming proper pressure and good practices are followed. 
2. It does that for some, not for others. I personally get aerophagia with pressure changes, so I use a fixed bilevel pressure. Others have no issues with it, so it varies from person to person.
3. I don’t know about bilevel and a larger pressure differential making it better. I’ll leave it to others more experienced to answer.

What I do know from my own experience is when I have had aerophagia, it invariably comes from me fighting the machine instead of breathing with it. Once I settle down, relax, and breathe along, things get better. 

I was taught at the SleepRider school of CPAP, so think everyone should start on a bilevel. The absurdity of having to jump through hoops whilst feeling like a dogs breakfast is silly. It is only software separating APAP from bilevel, so why not just use the bilevel? 

Don’t get me started on how totally bonkers health care systems are…

[obstructiveindividual]

Thank you for clarifying those things

I have an AirSense 10 so I can mimic bilevel to a certain extent with the EPR up to 3

Tonight I will try raising but fixing the pressure at 8 (with EPR on at 3) and see how things go!

I guess I should prioritise the RERAs and hope the aerophagia catches up once settings are stabilised?

Thanks for all the help so far

[obstructiveindividual]

So I experimented with a flat pressure of 8 with an EPR of 3

In general I have found this much better re aerophagia but now need to try and work out whether the pressure is enough
Based on my previous 95% indications I imagine likely it is not although my AHI score itself remains low

I have included the OSCAR chart but am not dialled in enough yet to pick out the RERAs myself
Happy to expand any part of the chart that might be useful

My current plan is to try to go up to 8.6 tonight
Would be grateful for any insight and whether this seems like a sensible plan

Thanks

[Deborah K.]

You were mostly between 8 and 10 when you were set to a range of pressure, so I think raising your static pressure is a good idea.

[obstructiveindividual]

Thank you

Have climbed to 8.6 and will try 9.2 tonight

What should I be looking for re "normal"? Have been looking online but can't seem to find what a gold standard night's sleep looks like!
On last nights trace 01:45 to 02:30 looks very uniform - should I be hoping for a whole night that looks roughly similar?

Happy to continue uptitrating the pressure

Thanks

[PeaceLoveAndPizza]

The secret to the gold standard night sleep, is that there is no secret, nor gold standard. Any sleep where you wake up feeling refreshed is the goal. If that means you have a high AHI and flow limitations that look like a mountain range, that is fine. It is all about sleep quality.

We would like to see a nice smooth flow rate graph and nicely rounded waveforms, but that is aspirational. Some get there, some do not. But it does not mean we do not get a good nights rest.

Don’t chase numbers, chase quality sleep.

[obstructiveindividual]

That makes sense - thank you
Have still not had a morning yet where wake up feeling refreshed unfortunately 

Am curious to hear what conclusions - if any - can be drawn by the escalation of pressures across the last 3 nights charts

Seem to have had a couple more than usual clear airway events last night which I understand can happen with increasing pressures and can often self resolve

Should I continue to increase? Should I pause here? Should I drop back down a bit?

Thanks

[PeaceLoveAndPizza]

You are well into the fine-tuning part of CPAP adjustments. From a visual review, the 9.8 is the best from an arousal reduction perspective. Each progressive increase looks to be slowly bringing down the arousals, so a few more slight bumps should be the tell.

If you are up to it, continue to slowly increase the pressure a few more nights. Give it two to three nights for each bump going forward to give each change a chance. Keep an eye on the flow rate and see if the spikes/arousals are being reduced.

Don’t go higher than 12, for now at least. If things fall apart, then drop back to the previous pressure. Once you find that point and have dropped back, you can try it again to see if it was an anomaly or is the real breaking point. If you find one morning you are right as rain, then stop there for a few nights to see if it continues.

No rocket science to this phase. Just need to use some plain good old Hobbit sense…