New to CPAP, awful aerophagia

[callamar75]

Thank you again. 

And I just want to explain that I get more sleep than that. When I sleep using the CPAP, I always reach a point where I wake up and feel like the mask is completely intolerable and I have to take it off. I always need to reach a full night of "regular" sleep afterwards. On the days where I use the CPAP I feel abnormally groggy and unrested during the entire next day, EXCEPT the one time that I had the setting at EPR 2 and min/max at 7.0. That's what I mean by "restful" -- Using it for even just two hours seems to have negative downstream effect on my entire next day, like grogginess and weird sinus pressure, except that one day. Particularly when the aerophagia was real bad, I felt like I had a hangover for two days. Since so far a little CPAP mostly feels bad, I worry that a lot will feel awful. I want to be compliant, I just worry it's doing more harm than good, and also my non-reasoning middle-of-the-night self just says "nope" at some point and takes it off.

[Sleeprider]

So what's holding you back from setting min/max pressure at 7.0 and EPR 2? Comfort is first, and minor issues like lower flow limitation are way off in the distance as goals.

[callamar75]

Oh well if it’s okay to have higher flow limitations, then that’s what I’ll do. I just don’t have a good sense yet of what is the most important thing to focus on — should it be number of apnea events, flow limitations, or how I feel the next day, etc? Initially the terrible aerophagia was priority number one by a mile, but you guys solved that pretty easily.

Thank you again for all the help.

[BoxcarPete]

The first two inform the third, but do not define it. For example, if you increase your pressure and make all obstructive events and flow limits go away but you are constantly waking up in the night to fart and burp, you will not feel better in the morning. Advice I give out freely but struggle with taking for myself is not to lose sight of all the factors that affect everyone like consistent sleep schedule and other good habits.

[callamar75]

Thank you. So far, sleeping with a CPAP is way less comfortable than sleeping without one — which means I’ve already decided it’s worth trading comfort for the sake of some numbers on a screen (at least that’s what it feels like at this point). I’m just putting faith in what doctors tell me about the numbers and their impact on my future health, and it’s hard to know when I should say the numbers are less important and comfort is more important. I’m envious of those people who try CPAP for the first time and wake up the next day a new person. 

And thank you for the reminder, I can definitely improve on my sleep habits. Also there are foods I know aren’t great for me to eat late in the evening and I should do a better job avoiding those.

[callamar75]

Yesterday I ran 13 miles and then slept 12 hours -- 6 with the CPAP and 6 without (as usual, "daytime me" was fully committed to wearing the CPAP all night, but "middle-of-the-night me" took it off).  I woke up this morning and my muscles feel freakishly well-recovered. It feels like I ran 4 miles yesterday, not 13. I'm wondering if that's a result of (a) sleeping 12 hours or (b) using the CPAP. 

Do other people experience faster muscle recovery from using the CPAP? 

My chart from last night is attached. 
   

[Sleeprider]

We can only speculate what your non-therapy sleep looks like, but this is excellent. Lactic acid is a normal byproduct of intense exercise, and lactic acidosis is a problem in the absence of good oxygenation. It is logical that better oxygenation (SpO2) in sleep would be healing. https://my.clevelandclinic.org/health/di...c-acidosis
https://journals.lww.com/acsm-msse/Fullt...se.16.aspx

[callamar75]

Thanks Sleeprider, that's interesting. I wonder if just watching TV for a few hours while wearing a CPAP on high pressure could make people's muscles recover faster -- it seems like a possibility from that study. 

Well I know it's best not to fiddle with settings too much but I'm an experimenter by nature so I've been fiddling. I had that amazing restorative sleep on Friday with fixed pressure 7 and EPR 2 but then on Saturday on the exact same settings I had a bad night of sleep. 

Last night I tried EPR 3 again, but this time at a fixed pressure of 8. I had tried EPR 3 before at a fixed pressure of 7, and I had a bad night of sleep. It felt bad again.

I also got a Contec pulse oximeter and I used it last night for the first time. I have a theory about why EPR 3 feels so bad for me. EPR 3 seems to increase my CAs, and it looks like sometimes when I have CAs, my oxygen drops. I know sometimes those CAs on the chart don't mean much, and not everyone's oxygen drops while they sleep, but maybe for me the increased CAs mean I'm getting less oxygen. What do you think?

[callamar75]

Oops, meant to attach OSCAR chart. 
   

[Sleeprider]

I agree the clustered CA events causes a lower SpO2. It doesn't quite fall to a level of concern, but it's something to minimize. We can take a look at a zoom of that event (3-minute zoom) and see how you got there. If you correlate EPR with centrals then maybe back off to EPR 2. Higher minimum pressure results in higher PEEP (positive end expiratory pressure) which is generally associated with greater oxygenation by increasing partial pressure of O2 for better perfusion and increased lung recruitment. Hopefully the CA events abate as you adapt to improved ventilation with CPAP. There are ways we can help reduce treatment emergent CA events, but they are kind of off-label, for example enhanced expiratory rebreathing space (EERS) https://www.apneaboard.com/wiki/index.ph...ace_(EERS) I don't think we need to worry about that for now.