New to CPAP, awful aerophagia

[callamar75]

Hello, I'm new to CPAP and am having a really bad time with it. I was diagnosed by an at-home test with mild apnea (I think 13 AHIs), with several drops in oxygen. I just started using a Resmed Autosense 10 Card-to-Cloud with a p30i mask. 

On my first night I kept waking up due to a horrible pain in my abdomen, like someone was giving a rug-burn to my intestines. When I took off the mask I started burping like crazy. I tried falling asleep a few more times but each time I would suddenly wake up from pain and I would take the mask off and burp like crazy. I stopped using the CPAP that night and got 8 more hours of sleep but still felt horrible the next day. I googled my symptoms and found out about aerophagia, which was a side effect I didn't know about. 

My pressure was originally set from 4cm to 20cm with no EPR and with a ramp. Based on some posts I read here, I changed the pressure to 5cm to 15cm with an EPR of 1 and no ramp. 

The second night of trying CPAP was last night. Not long after falling asleep I woke up in a state of panic from a dream that someone was shoving a hose down my throat and forcefully pumping air into my stomach. I had pain in my stomach and intestines and the worst smelling gas you could imagine (and lots of it). I took off the CPAP and slept 8 more hours, yet I still feel horrible today, like I have a hangover.

Does anyone have any suggestions? Would it be safe to go way lower on my pressure, like say min 5cm to max 7cm, with a higher EPR of 2 or 3? 

I've been practicing using the mask during the day with a low pressure. Would it help to practice while awake using the max pressure?

Thank you so much. 
       

[OpalRose]

To tame Aerophagia, you'll need to start over.

Keep your machine in Auto Mode with minimum pressure set at 7cm and max pressure set at 7cm. This would be the same as if using Cpap mode, but Cpap mode won't show flow limitations. Auto mode will report Flow Limitations which we need to lower by using EPR.

Try this for a night or two. If you still experience Aerophagia, then we'll lower the pressure. If not, we can raise it slowly until you find that sweet spot. (No Aerophagia and low Apneas).

Auto mode 7min-7max.

Set EPR to 2.

[callamar75]

Thank you so, so much!

[BoxcarPete]

For what it's worth, I've used my airsense C2C in CPAP mode quite a bit and it always reported FLs as normal. Only time it doesn't in my experience is during ramp.

I agree that the settings suggested are a good place to start, and min/max being the same will be the same behavior as CPAP mode.

[callamar75]

Okay I took one night's break from the CPAP and then for last night I changed my min and max to 7.0 and EPR to 2.0 (I messed around with the settings a little to feel the differences, but settled on what was recommended). 

I slept for an hour and a half and then woke up suddenly. I have no idea what woke me up. My mouth was open but I don't remember feeling any rush of air coming out or anything. It took me about 45 minutes to fall back asleep. I slept for about 3 hours more with the CPAP until I woke up suddenly around 4 am. I don't know what woke me up. Both times I woke up my stomach hurt a little bit from the aerophagia, but it was tolerable and nothing compared to the first two excruciating nights. I took off the CPAP after that.

What should I try next? The aerophagia is bearable on these settings, so does that mean I should increase the pressure? Or should I try to go lower to see if that eliminates it completely? Or should I stay at this pressure for a little longer to get more data?

Also, what causes the frequent nighttime waking while using the CPAP? Waking up in the night is normal for me, but it's usually because I have to pee, and I fall asleep pretty quickly afterwards. (The sleep doctor said that peeing is one of the body's ways of dealing with the low O2/excess CO2 in the blood from the hypopnias.) But last night there was no need to pee and no major pain -- I just woke up.

Thank you!
   

[Sleeprider]

You had no obstruction with the pressure at 7.0, Epr 2 so we can go to EPR 3 to help reduce the expiratory pressure and remaining flow limitations at 95% index of 0.12. That is still a lot of flow limitation which can cause respiratory effort related arousals (RERA), and the EPR will help with that. You can see the flow limits were pretty high just before that arousal. Your therapy has come a long way already, and you should just build on that success. Your leak rate was remarkably low, so even with your mouth open, you were still blocking the pressure from your mouth. That's great.

It only affects the on-screen features for your CPAP, but change the Essentials setting from On to Plus.

[OpalRose]

As long as you didn't experience pain, leave the min-max at 7cm, but change the EPR to 3.
Your 95% flow limitation is high and would like to see it below .05.

[callamar75]

Thank you so much. You have no idea how much better I feel hearing that. After the first couple of tries with the CPAP I was ready to quit, scary as all the downstream consequences of apnea are, so it's such a relief to know that things are going well. Thank goodness for this forum and all the kind-hearted helpers on it.

I will test out tonight with EPR 3 and I'll put the essentials on plus.

---

Thank you so much. I appreciate this so much.

[callamar75]

Hello again. Here is my data from the last two nights. Both nights were with EPR set at 3. The first night the pressure was 7.0 min to 7.0 max, and the next night I tried it at 7.2 min to 7.2 max. Neither night felt very restful. 

Most nights before I take the mask off, I wake up feeling like I'm struggling with something having to do with my breathing. Five seconds later I can't remember exactly what it was -- all I can remember is that it was unpleasant. I have trouble falling asleep unless I'm on my stomach, and I move and rotate a lot during the night but usually by the mornings I wake up on my back. I'm wondering if maybe when I get to the point in the night when I turn to my back I need more pressure, and that's what that struggle feeling is. I assume that's where the auto pressure would normally come in if I had a higher max. 

The best night so far, as far as how restful it felt to me, was at 7.0 with EPR 2, but that gave me a 95% flow limit of 0.12. I don't understand how pressure affects flow limits -- would it make sense to try EPR 2 but with a lower pressure of like 6.8? Or would EPR 3 with a higher min/max help? I'm still nervous about the aerophagia but willing to test out higher pressures. 

Here are my OSCAR charts. Thank you again.

3/12 - Min 7.0 Max 7.0 - EPR 3 -- AHI 2.38 - 95% Flow Limit 0.04
   

3/13 - Min 7.2 Max 7.2 - EPR 3 -- AHI 0.36 - 95% Flow Limit 0.09
   

[Sleeprider]

Feeling rested with 1:45 to 2.5 hours of sleep is not going to happen. You really need to stick with this and push therapy at least over 4-hours, and preferably over 7-hours. We can look at some zoomed images of your flow rate to see if there is something there, but if you feel under-ventilated, maybe a higher pressure will help as long as we don't trigger your aerophagia threshold.