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I started the Sleep Diary because I was changing my settings on a near daily basis trying to find a happy medium between restful sleep and minimal aerophagia. Shortly thereafter I saw a recommendation to turn off EPR and I've stuck with it because it reduced the aerophagia symptoms substantially. Not enough data to support a trend yet, but I'm hopeful I'll get some good insights down the road
Regarding Flow Limitations, I hadn't considered what that data was depicting. After reading the wiki and a bit of googling, it's essentially indicating that my airway isn't fully open and I'm experiencing mini-arousals? If that's the case, would it be better to make a gradual pressure increase to try to improve maintaining an open airway? How would re-introducing EPR help with reducing FLs?
Fyi, I'm referencing the attached table from the Wiki.
The relationship of FL being diminished by EPR, or on a bilevel the pressure support, it's due to the pressure differential between exhale and inhale. The inhale pressure has that increase bump, a power boost if you will. Then it should help exhale by the reduction as well for added comfort.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I'll reintroduce EPR to 1 tonight and cross my fingers that the aerophagia remains minimal. Is it worth adjusting pressure upwards, or should I leave it at 7.6?
11-20-2024, 05:10 PM (This post was last modified: 11-20-2024, 05:10 PM by SarcasticDave94.)
RE: OSCAR Result Interpretation & Clear Airways
Not certain honestly. Maybe just add EPR and check OSCAR stats. Unless therapy feels "off" in the night. Then you may bump it up.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Unfortunately I had a rough go last night.. I attempted the p10 mask, but felt like I couldn't get a decent seal and was distracted by how noisy it was. Ended up switching back to the n30i, but unfortunately that didn't feel right either after adjusting the straps numerous times.
Changes made from previous night:
Mode: CPAP
Pressure: 7.6 --> 8.2
EPR: 0 --> 1
While the upper bound of my flow limitations declined, I had more aerophagia and leaks. I felt like I was in and out of sleep all night because I was so gassy, and I ultimately threw in the towel at 4:30am and went mask-less.
Today I'm exhausted, fighting a headache, and feeling discouraged. Any recommendations for tonight?
Continuation of the above comment as I'd like to receive feedback on a wacky idea...
Going into the way back machine when I first started using my APAP, my Lofta prescription gave the overly broad range of 4 - 20cm. If I go back and look at some of my early days when I still had APAP on, my average pressures were quite low hovering around 5 - 6. Flow limit looks pretty good, too. Shortly thereafter, however, I initiated this thread seeking advice on how to improve and transitioned to a minimum of 7, max of 12.
All that said, now that I know that aerophagia is really a problem for me at ranges above 7.6 with EPR>1, is it worth dialing back my pressure to maybe 6.4 - 6.8 with EPR at 1 to see what happens?
When I look at the attached screenshots, I can't discern whether the pressure changes were a reaction to or a cause of flow limitations, but even at the low pressure settings OAs were minimal.
That said, from everything I've read on here, it seems crazy that a middle-aged adult male would respond well to such low pressure.
Anything seems possible within the realm of Apnea treatment. No harm no foul if you dare to experiment. Give it a go next session while being at the ready to edit it again if it should go off the rails.
Keep in mind the Min pressure and EPR relation of minimum that allows EPR to work unhindered.
Min pressure 5 EPR 1
Min pressure 6 EPR 2
Min pressure 7 EPR 3
That minimum pressure and above for each of the 3 lines will ensure EPR works fully from the therapy start.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
EPR is probably not contributing to aerophagia, since it lowers your pressure during exhale and thus lowers your average pressure over the night. So as Dave says, go ahead and experiment.
Me, I'd suggest min = max = 6, with EPR of 2. That's a nice low pressure that should help with aerophagia, and some EPR for the flow limitations. (Much lower than 6, many people feel a bit air-starved when they inhale.)
Thanks so much for the feedback. I made a few adjustments close to what you all suggested, and despite two challenging nights, I've got reason for optimism.
My FLs were much improved both nights, yet I wouldn't say either night was a good night. I'm starting to think the n30i isn't a great mask for me. I'm a side sleeper, thus one side of the air flow conduit is always blocked when my face is against the pillow. I realize the airflow reroutes to the other side, but for some reason it still feels like I'm not getting as much airflow as when I'm on my back. I've ordered a n20 and will try that out. I had no aerophagia on the 21st, which was great.
Last night my aerophagia was back, but I don't think it was a result of the slight bump in pressure or EPR. Despite the mouth tape, when I woke up a few times I could tell I was totally slack-jawed. I'm not sure how to address that or if that's a root cause of any of my troubles. I've tried over the counter mandibular devices, but they were awful. Chin straps look like they actively pull the jaw backwards. Not sure if a soft cervical collar would provide any benefit.
Any thoughts or guidance from this community would be greatly appreciated! Screenshots below..
The EPR of 3 really cleaned your FLs up. Your leaks are fine unless they wake you up. As for the sagging jaw and aerophagia, I'd suggest you go ahead and try a soft cervical collar, which can help to keep your jaw in place.
There's no reason to try to raise your pressure above 7, so I'd suggest leaving it there. That might help a bit with aerophagia. You could also drop it a little lower, though then you'd lose some of your EPR boost.
You're having what might be sleep-transition central apneas. Very common, and nothing to worry about. I mention that only to encourage you to bracket those events as you think about how you're doing.
Are you unable to sleep longer than you do? Or is that something you could work on?
