Restarting CPAP treatment, looking for guidance

[croc]

Hi everyone,

This is my second time trying CPAP treatment. First time was in 2021, but I gave up due to aerophagia – the pain was so horrible for multiple hours in the morning that I could not possibly work. I had to return the device (ResMed AirSense 10 AutoSet) to my health care provider since we could not find a suitable combo of a mask and settings to bring the aerophagia down. I knew nothing about OSCAR back then. My AHI was ~15 in the sleep study, and I have positional apnea.

I have been using a mandibular advancement device (= mouth piece) for the last couple of months, but it has done very little to my symptoms. I still snore and wake up extremely tired. I know snoring does not mean one has apneas but the symptoms persist. I purchased my own AirSense 10 this May, and this time I'm trying to set up the treatment myself.

I have used the device on and off for two months now. I restarted the treatment with previous prescription settings (min. 7.0, max. 12.0, EPR 3), and this time around the aerophagia has been quite manageable. I feel like I wake up many times during the night, and I also dream a lot. Feels like I'm missing the deeper and more restorative sleep. Sometimes I spring up sitting feeling really disoriented, possibly from an apnea.

Symptoms:

- Extreme fatigue
- Anxiety, irritability, mood swings
- Falling asleep when driving
- Bad recovery from exercise
- GERD like symptoms
- Low T

This time I'm more committed to use the device every night. I have attached reports from the two previous nights. The first report shows I'm using a full face mask, but that was one night I accidentally changed it – I'm using the DreamWear Nasal Cushion.

All your help and support is greatly appreciated!

[Sleeprider]

Aerophagia is caused by air passing the lower esophageal sphincter into the esophagus. You are using your CPAP at a low pressure of 7.0 with EPR 3 which gives an exhale pressure of 4.0. You could change the maximum pressure to match the minimum pressure of 7.0 so that the pressure is constant and does not increase during the occasional OA event. Another approach would be fixed pressure at 6.0 with EPR 2 which would be 6.0/4.0 pressure and may help. Our objective in therapy is to use pressure that is low enough to reasonably control respiratory events and aerophagia so that they are not cause of sleep disruption. Effective CPAP therapy does not mean you will have good sleep if there are other causes for arousal and wakefulness. We can work on the positive pressure efficacy and minimize aerophagia to the extent possible, but you may also need to look beyond the therapy to find better sleep.

[croc]

Thank you Sleeprider for your response, much appreciated. Aerophagia has not been as big of an issue as it was during my first treatment period, but I will try your suggestions to see if it subsides or disappears completely. I seem to get multiple CA events per night. Is there something I can do to bring them down?

[Sleeprider]

I don't see your CA events as particularly alarming, but they nearly always reduce with less EPR. Try a setting of 2 and we can observe the CA response and whether it increases the flow limits.

[Rice95]

I’ve had good results with the Corflex cervical collar. I also have moderate apnea. It’s very comfortable. I put a breathable Velpau silk sleeve  over it and it feels great. 
Stay on your side. STAY ON YOUR SIDE. :-)
Back sleeping kills numbers. I’ve trained myself (for the most part) using foam wedges lodged behind me. Also lodge a pillow between your knees to keep your spine straight , coupled with a flat pillow. If your head is cocked out of alignment it cuts off the airway. Make sure the collar is tight enough so the chin can’t slip inside the collar, BUT NOT TOO TIGHT AROUND YOUR NECK ! :-)
Message me anytime

[croc]

Thanks again Sleeprider. I will try the fixed pressure of 6.0 with EPR set to 2 and share my results.

Much appreciated Rice95! I actually have a 3M Futuro cervical collar laying around somewhere, but I'm not sure if it's optimal for this kind of use. And yeah, I really should learn to sleep on my side. I try but somehow always end up on my back. I have tried to use a body pillow to keep me on my side, but I keep tossing it away when I'm asleep. Will look into getting one of those wedge pillows. Thanks again for your suggestions and kind words!

[Rice95]

Absolutely! Best to you in your cpap adventures! 
Yes ! You should give the wedge a try. Have one for each side so you don’t have to drag it over to the other side during the night when you turn over. :-)
Good luck !

[croc]

Here's my data from last night. I changed the pressure from auto 7.0-12.0 to a fixed 6.0 and dropped EPR down to 2. Don't feel a big difference compared to previous nights, maybe a little more tired. No aerophagia this morning. Thoughts?

[Sleeprider]

I don't see any difference in therapy efficacy between the original settings with 7-12 pressure EPR 3 and the current 6.0 fixed EPR 2. It's a comfort call.

[croc]

Thanks. I will continue using the fixed pressure for now since I had no aerophagia at all this morning. New settings did not seem to affect the CAs. Is there something else I can do for those?