[Treatment] Five months in, things still aren't much better

[manacles]

I've been on CPAP for about 5 months now and I still have a lot of problems. Currently using the Vitera full face mask, and though I have no issues falling asleep I can't seem to get any good treatment. I've been having aerophagia, drooling, early waking up as well as waking up periodically through the night, and sharp increases in heart rate while asleep. I had previously been on 5-15 with no EPR but recently changed it to 10-15 with EPR of 3 to help with the heart rate and aerophagia issues, but aside from my heart rate becoming more normal, things don't feel that much better (aerophagia is still pretty bad). I've posted some OSCAR graphs and would greatly appreciate any advice on what I could try, thanks.

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A few more days, can also add additional screenshots or zooms

[Sleepster]

It looks to me like you might need to upgrade to the AirCurve VAUTO. This will allow you to raise the pressure support above your current EPR setting of 3, helping with the aerophagia.

As a temporary alternative you can try lowering your maximum pressure. Your OA index will likely go up, but if it goes up only a little and it reduces the aerophagia then it may be worth it. As we adapt aerophagia tends to subside, then you might be able to raise the pressure back up.

A mistake people make is in thinking that their adaptation period represents how crappy the rest of their life will be if they continue CPAP therapy. But we do adapt and it is worth it because it will make you feel better and live longer.

[Dormeo]

I agree 100% with Sleepster. You need to get more comfortable, which means taming the aerophagia. Your pressures go up largely in response to flow limitations, and those increases aren't going to help much with the FLs.

So I'd suggest setting your max to 12 to see whether that helps. Give it a few nights before you assess it. If you're still having aerophagia, the next step could be to lower both min and max, e.g., with a range of 8 - 10.

As Sleepster suggests, once you find settings that get rid of the aerophagia, you can tiptoe back up if you're seeing an increase of obstructive events. If aerophagia re-appears at any point, you back off, then try going up a little after a month or so. It's a way of finding the sweet spot, where events are controlled but the aerophagia isn't bothering you.

[manacles]

I'm an idiot who forgot about this post but will try to keep updating. I've tried decreasing the max pressure a few times but it doesn't seem to have much of an effect on aerophagia while pretty significantly increasing my AHI, so I've been sticking with 8-12 for the most part. I still get some pretty severe aerophagia though but I'm not sure what else I can do. I've also started tracking oximetry with the Viatom O2ring but the data seem to be all over the place, I don't know what to make of it. Overall, I still wake up a couple times per night, sleep 10+ hours a day, and still feel extremely groggy in the morning so I still think I've got a lot to work on. Here's my latest OSCAR session, would greatly appreciate any advice.

[Dormeo]

I'd be curious what would happen if you raised your minimum to 9 and lowered your maximum to 11. The higher minimum might head off some OAs; as you can see, some of your OAs come when your pressure has dropped way down. The lower max might reduce aerophagia as time goes by, though I realize it didn't help you right away (sigh).

Your O2 looks fine to me. A downward short spike may just mean the ring lost contact briefly. In any event, your O2 levels stay comfortably above 90, which is where you want them to be.

There seems to be considerable variation in the time you go to bed. It might be helpful to you to set more regular times for going to bed and getting up. And I might also suggest that you try paring down the 10 hours to 9. Sometimes long nights translate to groggy days.

[Sleepster]

I think you will need to switch to bi-level therapy, which will essentially allow you to raise EPR above 3. For example, the AirCurve VAUTO. I would schedule an appt with your doctor to discuss the aerophagia.

[manacles]

I've been trying 9-11 for a few weeks now and I still am getting aerophagia, is there anything else I can try? I've been trying to find a sleep doctor but I've been moving around a lot lately, will try to get an appointment

[Lucid]

Hi, manacles  I'm just struck by how high your heart rate is getting.  That can't be restful.  Did your sleep study mention anything about heart rate?

[Dormeo]

To Lucid: I'm not seeing a graph for heart rate. Am I missing something?

To manacles: Why don't you try max = min = 9 and see whether the aerophagia abates. If it does, you can gradually increase the max just until aerophagia reappears, then back it down just a notch. I've seen people say that a pressure difference as small as .2 can be the difference for them between having aerophagia and not having it.

This experiment may cause your FLs and OAs to increase. If they increase dramatically, then try min = 9 and max = 10 to see what happens.

[Lucid]

Hi, Dormeo  Pulse rate is on the third image, in red.  

The O2 ring measures pulse rate and movement, as well as O2.