[Treatment] seeing mostly clear airway, aerophagia

[ElusiveRisk]

I've been using my machine for a week and I've mostly been seeing Clear Airway (CA) events and I'm not exactly sure what to do (if anything). I've seen other threads attribute this problem to the pressure being too high, but my pressure is relatively low and it doesn't seem strongly correlated to pressure to my eyes. What could be causing this, or is this normal?

In my original sleep study I mostly had hypopneas with an overall AHI of 9, but my AHI in REM was 17 leading to frequent awakenings. Only 0.8 central apneas/hour. 

Not sure if it's related, but I've also been struggling a lot with aerophagia, hence enabling EPR and dropping my pressure from my originally prescribed 4-10 cmH2O.

[Gideon]

Welcome to the forum

A couple of issues, first your flow limits are high but we will get to them later.
Your min pressure is too low, so
Set your min pressure = 7
Your EPR is too high because of the central so we will step it down
Set EPR=2 (we may go to 1 tomorrow.

Try this and post tomorrow.

[ElusiveRisk]

OK, so EPR=2, pressure=7-8

What's wrong with the flow limits?

[ElusiveRisk]

Attached is last night Oscar data with the settings you recommended (EPR=2, pressure=7-8). I experienced a lot more aerophagia and it has been somewhat uncomfortable. 

I'll also note that I didn't fall asleep until around 0:45.

EDIT: I should also note that on Friday night I had an AHI below 1 with my old settings (EPR=3, pressure=4-8) but I'm not really sure what was different about that night. I also didn't experience very much aerophagia.

[ElusiveRisk]

I have been struggling with my APAP because I am swallowing A LOT of air. Some nights I wake up after ~4 hours and my belly is so uncomfortable I just sleep without using the APAP. Lots of intestinal pain immediately after use and unbelievable amounts of burping/gas for hours.

Normally the recommendation is to turn the pressure down, but when I do that my AHI tends to go up. See my prior thread. 

Are there other options for fixing this issue?

[Gideon]

Please keep your therapy threads together.
I'll get a moderator to merge them.
Decrease pressure and AHI goes up.  Which part of AHI and how much?
Set EPR = 3 and that will reduce your exhale pressure to 4-5 range.  Increasing EPR is one of the tools at your disposal to reduce effective pressure.

in resolving aerophagia we allow for higher AHI in favor of comfort and eventually, and slowly increase pressures back to a therapeutic range.
Try the EPR= 3, if that doesn`t sufficiently resolve the aerophagia reduce the Max pressure to 7.  If that doesn't work we reduce max pressure again say to 6. Note that now we are at very low pressures for any adult.

[ElusiveRisk]

Sorry and thank you about the thread thing. 

I'll go back to EPR=3, pressure=6-8, and if that doesn't work decrease max pressure. 

Which part of AHI and how much?

Almost always "clear airway", I've seen it as high as 6, but it's usually 3-5. Sometimes it's very low, though, I've seen it drop down to 1. My diagnosis is OSA and so I don't know what all these CA events are. 

Note that now we are at very low pressures for any adult.

I should note that I am relatively slim, with a BMI of 18.7, and I'm pretty much in a constant fight to keep my weight up. I also don't have any muscle tone.

[Gideon]

So no OA or H, Any RERA? Per your description you should be on an ASV, that is unless the amount of CA is not enough to justify an ASV.

[ElusiveRisk]

OA is almost always 0. H usually 0.2-0.5. RERA 0-0.5. 

Never considered an ASV, I am still waiting to talk to my doctor.

[Gideon]

I don't think you have enough CA to justify an ASV