When to increase pressure

[archangle]

Alas, most anti-gas pills won't do a thing (ovol is my fave for that) - they are to minimize gases from digestion and not air swallowing - so no luck there. I wish it would work, coz I also suffer from swallowing a ton of air, leaving me bloated during the day and even creating reflux, but there is nothing on the market that I know of that will work.

the only thing I have seen work a little bit is to burp yourself like a baby does when you get up in the morning - it relieves some of the air bloating.....

Ovol and the other simeticone anti gas pills reduce the foaming action and make it easier to burp it up. They don't actually prevent gas from forming, they just help you let it out. I don't know if CPAP swallowed air gets foamy, so it might or might not help.

[GaryG]

So don't take them lightly and unless clearly written on the prescription, don't take near the sleeping hour.

Just a comment. The antidepressant I take has a side effect of making me drowsy, which actually helps me go to sleep. But to each his/her own.

[Shastzi]

If the gas gets trapped in a painful way I just take Malox Plus.

[Sleepster]

I'm considering raising the pressure to be the range of 14 - 20. My AHI is great (6 months' is 1.48).

Is that AHI dominated by any one particular index?

For example, if the CA index is by far the biggest part of that 1.48, I would not raise the pressure. On the contrary, I would tend to think that the APAP is running away on you and setting itself at too high of a pressure.

Do you have any comfort issues with the pressure where it's at now? I think I recall you saying in the past (with your other machine) that you had some temporary aerophagia when the doc first raised your pressure?

[Sleepster]

After all I think they would "prevent" gas ahead of time, and in the morning, well its too late,

Medications designed to prevent the formation of gas are not going to help. Your body is not forming the gas. It's being pumped into your stomach by the CPAP machine. It's literally blowing up your stomach like a balloon.

So yeah, I'll probably increase my minimum at some point, but this aerophagia thing - will it go away?

Yes, it will go away on its own. Meanwhile you can drink carbonated drinks or take alka seltzer. Exercise also helps.

There are two opposing theories on body position. One is to keep your head and neck aligned so that the CPAP air can easily enter your lungs and thus avoid entering your stomach. You would try things like a wedge to keep your head and neck aligned.

The other theory, the one that worked for me, is to keep the neck bent. This pinches off the passage way to your stomach preventing the CPAP air from getting through. I slept on my side with my chin tucked against my chest.

Try this test. Take a sip of water, but don't swallow it. Tuck your chin against your chest and see if you can then swallow it. My anatomy is such that I cannot swallow with my neck bent this way. This is the reason, I think, that this strategy worked for me.

The doctor switched me to a BiPAP because of this aerophogia, which didn't seem to help at first, but as I said it eventually went away. The other thing that helped was that he also had to lower my pressure after the initial switch to BiPAP because it bumped my CA index up to around 17.

[PaulaO2]

I'm considering raising the pressure to be the range of 14 - 20. My AHI is great (6 months' is 1.48).

Is that AHI dominated by any one particular index?

For example, if the CA index is by far the biggest part of that 1.48, I would not raise the pressure. On the contrary, I would tend to think that the APAP is running away on you and setting itself at too high of a pressure.

Do you have any comfort issues with the pressure where it's at now? I think I recall you saying in the past (with your other machine) that you had some temporary aerophagia when the doc first raised your pressure?

Interesting way to look at it!

It is mostly the OA events that are increasing, although there is a slight rise in CA events but only from like, .5 to .7. The hypopneas aren't increasing in number, just in length of time. The OAs are getting longer, too. For example, last night's 19 OA events, 9 of them were 15sec or longer. Prior, they were all less than 13, usually just 10 or 11.

Last night my AHI was over 3. It's only been over 3 about 5 times total.

Starting on Jan 7th: (AHI and 95%/Max)
.91 - 16.74/16.98
1.79 - 15.86/16.98
1.24 - 16.24/16.89
*2.79 - 16.24/16.80
2.53 - 16.38/16.96
2.96 - 16.16/16.83
3.01 - 16.44/16.91

(*first night w/ new med)

And no, surprisingly, I never had the air issues with the Autoset like I did with previous changes. I was ready for it, but nothing. I think because it changes vs being a sudden 2 point increase and staying there.

And, just in case anyone is just dying to know, I had my Wellbutrin cut in half and added Lexapro. It is a good idea to switch anti-depressants every 2-3yrs because the brain figures out how to work around it. This is my first switch in over 3 yrs. It needed changing.

   

[Sleepster]

Looks to me like this is an effect of the medication. Which I think is temporary. That is, once your body adjusts to the new medications I think your AHI will drop back down. Let's be rational here, we're not talking about a large increase in AHI. I doubt it's even significant.

Since you're clearly spending a lot of your time near the upper range and you're not experiencing any discomfort, you could raise both the min and max pressures. You might want to wait and see what happens during the next couple of weeks before you do that.

[GaryG]

After all I think they would "prevent" gas ahead of time, and in the morning, well its too late,

Medications designed to prevent the formation of gas are not going to help. Your body is not forming the gas. It's being pumped into your stomach by the CPAP machine. It's literally blowing up your stomach like a balloon.

So yeah, I'll probably increase my minimum at some point, but this aerophagia thing - will it go away?

Yes, it will go away on its own. Meanwhile you can drink carbonated drinks or take alka seltzer. Exercise also helps.

There are two opposing theories on body position. One is to keep your head and neck aligned so that the CPAP air can easily enter your lungs and thus avoid entering your stomach. You would try things like a wedge to keep your head and neck aligned.

The other theory, the one that worked for me, is to keep the neck bent. This pinches off the passage way to your stomach preventing the CPAP air from getting through. I slept on my side with my chin tucked against my chest.

Try this test. Take a sip of water, but don't swallow it. Tuck your chin against your chest and see if you can then swallow it. My anatomy is such that I cannot swallow with my neck bent this way. This is the reason, I think, that this strategy worked for me.

Thanks for the thoughtful reply. I tried the sip test and I was able to swallow. As long as I know it will go away, the discomfort is not terrible.

[PaulaO2]

Thought I'd give an update.

The AHI has maintained between 2.4 and just under 4. Two nights it was below 1 but I think that was a fluke.

The central events have decreased in number as well as length of events. The hypopneas have remained fairly long, with several being over twenty seconds. The number of obstructive events have not dropped which is where the high AHI is coming from. They've slowly been decreasing in length per event but not in count.

The tiredness has decreased and I'm a tad less depressed so the medication is working at least.

However, I continue to have a 95% between 16.5 and 16.98. Once it reported 17. I am considering bumping the top number for ten days to see how it goes. I may raise it to 20 to see where I settle.

My pain levels have been high due to the weather so between that and the increased pain meds, I'm surprised the AHI leveled off.

[DocWils]

Okay, Paula, i am relived to hear of the stabilisation. Keep on top of it and let us know, but this is encouraging. You should be aware that your med does have as a possible side effect some respiratory depression, which could be manifesting right now, but usually with time that will level out - usually over a six to eight week adjustment period.