So frustrated

[always_tired]

I have an S9 Elite.

[always_tired]

I have an S9 Elite. The machine's been tested and it's fine. I'm normal on all other health measures - T, hormones, thyroid, etc. My main complaint is that it makes my stomach hurt. In 2015 we did an experiment. I saw my Neurologist. Complained of two persistent pains: my voicebox/throat and my stomach. He said go see GI. I saw a GI Dr. I took a PPI for a year. No change in stomach pain or voice box. No evidence of reflux of any kind via scope. Stopped the PPI after a year. One night on a red eye back from San Francisco (Feb '16) I impulse bought that SnoreRX. I slept w/o CPAP for a few months and felt great - stomach wise. The bloating went away, I didn't wake up in pain, etc. But over time I began to get tired. So then I went back to the GI and a new sleep doctor, since my old DR left the state. The GI said, well it sounds like it's the CPAP that's causing your discomfort. I agree. I'm me and I know that it's the CPAP. So I experimented with pressures. Anything above about a 6 or 7 hurts my stomach. My AHIs are better with lower pressure (they are <1). Anyway, I'm happy with my mandibular advancement device (MAD) and using a lower pressure. It's the falling asleep part that's annoying.

So back to my original issue - the CPAP does have a constant pressure. But when I have the EPR turned on there is still this slight pulsing I guess you can call it. It's fairly rapid. Like 3-4 little pushes of air per second. So what I don't like about the CPAP is that it opens up all my soft tissues, but then within a few minutes i start feeling a reverse burp, and then as I'm trying to fall alseep I relax and breathe more slowly - but I come back out of that because it feels like its pressuring me to NOT breathe. Oh, and one more thing. After sleeping for a bit, after I go through all of the above for about an hour, I'll occasionally wake up because the CPAP air is coming out of my mouth. And that's definitely on higher pressures - 8 or above.

So maybe I'll try the ramp, I've never used it. I'll let you know how it goes.

One other thing, I had a sleep endoscopy about a month ago and a turbinate reduction - which has been fantastic. According to the ENT, I collapse from front to back, not side to side, and it's primarily my tongue. I may go the route of doing the Inspire Sleep electric stimulation thing. The downside is I could never get an MRI if I needed one - and in my mind that's big downside. But, given that I'm in sales, I'm also pretty darn tired of having to travel with my machine.

[always_tired]

Here's a data dump

Google Drive spreadsheet

[always_tired]

Here's last night. I got new CPAP supplies day before yesterday. I still need to adjust my mask a bit. The strap came loose.

Screen Shot

[Sleeprider]

You are currently using your CPAP at a pressure of 8 and EPR at 3, for pressure of 8/5. The pulsing you sense is the FOT (forced oscillation technique) that Resmed uses to determine if an apnea is central or obstructive. While many of us never notice this pulsing, some people are very sensitive to it, and there are threads on the forum that reflect that http://www.apneaboard.com/forums/Thread-...uffing-Air

Most of your events are central in nature, and you don't have a need for more pressure than you are currently using. So a pressure of 8 appears to be sufficient, and you may be able to use an even lower pressure, if you also reduce EPR on a 1 for 1 basis as you reduce pressure. In other words, CPAP pressure of 7 with EPR at 2, CPAP pressure of 6 with EPR at 1. Lower pressure should help with aerophagia, but at some point you may see additional OA occur.

What you need to realize, is that when you feel the pulsing, all you have to do is to move air, and an exhale will work as well as inhale to stop it. During the transition to sleep you are experiencing a pause in your breathing. This is not unusual, and we might be able to reduce the frequency of this happening by reducing the EPR. The machine is not trying to make you take a breath, it is simply "sounding" whether your breathing pause is central or obstructive.

You are sensitive to FOT, so my recommendation is that you turn down pressure to the minimum that will stop obstructive apnea, and also turn off EPR. I would suggest a pressure of 7 with no EPR, and if you feel like air is getting into your stomach, try 6.0 pressure. By turning off EPR, you may have fewer sleep transition apnea, and therefore less FOT disruptions. Now that you know what it is, you can take action to stop it...breath.

[always_tired]

Thank you for such a thoughtful reply. I've used 6 pretty happily because the FOT is less noticeable and the EPR is very comfortable and I get no stomach pain. Also, for most of the year on 6 my AHIs were very good if not perfect. I like the idea of turning off the EPR because it's not that hard to exhale against. And I like the idea of a pressure of 7. 6-7 has always seemed to produce the best report metrics.

And thanks to others for the machine recommendations. Honestly, I'm not a huge fan of this machine because it seems like the technology is dated if you ask me. Then again, I sell IOT, AI, and machine learning algorithms so...

[Sleeprider]

There are some machines that do not provide detailed AHI data, and therefore do not use the FOT or pressure pulse (used by Respironics). These machines tend to be inexpensive. The new Resmed Airstart has the same pressure and EPR you are accustomed to, but because it does not provide detailed efficacy data, it probably does not have the FOT algorithm. At the same time it is relatively cheap. Just a thought.

BTW, if you zoom into some of your events and look at mask pressure or flow rate, you should see the high frequency FOT pressure pulses.