cpap and apap not effictive

[Sleeprider]

In order to post more images, you can host them at another website like Imgur. This tutorial explains how. http://www.apneaboard.com/wiki/index.php...pnea_Board

[Ezil71]

[richb]

I have some more thoughts on your rather interesting breathing pattern. It looks like your inhalation is being limited by something and you are compensating with a larger exhale. I suspect that your stomach is so full of air that your diaphragm can't move any further cutting off your inhalation. The aerophagia is probably related to the strength of your esophageal sphincters. Here is a link to an article on aerophagia with some suggestions on how to reduce its severity. http://www.sleepreviewmag.com/2010/10/aerophagia/ I'm not sure that you can get much improvement in your AHI until you reduce the severity of the aerophagia. I'm sure there are other members of this forum who suffer from aerophagia related to cpap. I hope some will chime in with suggestions that were helpful to them.

[Sleeprider]

Good thoughts Rich...glad to see you in this thread. That sure beats my "weirdness" hypothesis.

I agree aerophagia is an overlying problem to the RDI/ OA that was found in his original Dx, which is again a rationale to keep pressure as low as possible while dealing with obstructive issues. It also explains the correlation of increased hypopnea to increased pressure, and time in therapy. The pressure builds as the night goes on, resulting in more events towards morning, or a break in therapy to relieve it.

[Ezil71]

Interesting article. I have tried multiple treatments for gerd, even though I have no other obvious symptoms. I gave up because everything I tried actually made me feel much worse.

I have no doubt that some of the odd patterns are from constant burping, but they look pretty regular, so the can't all be that.

I would also add that I grind my teeth and have a night guard.

[richb]

Interesting article. I have tried multiple treatments for gerd, even though I have no other obvious symptoms. I gave up because everything I tried actually made me feel much worse.

I have no doubt that some of the odd patterns are from constant burping, but they look pretty regular, so the can't all be that.

I would also add that I grind my teeth and have a night guard.

The odd pattern (that I see) is that nearly every breath you take when asleep has a cut off top. This means that you do not have a normal inhalation pattern. Your stomach is so full of air that you can't inhale fully. Take a look at all of the suggestions to reduce aerophagia. GERD is just one of the many problems that those with aerophagia suffer. If you can get the aerophagia under control, you might have better results with the cpap.

Rich

[Ezil71]

As an experiment I tried setting my machine to Apap 6/10 with cflex 3

No surprise I ended up maxing out at 10, but not as early as I would have thought.

Here are some screen shots:

https://1drv.ms/i/s!AgFs7hWqVGNflWa5lMJK-ZUunhgw

https://1drv.ms/i/s!AgFs7hWqVGNflWQWqfKcW73bEnIC

https://1drv.ms/i/s!AgFs7hWqVGNflWMfZnAU4y9R3PF4

https://1drv.ms/i/s!AgFs7hWqVGNflWfOoMSyNs1aU4qg

https://1drv.ms/i/s!AgFs7hWqVGNflWXC5ZgeWMQN7VMi

What I find interesting is that early in the night my pressure was down around 7-8, and it suddenly goes way up to 10 with some periodic breathing.

Thanks again for the help.

[Sleeprider]

I really don't see any benefit to you setting your machine on auto and letting the pressures climb. I would set minimum at 6, maximum at 6 and avoid all pressure fluctuations. While I suggested a bilevel before, a Resmed Autoset would give you EPR that could give you a fixed bilevel pressure of 6/4. If there is any way to borrow, rent or try one, it might have interesting results.

Your OA is not that severe, and I agree with Rich that later in the night you become so bloated with air, the machine perceives it as obstruction and increases pressure. This is probably counter-productive, and I'd keep pressure low. You are not having any problems with a pressure of 6 (perhaps less?) through most of the night.

[Ezil71]

I'll give that a shot tonight and see how it goes. Does flex play any role at that lower pressure? would it be better to have apap 6/6 or even just cpap 6 without the flex at 3? What is the difference between having apap with both numbers the same vs just cpap at that number?

[Sleeprider]

I can't predict how you will respond to no Flex vs using it. That is what we wanted to see. I have mostly observed that increases in pressure are associated with events, and the increased pressure does not appear to resolve those problems, and may make them worse. What I'm proposing is to quiet the machine down and see if it helps. This brilliant approach of mine is called trial and error.