[split] msavarese (Therapy Thread)

[msavarese]

I really appreciate this website, thread, all of the information, apologize for the long post and hoping someone can help.

First Sleep Study in August 2021, at home, AHI: 56.2.  I received a Resmed Airsense 10 on November 10 (pressures (p) 5/20, full face mask), felt like I wasn't getting enough air, called doctor and lower pressure increased to 8.  December 1, noticed my stomach distended, belching and severe passing gas.  Tried chin strap, started wearing a back brace to provide some exterior resistance for my stomach and sleeping on a wedge. Saw doctor December 10 and decreased pressures (p 5/12).  Still had side affects, started messaging doctor and adjusting pressures mid December.  On January 3, was awakened with severe pain in my abdomen (p 8/10) at 3 AM.  I found this website, started reading your blogs, adjusting/experimenting with pressures on my own and found pressures 6/8 with EPR 3 reduced the discomfort/Aerophagia symptoms diminished/not as painful.  Changed doctors, 2nd in-lab sleep study, prescribed BPAP (will not provide details of sleep study).  Received Luna G3 BPAP 25A last week, settings 4 EPAP/8 IPAP, using nose pillow, and still experiencing aerophagia with side effects slightly less uncomfortable then CPAP with settings of 6/8 with EPR 3.  Still wearing a back brace to provide some exterior resistance for my stomach and sleeping on a wedge.  Sleep quality was GREAT during the last 2 weeks of November and AHI 1.8 average!  Since then, sleep quality is going from good to bad and back again without any pattern that I can figure out.  AHI has been as high as 10+ and as low as 3+.  One thing I like about the new doctor is that she's not obsessed with an AHI under 5.  She and I agree that anything under 10 is better than 56.2.

Does anyone have any suggestions to eliminate my stomach/abdominal discomfort?

Thank you, Mike
PS: Loved "Oscar" with the Resmed Airsense 10 and looking for similar software for the Luna G3 BPAP 25A.  They have an app that doesn't impress me....

[msavarese]

Hello,
I find myself wondering if my message was posted since no one has replied in the last week or no one has any thoughts or am I too impatient?
Also, how do I change the machine information in my profile since I'm using a different machine?
Thank you, Mike

[Sleeprider]

msaverese, you would likely get more attention to your question with an Oscar detail chart. The feeling of not getting enough air, can easily be that pressure is too low. Your original pressure was 5-20 pressure in Autoset mode and did not seem to cause aerophagia. It appears your doctor changed pressure to 8.0, probably fixed pressure and this resulted in discomfort. The next change was 5-12 pressure, and you still had discomfort, however we don't know what pressures were actually experienced with those settings. Pressure of 8-10 also caused discomfort. You appear to have discovered EPR and set the pressure from 6.0 to 8.0 with EPR 3 which worked. You are now experiencing degradation of that success. This is where an Oscar chart comes in. Let's take a look at why there might be a problem. My suspicion is that you may be experiencing some chin-tucking due to sleeping on a wedge. This can cause the airway to be obstructed in a clustered pattern. Let's take a look.

[OpalRose]

There is no current OSCAR support for the Luna G3 BPAP 25A.  

If you still have your AirSense10, post a screenshot of one or two nights and maybe SleepRider can suggest settings for your Luna BPAP based on your A10 use.  

Here is a link to update the information in your profile:

http://www.apneaboard.com/forums/usercp....on=profile

[msavarese]

Thank you both for your replies! I have updated my profile with my current machine and associated parts.

The only "software" I have been able to find and am using is the 3B App, which only shows individual night data for Compliance Time (7:45 (+/-0:20)), P95 (4.0), Mean Pressure (4.0), AHI, CAI, and Leak Time. Over the last week, my AHI has been between 2.6 - 6.0, CAI has been between 0.6 - 2.0, and Leak Time has been between 00:02 - 00:36.

My current issue is having to gear-up for bed with the Back Brace, the wedge and the distinct discomfort in my belly that is no where near what it used to be, but still very present and noticeable in the morning.

Any help would be greatly appreciated.

Thank you, Mike

[msavarese]

It’s been a while and I thought I’d post an update including what I did to minimize the side effects of the Aerophagia that I experienced in hopes this will help someone else.

Overall story: Since my last post, my sleep doctor admitted that she didn’t know what else to do for me in May 2022.  I did more research and found a Pulmonologist who is also a Sleep Doctor.  I saw him in June and we both agreed that another manufacturers' BiPAP machine might have more sensitive hardware and software.  I had to fight with the Medical Supply Company over a long period of time to get it, finally got a Resmed AirCurve 10 about a month ago and my side effects have diminished significantly!  No more distended abdomen, painful cramps in my lower abdomen and just a little burping in the morning.

Bottom line and what I did: I started with using an under the nose mask and setting the EPAP as low as it will go (Luna’s lowest setting is 4 cm H2O and the Resmed AirCurve 10’s lowest setting is 3 cm H2O).  Then, I’ve been lowering my IPAP pressure as my body adapted.  What I mean by that is that when my AHI was consistently 3 or lower for several days, I would lower the IPAP setting 1 step at a time.  What I mean by step is that the Luna BPAP reduces pressure .5 cm H2O at a time and the Resmed AirCurve 10 reduces pressure .2 cm H2O at a time.  When I stared using the Luna G3 BPAP 25A , in March 2022, my settings were EPAP 4.0 and IPAP 8.0 cmH2O.  When I stopped using the Luna BPAP, January 17 2023, my settings were EPAP 4.0 and IPAP 5.5 cmH2O.  When I stared using the Resmed AirCurve 10 on January 18 2023, my settings were EPAP 3.0 and IPAP 5.6 (cmH2O).  My settings today are EPAP 3.0 IPAP 4.0 (cmH2O).  

What I’ve learned:
1. My observation of the AirCurve 10 is that it is very smooth and intuitive when shifting between inhale and exhale compared to the Luna which enabled my body to acclimate to the new settings very rapidly compared to the Luna.  I worked with Tech Support at Luna and adjusted it as best we could and it still was nowhere near as smooth as the Resmed.
2. I learned that the stuffy nose symptom can be related to having the humidity set too high.
3. The doctors that I’ve worked with have focused on pushing drugs to reduce or eliminate the symptom/side effect and do not naturally look around to see what could be the cause of the symptom/side effect.

Hoping this helps someone.

Mike

---

Sorry, I forgot to note that with the settings at EPAP 3.0 IPAP 4.0 (cmH2O), my AHI was 3.2

[Sleeprider]

Hi Mike. Glad to hear it's going better. I didn't even realize the Vauto could be set to EPAP 3, IPAP 4. It seems you aerophagia dictates a low pressure. If you ever want to post an OSCAR chart, we can try to help interpret for you.

[msavarese]

I don't have the words in my vocabulary to effectively describe or express my deeply heartfelt appreciation for this venue and those of you who have posted your experiences and advice here. It has helped me learn more than I ever wanted to know and what I needed to know about Sleep Apnea that enabled me to take charge of my therapy and have a significant positive outcome!

THANK YOU!!! THANK YOU!!! THANK YOU!!! Mike.

[Sleeprider]

Mark, my signature has links to tutorials that instruct how to organize an Oscar chart http://www.apneaboard.com/wiki/index.php...ganization
and how to attach files, including image attachments http://www.apneaboard.com/wiki/index.php...pnea_Board

There is so much we can learn about your therapy from Oscar, and we can help you to use that information to improve your results. We advocate comfort first because sleep quality is ultimately what we are trying to achieve, but if we can reduce events and still keep pressure below your aerophagia threshold, that would be nice. It's going to be a challenge with these very low pressures. Thanks for your words of appreciation. It's the only pay volunteers here get.

[msavarese]

Thanks for the info. I didn't think you wanted my personal info posted. I'll post when I get some time to play with the settings, probably later in the week.
Thank you, Mike