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Stomach fills with air

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brunnerhome +0 points · 10 months ago Original Poster

I have an AHI of 17.5 measured at an in-facility sleep study. The report shows no sleep at pressures 3, 4, 5, 6, or 7, and then 3 minutes of sleep at 9. The sleep study showed that I slept for 54 minutes with 25.9% REM when the CPAP was set at 11 so that is what they set up for me to use at home. I think I was awake during the study - I was aware of the mask continually leaking. I have read that people think they do NOT sleep during the sleep study but the equipment shows that they are sleeping. I think I was just laying still and the equipment detected sleep. How does the equipment differentiate between wake and sleep?

The report also shows no use of a bilevel machine. I know that the technician tried a bilevel machine and it was hard to synchronize my breathing with it. Is it standard for a technician to use a bilevel machine and then not include that in the report if the person did not tolerate it very well? Maybe I got someone else's report.

So far I have not been able to tolerate the equipment. I am trying it in the daytime and at night. I have tried a ResMed 10 set at 4-20 and couldn't get it up to adequate pressure to breathe. I feel like I am suffocating. Now I have a Phillips Dreamstation set on 11. I have tried different masks. I have tried it with and without the ramp. I breathe through my mouth and the nasal pillows and partial masks don't seem to work. I have a beard and it is hard to get a seal. Most recently, using the full mask with the straps on tight enough to stop the leaks, it filled my stomach with air making it so I was unable to breathe. It took 30-60 minutes to recover from that and be able to breathe normally. I tried a PureSleep dental appliance and it makes me gag. I am not sure what to do next. I have a call in to Pulmonology and to the CPAP supplier's respiratory therapist. Maybe I am just not going to be able to tolerate this.

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Sierra +0 points · 10 months ago Sleep Patron

A few points to consider.

  1. The titration test using different pressures is to determine how much pressure you need to stop the obstructive apnea events. It is not about making you sleep.
  2. A BiLevel machine is typically only used if the APAP cannot provide enough pressure, i.e. more than 20 cm.
  3. The ResMed machine is probably better than the DreamStation and it can be easily set to a fixed pressure.
  4. The main reason people feel like their suffocating is when the low pressure and ramp start pressure is set too low. For example the 4-20 cm you tried on the ResMed is too low. I would suggest minimum pressure should not be less than 7 cm.
  5. A nasal pillow mask typically works best with a beard. That said my son has a full beard and uses a full face mask while tolerating the leaks.

My thoughts would be to try a nasal pillow mask with the ResMed machine set to 7 cm minimum and 12 maximum to see if that works for you.

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CoonForLoon +0 points · 9 months ago

I'm sorry you are currently not getting the treatment you seek. I think there is something for you that might take a few tries to find. I'll share my recent experience.

Recently I tried a new ResMed BiPAP trial machine plus new medium full face masks and had the awful experience of acid reflux at around 6:30am each day. The pain would last 6 hours and it felt like either a collapsed lung or heart attack would feel like. (I didn't have this problem while using my old Philips System One CPAP and large ResMed Quattro Air full face mask, but I was limited to 18 because my leak would be even worse than the 73% leak I had shooting too much in my eye.) I cranked it up to 25 inhale and 20 exhale and still had the problem. The machine would only push inhale if I triggered it. I really wanted it to sense my breathing rhythm and keep it going, but I guess they are not designed to do that. I even tried 25 inhale and 25 exhale to simulate max force CPAP and then even switching to CPAP mode at 20. I could not feel the extra pressure above 20. Honestly it felt like it was relative as if the 25 BiPAP == 20 CPAP. (I can tell the difference between 18, 19, 20 on my CPAP machines, so I am confused with the BiPAP.) The medium mask was too small because it barely would let me open my mouth before causing a leak.

I went back to my doctor and I told her that BiPAP doesn't work for me and the mask wouldn't let my mouth open to a natural degree. I was fitted with the large ResMed AirFit F20 and given a ResMed AirSense 10. This mask finally fits correctly which I think is the biggest contributor of the problems. I was able to set my machine to 19 and 20 without a leak, but I currently have it at 19 now. I'm able to get a great sleep pattern now. I also needed to turn off SmartStart because it would shut off on me even though there was no leak.

My doctor is surprised at my settings. No ramp, 18+ pressure. "That's a lot of pressure." ResMed still takes 10 seconds to ramp. Philips had a true 0 second ramp which I'll miss. I've tried low or average settings: I felt like it was full suffocation. I feel real comfort with my extreme settings and enjoy sleeping/napping/hanging out awake with the machine. I think if you can enjoy your settings while awake, it should then work well during sleep.

There is nothing wrong with the Philips System One. It just doesn't have "WiFi" so I couldn't get remote monitoring. I will definitely keep it as a backup/travel unit. I think the correct mask is the biggest factor in all of this.

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Sierra +0 points · 9 months ago Sleep Patron

It sounds like you know how to get into the Clinical Menu. Here are some settings I would suggest you try.

  • Ramp Time: Auto - This will hold the initial ramp start pressure until the machine decides you are asleep
  • Start Pressure - I would set this to a minimum of 7 cm or as much as you feel comfortable with while going to sleep. You can set it up to as much as your minimum pressure. This will ensure you are getting enough air to not get a suffocating feeling while going to sleep. Many users and some sleep technicians leave this set at the default 4 cm. That can feel very suffocating while the pressure ramps up.
  • EPR: On
  • EPR Type: Ramp Only. This will cut the pressure back on exhale only while you are awake. After you go to sleep it will stop the cutback and make the pressure more effective. If you are currently using EPR full time this may allow you to use less pressure during the night. 18 cm is a lot...
  • EPR Level: 3 cm. This will drop the pressure 3 cm on exhale until you go to sleep. This makes it easier and more comfortable to get to sleep.

Set up this way the machine will hold (not ramp) the pressure on inhale to your selected Start Pressure. On exhale it will reduce by the 3 cm EPR value for comfort. When you go to sleep the EPR reduction will stop, and the machine will go into automatic pressure control and only increase pressure when you need it. With the EPR off it should increase the pressure less than if it is on. Lower pressure tends to reduce leaks from the mask and feel more comfortable.

If you have a PC or Mac with a SD card reader you may want to download OSCAR. It lets you view the detailed data collected on your SD card. It can be very informative as to what is going on during your sleep. You know where the pressure goes, how much the mask is leaking, when events occur, and much more. Here is an example of what the Daily Report looks like. This is my sleep from last night. I have an Auto Machine but now have it set to fixed pressure CPAP mode. I have a fixed pressure of 11 and a ramp start of 9. You can see how it holds that pressure while backing off on exhale until I go to sleep. It looks like it took about 20 minutes to go to sleep the first time. I managed to pull the hose of my mask about 1:50 or so, and went to sleep in about 10 minutes after that. You can see from the Event Flags when I had events during the night.

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