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Bipap - Bloating/Gas Help

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misterhyde +0 points · about 5 years ago Original Poster

Been using my new Resmed AirCurve 10 Vauto since my doctor determined I needed Bipap. Since day 1, I have been bloated throughout the night and occasionally wake in morning with abdominal pain, as well as always being gassy throughout the night and upon waking up.

The doc and sleep therapist shrugged it off and my doc set my next visit for a 1 year. This was 4 or so months ago. So I've been dealing with it.

What/how do I share here from Sleepyhead so someone can take a look at my settings?

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Sierra +0 points · about 5 years ago Sleep Patron

The best thing to share is the Daily Detail report from SleepyHead. On a PC just use the F12 key to save the screenshot. A message will display in the bottom right of the screen where it is being saved. Then use Windows Explorer to find the file. Open a new post here with the Write a Reply button, then left click on the saved file and drag it to the body of the open new post.

This link on Aerophagia may be of some help in your bloating/gas issues.

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misterhyde +0 points · about 5 years ago Original Poster

Not sure what graphs helps, but I screenshot 2 at a time if needed. Here are the first 3. Also included the statistics.

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Sierra +0 points · about 5 years ago Sleep Patron

Can you share some history on how you ended up with a BiLevel machine? Were you using a standard APAP and it was not working? I would agree with bonjour's comments. You should ask about reducing your pressure support. That would likely reduce pressures without causing more obstructive apnea. It may also reduce the incidence of central apneas. It is possible a fixed pressure of about 12 cm with no pressure support could give you about the same incidence of obstructive apnea, and at the same time reduced central apnea. But, that is without knowing your history. Perhaps you have been there before and it didn't work...

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bonjour +0 points · about 5 years ago Sleep Commentator

Why are you at a PS/Pressure Support of 6?, that is higher than most who use the VAuto. Typically the EPAP pressure is what treats/prevents the Obstructive Apnea, and the PS is used for Flow Limitations, Hypopneas, and Snores. Your obstructive apnea seems to be well handled, bu pressure differences including PS do tend to increase Central Apnea/Clear Airway events.

My suggestion is to lower PS to 5 initially, observe your numbers, and see if lowering your IPAP pressure (by decreasing your PS) will improve your aerophagia or bloating.

Really important is how you are feeling.

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obbyone +0 points · about 5 years ago

I am also struggling with severe Aerophagia... I feel my belly growing every day. I never had this big of a belly. If someone can look at my records I will appreciate it and let me know if I am ok with my settings. Thanks.

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Sierra +0 points · about 5 years ago Sleep Patron

I would talk to your provider about any opportunity to reduce pressure. Your AHI is not too bad. You may have room to reduce pressure support and maximum pressures.

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obbyone +0 points · about 5 years ago

These were my results from the sleep study on August 2018 when I was diagnosed with CSA. Are my current settings of 14/20 the best recommended?

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Sierra +0 points · about 5 years ago Sleep Patron

Perhaps Sleeptech could help you with some analysis. It looks to me that they cranked up pressure until the obstructive and hypopnea events went away. Then they applied a back up rate to reduce the increased central apnea frequency. It would be interesting to see what lower non bilevel pressure would do. It seems like an EPAP as low as 10 cm significantly reduced the obstructive apneas. The backup rate seems to be quite effective in reducing the centrals.

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obbyone +0 points · about 5 years ago

Hi Sierra,

You think that I could try 16/10 one night to see what happens?

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Sierra +0 points · about 5 years ago Sleep Patron

Your results are outside of my range of experience. I would wait to see what Sleeptech or Bonjour says.

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obbyone +0 points · about 5 years ago

One more study results:

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Sierra +0 points · about 5 years ago Sleep Patron

These don't seem to be as good as the previous titration results you posted. It is surprising to me that you are now getting an AHI as low as 2 with a BiLevel. You may be a candidate for an ASV machine.

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bonjour +0 points · about 5 years ago Sleep Commentator

Obbyone, 20/14 w backup at 8 is the only successful trial that you had. NOTHING else was trialed with a backup.
The machine you are on is a fixed pressure bilevel machine with a backup rate. This means that your pressures MUST be set (high enough) ALL the time to manage the worst of the Obstructive events. Now that the Obstructive is managed, you have to manage the centrals. This occurs by setting a timed breath at 8 seconds. This is why your PS is set at 6, which for this purpose I believe is low.

An Auto machine would only go high when it needs to, which means that your Median pressure should be lower with an auto machine which should help mediate your aerophagia.
The approach with an ASV is an algorithmic one, to automatically and quickly provide pressure increases to manage obstructive events and when, and only when, you need it to provide a boost in Pressure Support to assist your breaths that are missing because of central events.

If I had been working with you thru the process I would have been talking about an ASV machine for you.

To step backward and reduce pressure to help relieve your Aerophagia I would do it 1 cmw at a time starting with 19/13 and observe for a couple of days before making another change, looking to see what happens to both your Obstructive and central elements.

Of concern in your sleep studies are your desats. Medicare says 8 minutes at or below 88% SPO2 is justification for oxygen supplementation. You have DeSats for most of the settings but we are not looking at whole report which should show the duration of the DeSats which would indicate how serious they really are. You should consider getting a recording pulse oximeter that is compatible with SleepyHead and see what it shows over night.

Also I would complain to your doctor frequently (squeaky wheel) about your Aerophagia. The purpose to show that you are not satisfied with your treatment because of the pain from your Aerophagia. The end goal to get an ASV which should run at mostly lower pressures and thus help your Aerophagia.

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