(New member) Aerophagia and Fragmented Sleep

[Hoops McCann]

I received my now recalled Remstar System One in June of 2015. I was probably 160lbs at 5'4'' at the time. My prescribed settings were as follows:
Pressure 5-15
Aflex level 3
Humidifier level 2
Ramp on 4 for 10mins

I had a hard time adjusting to cpap. Aflex felt like it was breathing for me so I turned it off. I didn't like humidifier and ramp so I also turned these off. I would adjust my pressure settings over time and eventually stayed at about 8-15 or 9-15.

I only went to my sleep doctor a few times, but stopped going. My sleep was better than pre-cpap and I was satisfied, but would always wake up multiple times throughout the night and feel tired in the morning. Very seldom would I sleep an entire 8 hours without being disturbed.

In Dec 2022 I felt like I was going to fall over while stepping up onto a sidewalk. It would result in me having what I believe to be an anxiety attack (more on that later). I went to the doctor, but they seemed unwilling to help.

At around Jan/Feb of 2023 I bought the Airfit f20 mask because I was getting tired of my old one (a Simplus one) blowing air on the pillow. The f20 felt like it didn't exhaust air like my old one so I reduced the pressure to 7-15 or 8-15. I somewhat felt claustrophobic, but that would go away over time.

In Aug 2023 I got a Dreamstation 2 after recalling my System One. I tried my original prescribed settings for 2 days and quickly changed them. I turned off Aflex, humidifier, ramp for the same reasons and settled at around 8.5-15 for pressure.

In Sept 2023 I woke up in the middle of the night with a headache and felt like I wasn't getting enough oxygen. I went to the Emergency room in a panic and was told I had an anxiety attack. I was prescribed Hydroxyzine and told to take it if I ever 'felt like that again' (in a panic). I've taken a couple since then.

In Oct 2023 I woke up with a dry mouth. This did not go away with any amount of water. The next day I went to a walk-in-clinic. I had a fever and was told to drink more water and use my humidifier (both of which I did). 2 days later I went back to the walk-in-clinic and was told I have a virus and to drink Gatorade + water. I got very little sleep during this period and everything started to ache constantly so I went to Emergency room the next day where I was told I have Insomnia and that I wasn't sick. I was told to drink water and take Hydroxyzine before sleeping. My dry mouth still persisted. The nurse who discharged me told me to try dry mouth lozenges (I had no idea they existed). I was able to sleep and the dry mouth went away to my surprise.

Later in October I decided to go to a different sleep doctor and see if they could help. I'm in the process of registering with a new DME and have a sleep study scheduled in a few weeks.

I'm now ~180lbs (have been for a few years). My AHI has been consistently under 1 when at pressures of 8.5-15. I sleep for about 4-5 hours straight while spending the rest of the night constantly waking up to burp out air (and out the other side). The past 3 nights I changed the minimum to 7.5 to try and get some relief from Aerophagia as I was starting to be in pain, but with an AHI of ~2 I'm not sure if it's the right thing to do.

I don't know when the Aerophagia started. I would say within the past few years. I've tried tucking my chin and raising my head in the opposite direction. Neither seemed to help, but I'm not sure if I was doing it right. I'm a side sleeper and noticed sleeping on my right side helped more than the left. I also have Bruxism and sleep with a mouth guard.

2023 has been a problem. I feel frustrated and tired. I would like to experience 8 hours of interrupted sleep without eating air.

Thanks for your time and I apologize for the long read with possibly unneeded information.

I'm open to any suggestions.

Nov 19 (most recent day at 8.5 minimum pressure):


Nov 23, last night (at 7.5 minimum pressure):

[Miss Emerita]

Welcome! You have some good numbers there, but aerophagia can be a bear. My suggestion would be to see what settings, if any, reduce the aerophagia wake-ups and see what those settings do to your AHI.

You might start by trying min = max = 7. Your AHI may well go up, but the point of the experiment is to see whether your aerophagia abates. Because sleep is so variable from night to night, I'd suggest you try this for at least three nights (unless it's a complete disaster for you).

Once you find settings that control the aerophagia, you can try making a few more adjustments to see whether you can get to a satisfactory AHI without re-introducing the aerophagia.

Two other thoughts occur to me. I wonder whether the mouth guard somehow makes it more difficult for you to keep air from going down your digestive tract. Maybe some other readers can weigh in on that. And aerophagia can be a result of anxiety. Do you think the anxiety is now pretty well controlled, especially at night?

[Hoops McCann]

Thanks for the response.

You might start by trying min = max = 7.

Might be a dumb question, but do you mean set both min and max to 7?

Two other thoughts occur to me. I wonder whether the mouth guard somehow makes it more difficult for you to keep air from going down your digestive tract. Maybe some other readers can weigh in on that. And aerophagia can be a result of anxiety. Do you think the anxiety is now pretty well controlled, especially at night?

Interesting thought. Before cpap I had a custom MAD (one with metal bars on both sides), but I developed jaw pain so I tried cpap. I kept using it for a while just to protect my teeth (no forward jaw movement). When I almost chewed through that I started to use these disposable ones: https://i.imgur.com/8P2tBrj.jpg.

I hadn't thought of Aerophagia being a result of anxiety. I don't take anything for it besides the Hydroxyzine when needed which hasn't been often. I would rather not take something like Zoloft every day to control it. I am also looking for a new PCP to see what they advise.

[Julie]

And I was thinking to raise your max pressure because it looks like it's 'capping' the min. that might want to go higher to deal with obstructives... aerophagia aside for the moment. I don't understand why your min. and max are overlapping on Oscar. I suppose you could try both ideas because leaving both at 7-8 effectively means you're on a fixed pressure, as plain cpap would give you.

[Miss Emerita]

Yes, i meant that you could try setting both the min and the max to 7. The goal is to see whether that takes care of the aerophagia. Your AHI may go up some, but because you’re having such disruption from air in your gut, that seems a reasonable experiment to try.

[Hoops McCann]

And I was thinking to raise your max pressure because it looks like it's 'capping' the min. that might want to go higher to deal with obstructives... aerophagia aside for the moment. I don't understand why your min. and max are overlapping on Oscar. I suppose you could try both ideas because leaving both at 7-8 effectively means you're on a fixed pressure, as plain cpap would give you.

I'm fairly ignorant as to why they overlap or even the difference between the two. I was able to find someone else who posted their Dreamstation 2 Oscar and it also overlapped like mine.

Yes, i meant that you could try setting both the min and the max to 7. The goal is to see whether that takes care of the aerophagia. Your AHI may go up some, but because you’re having such disruption from air in your gut, that seems a reasonable experiment to try.

Thanks for the clarification. I tried min and max on 7 last night - screenshot below. I don't remember waking up swallowing air. I do remember one instance of expelling air, but unsure if it was related to Aerophagia. I woke up multiple times during the night and I remembered two different dreams. I feel more rested than yesterday. I am honestly surprised the AHI is that low.

Nov 25 (7min 7max test day 1)

[Miss Emerita]

I'm glad to hear you felt more rested this morning. Like you, I'm a little surprised your AHI is as good as it is. We'll see how things go over the next few nights. I hope you'll continue to feel you don't really experience aerophagia at this pressure. Keep us posted!

[Hoops McCann]

I'm glad to hear you felt more rested this morning. Like you, I'm a little surprised your AHI is as good as it is. We'll see how things go over the next few nights. I hope you'll continue to feel you don't really experience aerophagia at this pressure. Keep us posted!

Me too. Thanks for your initial suggestion. I will keep posting in the coming days.

[Hoops McCann]

I don't feel more rested today. I slept for about 4-5 hours straight then felt like I spent the rest of the night trying to go back to sleep (or just waking up often). I remember one instance of eating a small amount of air twice within a couple of minutes. I yawned 4 times before getting out of bed which rarely happens. My AHI is again lower which is strange.

Nov 26 (7min 7max test day 2):

[Miss Emerita]

The good news is that you continue to have a reasonable AHI and are not plagued by wake-ups caused by the need to release air in your digestive tract.

The bad news, of course, is that you didn't sleep well during the later parts of the night. Sleep can be variable in quality from one night to the next, of course, and it can be very hard to figure out why one night is good and another bad. It could be something about your sleep environment, your stress levels, or your evening consumption of food and drink. But it also could be something you're not going to be able to figure out.

Nothing about the chart or your description of the night suggests to me that a change in your settings would make a difference, so I'd recommend continuing the experiment with these settings. I hope very much that tonight will be a better night.

[Hoops McCann]

The good news is that you continue to have a reasonable AHI and are not plagued by wake-ups caused by the need to release air in your digestive tract.

The bad news, of course, is that you didn't sleep well during the later parts of the night. Sleep can be variable in quality from one night to the next, of course, and it can be very hard to figure out why one night is good and another bad. It could be something about your sleep environment, your stress levels, or your evening consumption of food and drink. But it also could be something you're not going to be able to figure out.

Nothing about the chart or your description of the night suggests to me that a change in your settings would make a difference, so I'd recommend continuing the experiment with these settings. I hope very much that tonight will be a better night.

Yes I suppose I should focus more on the good news.

I will see how tonight goes. Thanks for your help.

[Hoops McCann]

I feel more rested than the other days. No eating air. Still woke up a couple of times. I haven't felt this good immediately after waking up in a long time.

Thank you so much for the advice. This forum is great.

Nov 27 (7min 7max test day 3):

[Miss Emerita]

Oh, that's great news! Don't mess with success; keep using those settings.

[Hoops McCann]

Oh, that's great news! Don't mess with success; keep using those settings.

Will do. I feel kinda dumb not even trying to limit the max pressure previously.

[Miss Emerita]

No, no, no! You were smart to use Oscar, smart to identify a problem, and smart to ask other users for ideas!