Exercise for upper esophageal sphincter to prevent aerophagia?

[metallikat36]

As I previously posted, I am off BPAP. A combination of things including the Aveo TSD and tongue exercises helped me achieve this. But, I still experience aerophagia, without swallowing. It's a passive thing. I do not have reflux problems that I know of. I will see a GI specialist starting in a month for other problems, but will complain of this now as well.

I believe 5 years of BPAP may have weakened the upper esophageal sphincter (UES). Also, exercises may have inadvertently increased the relaxation of the UES. There are certainly exercises meant to do just that for people with swallowing problems. But there appears to be exactly zero known exercises to strengthen the UES. Studies suggest different kinds of inspiratory muscle training can strengthen the lower esophageal sphincter (LES) barrier function and thereby reduce reflux. I wonder if this would also reduce aerophagia? Or conversely, could strengthening the LES reduce ability to burp and make aerophagia worse?

When you inhale, the UES is closed. I wonder if perhaps by good fortune that IMT might have either directly or indirectly strengthen the UES?

We all could use an exercise that targets UES to help prevent aerophagia. Any geniuses out there? The lack of UES exercises was mentioned in passing in one paper I read from 2020. I emailed an author to ask if he has come across any since then, but no reply.

Factoid:In emergency settings such as ventilation, if someone is refluxing, they can put pressure on the cartilage of your throat to manually hold close the UES to prevent aspiration.

[lazarus]

If one chooses to believe Mr. Google . . .

"By lifting and holding the neck from a supine position for 60 seconds at a time, you create enough tension in the muscle associated with the upper esophageal sphincter that it can strengthen the valve."--https://connect.mayoclinic.org/discussi ... the-lower/

[metallikat36]

"By lifting and holding the neck from a supine position for 60 seconds at a time, you create enough tension in the muscle associated with the upper esophageal sphincter that it can strengthen the valve."--https://connect.mayoclinic.org/discussi ... the-lower/

I am pretty sure this quote is in error. This is the Shaker exercise. It strengthens hyoid muscles. These muscle help pull open (relax) the upper esophageal sphincter to facilitate swallowing. This exercise helps swallowing, but could make reflux (and I believe aerophagia) worse, They appear to have removed the quote from the original LiveStrong article, which suggests they realized it was in error.

[metallikat36]

https://sci-hub.se/10.1002/lary.24735
Strapping one of these bad boys around your neck can increase UES pressure. But that's not exactly a solution.

[lazarus]

Isn't aerophagia usually associates with LES instead of UES?

[metallikat36]

Isn't aerophagia usually associates with LES instead of UES?

That's part of my question as well. Intuitively, I would think both sphincters are important, but that the UES is more important. If air gets past the UES, but not the LES, where does it go? Maybe it just stays there until you swallow it next. Hence LES strength may not save you. Or so I intuit.

[lazarus]

Steven Y. Park (ENT in NYC) used to speak of making sure the stomach was empty before sleep in order to prevent aerophagia.

As I (as a layman) understood the points of his presentation (made at an A.W.A.K.E. meeting I attended in Manhattan), any stomach contents can cause the LES to relax, and any stomach contents that then touch the esophagus itself can cause a protective reflex swallowing during sleep that is designed to protect the lungs from stomach acid. That reflex can cause air to be swallowed each time the body repeatedly tries to protect the lungs.

As I recall, he recommended that any PAP-therapy patient suffering from aerophagia not eat within four hours of bed. Then, if that helps, experiment to see how close to bedtime one can get away with eating.

That was a few years ago, so I may not be remembering the details of his presentation precisely, and prevailing theory and practice may have changed quite a bit in the meantime.

Some in the past have claimed, I understand, that a nasal mask lessens their aerophagia issues as compared to FFM.

I wish you well in finding the best solution for you.

-Jeff

[metallikat36]

Steven Y. Park (ENT in NYC) used to speak of making sure the stomach was empty before sleep in order to prevent aerophagia.

Thanks. That makes sense for preventing that reflex. Though ancedotally, I do the exact opposite. I feel by going to sleep on a full stomach, the food blocks the air from going deeper into the gut and I wake up with less gas.

[lazarus]

Steven Y. Park (ENT in NYC) used to speak of making sure the stomach was empty before sleep in order to prevent aerophagia.

Thanks. That makes sense for preventing that reflex. Though ancedotally, I do the exact opposite. I feel by going to sleep on a full stomach, the food blocks the air from going deeper into the gut and I wake up with less gas.

That short-term solution may be causing a long-term issue, since stomach acid can eat away at the LES and weaken it over time. That's one theory, anyway.

Many PAP users start out with a damaged LES, it is said, since the negative esophageal pressure caused by apneas (related to the repeated increased pull of the diaphragm during struggles to breathe when the upper airway was blocked) has pulled stomach contents up into the esophagus for years while the OSA went untreated.

All I know for sure is that my grandma would fuss at you for lying down with a full stomach.