Is Aerophagia(sp?) dangerous?

[fogels]

I have been having waking up with a lot of gas recently, but my best sleeps are on the high pressures that cause it. Can it be dangerous?

And does anybody know of any exercises that get the gas out in the morning?

Thanks

[dsm]

Well, In a way ...

Dangerous to your good relationship with your bed partner

The constant burps trigger reactions from some brands of Auto & raise pressure

It can make it look like all your weeks efforts to lower your waistline suddenly failed in a big way

Humour aside - I don't believe there is an physical danger, the body deals with the excess air the way it does with gas from a gassy meal which can be a lot worse than aerophagia.

DSM

[track]

I believe it leads to or at minimum will aggravate a latent case of GERD. The GERD in itself can aggravate the apnea....so in my opinion it can lead to a merry go round effect and where you stop no one knows.

[TossinNTurnin]

Actually, as a person who owns a particular dog breed where "gas and torsion" are a concern... I have to wonder ....

(gas and torsion ,.... where the dog's stomach fills up with gas and then twists... eventually killing them if not caught in time)

Is this something we should have to worry about ... or some version thereof?

[Snoredog]

My guess:

I don't think it is dangerous, at least I have never seen any papers on the complications of it other than discomfort it causes.

aerophagia is caused by air leaking past your LES (Lower Esophageal Sphincter) which is a sphincter valve at the opening to the stomach.

If that LES valve is sealing properly the air doesn't seem to make its way into the stomach which leads to discomfort you feel.

The LES may dysfunction because of effects of high stomach acid from GERD. stomach acid splashes up on that valve where it erodes the valve and then it doesn't seal like it should.

things to do:

-use lowest pressure possible on CPAP for OSA even to the point of allowing a higher AHI,
-elevate the head of your bed by 3-4 inches, this helps keep stomach contents especially fluids in the stomach away from the LES to allow it to heal.
-use of Prilosec or other acid pump inhibitor for 6 weeks or so would speed that healing process along.
-avoid foods which contribute to GERD such as pasta

theory of what happens w/OSA and GERD:

- you are lying horizontally flat, perfect conditions for stomach contents to flow backwards,
- you are breathing in and out during sleep, you relax, muscles in throat including tongue relax involuntarily,
- then on inhale, you begin to snore as base of tongue and back of the throat become closer together to the point of vibrating,
-with snore you are on the verge of having an apnea, upon further muscle relaxation, on inhale this air gap may close up to the point of slamming shut, (similar to placing your hand over a vacuum hose), but in this case it is your tongue and the vacuum comes from inhaling.
-This blocks off the airway what we call apnea,
-blockage now creates low pressure in esophagus which can suck stomach contents (including stomach acid) up past the LES into the esophagus, it may suck it back all the way up to the mouth and teeth, remember you are laying horizontally flat, very easy for this to happen. Your stomach has a lining of mucous like substance which protects the wall of the stomach from the corrosive effects of the stomach acid, your esophagus does not have this lining.
-over time that stomach acid coating the esophagus causes it to erode along with the LES, it may even attack and weaken the enamel on your teeth and lead to premature decay. You may wake with a terrible taste in your mouth, that is from the stomach acid.

So...

controlling GERD is a good idea
elevating the head of your bed is a good idea
lowering your CPAP pressure can lessen the discomfort,
continue to use the CPAP so it eliminates apnea as explained above.

autopap is many times the best for this because it can be set to low pressure then it only increase higher when an apnea is present, maintaining the airway patency helps the condition above from happening.

understanding what is happening is the key to eliminating the conditions for it to exist.

If you don't use Prilosec, you might try a PecidComplete (berry flavor is good) right before bed for a few weeks that seems to help and it costs less (Costco is the cheapest I"ve found for it).

Watch your diet for items known to aggrevate GERD like pasta. You can also eat lots of vinegarette salads, the vinegar contained being acidic fakes the stomach out and makes it think it is creating too much stomach acid where it produces less.

[Guest]

SD,

That is a great post !

Nice concise description & worth tabbing.

DSM

[track]

Good stuff snoredog but what's the deal with pasta? I thought it was things like milk,ice cream and beef(greasy) that caused ones stomach to have produce massive amounts of acid or things like tomatoes or oranges that are loaded with acid or veggies like broccoli that caused stomach problems. I can see the tomato sauce on the pasta causing problems but pasta itself?

[OldLincoln]

The gas can indeed be dangerous. TossinNTurnin wrote about a breed of dog that can die from it. Humans can also. When the large intestine is pliant it can and does move about which allows normal flexibility and digestion. When it begins to inflate it still can bend but causes discomfort. It's like a circus clown blowing up a hot dog balloon about half way.

However when painful it's like that same balloon full blown up, it wants to be rigid and instead of curving back and forth it begins to actually kink forming a blockage. It can also rupture the stomach or colon with really bad results, although rare.

As for tips to relieve the gas, the forum is loaded with them. My favorite was to remain laying down after waking and shutting the unit off. I'd lay on my back until a large bubble escaped, then first on one side then the other. It takes a few minutes but released a lot more gas than getting up and trying to force it out.

I never did try it but I thought about laying on my wife's large exercise ball and roll around a bit.

The whole subject should be compiled and put into the wisdom bulb.

[fogels]

Thanks for the input guys.

[wlo2008]

I notice I am having a lot of bloating. My tummy and waist seem to be getting bigger. And I have been being very strict with my diet staying under 1600 calories a day. But It seems the scale is going the other way. I am getting worried about this.

[Snoredog]

Good stuff snoredog but what's the deal with pasta? I thought it was things like milk,ice cream and beef(greasy) that caused ones stomach to have produce massive amounts of acid or things like tomatoes or oranges that are loaded with acid or veggies like broccoli that caused stomach problems. I can see the tomato sauce on the pasta causing problems but pasta itself?

I'm the wrong person to ask on that, but I think it is a "trigger food", GERD or no GERD, I'm not stopping eating my favorite spicy Mexican food, they would have to shoot me to get me to stop eating that.

But here is a video presentation on it:
http://www.healthcentral.com/acid-reflu ... video.html

as for which foods? There seems to be two theories, one is you avoid all acidic foods including oranges and use a PPI to turn off the acid altogether, then ther is the OTHER side which thinks you should actually consume more acidic foods, this makes the stomach think there is too much acid and it stops making more (when you eat acidic foods)

I took prescription PrevAcid PPI for a year, didn't cure me, so I follow the findings of this site, you can eat pretty much anything including pasta:

http://www.healthcastle.com/acid_reflux.shtml

But if I followed the diet my GI specialist gave me, well you couldn't eat much of anything.

[Snoredog]

The gas can indeed be dangerous. TossinNTurnin wrote about a breed of dog that can die from it. Humans can also. When the large intestine is pliant it can and does move about which allows normal flexibility and digestion. When it begins to inflate it still can bend but causes discomfort. It's like a circus clown blowing up a hot dog balloon about half way.

However when painful it's like that same balloon full blown up, it wants to be rigid and instead of curving back and forth it begins to actually kink forming a blockage. It can also rupture the stomach or colon with really bad results, although rare.

As for tips to relieve the gas, the forum is loaded with them. My favorite was to remain laying down after waking and shutting the unit off. I'd lay on my back until a large bubble escaped, then first on one side then the other. It takes a few minutes but released a lot more gas than getting up and trying to force it out.

I never did try it but I thought about laying on my wife's large exercise ball and roll around a bit.

The whole subject should be compiled and put into the wisdom bulb.

we are NOT talking about gas here, its $4.49 a gallon, we are talking about "air" that you swallow and/or gets past the LES into the stomach which is associated with bloating and stomach pain. It is aggravated by CPAP and a compromised LES, the LES compromised from the effects of GERD, condition ONLY noticed from the use of CPAP therapy.

GERD if left untreated can be dangerous and lead to esophageal cancer in fact it is thought to be the leading cause of stomach cancer. But the swallowing of air is not dangerous to my knowledge, if it IS then show us the research which says it is.

Intestinal or stomach gas is different than abdominal pains caused by CPAP known as aerophagia.

[O2sue]

I have the same problem with bloating. It got so bad at one point that my doctor ordered a CT scan to see if I had a tumor or something! But since my gut grows/shrinks by 6" at a time, but my weight doesn't go up and down, the doctor figured it was just air.

Regardless, it is uncomfortable AND very embarrassing. I have had people ask me when my baby is due...!!

The GERD connection is interesting. I had GERD so bad that my esophagus stopped working almost completely.

In addition to the other suggestions that are listed here for GERD, my doctor told me not to eat within 2-3 hours of going to bed. He also put me on a few rounds of Aciphex so my esophagus could heal. But the not eating before bed is the biggest help. (and that cure is free!)

I recently found out that PPI's, like Aciphex and Prilosec, are linked to causing osteoporosis, so it is not a good idea to depend on those to stop the GERD and continue to be naughty with what you are eating!

You should lay off the offending foods for several months while your esophagus heals. After that, you can go back to eating your regular food. Just monitor your heartburn levels. If you start getting it back, change your diet. I have had to accept the fact that I can't eat pizza at 9pm anymore!

[TossinNTurnin]

we are NOT talking about gas here,

Very good point, but, at least in my example, the gas and air are also conflated. In dogs, there are theories that if they are "gulpers" when they eat their food, the air gets into their stomach and causes the bloat and eventual torsion.

I HONESTLY don't know anything about it in humans ... but I do know it happens with dogs.

[OldLincoln]

What it is and isn't:
If it's not a liquid, and it's not a solid, it's a gas. I used the term gas because that's what Fogels used. There's another reason I use that term when speaking with people new to the experience. Most people relate to a burp as air, but farts as gas. Aerophagia is swallowing air usually related to eating too fast, uncontrollable crying, or chewing gum. However, when air is forced through your LES into the stomach it is called gastric insufflation (translated "push air into the stomach").

Why is that important?
The medical community considers aerophagia mostly as a nuisance caused by your doing as mentioned above. They do not take that seriously and I have only read of one incident of stomach perforation and that was a newborn crying when circumcised (damn good reason not to do that!). Also a 10 year old intellectually disabled child had a perforated colon from swallowing air.

However, Gastric Insufflation is taken very seriously, as it is considered not of your doing and doctors have more hands on (literally) experience with it. It is usually related to anesthesiology where the gas leaks past the mask flanges into the stomach.

How can it hurt you?
The real danger in gastric insufflation is a perforated colon dumping contents into your abdominal cavity, usually causing serious infection. Survival depends more on the significance of the infection than corrective procedure. In one statistical study, 38% with severe infection died while none with mild infection died, and you don't get to choose your infection level.

What's the GERD Connection?
There are a lot of studies around this one even dealing with CPAP. One of the more interesting articles was a woman with a history of severe GIRD and OSA who used a bi-level machine. She was being treated for something else and when she inflated the doctors had quite a time tying it all together. Somewhere around here I have a picture of the MRI showing the large intestine inflated and a big kink where it curves back on itself.

Since then, studies have confirmed what snoredog is saying that with a history of GERD (doesn't have to be current) your LES may be comprised. As in my case many years of GERD permanently damaged my LES. Once they invented Prilosec I tried it and haven't had a case of GERD since that I didn't deserve. However, my LES seals well (that's why I no longer have GERD) but the threshold for blow-through is much lowered. If pressure remains below threshold, no gastric insufflation. There's also an excellent study to discover threshold levels. The key learning is that it's very individualized, so you need to find your own level.

What can I do about it?
When I had a fixed CPAP machine set at 10, I inflated like a circus balloon daily and it was very painful. I actually felt like I was being ripped apart in my gut (below the stomach). I switched to an APAP which brought my average pressure into the 7's and no gastric insufflation since. Now, it averages in the 7's but races up to 11-12 to clear apneas then falls back. Going up I'm not getting air anyway and after clearing it isn't there long enough (avg 15 sec) to cause harm. So for me, switching from a fixed pressure CPAP to Auto level CPAP (APAP) was the answer.

Is APAP really OK?
All of the studies (performed correctly) I've read confirm that auto CPAP is as good or better for treating OSA as fixed CPAP. When I say performed correctly, some done with the low pressure set at the lowest and the high at the highest (20 point spread or so), and measure heart anomalies simply have faulty parameters. It's like measuring fire truck response time for a station 1 block away to one 6 miles away. The heart moves quickly and the time it took to ramp up to solve the issue was longer than the CPAP sitting there waiting.

But even those done with fairly wide parameters to resolve apnea measured well with CPAP and several better. The kicker is the APAP compliance is in the 70% range compared with 50% for CPAP. By the way, I don't know of any insurance that will pay for a CPAP but refuse to pay for an APAP - including Medicare. If the doctor writes it, it gets filled.

Just in my case, I was set at 10 and suffered at that setting, however it was not touching my apneas at 11-12 at all. That's not very good treatment yet there's no way I could go 12 on fixed CPAP. The doctor was talking Bi-Level set at 6/12 which would have put me at 12 50% of the time - not good.

Time for action!
So, fogels, if you talk with your doctor and he/she sets you up with a trial APAP set to a 6 point range or so, you might be pleasantly surprised. My doctor was against it until I took my research papers with me. I can easily print out dozens of studies as I mentioned above. Because I really believe I was heading for trouble I take the subject quite seriously and do not make stuff up. So I recommend that you print this out and give it him/her. It really is that important!

Good luck and let us know how it turns out.