Aerophagia - where to go from here?

I have only been on xPAP for a couple months now and I seem to have a hit a wall with improvement because of aerophagia. With my M series APAP set at 6-9 I do pretty well with the aerophagia (just a little bloating). When I try pressures of 10 or more for any length of time the aerophagia gets so bad it wakes me up because I blow up like a balloon.

I'm still getting around 3 apneas per hour (~4-5 AHI average). I have heard to feel fully rested many people find they need to get the apneas under 1 an hour.

I wake up much more rested than without xPAP therapy so I am thankful for that improvement. That said, I'm still more tired than I would like to be even after 8.5 hours of sleep. (still yawning/a bit foggy/need an afternoon nap) So I visited a GI doc and he said he had never heard of aerophagia induced with xPAP therapy but it made sense to him it would be possible, if not even likely. He said there was really nothing he could do for me about it. He said to go ahead and try Prilosec, but he didn't expect that to help the aerophagia (it hasn't). He said surgery is the only thing that could help, but he highly recommended I avoid that because he said it has a poor history of effectiveness over time.

So I'm not really sure where to go from here... Is there anything I can do to try and bring down those apnea numbers more or are they as good as they need to be? Should I trial an auto bipap machine or would that not provide any improvement from my current machine? I'm really up for any ideas.

I don't have experience with aerophagia, but I did find this article. Maybe it offers something for you to try?

http://www.cpap-supply.com/Articles.asp?ID=170

To summaraize, he suggests aerophagia can come from 1- high pressure, 2- mouth leaks (inducing reflexive swallowing), and 3- head position. So maybe air is coming out of your mouth if you are using a nasal mask? Or maybe a different pillow arrangement might help?

Again, I haven't dealt with this, so just throwing out ideas. Good luck!

TSSleepy, thank you for that article! I feel like I am stuck between a rock and a hard place...more pressure to get rid of the apneas, but that leaves me with more unbearable aerophagia. I've tried a chin strap/taping and that didn't seem to make much of a difference. I'll have to see about some different pillow arrangements.

Any other suggestions out there? Should I try a Bipap or is that likely to be fruitless?

Its seem to be a tradeoff for me. Last night no leaks, do not recall waking up even once, no mask adjustments. I never touched it all night that I can recall. That's the good, but when that happens I wake up with a red mark on my nose and the aerophagia is worse. I am titrated at 8 cm. I have no empirical feedback on apneas or leaks. Angelina hasn't reported me snoring since I started CPAP in mid December, however frankly she is a very sound sleeper anyway.

averian, To summarize, you are doing better with treatment than without; your bloating is controlled at 6-9; and at that pressure your AHI is 5 or under. While some do better with AHI scores lower than yours, it doesn't mean you are failing if you hang around where you are.

Sometimes we have to balance one thing against another. If pain from bloating would keep you from treatment then stick with what you have. You are discovering your LES threshold - the point at which pressure forces air into your stomach. You will probably always have some get past, but it should not cause extreme pain. The benefit of an APAP over CPAP is it can spend most of the time below threshold, yet clear events above that and return, thus reducing overall bloat.

I suggest after having it at 9 for awhile you up it up to 9.5 and see how you handle the bloat. If it's too much then take what you can get. Remember the purpose of this whole thing is to keep your oxy up at safe levels, it doesn't have to be perfect. It's better to have it on all night with 4-5 AHI than take it off after 4 hours, which "they" consider compliance.

I know exactly where you are coming from as I have been in the same boat for the last 2 years. I use gadgets to keep me off my back to minimize the AHI so I can keep the pressure in the 8 range. Even then I typically have an AHI around 5 and an AI around one...spend 0.3 percent of my time in apnea.

Every few months I decide to ratchet up the pressure and see if I can find a point where I can discard all the gadgets and sleep naturally but the pressure swells up my insides to the point I can hardly move early in the morning until an hour or so passes and the gas starts to come out. It's hurt so much a few times I literally had to lay in bed and not move for an hour or so...until I was able to release some of the air.

I don't know what I would do if I had to have pressures in the 14-20 range every night.....My stomach would probably swell up and I would just die. I have tried raising the head of the bed 5 inches and everything else mentioned on this board the last 2 years...nothing works. Other than trying side sleeping I don't think there is an answer.

I've struggled with this for over a year until about a month ago. The solution for me was moving to an auto BiPAP. I was on straight CPAP at 10, and had severe bloating and cramps. Reducing the pressure eliminated the bloating and cramps but my AHI went way up.

After moving to the BiPAP with IPAP Max set at and EPAP Min set at 6 the symtoms are finally gone. The exhale pressure was causing the problem for me.

I love the Internet and EBAY! After getting the royal runaround from my HMO and DME I finally have the solution to my aerophagia. My original machine was a straight CPAP with "C-Flex" (not much good) and the air just pumped into my stomach every night with the well-known consequences. I put up with that for over a year and finally requested an auto-titrating machine. As could be expected my request (even with GP's prescription) was refused. The next step, they said, was to "grieve" the situation, which I did gladly. Luckily the HMO has realized that apnea is something that needs much attention and patient care and the new Sleep Lab was my next visit. Several test machines later they determined I "needed" a BIPAP machine, which I obtained and began to use. The BIPAP was useless in combatting the aerophagia. During inhalation the air went in at the same pressure that the original CPAP pumped in. The result was aerophagia, not quite as much but still not acceptable. Back I went to the Sleep Lab where another machine was recommended, this time, with auto titration (which was my original request). In the meantime I began to look at the Internet to see what the BIPAP machine I had at home (now sitting on the shelf) was capable of doing. The "Auto" designation gave me my first clue.

The provider had set the machine to straight BiPAP, 11/6 and had never turned on the auto feature. Here's where it got interesting -- the "how to set your machine" pamphlet was available on EBAY for a few bucks and I was able to program the beast with all of the auto features. The result-----literally NO GAS and much better sleep. I realize this is heresy....the idea of a patient taking over his/her own therapy is highly frowned on. But who better to know what is working or not? Will post the results of my FAX to the Sleep Lab about my adventures.

I started out on a CPAP machine at a 12 setting, and like you experienced severe aerophagia...I went back to my sleep doc, and he changed me over to a BiPAP machine...initially I started out on the BiPAP at 12 and 8...it was better than the CPAP as far as swallowing air, but still pretty bad...I then went to settings of 11.5 and 7, and "Voila"!...the aerophagia pretty much went away!...so BiPAP and (particularly) a lower expiration pressure were the answers for me. Good Luck!

dcryandc wrote:I started out on a CPAP machine at a 12 setting, and like you experienced severe aerophagia...I went back to my sleep doc, and he changed me over to a BiPAP machine...initially I started out on the BiPAP at 12 and 8...it was better than the CPAP as far as swallowing air, but still pretty bad...I then went to settings of 11.5 and 7, and "Voila"!...the aerophagia pretty much went away!...so BiPAP and (particularly) a lower expiration pressure were the answers for me. Good Luck!

Did you have to have another sleep study to get a BiPAP machine? My sleep doctor insists insurance will not approve without another costly study. My current study is only about 2 months old.

OldLincoln wrote: ......... You are discovering your LES threshold - the point at which pressure forces air into your stomach. ........

OldLincoln has this figured out. It doesn't matter whether you use CPAP, APAP, BIPAP, or PENTAPAP, if the pressure at any time is above the LES threshold, then air will leak into your stomach.

Another point is that the LES threshold for individuals sometimes varies with sleeping position. In my case back position is best for avoiding aerophagia, right side is next best, and left side is very bad.

Despite this, I don't backsleep because the pressure requirements are much higher than sidesleeping.

In three years I have not found a good solution and suffer from many awakenings due to the pressure in the digestive system. This is the main reason I am so excited about this possibility: viewtopic.php?f=1&t=39245&p=343884&hili ... 27#p343884

the only reason I am on the cpap maching is for my stomach. I have bloating for the past 2 years. Not sure if I am doing the right thing by getting a machine? I have mild sleep apnea but now I am afraid my stomach will get worse. Any comments?

OldLincoln wrote: You are discovering your LES threshold - the point at which pressure forces air into your stomach. You will probably always have some get past, but it should not cause extreme pain. The benefit of an APAP over CPAP is it can spend most of the time below threshold, yet clear events above that and return, thus reducing overall bloat.

Please explain "LES threshold".

Jason S. wrote:Please explain "LES threshold".

http://digestive-disorders.health-cares ... isease.php

this talks about food or acid but this sphincter also allows or blocks air from entering the stomach.

copied in part
Gastroesophageal reflux disease or acid reflux disease is the back up of acid from the stomach into the esophagus. At the top of your stomach is a muscle called the lower esophageal sphincter (LES), which normally opens and closes allowing food to enter. It also prevents the acid in your stomach from getting out. With GERD the LES opens inappropriately, allowing acid from the stomach to get into the esophagus

Jason S. wrote:Please explain "LES threshold".

The Lower Esophageal Sphincter (LES) is the gatekeeper to the stomach which allows food in when swallowing and keeps it there. Just as reflux can force it's way out, air can force it's way in. The pressure at which air pushes past the LES is your LES Threshold and varies from person to person.

If your CPAP is set higher than your threshold you get air seeping into the stomach all night long. If on Bi-Pap the same is true but for 50% of the night. If on APAP, only the percent of the night at which your machine exceeds threshold is of concern.

I had CPAP set at 10 and suffered. I now have APAP set 6-13 and only 25% of the night exceeds my threshold of 7.5 and no pain.