She has abdominal gas and bloating. ?Prilosec

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Physician
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She has abdominal gas and bloating. ?Prilosec

Post by Physician » Tue Aug 26, 2014 10:57 am

PRIOR THREAD: viewtopic.php?f=1&t=99212&st=0&sk=t&sd=a#p921742


My friend is using an S8 for a unusual variant of UARS in which her CO2 goes up during the night, but she has no OSA. A week ago her doc set the S8 11-14 and said if the gas is a problem, elevate the pillow (she has) and try Prilosec (has not yet tried). She wears a chin strap to eliminate mouth breathing. Her Doc said she is welcome to adjust her machine in the Clinical Menu.

Gas still a problem (both ends) so she changed the machine to pressure 7 - 10.6 and she improved. Pressure 9.8, leak 0.36, AHI 5.4

This AM, still too much bloating: Press 10.2, leak 0.4, AHI 4.8. She changed the machine this AM to 7 - 9.

If she still has bloating, what to do next ? Has anyone tried Prilosec for aerophagia and has it been successful ? He next Doc appointment is not for four months. Rarely has daytime sleepiness. Concentrating is good. Yawning only occasionally and not everyday.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by JDS74 » Tue Aug 26, 2014 11:20 am

With no OSA events what is the breakdown of the AHI numbers. Mostly FLs and Hypopneas??
Do you have a way the measure (estimate) the CO2 levels during the night? Is it correlated to SpO2 levels?
Since EPAP is primarily effective against Hypopneas, have you considered/tried straight CPAP at the lower pressure of the range. It may be that the higher pressure for IPAP is not needed and contributes to the aerophagia???

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Re: She has abdominal gas and bloating. ?Prilosec

Post by Pugsy » Tue Aug 26, 2014 11:20 am

Is she using EPR? Unless already maxing out EPR at 3 I would add EPR to help with the aerophagia.

I don't have issues with aerophagia myself so I can't comment on whether Prilosec would help or not. Sounds like doc is thinking GERD issues. Wouldn't hurt to try though.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by Janknitz » Tue Aug 26, 2014 11:30 am

Prilosec is not a good long term solution! Ugh! It interferes with the normal and healthy production of stomach acid and Vitamin B absorption. It's a terrible path to set foot on.

Have her try the tongue placement technique and maybe a bipap with a wider pressure relief range before starting down the Prilosec path. And something other than a ppi if she absolutely needs meds. Simethicone, perhaps?
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Re: She has abdominal gas and bloating. ?Prilosec

Post by Physician » Tue Aug 26, 2014 12:37 pm

Pugsy wrote:Is she using EPR? Unless already maxing out EPR at 3 I would add EPR to help with the aerophagia.

I don't have issues with aerophagia myself so I can't comment on whether Prilosec would help or not. Sounds like doc is thinking GERD issues. Wouldn't hurt to try though.

Her Doc lowered the EPR from 3 to 1.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by Physician » Tue Aug 26, 2014 12:47 pm

JDS74 wrote:With no OSA events what is the breakdown of the AHI numbers. Mostly FLs and Hypopneas??
Do you have a way the measure (estimate) the CO2 levels during the night? Is it correlated to SpO2 levels?
Since EPAP is primarily effective against Hypopneas, have you considered/tried straight CPAP at the lower pressure of the range. It may be that the higher pressure for IPAP is not needed and contributes to the aerophagia???

The machine LCD shows (this AM) for the past night:

AHI = 4.8
AI = 1.7
HI = 3.1

I have an oximeter, but no way to measure her C02. Her Docs are not certain how to handle this because she has no OSA, no RLS, but in the absence of other diseases, she is not eliminating C02. The S8 has made a dramatic improvement. The issues have been:

1. Water in mask, cured by lowering the machine
2. Mouth breathing cured by a chin strap
3. Taking off the mask during the early AM (unconsciously) not yet cured
4. Aerophagia with gas out both ends and abdominal bloating. (Haven't yet tried Prilosec)
5. How to adjust S8 pressure settings for the most benefit and reduced to no aerophagia.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by Pugsy » Tue Aug 26, 2014 12:51 pm

Physician wrote: Her Doc lowered the EPR from 3 to 1.
Well...then I guess she had better try the Prilosec...lowering EPR raises exhale pressure and the reason air gets into the gut is that more pressure pushes on the Lower Esophageal Sphincter more and pushes right into the stomach. Lowering EPR without lowering the pressure will just result in more pressure on the LES and if it's weak already...makes for the air sneaking into the gut easier.

I can't see how Prilosec will help and like Janknitz says...that opens up a whole new can of worms with long term Prilosec usage.
But I assume he has his reasons.

Is her leaks still high? Over 0.4 L/sec?

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Re: She has abdominal gas and bloating. ?Prilosec

Post by library lady » Tue Aug 26, 2014 1:50 pm

For taking off the mask during the night, she could try taping it... one strip of medical tape on each side of her cheek... I don't know what kind of mask she has... but this can serve as a gentle reminder to leave the mask on. I have not personally done this, but other posters have mentioned this as a solution to help break the habit.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by Physician » Tue Aug 26, 2014 1:57 pm

Pugsy wrote:
Physician wrote: Her Doc lowered the EPR from 3 to 1.
Well...then I guess she had better try the Prilosec...lowering EPR raises exhale pressure and the reason air gets into the gut is that more pressure pushes on the Lower Esophageal Sphincter more and pushes right into the stomach. Lowering EPR without lowering the pressure will just result in more pressure on the LES and if it's weak already...makes for the air sneaking into the gut easier.

I can't see how Prilosec will help and like Janknitz says...that opens up a whole new can of worms with long term Prilosec usage.
But I assume he has his reasons.

Is her leaks still high? Over 0.4 L/sec?
Pugsy, you bring up excellent points. Prilosec does increase gastro-esophageal sphincter tone, so it could help. But why take something systemically until the CPAP settings are best adjusted ?

Her leak rates: last night = 0.04 L/s, week average 0.28 L/s

Will increase the EPR from one to 3 and leave pressure range 7 to 9, Depending upon her symptoms and AHI, will increase the 9. How about that ?

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Re: She has abdominal gas and bloating. ?Prilosec

Post by Pugsy » Tue Aug 26, 2014 2:14 pm

Sounds like a good plan to me.

Prilosec increasing the LES tone?...it helped with my GERD but only when I took the double dose thing (on the advice of my doc) but it just kept the GERD down to a low roar....but then I have a small hiatal hernia too.
Just been lucky that I really haven't ever had any of the typical aerophagia issues except for a couple of nights when I was experimenting. So I don't know how much it might relieve the air in the gut problems for someone else.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by sgifford » Sun Aug 31, 2014 4:24 pm

I've had CPAP machine since 2006 and have suffered with aerophagia the entire time. Refuse to have surgery on my esophageal sphincter (Nissin's procedure), don't care to take Prilosec so take GasX tongue strips in the AM as needed (I should buy stock in that company), and also found that binding my waist/lower ribs with a wrap bought at Academy (it's a weight loss wrap, black/gray, about 7-8 inches tall and fastens w/Velco) does help somewhat. I can't bind my ribs too tightly - need to easily breath. I presume the increased pressure on the stomach helps thwart the air from CPAP machine from entering stomach. This just helps a bit, it doesn't prevent it from happening entirely, but I'll take any help I can get.

Would love to hear anything anyone else has stumbled upon that help with this. Aerophagia is vicious. I don't even use my CPAP machine the night before any special event because it takes 2-3 hours to get over it. I've learned the base of my tongue is the culprit in my OSA, it falls backward and occludes airway. Slide sleeping doesnt help much, but sleeping face down in the space in our split adjustable bed does!

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Re: She has abdominal gas and bloating. ?Prilosec

Post by LSAT » Sun Aug 31, 2014 5:24 pm

I have found that Gas X does little for me since the aerophagia is mostly air...not gas. You are not doing yourself any favors by ignoring your acid reflux problem. It could get worse and develop into something very serious. Hopefully you are being examined by a good GI regularly.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by sgifford » Sun Aug 31, 2014 5:40 pm

Actually since going to a vegetarian diet, and staying away from much bread & sweets, I do not have GERD anymore. Also, air is a mixture of gases - 21% oxygen, 78% nitrogen and a smattering of others.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by palerider » Sun Aug 31, 2014 6:08 pm

sgifford wrote: Also, air is a mixture of gases - 21% oxygen, 78% nitrogen and a smattering of others.
har har har.

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Re: She has abdominal gas and bloating. ?Prilosec

Post by LSAT » Mon Sep 01, 2014 10:12 am

sgifford wrote:Actually since going to a vegetarian diet, and staying away from much bread & sweets, I do not have GERD anymore. Also, air is a mixture of gases - 21% oxygen, 78% nitrogen and a smattering of others.
Could the vegetable diet be your problem and not the Aerophagia?

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