My fight with aerophagia (air swallowing).

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Sleeper Agent
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My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Fri Jul 18, 2014 1:14 pm

I am posting my on-going experience for the benefit of others, as a record for myself, and to let others share their advice.

- Saw a big improvement during the first 3 days of CPAP, but was still tired/sleepy. (5 < AHI < 6, pressure 9)

- Forced myself to sleep on my side by taping a bottle to my back. Massive improvement, sleepiness completely gone for 3 days. Started experiencing painful aerophagia (air swallowing), and waking up in the middle of the night with a huge bloated stomach. (1 < AHI < 2, pressure 9)

- Tried sleeping on two pillows = no or very minor help. Turned the pressure down to 8 for a day, higher AHI but still as effective I think. Woke up with painful aerophagia. (2 < AHI < 3, pressure 8 )

- Turned the pressure down to 7 for 3 days. Same AHI as 8 it seems. At the beginning, it feels as the aerophagia was reduced to a tolerable level. But last night, I woke up with a painful bloated stomach. Note: it took 2 hours longer for this to happen under pressure 7, vs under pressure 8. Daytime sleepiness has RETURNED over the last 2 days - this might be related to the fact that my CPAP usage has been 4-5 hours everyday due to air swallowing, and the disrupted sleep, I don't know. (2 < AHI < 3, pressure 7)

Will try changing my EPR from 2 to 3 tonight (with pressure still at 7). On my list of things to try: Gas X to see if I can tolerable the aerophagia, or even trying going down to 6.5 or 6.

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Lazer1234
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Re: My fight with aerophagia (air swallowing).

Post by Lazer1234 » Fri Jul 18, 2014 2:09 pm

Here in Sweden they say that F&P Icon+ are better to handle aerophagia. I dont now why, maybe the Sense Awake ?
Is it someone now why?

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Cowboy Casey
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Re: My fight with aerophagia (air swallowing).

Post by Cowboy Casey » Fri Jul 18, 2014 6:30 pm

so, I started out the same way.. I started out with a pressure of 11 cpap, went to a bipap and had to go all the way down to 5 epap and 9.6 ipap... now I am on and asv and have it at 7 epap min and 10 epap max and pressure support at 6.5... when my epap stays under 8.5 I am fine but I still get aerophagia when my epap goes above 8.5 and my PS goes up, my pressure is then getting in the 13 to 15 pressure range...

what I am thinking is the longer we use these machines our bodies are getting use to the pressure and its not happening as much... maybe we are learning what positions we need to be in or something, but it is getting better for me...

I also use Phazyme Ultra Strength 180mg and it seems to help....

http://www.walgreens.com/store/c/phazym ... 95-product
PR System One REMstar 60 Series BiPAP Auto SV Advanced
https://www.cpap.com/productpage/pr-60-series-bipap-autosv-advanced.html
Pilairo Q Nasal Pillow CPAP Mask with Headgear
https://www.cpap.com/productpage/fp-pilairo-q-nasal-pillow-cpap-mask.html

sawinglogz
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Re: My fight with aerophagia (air swallowing).

Post by sawinglogz » Fri Jul 18, 2014 7:26 pm

I tried all the usual tricks -- lifting the head of the bed, improved reflux hygiene, tucking chin vs. extending, etc. Nothing much helped.

The things that seem to have made the most difference:

1) Sleeping tilted toward my left side (rather than right).

2) Keeping my lower jaw back a little bit. Due to a mouth guard I was tending to have it a bit forward. Moving it back to where it is when I chew made the biggest difference.

3) Eliminate leaks. When there are leaks my ASV doesn't switch from IPAP to EPAP fast enough, which means after my lungs have stopped expanding, I'm still on IPAP for a brief moment, which tends to push air into my stomach since it has nowhere else to go.

PM me if you'd like to talk more about it. This was a huge battle for me for nearly a year.

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avi123
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Re: My fight with aerophagia (air swallowing).

Post by avi123 » Fri Jul 18, 2014 10:50 pm

As a beginner CPAPer who have low respiratory system compliance, you are likely to develop gastric and intestinal distention with air (its medical term is “meteorism” in contrast to “aerophagia” which is used for intestinal distension resulting postoperatively) . The cause for this distention is because your mouth pressure during CPAPing can be above your lower esophageal sphincter pressure, while your mouth is occluded. You should keep your mouth somewhat open to let some trapped air go out from your stomach to the atmosphere, even if this mouth leak affects somewhat the CPAP’s proper treatment.

Saying it another way:

If you tape your mouth’s lips because you want to reduce your mouth air leak and thus improve the XPAP treatment, then you’re likely to invite a Meteorism situation. In such a situation you lock- in extra ingested air in your GI tract. The extra air has no easy way to go and be vented to the atmosphere. You better of keeping your mouth somewhat open to let some trapped air go out to the atmosphere, even if this mouth air leak has some negative effect on the XPAP’s proper treatment. An elastic Chinstrap that allows some mouth opening could solve this problem. Keep yourself somewhat vented while you train your body.

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Sleeper Agent
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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Sat Jul 19, 2014 10:16 am

I think last night was a success. Kept the mask for 8 hours, and had the lowest AHI I ever had since starting CPAP. (0 < AHI < 1, pressure 7, EPR 3)

It appears that upping EPR from 2 to 3 helped. There was a tiny bit of gas, but nothing really noticeable most of the time. Will see how it goes over the next few nights.

- Median leak rate 1.20 L/min, and 95% is 2.40 L/min. Acceptable I think?
- I use a full face mask, so no chin straps, tapes etc.

P.S.
Strangely, I don't feel as manic (high energy, happy, productive) as I was when I first started CPAP. Could be because of the aerophagia sleep disruption that has been happening all week (monday to thursday).

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Sun Jul 20, 2014 11:57 am

Another night with pressure 7 and EPR 3. A little aerophagia remains. I was farting out the gas during the night. But definitely much more tolerable than before.

AHI 2.53! But only 1 obstructive event, the rest are centrals. I have obstructive sleep apnea, so I guess the centrals must be false positives.

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Re: My fight with aerophagia (air swallowing).

Post by chunkyfrog » Sun Jul 20, 2014 12:36 pm

Sleeper Agent wrote: . . . Strangely, I don't feel as manic (high energy, happy, productive) as I was when I first started CPAP. Could be because of the aerophagia sleep disruption that has been happening all week (monday to thursday).
It also might be a side effect of a reduction in stress hormones, an abundance of which may give us a sort of "high".
One of the reasons why I never needed coffee until later in the day pre-cpap.
There are several, make that many, threads discussing aerophagia and how to deal with it.
We really need a sticky with solutions for this, guys.
[edit] I guess we do:
wiki/index.php/Aerophagia

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Sun Jul 20, 2014 2:18 pm

Question: if the aerophagia is mild and tolerable (but uncomfortable), will it go away with time if I leave the settings unchanged?

Does the body adapt and stop swallowing the air?

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chunkyfrog
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Re: My fight with aerophagia (air swallowing).

Post by chunkyfrog » Sun Jul 20, 2014 4:21 pm

Mine did, which is not uncommon, however the time varies, and a few continue with aerophagia.
Some find that using a bilevel is helpful, but getting insurance to allow it is a guaranteed struggle,
but not one you "can't" win. If it comes to that, be insistent, and consistent--do not give up.

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Re: My fight with aerophagia (air swallowing).

Post by Sleeper Agent » Sun Jul 20, 2014 6:09 pm

chunkyfrog wrote:Some find that using a bilevel is helpful, but getting insurance to allow it is a guaranteed struggle,
but not one you "can't" win. If it comes to that, be insistent, and consistent--do not give up.
Thanks for the advice.

I am going to try my current settings and collect data for a few days. I think it might be tolerable. Hopefully it will go away.

Else, I might try an even lower pressure (6.5) and see if my AHI is affected. Or sleeping on a wedge. Or Gas X. Thank goodness there are still options and its actually not too bad now.

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Re: My fight with aerophagia (air swallowing).

Post by mrog » Mon Jul 21, 2014 11:58 am

My prescribed pressure was raised to 17 last year. I have really bad aerophagia at that pressure. Plus leak management can be a nightmare, since my face shape doesn't conform well with any of the masks on the market. (I could go on forever about leak control, but I don't want to go too far off topic.)

I got an oral appliance (SomnoMed) last year. It couldn't replace CPAP for me, but it allowed me to breathe well at pressures as low as 13. This was a huge improvement. The problem is that SomnoMeds are really expensive and they're inconvenient to wear and keep clean. After 6 months of use, I found that just by wearing my chin strap differently, I could stop using the oral appliance and still sleep well. I have a homemade chinstrap similar to the RipVW100 (http://www.ripvw.com/). I put it on so it touches my throat, then I slide the attachment points forward a bit. This pushes my skin forward so it bunches slightly under my chin. It also causes my tongue to move forward so it just touches my teeth when I'm supine and completely relaxed. With this arrangement, I can keep my pressure set to 14. It's not quite as effective as the SomnoMed, but it's about $2,000 cheaper and it's far more convenient and comfortable. Also, I don't get the painful aerophagia that I get at 17.

Also, yes, you can get used to high pressure. If you ramp up slowly over a period of weeks or months, your body may adapt comfortably.

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Denial Dave
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Re: My fight with aerophagia (air swallowing).

Post by Denial Dave » Mon Jul 21, 2014 12:41 pm

I had aerophagia really bad and painful when I started almost 2 years ago.

It took about a month for my body and mind to adjust to having air "pumped" into me.

SO there may be some truth to the theory that it will go aways in time if it is mild.

FWIW -- I'm on 19 IPAP and 14.4 EPAP these days with no aerophagia.

Dave

Sleeper Agent wrote:Question: if the aerophagia is mild and tolerable (but uncomfortable), will it go away with time if I leave the settings unchanged?

Does the body adapt and stop swallowing the air?

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Re: My fight with aerophagia (air swallowing).

Post by englandsf » Mon Jul 21, 2014 12:50 pm

Full face masks definitely make it worse as does swallowing mucus during the night. Sinus rinsing can stop the a latter and get you onto nasal only mask instead.

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Re: My fight with aerophagia (air swallowing).

Post by Denial Dave » Mon Jul 21, 2014 1:11 pm

Sinus rinsing isn't always the answer nor are nasal masks.

englandsf wrote:Full face masks definitely make it worse as does swallowing mucus during the night. Sinus rinsing can stop the a latter and get you onto nasal only mask instead.

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