Reducing aerophagia?

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So Sincere
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Reducing aerophagia?

Post by So Sincere » Sun Nov 29, 2015 10:12 pm

Short of surgery or lowering xPAP pressure, does anyone have recommendations for minimizing aerophagia? Unless there is a better alternative, I plan to have my RT drop my min EPAP pressure by .5 or 1 cm. It's currently at 13 cm. My AHIs are ~1.0, so I think I can risk it.

I first started having problems when I got my mouth leaks under control. I guess my mouth had been acting as a relief valve. Now, as I fall asleep, I play esophageal tug-of-war--I swallow air and then burp it back, over and over a few times until I nod off. I'm not aware of the swallowing part, just that there is air in my gastroesophageal tract where there wasn't a second ago. I think the discomfort and mild-to-moderate pain in the center of my chest due to the buildup of air in my stomach causes me to wake up several times a night. It of course gets worse as the night progresses. Don't get me wrong, I'm not in agonizing pain. It's just rather unpleasant. Once I get up, I burp the air back out a few times over the next hour or so.

As an aside, technically, I don't think "aerophagia" or "swallowing air" describes what I'm experiencing. I am not swallowing anything. My BiPAP machine is forcing air past the upper and lower esophageal sphincters down into the stomach--they are essentially leaking, I suppose. None of the processes involved in swallowing occur. I wonder what an accurate descriptive or medical term would be for this.

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Julie
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Re: Reducing aerophagia?

Post by Julie » Sun Nov 29, 2015 10:30 pm

Hi, I'm more concerned about why you would wait for your RT to lower the pressure on your machine rather than doing it yourself (as we all do)?

If you need help, we can supply that. Do you not have the clinical manual for your machine - we can also let you know where to find it.

Let us know if you'd like some (more immediate help) with your therapy of your OSA.
Last edited by Julie on Mon Nov 30, 2015 5:26 am, edited 1 time in total.

JDS74
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Re: Reducing aerophagia?

Post by JDS74 » Mon Nov 30, 2015 5:21 am

Welcome to the ASV club. It might be helpful it you change your subject line to include ASV to those users will be more likely to respond.

The correct medical term for what you are experiencing is Aerophagia.
Can you post your settings for your machine? That might help in getting advice to help control what is going on.
EPAP Min is one parameter to think about.

However, without seeing all of them, I'd be careful of changing anything as ASV machines are very different from other CPAP's because they need to have sufficient pressure differential between EPAP min and Max pressure to operated effectively in ventilator mode. It may be that your problem is caused by the current value of EPAP+Pressure Support during the night. Fixing that may be complicated.

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Julie
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Re: Reducing aerophagia?

Post by Julie » Mon Nov 30, 2015 5:28 am

He knows it's 'aerophagia' - see his subject line!

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Pugsy
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Re: Reducing aerophagia?

Post by Pugsy » Mon Nov 30, 2015 6:26 am

Would the term gastric insufflation or gastric distension make you happier?
I know that aerophagia involves the "swallowing" part and while we aren't maybe in the act of knowingly swallowing... the air is sort of being force fed into the esophagus.

You might find this useful...or just google "gastric insufflation" to see a little more.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525982/

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Re: Reducing aerophagia?

Post by McSleepy » Mon Nov 30, 2015 10:41 am

My IPAP pressure is currently at 20cm and I'd be near exploding if I didn't sleep on my stomach. I still ingest air, but not as much to be a problem. By the way, the -phagia (https://en.wiktionary.org/wiki/%E1%BC%9 ... E%BF%CE%BD) suffix comes from the Greek word that designates something ending up in your stomach. The English word "swallow" kind of implies the usually associated motions of your tongue, pharynx and throat, but it doesn't have to be. Anyway, sleeping on your stomach is generally beneficial for OSA, but it comes with difficulties using a mask, so it can be a trade-off. I have not found a different solution (yes, I exercise my abdominal muscles).
McSleepy

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So Sincere
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Re: Reducing aerophagia?

Post by So Sincere » Mon Nov 30, 2015 10:50 am

Pugsy wrote:Would the term gastric insufflation or gastric distension make you happier?
I know that aerophagia involves the "swallowing" part and while we aren't maybe in the act of knowingly swallowing... the air is sort of being force fed into the esophagus.

You might find this useful...or just google "gastric insufflation" to see a little more.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525982/
Thanks, I was also wondering what the medical term was for air in the stomach. Now I know. Having been a volunteer EMT, I should have know this but never heard anyone use this term. It's a common risk during intubation.

UPDATE: Oh, you're right. I was thinking that "gastric insufflation" just meant "air in the stomach," but according to A Dictionary of Dentistry, it means "The blowing of air into the stomach..." That's it. Thanks!

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Last edited by So Sincere on Mon Nov 30, 2015 11:48 am, edited 1 time in total.

So Sincere
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Re: Reducing aerophagia?

Post by So Sincere » Mon Nov 30, 2015 10:58 am

JDS74 wrote:It might be helpful it you change your subject line to include ASV to those users will be more likely to respond.
I would have thought that this would be a problem with all positive-airway machines. Are you saying that this only happens with ASVs?
JDS74 wrote:However, without seeing all of them, I'd be careful of changing anything as ASV machines are very different from other CPAP's because they need to have sufficient pressure differential between EPAP min and Max pressure to operated effectively in ventilator mode. It may be that your problem is caused by the current value of EPAP+Pressure Support during the night. Fixing that may be complicated.
Oh, okay. As I said in my post, I plan on having the RT make the adjustments for me. Presumably, she'll know how these parameters interact with each other to achieve the effect I'm looking for.

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So Sincere
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Re: Reducing aerophagia?

Post by So Sincere » Mon Nov 30, 2015 11:08 am

Julie wrote:Hi, I'm more concerned about why you would wait for your RT to lower the pressure on your machine rather than doing it yourself (as we all do)?
I assumed that some parameters are blocked by the prescriber because I see some described in the manual that I don't have access to when I scroll through the options on my machine. Is that possible? I always thought there was some way to override or reset whatever is preventing my access to them. However, at this point I have a good relationship with my neurologist and her RTs, and I just as soon let them make the adjustments, especially if that satisfies their control fetish.

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Re: Reducing aerophagia?

Post by So Sincere » Mon Nov 30, 2015 11:37 am

McSleepy wrote:By the way, the -phagia (https://en.wiktionary.org/wiki/%E1%BC%9 ... E%BF%CE%BD) suffix comes from the Greek word that designates something ending up in your stomach. The English word "swallow" kind of implies the usually associated motions of your tongue, pharynx and throat, but it doesn't have to be.
(First off, I'm a word geek. I love words, their use and history. I split hairs to better understand them. To wit, the following.) Interesting, but it looks like it has always had the sense of something being actively eaten or consumed, not merely the passive presence of something in the stomach. Every definition I find (online, of course) for aerophagia says it's the swallowing of air, and every definition of swallowing describes a complex process typically for the ingestion of food and drink. However, we do truly swallow air when we eat and drink. We also swallow air along with saliva. But this swallowing is the real deal. When we use "aerophagia" or "swallowing air" with respect to positive-airway machines, we are not referring to swallowing as dictionaries and most people understand the term. It would just be nice to be able to distinguish between actually swallowing air versus having air forced down our throats with no swallowing involved. I'll continue to use these terms (incorrectly), but I'll also be on the lookout for something more accurate.
McSleepy wrote:sleeping on your stomach is generally beneficial for OSA
I didn't know that, but I'm just not comfortable sleeping on my stomach. Oh, I guess by doing this one exerts pressure on the stomach which may be enough to counteract the pressure from the machine. Interesting. I'll give it a try. Thanks!

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JDS74
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Re: Reducing aerophagia?

Post by JDS74 » Mon Nov 30, 2015 1:35 pm

Depending on the patient, aerophagia can occur with any CPAP machine. It's just more likely with the large pressure variations with ASV. It's the higher pressures that does it. Of course, what is higher depends on the patient's anatomy.

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Re: Reducing aerophagia?

Post by So Sincere » Mon Nov 30, 2015 1:50 pm

JDS74 wrote:Depending on the patient, aerophagia can occur with any CPAP machine. It's just more likely with the large pressure variations with ASV. It's the higher pressures that does it.
Oh, okay, that makes sense. However, I notice it even during the ramp-up time after I put the mask on--that's when my machine and I play tug-of-war.

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Julie
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Re: Reducing aerophagia?

Post by Julie » Mon Nov 30, 2015 6:14 pm

You're not blocked or locked out of your machine, but you need to look at the clinician manual (not just the 'top layer' of info they gave or showed you. If you go to Apneaboard.com and scroll down (2nd pg I think, but hunt around) you'll find your machine model # (the bottom of yours - after emptying water out - should give you a number and/or use the name from the top where controls are) and be able to DL the manual. A whole new world will open up!

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Re: Reducing aerophagia?

Post by McSleepy » Mon Nov 30, 2015 7:42 pm

So Sincere wrote: (First off, I'm a word geek. I love words, their use and history. I split hairs to better understand them. To wit, the following.) Interesting, but it looks like it has always had the sense of something being actively eaten or consumed, not merely the passive presence of something in the stomach. Every definition I find (online, of course) for aerophagia says it's the swallowing of air, and every definition of swallowing describes a complex process typically for the ingestion of food and drink. However, we do truly swallow air when we eat and drink. We also swallow air along with saliva. But this swallowing is the real deal. When we use "aerophagia" or "swallowing air" with respect to positive-airway machines, we are not referring to swallowing as dictionaries and most people understand the term. It would just be nice to be able to distinguish between actually swallowing air versus having air forced down our throats with no swallowing involved. I'll continue to use these terms (incorrectly), but I'll also be on the lookout for something more accurate.
That is only because there really aren't that many ways by which something can find its way into one's stomach, but alternatives do exist. From the above reference of the etymology of the word: (“to divide, distribute”) with a semantic shift "I received a share" → "I consumed" → "I ate". The association is "if it's in my stomach, I must have eaten it!" We people like to eat and it shows.
McSleepy

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Re: Reducing aerophagia?

Post by Greg Riddle » Mon Nov 30, 2015 8:00 pm

So Sincere wrote:
JDS74 wrote:It might be helpful it you change your subject line to include ASV to those users will be more likely to respond.
I would have thought that this would be a problem with all positive-airway machines. Are you saying that this only happens with ASVs?
JDS74 wrote:However, without seeing all of them, I'd be careful of changing anything as ASV machines are very different from other CPAP's because they need to have sufficient pressure differential between EPAP min and Max pressure to operated effectively in ventilator mode. It may be that your problem is caused by the current value of EPAP+Pressure Support during the night. Fixing that may be complicated.
Oh, okay. As I said in my post, I plan on having the RT make the adjustments for me. Presumably, she'll know how these parameters interact with each other to achieve the effect I'm looking for.
It is not just asv. I'm on bipap and wake up everyday to varying degrees of distention. I've found that if I limit my ipap max to 21 lowered my epap min to mid 13s. And raised my ps to around 6 then I can keep my ahi to around 2 and keep from waking up in pain from the gas.