What can you tell me about Aerophagia?

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lynbarnes
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What can you tell me about Aerophagia?

Post by lynbarnes » Mon Mar 30, 2015 11:38 am

I started Cpap treatment on 18 March. I have been doing fairly well and have adapted to the mask pretty well. Since Saturday, I have been having gas pains. I've always had issue with intermittent gas in the afternoons, but this is different and in the mornings (and in the evenings). My allergies have started (I had allergy shots about 15 years ago) and it feels like I'm coming down with a cold. Could this be what's contributing to the aerophagia?

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Julie
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Re: What can you tell me about Aerophagia?

Post by Julie » Mon Mar 30, 2015 11:44 am

First, try lowering your humidity setting if you feel 'cold-ish' as you may not need it on high (or at all) and it can cause cold symptoms.

As far as the aerophagia goes, how high is your pressure set to? Sometimes lowering it just by 1-2 cm can make a difference as long as your AHI, etc. is not appreciably affected.

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Pugsy
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Re: What can you tell me about Aerophagia?

Post by Pugsy » Mon Mar 30, 2015 11:52 am

The "cold" or "allergy" symptoms could be related to humidity setting on the humidifier.
What setting are you or were you using? If lower setting has been used then you might try higher setting and if a higher setting has been used you might try a lower setting. The nasal mucosa respond to getting either too dry or too moist by swelling up and acting like we have a cold or allergy attack.
What your nasal mucosa may or may not need is something that is very individualized and just something you have to sort out yourself.
Google "cpap rhinitis" to get an idea what I am talking about.
I need as much moisture as I can possibly get and Julie needs minimal to non extra....there is no right or wrong though...there's just what works for you as the individual.

When you have time please add your equipment to your profile like I have mine.
wiki/index.php/Registering_Equipment_in_User_Profile
Depending on your equipment there may be additional options available.

Aerophagia....again what equipment are you using and what pressures are you currently using and are you using any exhale relief that may be available with your equipment?
wiki/index.php/Aerophagia
If your nose is really congested it may be causing more mouth breathing than usual which could potentially increase the chance of air going into the digestive system so dealing with any congestion might help and needs to be done anyway.

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SGearhart
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Re: What can you tell me about Aerophagia?

Post by SGearhart » Mon Mar 30, 2015 11:57 am

lynbarnes wrote:I started Cpap treatment on 18 March. I have been doing fairly well and have adapted to the mask pretty well. Since Saturday, I have been having gas pains. I've always had issue with intermittent gas in the afternoons, but this is different and in the mornings (and in the evenings). My allergies have started (I had allergy shots about 15 years ago) and it feels like I'm coming down with a cold. Could this be what's contributing to the aerophagia?
First, Welcome to the forum!

Your sleeping posture can have an effect on your problem. This can be caused by having your chin tucked into your chest. Try to position your head, neck, and back closer to a standing posture while you're lying down.

I hope this may help. - SG

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Re: What can you tell me about Aerophagia?

Post by Wulfman... » Mon Mar 30, 2015 12:16 pm

Here's the link to a forum search on "aerophagia". Lots of reading there.

viewtopic/t104831/search.php?keywords=aerophagia


Den

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JV1967
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Re: What can you tell me about Aerophagia?

Post by JV1967 » Mon Mar 30, 2015 1:39 pm

I'm hoping that I don't have to deal with a lot of Aerophagia, as I did in the study. I want to just sleep well and not constantly fart on my boyfriend. My ASV is scheduled to arrive tomorrow, and I have to use a FFM, because I have sinus problems that can't be handled with decongestants; I'm on anxiloytic medication. I sometimes mouth breathe, so... fingers crossed. If it becomes a huge issue, I will try to call my doctor and see what she says about it. I think perhaps it's time to use more of that CVS sinus rinse stuff.
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Re: What can you tell me about Aerophagia?

Post by JV1967 » Mon Mar 30, 2015 1:42 pm

By the way, is Aerophagia mostly a FFM problem, or do people on nasal masks/pillows get a lot of it too?
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Pugsy
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Re: What can you tell me about Aerophagia?

Post by Pugsy » Mon Mar 30, 2015 2:04 pm

JV1967 wrote:By the way, is Aerophagia mostly a FFM problem, or do people on nasal masks/pillows get a lot of it too?
Aerophagia isn't limited to FFM users...it can happen to any mask user. I have been lucky and only had it happen really bad a couple of times and I use nasal pillows.
It also isn't limited to people with "high" pressures. It can happen at lower pressures as well but it is more commonly associated with higher pressure needs.

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JV1967
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Re: What can you tell me about Aerophagia?

Post by JV1967 » Mon Mar 30, 2015 2:55 pm

Pugsy wrote:
JV1967 wrote:By the way, is Aerophagia mostly a FFM problem, or do people on nasal masks/pillows get a lot of it too?
Aerophagia isn't limited to FFM users...it can happen to any mask user. I have been lucky and only had it happen really bad a couple of times and I use nasal pillows.
It also isn't limited to people with "high" pressures. It can happen at lower pressures as well but it is more commonly associated with higher pressure needs.
Thank you, Pugsy.
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robysue
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Re: What can you tell me about Aerophagia?

Post by robysue » Mon Mar 30, 2015 2:56 pm

lynbarnes asks: What can you tell me about Aerophagia?
Short answer: It's painful.

Long answer: Aerophagia has been one of my recurrent problems ever since starting PAP some 4 1/2 years ago. At the beginning it was miserable for me. I even dreamed about it. (See viewtopic.php?f=1&t=55868&p=523291&hilit=+goose#p523291 for a blast from the past.)

More seriously: Aerophagia is like so many things with this crazy therapy. What works wonders for one person doesn't do diddly-squat for someone else with the same problem.

For me, what "worked" was a combination of a switch from CPAP/APAP to Bi-level with slightly lower pressures than what I was first tirtrated with along with a lot of time to simply get used to this crazy therapy. Keeping my tongue firmly up against the roof of my mouth when I'm asleep is very important to me: When the tongue is in this position, it helps keep air from getting into my mouth, which then leads to me swallowing the excess air. And as I slowly learned to actually sleep with this alien on my face and spend less time awake with the mask on, that also helped. But even now, after 4 1/2 years, I still have the nights where the aerophagia raises it's ugly head and I wake up with a basketball in my stomach. When that happens, the best thing I can seem to do is to do more walking than usual and to not worry about the need to fart until my stomach feels better.
SGearhart wrote:Your sleeping posture can have an effect on your problem. This can be caused by having your chin tucked into your chest. Try to position your head, neck, and back closer to a standing posture while you're lying down.
Sleeping posture can indeed affect aerophagia. But in my case tucking my chin towards my chest helps keep the aerophagia down to a bearable level. When I keep my head and neck "closer to a standing posture" while I'm lying down, that usually leads to the feeling that I'm a balloon being blown up by my machine pumping air down my gut. And if I happen to fall asleep that way, I'm much more likely to wake up with a basketball in my stomach. So while it's worth trying to not tuck your chin (if that's what you're doing), untucking the chin may or may not help. You'll only know once you try it.

Other things that may (or may not) help in the battle against aerophagia:

1) Don't eat too late. A full stomach seems to be more prone to aerophagia problems than an emptier one.

2) Elevate the head of the bed. Indeed, do all the usual self-treatment for GERD things.

3) If you have ever been diagnosed with GERD, get serious about treating it and keeping it under control. There seems to be a correlation between GERD and aerophagia in new CPAPers. If you've never been diagnosed with GERD, it still may be worth asking your PCP about whether you might have it and how to manage it if you do.

4) If you've changed your sleeping position in order to accomodate the CPAP mask, work hard on figuring out how to make your favorite sleeping position work with the machine. In some cases, sleeping in a new position that is not fully comfortable can lead to additional spontaneous arousals. And spontaneous arousals can lead to swallowing. And swallowing can lead to aerophagia. Which then causes more arousals and more swallowing and more aerophagia. In other words, it's important to make sure that you're genuinely comfortable in the position you fall asleep in.

5) More on the arousals: Anything that leads to fragmented sleep and lots of lying in bed half asleep and half awake can increase the tendency to swallow while you have the mask on. And so if you're getting a lot of fragmented sleep, trying to identify and address the reasons the sleep is fragmented in the first place may help keep the aerophagia under control. That's really why time more than anything I specifically did is what eventually allowed aerophagia to become an occasional problem for me instead of a constant problem: Eventually my body finally started to get used to sleeping with the machine and the hard work I did on CBT-for-Insomnia helped to consolidate my sleep cycles enough where I was no longer arousing and swallowing air all night long.

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lynbarnes
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Re: What can you tell me about Aerophagia?

Post by lynbarnes » Mon Mar 30, 2015 4:14 pm

Thanks for the quick response and all the good advice...

So, I thought my machine stuff that I filled out would automatically show in my signature. How do I make it show in my signature?

I am using an ResMed S10 Elite; I have a full-face mask because I know I am a mouth-breather. The Resmed P10 or something like that (I don't have it memorized and I don't have the info with me). I am on a pressure of 8 with a ramp from 4 to 8. The humidity is set to auto; I'm not sure that it's a humidity thing because the problem started happening after I started swimming again (now that I have the energy and motivation to do that). My sinuses were already irritated when I went to bed. I notice that I am waking up at night because my nose is itching (the allergies) and I think they are also causing issue with my sinuses being irritated. I was taking an antihistimine before bed for a while, but I didn't last night and woke up miserable this morning.

I read somewhere else that taking probiotics can help with aerophagia. Any thoughts?

Anyone use the sinus rinse (i.e. Neilmed) to help with sinus issues?

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Re: What can you tell me about Aerophagia?

Post by ChicagoGranny » Mon Mar 30, 2015 5:30 pm

SGearhart wrote:Your sleeping posture can have an effect on your problem. This can be caused by having your chin tucked into your chest. Try to position your head, neck, and back closer to a standing posture while you're lying down.
TheLankyLefty takes the opposing view - https://www.youtube.com/watch?v=-65JWNBttnE

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Morbius
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Re: What can you tell me about Aerophagia?

Post by Morbius » Mon Mar 30, 2015 5:31 pm

What can you tell me about Aerophagia?
It means you probably (see above) got GERD:

http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=28760

http://www.sleepreviewmag.com/2010/10/aerophagia/

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Morbius
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Re: What can you tell me about Aerophagia?

Post by Morbius » Mon Mar 30, 2015 5:40 pm

And don't forget "Bad Sleep:
deltadave wrote:
robysue wrote:Are you saying:

Arousals lead to aerophagia and aerophagia leads to decreased sleep efficiency due to additional wakes caused by the aerophagia?
'Zactly!
CarpeNoctum wrote:Gerd/aerophagia causes arousals more the awakenings.
The algorithm below attempts to explain the relationship of all these factors, but did you review the other posts in that thread?
deltadave wrote:
ignorant1 wrote:That begs the question of if that would cause a change in thoracic pressure, enough to overcome the LES “seal” against the increased respiratory tract pressure from xPAP?
The pressure required to open a normally functioning closed LES is about 25 - 33 cmH2O. Clearly, the unpredictability of aerophagia requires there to be other factors underfoot.

Keep in mind that the easiest way to relax an LES is to simply swallow. (As an aside, I would also offer that the easiest way to elicit a swallow during sleep is to generate an arousal, which may be the mechanism of the PLM point. It's not PLMs, it's the subsequent arousals).

In re: inspiratory waveform engineering, if you rapidly force a breath into a dead (essentially) cat, you can elicit some potentially untoward responses:
In 2001, Lang and colleagues found that esophageal receptors trigger relaxation of the UES on sensing rapid distension, but activate contraction of the upper esophagus (including contraction of the UES) on sensing slow distension.
Easy To Understand Regina Patrick Article

Complicated Scientific Stuff

It would seem then, that this phenomenon would preload the esophagus and create the milieu for aerophagia (in order to have aerophagia, you need some "phagia".

Image
deltadave wrote:Interesting stuff to read (and previously referenced by -SWS in a short, largely unnoticed thread):

CPAP and Things That Go “Burp” in the Night

Aerophagia and Gastroesophageal Reflux Disease in Patients using Continuous Positive Airway Pressure: A Preliminary Observation
deltadave wrote:Arousals.

It's always about sleep quality.

Image

chrysogognus

Re: What can you tell me about Aerophagia?

Post by chrysogognus » Tue Mar 31, 2015 3:17 pm

I'm fairly new to cpap - I've been lurking here but registered since this is a question I might be able to help with.

I woke up in the middle of the night with some intense stomach pain. It was bad enough I wondered if I needed to go to the ER. It turned out it was gas from aerophagia.

It may be connected to GERD (I don't think so in my case, but it's worth considering). What I've done (and some combination of this has helped) is:

* Taking gas-x when it feels like it's going to be bad.
* sleeping with my head elevated somewhat (although this does make it harder to sleep)
* drinking carbonated water in the morning.

I think the last one is the most helpful - it kind of helps force the gas out when I burp, even though it seems counterintuitive.

I've only had one incident of it so far, but it was pretty bad and painful - maybe one of those ideas will help.