Do you, or have you had problems with Aerophagia?

If you have had it, and you resolved it, how did you accomplish it? As I have said before, I'm tootin' louder than a whoopie cushion. Advice is greatly appreciated. Thank you.

You know, JV, I had it when I first got on cpap but it went away. I don't remember it lasting for a terribly long time either. There was nothing I did, I think I just got used to sleeping with all that air rushing me while trying to get to sleep. I am at much higher pressures now and it has not come back. Has this been going on for long? Hopefully, someone else can help you with some answers! Best, Tuza

I am afraid I am repeating myself on the same things to the same people. Sorry. this is the best I know.

Once I had a sleep study, I had to get after a few hours to walk around and belch out gas. True aerophagia related to sleep apnea treatment, as I define it, is caused by air being pumped into ones stomach during the exhale cycle of breathing, when the machine is still pushing air. Some of the things others have suggested, like taking Malox type things, or Simethicone, (which reduces surface tension in gas bubbles, which allows smaller bubbles is not of much help sleep apnea type problems.) Same with sleeping partially upright, the xPAP machine is still pumping air into the stomach. It is also confusing because many of us also have, concurrently, GERD, which some of those things might help.

One of my sleep docs explained the origin of my problem like this (yes, your issue may be different.) I inherited from my parents the size of my nose, small. Even as a baby I probably gasped for breath, because of the small size of my nose. This had another effect, that gasping created a sump pump effect where stomach acid was pulled up over the valve just above my stomach, over years damaging it. When I became a teen ager, this gasping had the secondary effect when in normal aging, my jaw would extend more forward and widen, that it did not. The soft tissue of the back of my tongue and such. Now when I slept that soft tissue would fall back and cover the air way. When my brain sensed that I needed O2, it would wake up enough to take a breath, and I did not have continuous restful sleep which should culminate in dreams, and in the last hours of the night, really rejuvenating sleep. This doc had done a number of experiments where he placed sensors in the nose of sleep apnea patients, and nearly all of them had acid detection rising up from the stomach. The valve above the stomach can normally, undamaged, hold out against a pressure of 20 on the xPAP, so air can not get into stomach.

So now we got multiple things going on, and we add in an xPAP machine with it blowing air into our stomachs. Well, taking some kind of stuff just before bed, like Malox may keep the GERD from irritating the lining of our esophagus, but not stop the air problem. BTW, in my experience, Gaviscon, the most expensive of those liquid things, may be the best for that. But you wanted to stop Aerophagia.

As you have already found out, walking around and belching out the air helps. I believe that some of those who get up and say that they feel bloated, and like they can not inhale air when they first get up, have Aerophagia, pressing on the lungs and heart. That may be an over simplification.

One of my Sleep Docs in Utah, told me, when I asked about an ENT doing something about resizing the soft tissue at the back of the throat. That now the ENT's who used to do those surgeries, never did them for that reason. He sent all his patients to the sleep doc. Even though the ENT could have easily made a lot of money doing those surgeries, the ENT just had enough experience that getting rid of the soft tissue with surgery would not solve the problem, the person would still have sleep apnea, just now with a scar and some bitterly painful memories.

One could have the valve at the top of the stomach fixed, but it means you will spend some of the rest of your life eating very small bites and small portions. The valve will probably get damaged again by the stomach acid, just as it did before. Then you can eat a more normal sized bite.

I found the last door. A Bi-Level machine. It has a pressure change level between the inhale and exhale of at least five. EPR has a change of three. I suspect the shape of the wave of air pressure is different between EPR and Bi Level. I have heard that their is a difference between the wave shape of how fast the air pressure changes between the PR and Resmed machines. Anyway, I know that someone suggested that you set the EPR to as high as it will go for your machine. (and EPR is the name for this pressure change for only one machine, I dunno what the other is.) Philips Respironics calls their Bi Level to be Bi Pap, and Resmed calls their Bi Level VPAP.

I suspect there is more going on with my use of Bi-Level than what is thought of. I need a pressure of a bit less than eleven to keep my airway open. But when I inhale, the opening in my throat is so small that the eleven will not supply enough air to fill my lungs before I begin to inhale again. Might be that to keep the airway open when I am inhaling, that I need more pressure at that time to keep my airway open. ??? Complicating all of this are the standards. I once used a straight pressure of 11, had an AHI of less than five, and did not feel rested. So I turned on the auto feature of my machine. (Let us go back a bit, after my first titration, my sleep doc said I should only use a straight pressure, meaning I personally did not respond well to Auto) The other thing that happens with Auto is that the extra pressure creates leaks, and the machine ends up chasing leaks more than raising pressure for therapeutic need. I got up to a starting pressure of 13 and a top pressure of 15.5 running auto as straight pressures. I had severe Aerophagia. I had an AHI of like .1, and I felt rested. My first sleep doc was right, my body, mind, breathing patterns do not respond well to auto. My body will try to cooperate with the machine, and seem to breathe all right with a straight pressure of eleven, but I do not get rest.

Doctors do not usually begin to test for Bi-Level until the pressure is like 12 (so I was told). To get Medicare to pay for a Bi_level machine, one must fail CPAP. That has some specific standards to meet. In my case, If I used a straight pressure of like 11 or 12, my heart would miss beats, and I had other waking anomolies. Hard to say, I was on straight pressure for like six hours, I do not think I ever slept, and they only put me on Bi Level when I called them to come in and dig the Nitroglycerine out to stop the chest pain. That chest pain not being from Aerophagia.

Still, even if your doc felt when he saw you that a BiLevel was where you were headed, the way insurances read now, he has to have you use CPAP, and fail CPAP before trying BiLevel. Those with some breathing problems, and MS/MD, or higher pressure can jump straight into BiLevel. BiLevel machines cost the insurance companies more. Keep in mind that BiLevel is sometimes classified as for the comfort of the patient. BiLevel is never approved by Insurance to prevent Aerophagia.

The other side of the story, some months after I started using BiLevel, (VPAP in my case) I could stop taking Prilosec, and the GERD was gone. What I also discovered is that for years I had thought I had bad Allergies, which made my nose drip, which put more bacteria into my stomach, which created more stomach acid, which as GERD/reverse sump effect, came up and danced on the top of my wind pipe, when I had coughing spells that would stop my heart and make me dizzy. Then no more stomach acid rising up to make my nose drip, and so on. No more coughing spells that made me dizzy.
Yippee. I had successful sleep with an AHI of less than .2.

Now the GERD is partially back. SIGH. Partially from pressure on my abdomen, as well as other things. Some of the other things that cause a large abdomen are fatty liver, pancreatitis (swollen pancreas) both of which can make gas in my innards. BTW: I did not use to know. Pancreatitis causes a bunch of that gas in my bowels, really smelly gas, and leaves oil on top of the water when I have a bowel movement.

I also talked to him about the "Falcon Position" of sleeping. He said he did not usually bring it up, because he did not want his patients to do it. Particulary in my case where I had a large abdomen. If I lay on my stomach, my huge belly would put, extra pressure on lungs, would mean the machine had to pump harder to get sufficient air into my lungs against all the other pressure. This need would build up during the need if I had any Aerophagia, and might create ---drama. Like a trip to the ER. I know that goes against some of you folks who use the "Falcon Sleeping Position," think. I am just repeating what my sleep doc said. I don't think the Sleep Doc liked to talk about the Falcon Position, because those who intended to do it, only ended up arguing with him. He once said that he loved to help people and educate people about Sleep Apnea and what could be done about it. Mind, he walks the talk. He works for a charity hospital which does not pay him as much as he could make if he went private for fewer hours of work. He stays with one patient until all the patients questions, needs, concerns are answered. So I tend to trust what he says.

Before xPAP machines, not so long ago, about the only treatment for Sleep Apnea was a- Tracheostomy (sometimes called tracheotomy) is the creation of an opening directly into the trachea (windpipe) in the neck for the purpose of assisting breathing. Doc said it might be hard to believe, but xPAP machines were easier than trying to take car of the open wind pipe hole.

That is positive thinking than what I have going now. I can not see through my car window in the morning from the overnite accumulation of greenish pollen. So I am coughing, it will be worse for some months more. A skunk is now squatting under the floorboards of my house. I think he likes to sleep just below my bed. I tried the old farmers adage, put moth balls under the house. The city dog nappers (AKA animal control) laughed and said that would not work. So I smelling really noxious mothballs as well. They will bring over a live trap and use cat food, when one of their many traps is free. Obviously they are all in use. Their capture the day before had been at the City Managers house, so I am betting Animal Control will get funded for the rest of the summer. I have been waiting two weeks for them to bring back that trap. They also said not to annoy the skunk.

Yes, Pugsy. I was kinda aware that the OP was further along, I was just trying to be thorough, thinking to write something useful for others, not just OP. I realized I should have mentioned that, but I was tired of typing, and still have really bad sentences in this. To me, usually Aerophagia is air one belches out. Although one can fill up the who system with air. My doctor has a x-ray scan to prove it happened to me. I also thought this was the patient who had moved onto an ASV. I am probably wrong about that as well. After I laid down I thought a person like me, with OSA should not give information to anyone using an ASV, and whose problems are Centrals. I am also aware that an ASV is often set that when it detects a Central, It will jump up the pressure to like 20 to get a person breathing. I guess the machine also knows when a persons lungs are already filled with air to do that. I am trying to say, ASV is a whole different world than many on this forum sleep in.

JV1967 asks: Do you, or have you had problems with Aerophagia?

Short answer: Yes, I've had it in the past. And I still sometimes have it.

Long answer: I use pressures that are much lower than what you need as I recall. And I've never been diagnosed with GERD, but then I've also never been tested for it. (No GERD symptoms to speak of, except for the fact aerophagia and GERD can be related.)

What worked for me?

Unfortunately, the main thing that worked for me is not particularly useful to you since you're using an ASV machine.

The thing that really helped me was switching from CPAP to Bilevel was pretty critical---even at my low pressure. I was originally titrated at 9cm and the aerophagia started right away when I was using a Resmed S9 AutoSet in CPAP mode at 9cm with EPR = 3. The aerophagia started right away and lead to a number of serious comfort issues and seriously disrupted my sleep to the point of triggering a significant crash-and-burn in terms of my daytime functioning and how I was feeling. (I not only felt 100 times worse, I looked horrible enough that folks at work were asking me what was wrong.)

But since you're on an ASV, switching machines is not going to work. And playing with reducing the pressures is not a particularly good idea since you need the high IPAP at times to trigger the inhalations when your machine is worrying that you aren't breathing well. (That's how your machine treats your central sleep apnea problem.) Still, if the aerophagia is really uncomfortable, you're going to need to complain (possibly loudly) to the sleep doc (or his nurse or PA) about it. It's possible that perhaps some small tweaking with the pressure settings might take the edge off the aerophagia without leading to too many central apneas.

Even after they switched me from CPAP/APAP to bilevel, I've continued to have real problems with sleep fragmentation---although they're not as bad as they were that first year on PAP. And my aerophagia is definitely worse when I'm not sleeping soundly. While it's no longer a nightly battle for me, it still raises its head on a regular basis. My pet theory, based on things DeltaDave/Morbius has written, is that my aerophagia is part of a viscous cycle of

... arousals lead to swallowing which leads to aerophagia which leads to more arousals which leads to more swallowing which leads to more aerophagia which leads to more arousals which leads ....

To put it more bluntly: In my case, bad sleep causes aerophagai and aerophagia causes bad sleep. Fixing the bad sleep helps minimize the aerophagia.

You also ask:

JV1967 wrote:If you have had it, and you resolved it, how did you accomplish it? As I have said before, I'm tootin' louder than a whoopie cushion. Advice is greatly appreciated. Thank you.

Things that have helped minimize my problems with aerophagia include:

• Not eating too close to bedtime. A full stomach seems to be much more sensitive to the air being pushed down my gut.
• Keeping my latency to sleep excessively short. If I'm not asleep within 5-10 minutes of masking up, I'm much more likely to have a difficult night due to aerophagia. In my case, I've had to become willing to take more Ambien than I'd like to keep that sleep latency really short. I also have to be pretty vigilant in terms of a bunch of sleep hygiene things, including trying to maintain a regular wake up time regardless of when I get to bed and how well or poorly I sleep. I also try very hard to not go to bed before I'm genuinely sleepy. And it took several months of pretty hard CBT-Insomnia to get my latency to sleep down to the 5-10 minutes I need in order to be comfortable with the mask on my face.
• Finding a sleeping position that was very close to my favorite pre-CPAP sleeping position. When I first started PAPing, it seemed as though I simply could not figure out a way to route the hose when I was in my favorite sleeping position---with my head under the covers and my nose nestled into my hubby's armpit. And falling asleep in "new" sleeping positions was very difficult and that tended to feed how miserable I felt with the mask on my nose and air being blown down my gut.
• Time. The longer I used the BiPAP with my current settings, the more my body got used to how it feels to sleep with the machine. And that itself has lead to minimizing the number of times I wake up each night. (I still wake up way too many times on too many nights, but it's not as bad as it was back in the dark days of 2010-2011.) And fewer night time wakes and arousals leads to a lot less aerophagia in my case.

If your aerophagia remains intolerable for the next couple of weeks (or months), you should complain to the sleep doc's office. If you're really pain from the aerophagia, you need to:

• Document how bad the aerophagia is. Keep a journal. Each morning mark down a subjective view of how bad the aerophagia is that morning and whether you had wakes related to aerophagia during the night. Since daytime "tooting" is one of your issues, keep tabs on how long the excessive "toots" last after getting up.
• If the pain from aerophagia becomes severe, call the sleep doc's office to report it. Seriously---the only way you can get some sleep docs and their nurses and PAs to take notice that you're having really serious adjustment problems is to complain on a regular basis.
• Bring your journal with the data on how bad the aerophagia actually is with you to each and every follow up appointment. Figuratively hit them over the head with just how bad you're feeling by showing them what you've been writing. That way the nurse can't assume that you're exaggerating if you say you're waking up almost every day with severe aerophagia problems that take 2 hours to resolve.

Good luck

(Edited to make this response more tailored to the OP's needs. I first missed that he's using an ASV.)

Hey everyone talking about OP has to fail cpap before someone can go to bilevel for aerophagia...
She's already on a bilevel machine...specifically ASV bilevel due to centrals and she has to use higher pressures to treat the centrals because that's how the ASV machine works.

No sense in telling her that she needs to fail cpap to move to bilevel because she is already on bilevel.

I have found sleeping on my left side helps.
It is supposed to be related to anatomy and gravity.
It also keeps exhaust air off my sweetie.
{{{well, at least from the mask}}}

robysue wrote: I first missed that he's using an ASV.

And also he's a babe.

Morbius wrote:

robysue wrote: I first missed that he's using an ASV.

And also he's a babe.

Yeah, I missed that too.

Can I blame it on Pugsy's aliens?

robysue wrote:

Morbius wrote:

robysue wrote: I first missed that he's using an ASV.

And also he's a babe.

Yeah, I missed that too.

Can I blame it on Pugsy's aliens?

I thought Pugsy was an alien....

As Pugsy has said, I am already on an ASV BiPap, and it is for sleep onset cenrtrals with a small amount of obstructive going on in REM sleep. I called my doctor, and she is going to try to lower my pressure a bit. I was also tested for GERD, by a barium swallow x ray, at the hospital.

What I want to know is, is Aerophagia dangerous or harmful to the body? I just fart a lot, all night, and in the morning, so far, no pain.

Oh, and another thing I've noticed is that when I wake up, It feels like I'm not getting enough air OUT of myself. It is harder to breathe out against the pressure.

Morbius wrote:

robysue wrote:Can I blame it on Pugsy's aliens?

I thought Pugsy was an alien....

second the motion.

chunkyfrog wrote:I have found sleeping on my left side helps.
It is supposed to be related to anatomy and gravity.
It also keeps exhaust air off my sweetie.
{{{well, at least from the mask}}}

I have to sleep on my left, due to a previous head injury that causes right side vertigo. I also sometimes stomach sleep, but that probably doesn't help. Unfortunately, the left side sleeping hurts my left hip. I just spoke with the DME, and they lowered my pressure last night via the modem. I still woke up farty, and had night farts. My AHI was 0.26, instead of 0.0, after the pressure change. I saw it on Sleepyhead.

I have yet to experience pain in my stomach, and to state the obvious, I hope I don't.

JV1967 wrote: What I want to know is, is Aerophagia dangerous or harmful to the body? I just fart a lot, all night, and in the morning, so far, no pain.

As far as I know: If the aerophagia is not disrupting your sleep AND you're not in any real pain AND you don't have GERD, you probably don't need to worry too much about it.

Pugsy wrote:Hey everyone talking about OP has to fail cpap before someone can go to bilevel for aerophagia...
She's already on a bilevel machine...specifically ASV bilevel due to centrals and she has to use higher pressures to treat the centrals because that's how the ASV machine works.

No sense in telling her that she needs to fail cpap to move to bilevel because she is already on bilevel.

Onset centrals. Hypopnea. Pugsy, even though I have mentioned this in another response, I want you to be able to see it. They lowered my pressure a bit last night from the modem. I did not get 9 hours of sleep. I had the mask on for that long. I actually got only 6, with perhaps a couple of quick naps and wakings during the time after that while I was in bed with the mask still on. I do this to get used to it. Most recent is to the left; last night.

2 days of CPAP Data, between Tue Mar 31 2015 and Wed Apr 1 2015
Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 09:17 08:03 08:03 08:03 08:03
Compliance 100% 100% 100% 100% 100%
Therapy Efficiacy
AHI 0.43 0.31 0.31 0.31 0.31
Obstructive Index 0.00 0.00 0.00 0.00 0.00
Hypopnea Index 0.43 0.31 0.31 0.31 0.31
Clear Airway Index 0.00 0.00 0.00 0.00 0.00
Leak Statistics
Average Leak Rate 0.49 2.07 2.07 2.07 2.07
90% Leak Rate 2.40 10.80 10.80 10.80 10.80
% of time above Leak Rate threshold 0.01% 0.01% 0.01% 0.01% 0.01%
Pressure Statistics
Average Pressure 8.86 9.15 9.15 9.15 9.15
Min Pressure 4.16 4.12 4.12 4.12 4.12
Max Pressure 17.62 18.16 18.16 18.16 18.16
90% Pressure 12.60 12.98