Miserable!!!!

I have sleep apnea. My machine from sleepwell was originally calibrated at 12 but I have it set at 4.5. I get no benefit from it being that low and remain a walking zombie. The second I turn it up to a pressure that works in terms of breathing, I can instantly feel air moving down to my stomach and acid reflux occurring. My gastro dr. couldn't tell me anything about it and just gave me protonix and my neurologist who diagnosed me with the obstructive apnea had nothing to say. All they did was give me a stupid chin strap even though it happens when my mouth is shut. Is there any solution to this at all or am I stuck between not breathing or feeling like a acidic beach ball every night?

You're not stuck between the rock of aerophagia and the hard place of OSA. But it will take some real work and commitment from you to get out of that jam.

It's no surprise that you are seeing no improvement using the CPAP at 4.5cm when your prescribed pressure is 10cm. Does your machine have a ramp or "settling" feature that allows you to fall asleep while the machine increases the pressure from a low starting value (say 4cm) up to your prescribed pressure (10cm) over the course of 5--45 minutes? If so, then using the ramp may allow you to get to sleep more comfortably and still have the pressure high enough to properly manage the OSA once you are asleep. I'd recommend setting the starting ramp pressure at 4.5cm since you seem to tolerate that. And I'd recommend setting the ramp time to be about 5 or 10 minutes LONGER than the length of time it usually takes you to fall asleep.

Air in the tummy is called aerophagia. It's a pretty common side affect of PAP therapy. But there are things that you can do to minimize the problem. For lots of suggestions, do a search for aerophagia on this board. You will get tons of hits. For some folks aerophagia remains a problem, but it can be minimized. For others, it eventually goes away on its own. Some of the things you can do to try to minimize the aerophagia include:

1) All the standard self-help things for GERD: No late meals, a diet that doesn't bother the stomach, elevating the head of your bed, and so on.

2) Experiment with your sleep position. Some folks find that aerophagia is worse in some positions than others. For me, I find that it's the position of my head and neck that seem to matter. If I sleep with my chin tucked down towards my chest, I tend to get little or no aerophagia. If I sleep with my chin stuck up in the air, I get a lot of aerophagia.

3) Keeping air out of the mouth is critical. Once air has leaked into the mouth, there are only two ways for your sleeping body to try to get rid of it:

• Swallowing the air, which leads to aerophagia, or
• opening the mouth, which leads to mouth breathing and a loss of pressure OR it allows even more air to get into the mouth so when you shut your mouth, there's still air in it, which leads to either swallowing the air or more mouth breathing ...

As you can see, this is a vicious cycle. For many of us, the key element in keeping air out of the mouth is tongue placement. If your tongue is resting against the roof of your mouth with the tip of the tongue resting against the roof of the mouth right where it meets the back of the top front teeth. When the tongue is in this position, it blocks air from getting into the mouth in the first place. It is possible to train your tongue to stay in this position when you sleep. Again a search of the forum will lead you to posts about how to do this.

4) Get serious about treating any nasal congestion you have. If it's even slightly congested, it's more difficult to breathe exclusively through the nose, and hence it's more likely that at some point, you'll open your mouth---even if it's just a tiny little bit. And as soon as your lips are open and your tongue comes off the roof of the mouth, air goes into the mouth. For me, I finally had to resort to using a NeilMed sinus rinse bottle (kind of like a version of a neti pot.) Nights where I forget or chose to not do the sinus rinse tend to have more aerophagia problems.