Coughing after eating...

[joeljjk11]

Last night I lowered my pressure to minimum 14 - maximum 20 from 15-20, with EPR of 2. I have the humidity set at 6 with hose temp of 84 (this may seem high to some but I like high humidity). I feel really good at this pressure but I have noticed that I will cough after I eat, I am not sure if this is heartburn or if my throat is somehow irritated. The odd thing is though is that this does not happen at higher pressures but always seems to happen when I lower my pressures. My AHI numbers do not fluctuate much at the lower pressure and I feel better overall but I am not sure why this heartburn coughing happens. Could this have something to do with my humidity and that my throat is irritated or something? I can't figure this out, my equipment is in my signature. Thanks!

Joel

[Janknitz]

Not sure if that has anything to do with it. Does your pressure stay at 14 instead of 15 or higher???

CPAP helps me by reducing reflux which is triggered by apnea (struggle to breathe causes a pressure gradient that pulls gastric juices up into the airway. Reflux causes swelling and irritation in my upper airway and can trigger my cough variant asthma. Sometimes when I have reflux I aspirate, which is really awful.

But why that would trigger coughing specifically after eating (and not when the reflux occurs) is a mystery. I think that you need to see either an ENT or a GI doc about this. It may have nothing to do with your CPAP pressure. It may just be coincidental.

[zonker]

absent any others coming in with exactly your same symptoms, i would agree with janknitz.

i don't know how old the op is, but i've found over the years that my throat has gone from smooth to more "flappy" like. (sorry for the medical terminology.) i will have problems every now and then with swallowing pills or even sips of water. drier foods such as snack crackers can make me cough.

i also have a mild hiatal hernia, which doesn't help things.

so, maybe consult a doc? you might not get in to see them in person, but maybe a phone call or teleconference would be sufficient.

good luck!

[chunkyfrog]

I am no longer able to eat unless I am sitting straight upright.
If I am reclining, even a little, things go down the wrong way and I have a horrible coughing fit.
I am 73, and this has been happening more as time goes by.
Am I totally messed up?

[Lightweaver]

Last night I lowered my pressure to minimum 14 - maximum 20 from 15-20, with EPR of 2. I have the humidity set at 6 with hose temp of 84 (this may seem high to some but I like high humidity). I feel really good at this pressure but I have noticed that I will cough after I eat, I am not sure if this is heartburn or if my throat is somehow irritated. The odd thing is though is that this does not happen at higher pressures but always seems to happen when I lower my pressures. My AHI numbers do not fluctuate much at the lower pressure and I feel better overall but I am not sure why this heartburn coughing happens. Could this have something to do with my humidity and that my throat is irritated or something? I can't figure this out, my equipment is in my signature. Thanks!

Joel

Do you see more events or fls with lower pressure? If you are getting lpr with lower pressure (as described above) the pepsin from your stomach would get lodged in your throat tissues and next time you eat anything moderatelly acidic, it would activate and irritate your throat. (I swear I did not make it up, lol, I've read a whole book on the topic)

[joeljjk11]

I increased my pressure 14.4 minimum last night to see if it would resolve the coughing but it did not. I am going to try 14.6 minimum tonight and see if that does anything, I want to use the lowest possible pressure that does not trigger the heartburn. It is not as bad as yesterday though with 14.4 minimum but still there. It is like a lump in my throat and I have to cough or clear my throat every time I drink or eat anything. This always happens when I lower my pressures, ugh.

Joel

[joeljjk11]

Could EPR affect this for me? What if I left the pressures at 14-20 but changed the EPR to 1 instead of 2 so it was only going to 13 on exhalation? Not sure if this would have an impact.

Joel

[Dog Slobber]

Could EPR affect this for me? What if I left the pressures at 14-20 but changed the EPR to 1 instead of 2 so it was only going to 13 on exhalation? Not sure if this would have an impact.

Joel

Using CPAP during the night, is not contributing to coughing after eating, hours later. Making slight changes to your therapy settings won't change a thing.

[joeljjk11]

I disagree because I do not have heartburn at all or reflux when my pressures are higher but this happens once I start to decrease them. I think it does have to do with my CPAP machine because this has been an issue going back many years.

[Dog Slobber]

Numerous virgins have been sacrificed in anticipation of bountiful crops, because of incorrect pattern recognition and non-existent causation.

[jimbud]

Numerous virgins have been sacrificed in anticipation of bountiful crops, because of incorrect pattern recognition and non-existent causation.

Happy Days (2).jpg

JPB

[Janknitz]

I am no longer able to eat unless I am sitting straight upright.
If I am reclining, even a little, things go down the wrong way and I have a horrible coughing fit.
I am 73, and this has been happening more as time goes by.
Am I totally messed up?

Chunky, this is a good question for your doctor. You should ask to see a speech therapist who specializes in swallow disorders. The doctor might order a "video flouroscopy" to see what's happening--it's a video X ray where they have you eat and drink a radio-opaque substance to see exactly what happens when you swallow, all the way down to the stomach. And hopefully the will test you in positions other than fully upright so they can see what's happening.

Sometimes there is a neurological issue that interferes with the coordination of your swallow and the placement of the epiglottis at just the right time to protect the airway. Or it could simply be muscle weakness for whatever reason (sometimes this can be improved!). It sounds like you have a strong protective cough, but the danger is aspiration pneumonia. Although one of the treatments is good positioning (sitting fully upright and tucking your chin to protect the airway when you swallow) which you are already doing, it's still important to know WHAT is happening and WHY. If it happens particularly with liquids, drinking thicker liquids or liquids that are very cold or carbonated can sometimes help trigger the right coordination of muscles to protect the airway.

This issue really bears addressing. When I worked in hospitals I found nurses spectacularly unaware of this issue, even when I worked in a rehab hospital that specialized in patients with neurological deficits (stroke and brain injuries), and in ICU's with a lot of post stroke patients who almost universally have swallowing issues in the acute phase. They thought nothing of giving these patients their meds with water while raising the head of the bed at most 45 degrees (it takes time and a lot of work to properly position a patient at 90 degrees in a bed, and if there's weakness in trunk muscles its even harder).

One house of horror I worked in (briefly) would do this routinely in the ICU (and nothing I said would persuade them differently! ) so that these patients were just starting to develop their aspiration pneumonia symptoms (usually it's subtle, starting with low grade fever) when they were transferred to skilled nursing (thus the hospital ICU didn't even notice they were causing this), and they typically died of their pneumonias a few days later. I also could not convince the doctors to order thickened liquids, they routinely ordered "clear liquids" which are THIN and contributed immediately to the problem. These people should know better but they don't. I'm ever more cynical about medical education now that my daughter is almost done with med school. Too much of medical treatment is based on tradition, not science. While I observed that during my prior career, seeing her study materials proves that's absolutely the case.

Chunky, G-d forbid you ever get sick and end up in a weakened state, something as seemingly innocent as not raising the head of the bed enough to give you your meds could kill you. Since it's a known problem, if you address whatever's going on now, hopefully your medical providers and family can advocate for you so they don't kill you in a hospital setting because they are unaware of your issue.

[chunkyfrog]

Thank you.
I will bring it up at my next appointment.