Aerophagis need help!

[Idget]

I have been on CPAP since September. After about two months I really made great progress. I finally found my mask, the headrest, which I love. I got my numbers down below 2, with help of side sleeping. However, in the last week, I started getting bloating, gas pains at night due to aerophagia. Finally last night I had to take off the mask due to the extreme discomfort. Tried sleeping rest of night without mask and woke to sore throat due to my heavy snoring. So I am between a rock and hard place, can't leave with it or without it.

I have a Resmed Elite set at 15 with EPR of 2. My plan is to go all the way down to 10 and see if this controls and eliminates the aerophagia. Then gradually go up to see where it starts again. I may have to live with a higher AHI as a result.

Has anyone else had success at eliminating aerophagia? If so I would appreciate some of other's solutions. Also would a Bipap or Apap work better. I believe the Resmed Elite with EPR works similar to the Bipap. The EPR settings reduce the exhalation from 1 to 3.

Thanks in advance for any advice or maybe my plan is on track.

[momadams]

For me, it eventually just stopped on its own as my body accomodated.
Until then, Gas-X was my best friend.
Shari

[rested gal]

Idget, I'm sure no doctor, but I think you're doing exactly the right thing...as opposed to just having to stop using the machine altogether. Get the pressure down to where it doesn't cause painful bloating and gradually work it back up over days or weeks, if you can.

"Some" pressure is better than none, imho, if the alternative is having to turn it off. I understand what you went through. Been there, had that happen... aerophagia to a degree so painful you have to stop.

Everyone's different, but having used a LOT of different machines, the machine I'd recommend as the most likely to prevent the kind of painful aerophagia you described having is this one:

Respironics REMstar Auto with A-flex. Not just C-flex... be sure it's A-Flex.

I believe the Resmed Elite with EPR works similar to the Bipap. The EPR settings reduce the exhalation from 1 to 3.

That's what I used to think, too...that EPR dropping pressure an exact 1, 2, or 3 cms for exhaling would feel just like a real bipap set for that many cms difference between IPAP/EPAP.

I have several bipaps and an Elite. I've experimented extensively, setting the bipap to use exactly the same pressure and give the exact 3 cm drop in exhale that an Elite is supposed to give when set for EPR "3." I was surprised to find that EPR feels nothing like a bilevel.

I think the unexpected "brick wall" feeling (compared to the way bipaps handle exhalation) of the Elite's EPR is because EPR doesn't actually drop the pressure the full 3 cms at the beginning of exhalation. EPR seems to give very little at the beginning and then moves the pressure down as the exhalation progresses.

A BiPAP machine, on the other hand, drops to the lower exhale pressure immediately the very instant a person starts to breathe out. Big difference. The start of exhalation is where we really need a good drop...to get the exhalation started easily.

A BiPAP might help, but you'd still be dealing with a higher inhale pressure along with the lowered exhale pressure.

The Auto with A-flex gives me the same "natural" feel to breathing that I get with the BiPAP Auto. The same ease in breathing out, and the same smooth transitions. The same feeling of no resistance when starting to exhale.

It's very possible that you don't need a pressure of 15 most of the night. Or perhaps at all on most nights. I'd go for the Auto with A-flex as the most likely machine to relieve your aerophagia problem.

If lowering the pressure on your current machine doesn't help, you might want to get your esophagus checked out thoroughly. Untreated or undertreated acid reflux (GERD) can do a lot of damage. People can have years and years of "silent GERD" without having any heartburn symptoms at all. A weakened lower esophageal sphincter (the "LES") could be letting cpap air at any pressure (even very low cpap pressure) get pushed into the stomach.

If that turns out to be the case, there is a laproscopic surgery procedure called Nissen fundoplication that can tighten the LES.

http://www.umm.edu/general_surgery/nissen_fundo.htm

Good luck!

[Idget]

Thanks rested gal. I contacted my doctor and he doesn't write prescriptions for autos. He told me that they are not approved (forget the name of the association he mentioned) and that they are not yet reliable. So I guess I am stuck with the elite. I don't think the issue is with the exhale, but the inhale I swollow air. Your are right about gerd. I was diagnosed several years ago with gerd and was on medication. I got off the meds a while back and have treated myself with good success. But I believe the problem probably does lie with LES and hiatel hernia. It probably means a trip to visit an internist to check into. In the mean time, will see how going down in pressure from 15 to 10 or 11 and then work back up. The funny thing is I didn't have this issue the first three months on CPAP.

[track]

It typically is not near as bad when you sleep on your back..if you can and it doesn't worsen your apnea. You can try elevating your bed 3 to 4 inches at the head. I find that I have to go to 8 to really minimize the air intake but 10 is a whole lot better than 15.

[rested gal]

I contacted my doctor and he doesn't write prescriptions for autos. He told me that they are not approved (forget the name of the association he mentioned) and that they are not yet reliable.

If (big "if") the name of the association he mentioned happens to be the American Academy of Sleep Medicine (AASM), here's an interesting little excerpt from the summary of a 2001 Review by a task force apppointed by the AASM:



I added the bold red emphasis to some sentences. I also omitted the remainder of the summary, which I interpreted as pointing out:

1. auto-adjusting treatment is not appropriate for some patients.
2. different brands of autopaps respond differently to the same patient and treat him/her differently.
3. more studies are needed to determine if autopap increases compliance or efficacy of treatment over conventional cpap and bilevel.

I don't see any of those things as being a matter of autopaps being "unreliable." I see (1) as an indication that autopaps are not for everyone. Neither is a cpap or bilevel machine right for everyone across the board. I see (2) as an indication that various brands of autopaps treat differently. So do different brands of cpap and bilevel.

The point I'm making with the excerpt is that the AASM's task force did not disapprove the use of "auto-adjusting" treatment of OSA in some patients.

If the doctor doesn't want to prescribe an autopap, that's up to him. However, if the AASM is the organization he is saying doesn't "approve" autopap, I'd wonder about that.

Of course there is a difference between "approving" and "not disapproving." Personally, I'd hang my hat on these words in the Review:

The data indicate that APAP can be used to treat many patients with OSA (auto-adjusting) ...

But hey, I'm a little biased. I've had four continuous years of excellent auto-titrating treatment and am looking forward to many more!

[Idget]

thanks again rested gal for your valued comments. I do like my doctor, I never had a doctor that spent an hour with me and he will call back same day when I call for help. Having said that he looked at me in shock when I told him I bought the resmed software to monitor my progress. I don't believe he thinks patients should be that "involved" in their treatment. I obviously have ignored that since I will only see him once a year and I do monitor my progress and lower/raise my pressure (he doesn't know that yet and would probably blow a gasket if he knew). I will continue to use the CPAP to work on my progress of eliminating the aerophagia, but I am changing my diet since I have hiatel hernia and gerd which is probably acting up due to eating habits over the holidays (too much brie).

[insylem]

, Gas-X was my best friend.
Shari

Gas-X Works for that??

[Pugsy]

Gas-X Works for that??

For some people, yes, it will help reduce aerophagia.

[sylvie]

Finally last night I had to take off the mask due to the extreme discomfort. Tried sleeping rest of night without mask and woke to sore throat due to my heavy snoring. .

There's a sure cure for this but it takes really wanting it and the ability to do so. Your story is exactly like mine was. I now use the Somnodent mouthpiece which adjusts my lower jaw forward during the night, thus allowing the cpap to do its job 10,000 times better and at a significantly lower pressure. With my bed raised 4 inches, and the mouthpiece adjusted just so, I no longer at all have aerophagia issues. It makes sense once one realizes that if you move the tongue from the back of the throat, the air flow is much more efficiacious. This is a fact and I hope it helps.

By the way, without the mouthpiece, the pressure was hitting 16 and 17. Now I use straight cpap at a pressure of 9--HUGE!!

[LSAT]

5 year old post

[chunkyfrog]

Gas-X? On first reading this, I thought, 'No way"; but then, it occurred to me
that at least some of the gas might actually be the type affected by simethicone-
-not swallowed, but produced by chemical processes in the stomach,
perhaps even triggered by swallowing air, or just stress of new breathing patterns, etc.
At the very least, it is a cheap, relatively harmless thing to try--and if it helps; Wonderful!
Even a placebo has value.

[lazer]

All I can add it is:

"It's better to burp and taste it then fart and waste it"

[VVV]

Gas-X? On first reading this, I thought, 'No way"; but then, it occurred to me
that at least some of the gas might actually be the type affected by simethicone-
-not swallowed, but produced by chemical processes in the stomach,
perhaps even triggered by swallowing air, or just stress of new breathing patterns, etc.
At the very least, it is a cheap, relatively harmless thing to try--and if it helps; Wonderful!
Even a placebo has value.

Simethicone is just an anti-foaming agent and is not chemically active. It does not reduce the amount of gas. However it helps by breaking up small bubbles of gas which then combine into bigger bubbles. So whichever end you are working out of you produce a few big "ones" (use your imagination) instead of many little ones.

[VVV]

Looks like that cat has some help in speeding up the relief of gas. But it must have an impact on sleep.