How can I stop swallowing air?

Brian12465 · Post by **Brian12465** » Mon Jul 17, 2006 7:22 pm

After 4 days, I'm starting to adapt to some of the aspects of using my machine, but I still wake up in the middle of the night with my stomach hurting because so much air is going there instead of into my lungs. I'm using a bi-level ResMed VPAP III w/ inhale/exhale pressures of 13/7, and a Mirage Swift nasal pillow system.

The other thing that happens is that my mouth sometimes opens a bit, despite the virtually useless chin strap, and I wake up making a noise that sounds like a horse exhaling.

Any suggestions?

Goofproof · Post by **Goofproof** » Mon Jul 17, 2006 7:39 pm

The machine and pressure you have should give you the best ride as far as swallowing air, any other XPAP solution would be harder on you, you are lucky there. Your Dr. may be able to prescribe drugs to help, and maybe with time it will get better.

As far as the air coming from the mouth, that's a no, no. A FF Mask will control that, or taping your mouth shut. If you don't get the mouth leaks under control you loose treatment pressure you need, kind of like going through it for nothing. Jim

rested gal · Post by **rested gal** » Mon Jul 17, 2006 10:55 pm

Brian, Goofproof is telling you right about the absolute need to stop the mouth air leaks. That "noise like a horse" you describe is air escaping out your mouth -- out through loosely closed lips. Treatment air really needs to be breathed straight down the windpipe instead of taking a detour and puffing out your mouth. As Goofproof said, if we're gonna go through this kind of treatment, we sure want to get the full benefit from it.

Stomach hurting because of air going into it.... Brian, I sympathize with you on that. It's called aerophagia, and it happens when air gets either inadvertently swallowed or gets pushed past the esophageal sphincter. Happens to me with any bi-level machine I've tried (except one...more on that at the end of this long post) including the one you are using (VPAP III) if I set the IPAP pressure above 12. If I have the IPAP set for 12 or less, it doesn't happen to me. Makes no difference where I've set the lower EPAP pressure. IPAP more than 12 is the threshold for aerophagia to hit me hard.

I'll get very painful bloating that will wake me within an hour or two. I would have to turn the machine off and stop treatment (it can be that painful) if I didn't know how to set the pressure lower. Some people get aerophagia even with less pressure, some with higher pressures, some not at all.

Doctors and DME's will often tell you, "Keep using the machine, you'll get used to it and the problem will go away." Maybe, maybe not. They should have their stomachs pumped full of air and told "get used to it." Granted, I'm a wimp about pain, but aerophagia is excruciating to me. Certainly can disturb sleep.

I'm not a doctor, and I'm not suggesting you do what I'd do. With that disclaimer out of the way, here's what I'd do -- and have done: I'd drop that IPAP pressure down a notch or two until I found a pressure that did not cause painful aerophagia. (I'd also tape my mouth to stop mouth air leaks. ) It's very possible that gradually, over several weeks, a person might be able to start raising the pressure as they got more used to it, and maybe finally get back up to the prescribed pressure.

So...you might want to talk to your doctor about letting you reduce the pressure for awhile. Personally, I'd not go one more night at a pressure that causes that kind of abdominal pain from air getting swallowed or pushed into the belly.

I'd be pressing the magical right and downarrow buttons together, to get into the clinical menu of that ResMed machine. I'd drop the IPAP pressure setting to where I could use the machine without getting aerophagia. I figure that suboptimal treatment that allows me to actually sleep is better, imho, than a prescribed pressure that I can't tolerate and could cause me to have to stop treatment completely.

Interestingly, when using an autopap set 9 - 16 I don't have aerophagia at all, even when I see from the software data that the auto occasionally had to use pressures of 13 or 14 for a few minutes on some nights. Apparently, short periods of pressures above 12 don't bother me. But hour after hour of IPAP pressure above 12 sure does, no matter where the EPAP is set below it.

You might also want to talk to the doctor about writing a specific Rx that would make the DME let you swap your VPAP III bi-level for a combo bi-level/autopap machine: Respironics BiPAP Auto with Bi-Flex. I bought myself one recently -- been using it three weeks and loving it. Varies the pressure as needed, like an autopap does (you might not need 13 for IPAP all night long) while at the same time giving that wonderful complete exhalation relief typical of bi-level machines.

Brian12465 · Post by **Brian12465** » Tue Jul 18, 2006 12:47 pm

Thank You! This is extremely helpful information.

Brian

Sleepless on LI · Post by **Sleepless on LI** » Tue Jul 18, 2006 5:52 pm

Brian,

Have you ever been told you may have GERD (gastroesophageal reflex disease)? If so, there can be damage, if left untreated, to your lower esophageal sphincter allowing the air to be pushed past it, when it normally should remain shut and now allow that, causing the air from your machine to travel into your stomach and digestive tract causing painful gas. If you have untreated GERD, it is definitely something that needs to be taken care of not only for the sake of severe aerophagia/gas, but because it can cause other health problems, including cancer of the esophagus due to acid erosion over time.

Not trying to frighten you, but the more I've learned, the more I know that GERD and OSA seem to go hand in hand. Studies I've been directed to show that when one is diagnosed with one, the other should always be looked into, too. What we assume is normal aerophagia could be a symptom of something more serious.

IZATIRED2 · Post by **IZATIRED2** » Tue Jul 18, 2006 8:55 pm

Just an idea . I complained to my sleep doc about the same problem. She told me to stay away from caffeine because it causes the valves that Lori was talking about to stay open. I stopped drinking caffeine coffee and it seems to be better. I still have a pepsi now and than and I can sure tell the difference with the aerophagia.

Drew

GoodKnight · Post by **GoodKnight** » Wed Jul 19, 2006 11:56 am

Brian,

The Stanford Sleep Clinic doctors that I saw prescribed an auto PAP machine for me to get rid of the aerophagia I had when I used a constant CPAP of 12 prescribed by them.

So the premiere sleep doctors in the US understand that auto machines relieve aerophagia. The therapy is somewhat compromised, but it is a good trade off and works for me.

If I were you, I would push my sleep docs to prescribe the auto Bilevel machine that RG discussed.

I also have GERD caused by the CPAP that was being treated with Prilosec when the aerophagia happened. It felt very much like GERD, but the docs said: no it was aerophagia.

Good Luck

Sleepless on LI · Post by **Sleepless on LI** » Wed Jul 19, 2006 12:02 pm

Unfortunately, auto pap did nothing for my aerophagia. It was HORRIBLE. If your LES is compromised to a extensive degree, any amount of air you push into your esophagus via xpap is going to travel past it, into the stomach/digestive tract, causing the gas-like symptoms.

I think it's really important, especially knowing you have GERD, to perhaps get an upper endoscopy to see the extent of any damage you might have existing. Although Prilosec can help calm the savage beast and repair some damage, in some severe cases, sometimes endoscopic or laparoscopic augmentation of the LES is necessary.

Best of luck.

Mask	Humidifier