New CPAP user swallowing air

[RomanDelta]

Hi All,

I've been using a CPAP for about a week, but I am waking up with horrible cramps, bloating, heartburn, etc... Couldn't figure out what was going on until I did a google search and now I am certain I am swallowing air. So I stopped using the CPAP and all those symptoms went away immediately. Problem is, CPAP was just starting to help, but to be honest with you, I'd rather be tired than have those awful cramps and bloating waking me up throughout the night, and then lasting all morning, so I am at a loss for what to do. Below is my setup:

Respironics Dreamstation
Pressure 7
Ramp 4
I have the feature that lowers the pressure on exhale (BiPAP??)
Humidifier 4
Heat 1
Full face mask (mouth and nose only. Not the one that covers eyes too)

Any advice is appreciated. I have a nose-only mask as well but have not tried it. Does that typically make a difference in preventing aerophagia?

[Pugsy]

I have the feature that lowers the pressure on exhale (BiPAP??)

No, not called bipap but it does create a bilevel situation but not much of one.
It's called Flex exhale relief.

Which DreamStation mode?

DreamStation CPAP
DreamStation Pro Cpap
DreamStation Auto CPAP
DreamStation BiPap Pro
Dreamstation BiPap Auto

Whichever Flex exhale relief you have available....what is it set to?

Check this out.
wiki/index.php/Aerophagia

[katestyles]

I have use extra strength Gasex. It helps some.

[babybear]

Hello

I have been on cpap for 10 months now and when I first started, I was swallowing air and had cramps and gas every morning as well as feeling lightheaded and a little dizzy. It was awful and I was very discouraged. Since I work in a setting with elderly people who have many of the diseases you could possibly develop if you don;t use cpap, I knew it was not an option for me to stop therapy. A soft cervical collar made a huge difference for me as I wore it to cut down on my events but discovered it did not make a difference with my events but noticed when I wore it I did not have gas and when I stopped the gas came back however I am not sure why. I stopped using the collar after 7 months of cpap therapy and hardly have any gas and when I do it doesn't hurt as I believe the body adapts. Please don't stop as there is so much worse to come from not continuing therapy. I promise you're body will adapt and you will feel so much better. I wish you luck.

[RomanDelta]

Thank you Kate and Babybear for your comments. I think I am going to try to tweak a few things.

Pugsy, I will get you my exact details for the CPAP tonight.

Questions:

1. Should I try my nasal-only mask? The main reason I use full face is because the nasal plug mask hurt my nose because I have no cartilage, so the titration specialist switched me to a full face mask. I've never tried the one that only goes over your nose. Wondering if that would help?

2. Is my humidity to heat ratio causing me to swallow you think? 4 Humidity, 1 Heat.

[Pugsy]

Try the nasal cushion mask. I don't know that one type of mask promotes more aerophagia than another but it is sure worth trying.

What usually happens is the airway and esophagus are common (as one) until it splits and one section goes to the lungs and the other goes to the stomach. There are 2 sphincters in the esophagus...one upper and one lower right at the stomach and esophagus junction.
Usually the culprit is the LES...Lower Esophageal Sphincter...it is maybe weak or damaged and it doesn't close off well enough to keep the air in the esophagus from entering the stomach.
So we don't really "swallow" the air so much as it is the sphincter just lets the air get into the stomach and too much will of course cause problems....pain, bloating, nausea, lots of belching, lots of farting.

There are some things we can try to do to lessen the problem....first one I always suggest is adding in exhale relief if the machine has it available. Sometimes just that little reduction during exhale is enough to reduce that pressure at that sphincter so it doesn't let so much air pass into the stomach.
That's why I asked about your Flex setting and which machine for sure...Different machines and modes have different forms of Flex (exhale relief).
If your Flex isn't on....by all means turn it on and set it to 3 which will give you the greatest amount of exhale relief.
Respironics machines won't go above 2 cm exhale relief even at that setting of 3 because that's just how they do things. They base the amount of reduction you actually get on how forcefully you breathe.
Also...Flex won't engage unless the pressure is 6 cm or higher. So if you are using ramp at all you won't be able to feel the difference while awake if ramp is on because ramp usually starts at 4 cm.

Sometimes people find that the aerophagia issues tend to disappear with time and as they start sleeping better with less frequent wake ups. For some reason people tend to wake up and sometimes they do take an extra gulp of air which ends up down at that sphincter and slides into the stomach just adding to the problem. Sometimes its arousals that feed the aerophagia monster.

[RomanDelta]

Thanks Pugsy. I am pretty sure it is set to 3 already but I will check tonight.

My pressure is 7 but I use 45 minutes of ramp at 4, so maybe I should just go straight into 7 and see what happens.

Will try the nasal mask tonight and see what happens.

As for the LES - I have had GERD for the past 15 years so that doesn't help things, but I've recently gotten myself off of all meds. Took tens of thousands of dollars and a lot of restorative therapy, but I am down to 1-2 times a week needing the meds. The aerophagia makes it so I need it again every night, which is a no no after all that work.

Do you think humidity 4 heat 1 could be making the air tickle my throat, causing it to swallow or something? I can't imagine those are optimal settings. I generally have dry mouth and hate being hot, so that's why I set them that way. It came from the sleep clinic set to 3 and 3.

[Pugsy]

I have never known (or experienced) humidity affecting aerophagia one way or the other.
Not saying it can't affect it but I just don't see how unless you aren't comfortable with what you are using and you wake up often and have a bunch of arousals. Humidity setting and hose air temp is strictly for comfort. If you aren't having any nasal issues then your nasal mucosa is probably happy with your current setting...and the hose air temp is just for comfort and rain out (condensation) prevention.

Most likely your LES is slightly damaged from the years of GERD making it so it doesn't close off quite like it needs to.

You may simply need to start prodding your doctor about getting you on a bilevel machine that can offer a bigger difference between inhale and exhale than you can get with the Flex setting.
It's usually the first step when people have really bad aerophagia issues that they can't get resolved well enough that they can sleep with cpap and not make themselves miserable the next day.

[Pugsy]

Oh....do let me know which machine model you are using...depending on which model you are using....I might have an idea of something else to try.

[chunkyfrog]

Sleeping on the left side helps prevent air from going the wrong way.
I have also used Gas-X for good results.
Some find that using extra pillows or raising the head of the bed helps align things better.
Not using cpap is never an option.

[RomanDelta]

Thanks again Pugsy. Will do with the CPAP model and what not.

So it sounds like potentially the exhale is the problem. Difficult concept to wrap your head around IMO since one would generally associated swallowing air on intake as opposed to exhale I would think, but I am still very new to this world so I am open to anything.

Chukyfrog,

Yeah I actually have a platform bed that raises all as one unit, so I sleep on a 10 inch include. Kind of like this: \

This is to keep acid at bay. I tried Gas X as well. It did help a little but not substantially. As for sleeping position, I find that if I sleep in any position other than my back, I get pains and cramps. If I sleep on my right side = Acid. If I sleep on my left: Intestinal cramps. If I stay on my back I can get through the night but once I wake in the morning = bloated and cramped. I guess I could just stay on my back all night, but I'd really like to be free to change positions. Meh, guess we can't expect to have it all eh?

[Pugsy]

Having a drop during exhale relieves the pressure a bit on that sphincter....the idea is to relieve it enough that not so much air sneaks into the stomach.
Fairly common problem when people are using pressures in the teens...not so common at pressures in the single digits like yours but not totally unheard of either.
I have a good friend here on the forum who has to use a bilevel machine because pressures of 6 cause her significant problems but she needs 8 cm to hold the airway open. She had to come up with a very fine line in a range of settings that could both deal with her OSA and not cause huge belly issues. Regular cpap/apap couldn't let her make the necessary tweaks to get it done so she had to go to bilevel.

[RomanDelta]

Pugsy,

Whats the difference between a Bilevel CPAP and a CPAP with the pressure decrease on the exhale feature? Seems like the BiPAP reduces pressure further on exhale than C-Flex does, whereas C-Flex only does it a max of 3. So I guess the question is: If my pressure setting is 7, and C-Flex drops exhale to 4, would dropping it beyond 4 with a BiPAP really make all the difference?

[Pugsy]

Flex won't drop more than 2 cm even at the setting of 3. Now ResMed machines will do a per cm drop per setting but not Respironics.

Bilevel allows for a much greater difference between inhale and exhale...like 4 or 5 or 6 cm drop.

These machines won't drop below 4 cm....and you aren't getting 3 cm drop with Flex at 3...the most you can get is maybe 2 cm and that's based on how forcefully you breathe.

[RomanDelta]

Ok so then if I am at 7 on inhale, then I am at 5 on exhale with C-Flex at 3 right?

If so, I will be amazed if dropping the pressure on exhale below 5 resolves it. Seems so low already.

What is the theory on what this causes aerophagia again? Is the LES open on exhale? Or do they not really know why? I've also seen other folks around here claim that C-Flex is the cause of their aerophagia. Ugh, so hard to know which end is up.