kewlpewl,
First, I sympathize with you. Severe aerophagia (at relatively low pressures) was my nemesis during my first year or so of CPAPing, and even now, 15 years later, I have occasional problems with it. But for the most part, I can keep it under control.
Next, a bit about what's going on: Aerophagia is caused by air getting into your stomach. You already knew that, of course. But it's important to have an idea of how that air gets into your stomach. One culprit can be a weak esophageal valve that opens and allows air into the stomach. That same weak valve is also the culprit in GERD---when it opens, acid from the stomach can reflux back into the esophagus. Another culprit is excess air making its way into the oral cavity and then swallowing in an effort to get rid of the excess air. That excess air gets into the oral cavity typically gets into the oral cavity when your tip of tongue drops off of its usual (normal) place touching the roof of the mouth just behind the upper incisors while you are breathing through your nose. When that happens, air can enter the oral cavity from the nasal cavity through the back of the mouth. This can lead to "chipmunk cheeks" as the air builds up in the oral cavity. Then you swallow and that air goes into the tummy, where the only way to get rid of it is through burping and farting.
The other way to attempt to get rid of that excess air in the oral cavity is just opening your mouth. However, when you are using a CPAP, "just open your mouth and exhale" isn't as simple as it seems: If you are using a nasal mask, opening your mouth when the tongue is not in the correct position leads to a significant leak, which, in turn causes the machine to blow air at an increased rate in an effort to compensate for the leak and
maintain the current pressure setting. And that can make it difficult (impossible?) to just get rid of the excess air by opening your mouth. If you are using a FFM, opening your mouth doesn't automatically trigger a leak, but since the whole area under the mask cushion in pressurized, you still have to force the air out of the mouth---it won't just "rush out" on it's own.
So the first piece of advice is to pay attention (in the daytime) to where the tip of your tongue is when you are breathing through your nose. If you find that it's dropping off the roof of the mouth during the day, then it's most likely dropping down at night and that may be the trigger of the aerophagia. By consciously working on training your tongue to stay in the correct position during the day, it will help encourage the tongue to stay put during the night.
Next: Standard advice for dealing with GERD problems tend to help with aerophagia: Don't eat right before going to bed. Try (if possible) to have your biggest meal far away from bedtime. Don't overeat in general. Avoid sleeping on your right side. (Sleeping on your left side is fine.) If you want, you can try elevating the head of the bed a bit.
Now to look at a few things you specifically mention:
kewlpewl wrote: ↑Tue Aug 06, 2024 7:44 am
My current settings were advised on a thread I made on apneaboard.com in 2020 after my at home sleep study where I was diagnosed with sleep apnea with 46AHI. My sleep physician at the time wasn't much help and just sent me on my way.
I felt like I was getting ignored in my follow up questions there, and quite possibly rightfully so and also coupled with the aforementioned cycles of defeatism, and thought to try a different community for assistance. My original thread can be found at
https://www.apneaboard.com/forums/Threa ... OSCAR-data (I'm sorry if there is a rule i've missed on cross-posting from other forums).
Your current settings are Auto mode with a pressure range of 13-20 and EPR = 3. Your original machine appears to be a PR DreamStation 1 and it looks like your original script was for using Auto mode with a pressure range of 4-20 and you had A-Flex set to either 2 or 3. (I would guess 3.)
My guess is that you tweaked the pressures because when the pressure was set to 4-20, your treated AHI was higher than you liked, there was still a lot of snoring going on, and the PR machine was also scoring some flow limitations and RERAs when the pressure was 4-20; and people were correctly pointing out that a higher minimum pressure would help the machine do a better job of preventing your apneas, suppressing the snoring, flow limitations, and RERAs.
But higher pressures tend to aggravate aerophagia. And on August 5, the night you specify that you woke up with the aerophagia was really painful, you woke up after spending quite a bit of time at or near 20 cm H2O (on inhalation). The most recent data (Nov. 27-29), you didn't spend large amounts of time at 20 cm, but you did have peaks of pressure where you were snoring and/or flow limitations were being scored. And it looks like the snoring and flow limitations are what's driving the increase in pressure from your minimum setting of 13 all the way up to the 17-20 cm range.
So one thing you might want to do is experiment with
reducing the pressure even though you may have more flow limitations and/or snoring scored. But you may
sleep better with a bit more snoring and flow limitations, but less aerophagia.
I would suggest using a pressure range of 13-15cm for a few days and see what happens, particularly with the aerophagia. In other words, you may need to do some experimenting to find what the maximum pressure your stomach can tolerate before the aerophagia kicks in and becomes painful. In the end, you want to find a pressure range that keeps your aerophagia under control, but also is high enough to keep your AHI reasonably decent. (You don't need to aim for an AHI < 1.0 every night.)
You also write:
Potentially relevant info:
34yo, overweight bmi, using soft cervical collar, medicated for depression (escitalopram) and ADHD (lisdexamfetamine)
The overweight bmi may be aggravating things, but your weight is what it is.
Using the soft cervical collar to keep your head from falling forward and/or your jaw from opening may be counter-effective: If the collar increases your discomfort when you are trying to get to sleep, that can lead to (unconscious) swallowing of air and an increase in aerophagia.
You also write:
I'm all over the place when it comes to sleeping position, I try to go to sleep on my side (hoping that it will lead to more open airways) but often wake up either on my other side/back/stomach. I also wake up infrequently with numbness/paraesthesia (I hope that's the correct term) when sleeping on my side.
So you're an active sleeper.
If you want to sleep on your side, try to stay (as much as possible) on your left side. As for back or stomach sleeping: Both are likely to cause less aerophagia than sleeping on your right side.
It's also extremely important when fighting aerophagia to sleep in the position(s) that seem most natural to you (with the exception of sleeping on your right side). Here's why: Sleeping in a position that your body doesn't really want to sleep in can lead to restless sleep and micro-arousals. And it's not uncommon to swallow air when you arouse. Hence minimizing arousals also helps with battling aerophagia.
So here's my overall recommendations:
1) Try limiting the max pressure setting to something like 15 for the time being. Yes, you will have more events, and more snoring. But it's important to find a pressure that doesn't trigger the painful aerophagia. Once you know how high you can set the pressure without triggering the aerophagia, you may be able to slowly start increasing the pressure up in order to get the AHI nice and low and eliminate much of the snoring.
2) Try to avoid sleeping on your right side. Allow yourself to go to sleep in whatever position is most comfortable, except for the right side.
3) Don't eat close to bedtime. Also try to limit or eliminate any alcohol close to bedtime.
4) When you wake up with aerophagia, turn the machine off. Sit up in bed and take the mask off and just breathe for a few minutes. See if moving around in bed helps you burp or fart enough for the stomach to feel better. If not, get out of bed and move around. Sit quietly in a chair in another room while allowing the stomach to deal with the air and feel less bloated. Go back to bed only when the stomach feels better, and put the mask back on and restart the machine. By restarting the machine, you force it to go back to your lowest pressure setting, which will help the stomach.
5) You might also want to consider turning the Auto Ramp on with a beginning ramp pressure of something like 10cm. This will allow the stomach to not deal with your full beginning pressure of 13cm when you are first trying to get back to sleep after every wake. But the Auto Ramp will increase the pressure up to 13cm once you have established a nice, regular, sleep breathing pattern of respiration.
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