Newbie with a question! Gastric insufflation

[Evergreen123]

Hi everyone! I am new to CPAP. This past Thursday marked my 1 week anniversary on the machine I have been diagnosed with severe OSA. I am a very thin 37 year old woman, who (apparently) was born with a very small upper airway. That, and I have severe environmental allergies (which have made me a habitual mouth breather). I underwent bilateral turbinate reduction in April, started Nasonex, Zyrtec, as well as allergy immunotherapy shots. All of this was (is) a huge success in opening up my nasal passage. However, the OSA continued due to my airway collapsing and my tongue falling back. I am not a candidate for a mouth piece, due to the severity of my OSA as well as my severe TMJ.

Fast forward to now. I am having a lot of trouble with gastric insufflation. My pulmonologist and RT are working closely with me to get this taken care of. However, I would like VERY much like to get some advice from other CPAP patients. I was prescribed a pressure of 6, and my heated humidifier is set at 5 (max is 6). I wear the Swift Nasal Pillows. My machine is the ResMed.

I am tolerating the mask VERY well. Honestly, I wake up and forget that it is on and I have absolutely no leaks (I assume due to the low pressure). At the pressure setting of 6 my stomach fills up with so much air that I am in AGONY by the next morning. I stuck with the 6 for about 4-5 nights, just to see if it would spontaneously resolve on it''s own as my body got accustomed to the CPAP. I am not mouth breathing nor does my mouth fall open too much at night (that I am aware of). On the rare occasion that it does, I wake right up - shut my mouth and go back to sleep. My humidity seems to be appropriate. I have no congestion, dry mouth, or coughing.

I spoke with my doc and RT over the course of this past week. For 2 nights they lowered my pressure to a 5. On this setting I do not have ANY gastric insufflation. I slept pretty well through the night (woke up a few times). I tried 6 again last night, and once again I filled up like a balloon.

However, I just don't feel the pressure setting of 5 is therapeutic. I know it is still VERY EARLY into therapy and that it takes awhile to start feeling better. Although I do not wake up feeling any worse off than before, I surely do not wake feeling any better or refreshed at this pressure. My RT and doc said that they will likely put me on a BiPap later this week. Their goal is to get my pressures up, without the insufflation. They highly doubt 6, let alone 5, is therapeutic (despite my sleep study recommending 6).

Here's my question: Does this sound right? Has this happened to alot of other people? Do you think switching to the BiPap will help? I am just upset, because I am tolerating the mask so well and I am also VERY committed to making this work for me. I have felt so rotten for sooooooo long. And I am so upset that this is now happening to me

Thanks everyone

[Pugsy]

Welcome to the forum.

Robysue has battled aerophagia at what most of us would consider very low pressures. It can happen at any pressure.
She ended up with a BiPap machine and yes...it helped her a lot.
I imagine she will be around later to offer her support.
I have been very lucky and only had it happen to me rarely.

In the meantime could you add your equipment to your profile like I have mine below?
With luck you have a machine that will offer some data so we can see just how that 5 cm pressure is managing things.
If you have a full data machine you can use SleepyHead...check out my signature for links and information.
You can also use ResScan. Send me a note if you find out your machine offers data and you want ResScan.
Here is an example of ResScan
http://montfordhouse.com/cpap/resscan_tutorial/

[sewsleepy]

I had a lot of trouble with this when I started on cpap too. Actually, I should say apap, I use apap. At some point it went away. Now that I think about it, it went away around the time I switched from the swift LT nasal pillow mask to the swift FX. I was able to lower my pressure on the FX. I don't know if that is the reason or if it's a coincidence, or if my body just got used to it with time.

[Evergreen123]

Equipment added! I am pretty sure I have no data capabilities

[chunkyfrog]

Treating this with an Escape?
Does this make sense to anyone here?

[SleepingUgly]

Lots of people overcome aerophagia. Some do so by switching to Auto-Pap. Some find improvement when they switch to bilevel. Some say sleeping on a wedge helps. Unfortunately none of those things work for me. I'm pretty much a CPAP failure due to aerophagia. I can't even approach the pressures I need (higher than yours) without aerophagia, so I'm chronically under treated, and presumably that's why my EDS has not resolved (...until proven otherwise).

My mouth opening will make my aerophagia worse (possibly the arousals from a mouth opening lead to swallowing? Not sure). Even though it sounds like your mouth is shut during the night, the easiest thing to try first would be to rule out the possibility your mouth is opening.

[SleepDepraved2]

I have found that being on auto BiPAP has resolved my aerophagia. I am on a 2-week trial of the auto BiPAPA because of the problems I have had with aerophagia. I started out with a standard BiPAP set at 21 and 17. The pulmonologist's office lowered it to 19 and 15 because of the aerophagia, and that helped a lot but didn't totally resolve it. So they decided to trial the APAP. With the APAP my highest pressure seems to be 17, though the machine isn't giving me enough data to tell whether that is constant or how much it varies. I still get a little aerophagia if I sleep on my right side, but not enough to be a deal breaker.

After next week, I have to return the machine to the DME and go back to my other one. Hopefully, once they realize that I did better on the auto BiPAP they will give me one of my own.

[llavalle]

I have the same problem.

I'm running at 8cmH20 but I have severe gastric insufflation. It is not aerophagia, I'm not actually swallowing air. I did a simple test : brought the CPAP machine in the living room and watched a movie while getting therapy.... while making sure I was not swallowing anything. After 1h-1h30 my stomach was filled with air and I was starting to feel uncomfortable. My belly becomes inflated and I feel like my stomach is herniating.

The worst part is that my MD(I'm in Quebec, Canada, where pneumonologist handle OSA problems) does not seem to believe me! She says I'm swallowing air and that it's impossible that air is getting in my stomach!

Do you think I BiPAP could help here? Everything else about the CPAP works for me. I wear the mask all night... I wake up rested and full of energy... it's really amazing...

[ardmore]

I am relatively new to CPAP therapy. Started in July and the sleeping part is going well, have not fallen asleep once in the early evening. The benefits were immediate. Had trouble at first with the mask breaking down the skin on the bridge of my nose but switched to the nasal probes which works well.
My only continuing problem is bloating. Now on a bi-level Resmed machine and it has eased slightly but certainly not gone away. Trying the Gas-x tablets to see if that helps. Some days the burping is a real pain in the rear end. My wife is now trying to wean herself off the earplugs - that may take longer !