Gastric Insufflation ideas

[Better]

Hi there,

This is my first post. I have been using CPAP for a couple of months now and I never cease to be amazed how much better I am feeling. For the first few nights I slept a whole 9 hours repaying whatever sleep debt I could. I have not slept this well without medication for over 20 years. I use an S9 in fixed CPAP mode with a FFM. My RDI is 11 without CPAP. AHI only 3 but RERA count is 8. I have a narrow nasal passage which might contribute to the RERAs/UARS. I also now use a hypertonic saline spray each night to open up my nasal passages.

Anyway, there is always room for improvement and the biggest issue I face right now is Gastric Insufflation (not aerophagis because I don't have to swallow while awake to feel my esophagus filing up plus resultant burping). I don't have GERD (to the best of my knowledge). I have increased EPR as high as possible (i.e. 1) without adversely affecting my therapy which I adjust about 10+/-0.5cmH2O. I have tried all the things listed elsewhere to reduce the insufflation and a lot of them help but I am having to compromise my pressure setting to reduce the insufflation. Anyway I won't repeat everything I've tried here for brevity.

I have an idea. Because there is a higher pneumatic resistance between my nasal passages and my esophagus compared to between my mouth and my esophagus, then if I open my mouth there will be a higher pressure presented to my esophagus. This will cause the sphincters to open more easily. So what if I tape up my mouth while using a FFM to reduce Gastric Insufflation ? You might suggest instead I use a nasal mask, but if I still have to tape my mouth to prevent mouth leak (and reducing therapy efficacy) then what difference would using a nasal mask make ?

Thanks for reading.
Peter

[SleepingUgly]

I don't know what you mean about the higher pneumatic resistance. I think taping your mouth shut will help if swallowing is actually occurring, with or without your awareness. But if it's not mediated by swallowing, I don't think it would necessarily help, and if you need to burp, taping will make that more difficult. You could always try it and see what happens. If you're taping and not using your mouth to breathe, it's your choice whether you are more comfortable in a FFM or a nasal mask. Most people prefer less mask.

[chunkyfrog]

Was the GI diagnosed by a doctor?.
This condition is not common, and has been studied among PARALYZED patients--
not to say that they are the only ones who can have it, but a doctor would have to diagnose it--
and having done so, would normally start working on solutions.

[SleepingUgly]

I don't know, Chunky... This is exactly what I have.

BTW, gastroenterologists do not deal with this condition.

[chunkyfrog]

So it's basically thrown in the basket marked "duh"?
(as in we don't know yet, and nobody's looking) That's twisted.

[SleepingUgly]

So it's basically thrown in the basket marked "duh"?
(as in we don't know yet, and nobody's looking) That's twisted.

Unfortunately for people like me, pretty much.

[The Choker]

Because there is a higher pneumatic resistance between my nasal passages and my esophagus compared to between my mouth and my esophagus, then if I open my mouth there will be a higher pressure presented to my esophagus. This will cause the sphincters to open more easily.

This is not true. When your mouth is closed the CPAP will bring the pressure inside your airway to the same level, no more, no less, as when your mouth is open.

But hey, you (and I) have a problem and reasonable experimentation is a good thing. Go for it!

BTW, if not already done, I highly recommend you have a

Diagnostic laryngeal endoscopy involves the careful evaluation of both the anatomic and physiologic aspects of the nasopharynx/velum, pharynx, base of tongue, and larynx

.

An ENT can do this in his office on the first visit. It just takes a minute or two and mine was covered by the $50 specialist visit co-pay. You might learn something new about

I have a narrow nasal passage

.

Also, if the ENT sees inflammation or damage of the vocal cords it is an indication of reflux. The next step would be an upper GI endoscopy to look at the esophogeal sphincters.

Good luck!