Severe Aerophagia & Cpap

[Bigmike52]

I have been on Cpap for about 18 months and with-in the last 3 weeks have developed aerophagia and all the symptoms (discomfort, pain, gas, bloating & diarrhea) The only thing I changed in my therapy was turning up my humidifier to 4 to help with my dry mouth. I lowered my minimum pressure about 1cm based on this link: https://www.sleepapnea.org/treat/cpap-t ... solutions/ my A-Flex is set on one. My question is can anyone suggest a new pressure or A-flex setting that can help? I have been using a Airfit F20 mask as my primary and a Wisp Nasal as a secondary, but I get the problem with both. I have attached my latest screenshot in case someone needs to look at the numbers. I need to improve my "sleep" time but once the aerophagia wakes me I can't get back to bed. I appreciate any help someone can give me.

Screenshot (39).png

[Pugsy]

You can try increasing your Flex setting to 3 and see if that help much. It will allow the greatest amount of reduction during exhale.
It's not a full 3 cm like people can get with a ResMed machine and EPR but it might be enough to help with the aerophagia.

Respironics exhale relief is flow based instead of being an across the board drop of a cm per setting.
Meaning the amount of reduction actually depends on how forcefully you breath and even then the most you can get is a 2 cm drop even at the setting of 3.

Worth trying for sure. It might just be enough.

[Bigmike52]

Pugsy...Thanks for the tip. I will try it this evening.

[Jas_williams]

Maybe you need to reduce your min of 11 slightly your machine is not doing much in the way of pressure changes overnight if you drop the min pressure a bit you may be more comfortable but events may rise but until you try you don’t know

[Pugsy]

FWIW I also agree with Jas about the minimum reduction. It looks like you have some wiggle room to reduce the overall baseline pressure a bit and not allow too much to sneak past the defenses. I didn't mention it because you really asked about Flex relief.
If using more Flex doesn't help or you don't like the timing that the setting of 3 offers or it isn't enough of a reduction....lower that minimum setting a little bit. Let the machine go higher only when it just needs to and shorten the time at the higher minimum.

[Bigmike52]

Thanks Pugsy and Jas. I set Flex to 2 last night and will keep it there tonight as I like to see if another night will deliver the same numbers. I then will set Flex to 3 tomorrow night for two days to see what was more comfortable. I have only used Flex1 in the past and was surprised how comfortable it was at Flex2. I also set minimum to 10 last night and as expected between the Flex and the Minimum adjustments, my events increased. I did experience less severe aerophagia, so hopefully we are moving in the right direction. I also set my humidifier down. Do you both believe it has nothing to do with aerophagia and I can reset the humidity to 3 or 4? I am not concerned about the increase in events, (within reason) as I know comfort is what we are trying to achieve. I truly appreciate both you and Jas help and I am confident we will get this corrected.


Mike

Screenshot (40).png

[Pugsy]

I don't see how humidity might affect aerophagia unless someone is maybe having some nasal congestion from either too little or too much added moisture and the congestion tends to maybe make someone maybe mouth breathe or gulp air or have some arousals which can also cause people to gulp air occasionally. That's long skinny limb to go out on IMHO that just doesn't bear much weight in my book.

Aerophagia happening is because the air sneaks past the sphincters in the esophagus (there are 2..upper and lower) for some reason or other and makes it into the stomach and the digestive system further down the line. Why some people have much more of a problem than others...dunno unless the sphincters are more compromised than others for some reason or other. Weakened maybe by something.
I don't see moisture affecting those sphincters...I do see continual pressure being placed on the sphincters affecting them. They try to hold the door shut but sometimes they just can't be strong enough to get it done.
Adding more potential exhale relief will reduce the continual pressure some...lowering the minimum also reduces the continual pressure.
Sometimes there is a very fine line between what the sphincters can handle and keep the door shut well enough and what they can't.

I don't normally have aerophagia issues but I have had them twice in all the years on cpap that have been bad enough that if it was something commonly happening to me I would definitely be doing something to stop it because I was ill all day because of it twice.
Pain, nausea, etc...all day. Miserable.
Once was when I used a full face mask for a trial. Never did understand why that might have caused it.
Second was when I turned my AFlex of 2 that I had been using for years totally off. Just wanted to try it with AFlex off...only did that one night. The results were so bad I just didn't want to experience it again. Now I do have a bit of a hiatal hernia and a bit of damage done to the LES (lower esophageal sphincter) which is right at the stomach and esophagus junction. These factors may have been a factor...or maybe not...in my discomfort. It's not something I want to play with to figure out. No sense in being miserable when the fix is relatively easy to maintain.

[Jas_williams]

I don’t see humidity effecting anything either. So pop it back to where your comfortable. Lets see if these settings changes help over a few days, I would not try more flex yet either as your CA’s and periodic breathing went up a bit.

[barky2]

Mine stopped when my Dr changed my pressure from adjustable to steady, it also helped me sleep better, the only problem I am having now is falling back to sleep with my mask on because it is uncomfortable