Is this Aerophagia? It's ruining my ASV therapy

[Unkikonki]

I've been dealing with aerophagia pretty much since the start of my ASV therapy over 8 months ago. By aerophagia I mean excessive flatus due to air swallowing. Honestly, I didn’t mind it at all as it didn’t seem to impair the effectiveness of my ASV therapy. It was just a minor inconvenience.

However, a few weeks ago, I started experiencing something new that seems related to aerophagia, and it’s preventing me from sleeping in the early morning: as I drift off and my muscles relax, air seems to get stuck in my throat, waking me up immediately and forcing me to either burp or swallow the air. This cycle repeats no matter how many times I try to fall back asleep. It sometimes occurs at night when I first go to bed, but it’s most prevalent during early morning's REM sleep.

This issue is depriving me of those last couple of hours of sleep that would make me feel fully refreshed.

I know that one common suggestion for addressing aerophagia is to reduce CPAP/ASV pressure. I tried lowering it (from 11.0 EPAP min to 9.0 EPAP min), but it greatly reduces the therapy's efficacy—in other words, the remedy is worse than the condition. I’ve fine-tuned my settings quite precisely, so I don’t think there’s much room for adjustment there.

Has anyone else experienced this problem? If so, how did you resolve it?

[robysue1]

It sounds to me like it could very well be aerophagia, possibly related to your ASV machine having increased the pressures (both IPAP and EPAP) in response to a series of "events", possibly false events scored while you were trying to drift back to sleep.

Rather than change the machine's Min EPAP setting, which in turn has reduced the effectiveness of your therapy, I would suggest this rather simple thing to try: Try turning the machine OFF and then back ON. This will force the machine back to the starting pressures: EPAP = Min EPAP from your settings and IPAP = Min EPAP + Min PS.

If you are also getting the same problem when you are first trying to get to sleep at the beginning of the night, then you might want to investigate whether your ASV has a ramp setting that could be set so that you have lower pressures just during the ramp period while you are trying to get to sleep, but the pressure remains at an effective minimum pressure level after the ramp period is over. Restarting the machine when you experience the problem in the morning will cause the machine to start at the more tolerable ramp pressures. And as long as the ramp period is not excessively long, you won't be sleeping at a suboptimal pressure setting for any length of time.

[Unkikonki]

It sounds to me like it could very well be aerophagia, possibly related to your ASV machine having increased the pressures (both IPAP and EPAP) in response to a series of "events", possibly false events scored while you were trying to drift back to sleep.

Rather than change the machine's Min EPAP setting, which in turn has reduced the effectiveness of your therapy, I would suggest this rather simple thing to try: Try turning the machine OFF and then back ON. This will force the machine back to the starting pressures: EPAP = Min EPAP from your settings and IPAP = Min EPAP + Min PS.

If you are also getting the same problem when you are first trying to get to sleep at the beginning of the night, then you might want to investigate whether your ASV has a ramp setting that could be set so that you have lower pressures just during the ramp period while you are trying to get to sleep, but the pressure remains at an effective minimum pressure level after the ramp period is over. Restarting the machine when you experience the problem in the morning will cause the machine to start at the more tolerable ramp pressures. And as long as the ramp period is not excessively long, you won't be sleeping at a suboptimal pressure setting for any length of time.

Robysue, I have to admit I was skeptical about an easy fix that didn't involve decreasing EPAP, but your suggestions seem to be as good as it gets. I will definitely try both tonight and will post an update after a few nights. Thanks a lot!