cpap plus aerophagia equals poor sleep

[rockAteer]

Aerophagia is swallowing air, and the new, higher pressure settings on my machine result in great trouble drifting off to sleep and being wakened with a stomach ache. For me, the aerophagia is involuntary and doesn't occur when sleeping without my cpap (!). My Sleep Clinic hasn't been much help. I did a forum search on "aerophagia" with no results. Maybe it's been talked about somewhere else in different terms. Any help or redirection on this problem is greatly appreciated.

BTW, I'm new to this forum. I'd wave to everyone, but I'm too tired.

':mrgreen:'

[Linda3032]

Rockateer

I've not suffered from aerophagia, but others here have and can offer lots of tips.

If nothing else, can you turn the pressure lower for a night or two?

Love your avatar and Mr Greenie at the bottom of your message.

[NightHawkeye]

The best mitigating measure I've found for aerophagia is using an APAP. Much of the night my pressure needs are minimal. If I had to spend the entire night at my titration pressure, I'd be a rocketeer, like you. (Sorry, I couldn't resist.)

As it is, most nights aerophagia is not terribly bothersome. Don't get me wrong, it's not a perfect cure, but APAP does make aerophagia better for many.

Regards,
Bill

[WillSucceed]

I think that NightHawkeye is right about APAP being helpful to reduce aerophagia as APAP, by design, allows lower overall pressures during sleep when compared to CPAP.

When I first started treatment with CPAP, at a pressure of 15, I had aerophagia something hateful and found some limited relief by avoiding food for several hours before bed and elevating my head/upper chest somewhat with pillows while sleeping. I know that some folk elevate the head of their bed rather than just propping themselves with pillows. These tips might work for you as well.

You have not mentioned which machine you are using... if you are using a RemStar with the C-FLEX enabled, you could try turning C-FLEX completely off (not just turning it down, but completely off -you do this through the clinical menu) and see if that helps. I found that turning it off completely dramatically reduced the aerophagia. Each of us is different in our response to treatment so turning off C-FLEX is no guarantee of an answer; it worked for me but might not work for you.

If you are going to stay with a CPAP rather than an APAP, you could talk with your Dr. about lowering the pressure somewhat. There is a possibility that this could help as well.

Good luck! Don't give up on treatment; many of us have been where you are and are wishing you success.

[rockAteer]

Thanks for these replies!

Actually my pump is a BiPAP. Um, I haven’t found a “BiPAP Talk” forum, so… Anyway, I’m using a leased Puritan Bennett KnightStar 330. I’ve been told this is a more “feature rich” machine than I need now and there’s a (not very interesting) story of how I got it.

I have no idea how to access the pump’s settings. It seems I am not authorized (maybe because it’s leased?), because only the vendor and techs at my sleep clinic can change the pressure settings, etc. Frankly, I’ve always been annoyed about this. When the clinic techs change the pressure they usually have to call P-B to get the access code or whatever. Guess they don’t see these very often.

When I whined about the aerophagia problem, the clinic did agree to lower the pressure from 22 psi to 20, but no further. The change didn’t make an appreciable difference. I don’t know if the machine’s got anything like C-Flex. Maybe it’s mentioned in the User’s Guide—it’s around here somewhere.

I’m ignorant of APAPs (plus a great number of other things). Is this the same as an automatic CPAP? I wish there was a different kind of air pump. It would monitor breathing without pushing constant air pressure (or at least enough low pressure to overcome frictional resistance due to the tubing) and only activate full air pressure during an apnea event. Is APAP like that? I know I’m tired of all the bubble and squeak (no, not the British dietary nightmare) coming from my air mask.

Thanks again! I hope I can make contributions here in kind.

':mrgreen:'

[blarg]

I guarentee you can change your own pressure, but it's unwise to do so without some knowledge of what's going on.

Since you're using a BiPAP, you have two pressures, which we call IPAP (Inhale positive air pressure) and EPAP (Exhale....). 20cm/h2o is a lot of pressure (probably your IPAP), and if it were me, I'd want to be sure that I really needed that much pressure to get rid of the events.

CFlex is a feature on Respironics machines that provides some exhale relief. You won't see it mentioned in your manual. I'm not sure if your machine records data that would be useful, perhaps other silverlining users can chip in here.

[rockAteer]

"silverlining users"?

.... 20cm/h2o is a lot of pressure (probably your IPAP), and if it were me, I'd want to be sure that I really needed that much pressure to get rid of the events....

*smacks forehead*

Ahh! I haven't entirely made the jump from Imperial to Metric pressure units. Yes, a sleep study titration resulted in the high setting. The higher setting has really blown me away. *groan*

Stumbling around here, but it looks like the APAP machines may be what can help me.

':mrgreen:'

[NightHawkeye]

Actually my pump is a BiPAP. Um, I haven’t found a “BiPAP Talk” forum, so… Anyway, I’m using a leased Puritan Bennett KnightStar 330.

In that case, you might be interested to know that there is one machine available which combines the APAP functionality into a BiPAP machine. That machine is the Respironics BiPAP-auto.

I have no idea how to access the pump’s settings. It seems I am not authorized (maybe because it’s leased?), because only the vendor and techs at my sleep clinic can change the pressure settings, etc. Frankly, I’ve always been annoyed about this. When the clinic techs change the pressure they usually have to call P-B to get the access code or whatever.

The lack of authorization is a frequent refrain around here. Hopefully, somebody familiar with that machine will happen along here to pass along that information. Gaining access to the settings menu is likely similar to the more common PB products, and I'm pretty sure that folks here can tell you that info.

I guarentee you can change your own pressure, but it's unwise to do so without some knowledge of what's going on.

Actually, there have been studies done which show that even us unknowledgeable users can adjust our own machines as good or better than the professionals. No need to feel intimidated by the machine, rockAteer.

I don’t know if the machine’s got anything like C-Flex. Maybe it’s mentioned in the User’s Guide—it’s around here somewhere.

No, only Respironics machines have C-flex, or Bi-flex, which is a similar comfort capability for their BiPAP machines. The BiPAP-auto does have Bi-flex capability though.

I’m ignorant of APAPs (plus a great number of other things). Is this the same as an automatic CPAP? I wish there was a different kind of air pump. It would monitor breathing without pushing constant air pressure (or at least enough low pressure to overcome frictional resistance due to the tubing) and only activate full air pressure during an apnea event. Is APAP like that?

Exactly. My APAP is set for a range of 5 cm pressure to 15 cm pressure. Most nights it stays around 5 cm for 1/3 to 1/2 the night, but then hovers around 10 cm pressure during my REM sleep when I'm prone to apnea. As a result I get pumped from aerophagia much less than I would otherwise.

The BiPAP-auto accomplishes the same functionality for BiPAP.

Welcome to the forum, rockAteer. I think you'll like it here.

Regards,
Bill

[GoodKnight]

Welcome rockAteer,

Using APAP to reduce or stop aerophagia was prescribed by my Stanford Sleep Clinic doctor for me and it worked. I was at a pressure of 12 at the time and the APAP completly eliminated the problem for me.
So this is not some unproved idea and I would recommed that you explore it with your doctor to make it happen.

Good Luck

[rockAteer]

In the very brief time that I have been a member of this forum I have become aware of several useful (to me) things.

1. There are some nice folks here who know more than I do about apnea and related problems, plus treatment options and are willing to share their knowledge.
2. (through a Private Message) People can do a titration study at home with various kinds of equipment. So far my studies have only been done “in patient” with a bazillion wires attached to me and costing nearly as many bucks.
3. My sleep clinic, which is closely associated with a big time/big bucks/big deal university near Palo Alto, California, USA, can’t tell me about APAP technology or home trials when I presented them with my aerophagia problem 3-4 months ago.

I’m sure glad I found this forum. I feel better already!

':mrgreen:'

[Catnapper]

The home titration is usually done after the sleep study with the bazillion wires, etc. That sleep study checks for lots of sleep problems that the home titration cannot measure. The home titration mostly verifies the pressure you need.

Catnapper

[Guest]

rockAteer,

Good luck on finding a permanent solution to Aerophagia. I really believe most who are afflicted will conclude it's an on-going challenge. I've been on CPAP since last September and it's been a constant problem with my therapy. My RX air pressure is 15 and I get a lot of air pumped into me...........much more than just into my lungs!!!!! Pain and bloating have been a continual problem. I have tried everything suggested to me so far except changing machines..........which isn't an option. My healthcare provider is the VA and they supply one machine from one manufacturer and that's it.........or so I've been told by my Primary Care Physician. When I tried elevating the head end of the bed, my AHI almost quadrupled! If I drop my pressure, the same thing happens. Just hang in there and try everything you can. Sooner or later, things will come together.

[WillSucceed]

Despite the previous post from Guest regarding being stuck with aerophagia, I think that it can be reduced. Talk with your Dr. about pressure change and try the other tips that folk have offered.

The pain that I had from aerophagia (initially) was so bad that I ended up in the ER. Hopefully, you will find some relief.

[rockAteer]

This is a follow-up to my problems with aerophagia and cpap.

Back when my original message was written, I was forced to abandoned cpap based on my old Rx and the subsequent difficulties sleeping that swallowing air caused me. In fact, I stopped using it because I needed to get some sleep. This cpap pressure Rx came from a west coast clinic study (the third one) associated with a prestigious university in the San Fran Bay area, which I am located close to. To make a long story short, I sought a second opinion at another local hospital-associated clinic and learned that some of my body movements (recorded during my sleep study and then watched in person by the study's technician and who took the time to care) could result in (something like) false-positives for a more severe apnea problem. The study's result was that pressures could be reduced from 20+ to about 8-10, which is where I started many years ago. Since then, with these lower settings, I sleep very well, thank you, with CPAP pressures that do not cause me aerophagia.

There is a lesson to be learned here (and I think I paid for this opinion over time): Not all of the people associated with (and stand to gain by an association with) prestigious universities know wtf is going on down in the labs where us tired grunts are trying to get some rest. These people suggested that my only alternative was head/neck surgery and that may not fix the problem. My new clinic proposed (and this may be unique to people like me based on my physiology) a dental appliance (similar to a dental "night guard" for grinding teeth) would obviate the need for a cpap and mask. You gotta be kidding me.

Live and learn, if it doesn't kill you first.

Oh yeah, some hardware has changed too. I use a Resmed pump and mask now.

[roster]

Nothing has changed. Here is a quote from a post I made this evening.

Here is a quote from Dr. Mack Jones, a retired sleep doctor who is author of Deadly Sleep, http://www.amazon.com/Deadly-Sleep-Your ... 695&sr=1-1.

.... couldn't agree more with you regarding the sad state of sleep medicine. It's a
shambles; the sleep industry is a failure. Many sleep labs are failing
to do their jobs and putting patients at risk from misdiagnosis, no
diagnosis, lack of educating their patients, no followup, and the list
goes on. Medicare and insurance companies are aiding and abetting this
boondoggle.

The false negative rate of sleep studies, even in accredited sleep labs,
borders on the criminal (these patients go home thinking they don't
have a problem to suffer the catastrophic consequences of their
misdiagnosis). Something must be done to correct false negative tests.
One way to is to reduce the number of in-lab sleep studies. Forty
percent of sleep apneics do not need a sleep study because they have
already been diagnosed by a witness. A majority of others could have a
home study or go straight to an ACPAP with a smart card (diagnosis and
treatment all in one). The complicated patient (those with CHF, COPD,
etc.) can see a sleep doc (good luck).

All physicians should be able to diagnose and treat their OSA patients.
It's not rocket science, even surgeons can learn how to do it.
http://www.sleepguide.com/forum/topics/ ... e-of-sleep

viewtopic/t55336/Home-Sleep-Test-or-Sleep-Lab.html