BiPAP Cures Aerophagia

[roztom]

I've got my C-Flex on 2.

Lori, why don't you try it on one ? Starting on 3 is like jumping into the pool and then checking if there's water

Tom

[Sleepless on LI]

They really should allow test drives, or nights, don't ya think?

Regards,
Bill

YES! And not only with machines, but masks, too.

I think I'm okay for now. The past two nights haven't been that bad for the aerophagia. Perhaps it has something to do with the Fixodent? I guess I'll just let those gassy sleeping dogs lie for now.

Thanks, Bill.

[john5757]

I think I'm okay for now. The past two nights haven't been that bad for the aerophagia. Perhaps it has something to do with the Fixodent? I guess I'll just let those gassy sleeping dogs lie for now.

I am going to try the Fixodent Fix as well. I am have more of the aerophagia problem after 1 and ½ years on APAP even when the overall pressure went down the issue with aerophagia increases. Take care

P.S. I do not like Cflex either and nobody is talking me back on it. The BiPAP is quite expensive to try.

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CPAPopedia Keywords Contained In This Post (Click For Definition): APAP, aerophagia

[dsm]

I tried Bill's suggestion of narrwing the pressure range on my BiLevel and thus far even the small residual aerophagia has reduced even further.

This leads me to wonder if the real culprit is rapid changes between CMS

Here are some hypothesis ...

- the higher our CMS (on cpap) the higher the probability of aerophagia

- the wider the gap between pressures (cflex, bilevels) the greater the probability of aerophagia

And another (but I don't have any evidence for this one) ...
- the faster the change in pressure, the higher the probability of 'mouth pops' & aerophagia (cflex (3) & Bilevel rise times)

Undoubtably each individual will have other inherent predispositions to air swallowing that are apart from the points above. It seems it is a quite complicated issue because there are so many variables.


This is a worthwhile line of investigation. Bill, I really enjoy reading the things you experiment with - very useful and thanks a million for putting so much of it here.

Cheers

DSM

PS I managed to purchase a VPAP III S but won't have it for at least 3 weeks. Am very very keen to see what data it reports.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, aerophagia

[Guest]

I tried Bill's suggestion of narrwing the pressure range on my BiLevel and thus far even the small residual aerophagia has reduced even further.

Don't remember saying that, DSM. I do remember thinking the opposite though. I actually have no idea, but have been considering so many possible changes that I'm paralyzed into inaction. Instead, I've just been lazily enjoying the BiPAP at the current fixed pressures of 9/6 with Bi-flex ON. I've spent almost a week at these settings and enjoying it. Here's why:
- being able to stay in bed the whole night (haven't done that in almost 40 years)
- feeling somewhat like I felt at 17 again
- not having to deal with anything more than minor aerophagia
- not worrying too much about mouth breathing (I caught myself with minor mouth leaks a couple of times last night, and wouldn't you know it, had the worst desats in a week too, with lows of 93%.)

Here are some hypothesis ...

- the higher our CMS (on cpap) the higher the probability of aerophagia

I'm thinking we can safely call this one fact, DSM.

- the wider the gap between pressures (cflex, bilevels) the greater the probability of aerophagia

Not sure about this one. Something I noticed immediately though, is that the rapid pressure change from IPAP to EPAP feels like the machine is sucking the breath out of me. Presupposing that aerophagia either occurs during the first part of the exhale cycle, or the conditions for aerophagia are set during this time, then perhaps the rapid pressure change actually sets up the conditions whereby aerophagia cannot occur. (i.e., valves might get set at this point) As an example, if I need to swallow while on BiPAP, only certain times are good for doing so, otherwise the eustacheon tube will plug up, and then I'll need to pop my ears.

- the faster the change in pressure, the higher the probability of 'mouth pops' & aerophagia (cflex (3) & Bilevel rise times)

Following this logic through then, CPAP would be the ideal situation, but we know that's not true. Instead, we know that BiPAP induces less aerophagia, so some pressure change must be required. I guess I'm gonna have to experiment with Bi-flex ON and OFF to see what difference it makes. Also gonna have to experiment with the ramp times, and pressure settings to see what works best. Hmm . . ., seems like a lot of experimenting. . .

Undoubtably each individual will have other inherent predispositions to air swallowing that are apart from the points above. It seems it is a quite complicated issue because there are so many variables.

No doubt. I'm surprised to be able to control aerophagia without having to consider surgical options, but also more than a little happy about that. I consider myself fortunate to be where I am right now.

This is a worthwhile line of investigation. Bill, I really enjoy reading the things you experiment with - very useful and thanks a million for putting so much of it here.

Thanks, DSM. I'll turn that one around though, as I very much appreciate your contributions here. Just like when you were talking about aerophagia occurring during the exhale cycle. That made so much sense that I immediately got out the BiPAP-auto which had been wasting away and put it to use.

I guess it all just boils down to the fact that collaboration on this forum provides benefits which are greater than the individual contributions.

Regards,
Bill

[NightHawkeye]

Wonder when I'm gonna quit "guest" 'ing myself.

[dsm]

I tried Bill's suggestion of narrwing the pressure range on my BiLevel and thus far even the small residual aerophagia has reduced even further.

Don't remember saying that, DSM. I do remember thinking the opposite though. I actually have no idea, but have been considering so many possible changes that I'm paralyzed into inaction. Instead, I've just been lazily enjoying the BiPAP at the current fixed pressures of 9/6 with Bi-flex ON. I've spent almost a week at these settings and enjoying it. Here's why:
- being able to stay in bed the whole night (haven't done that in almost 40 years)
- feeling somewhat like I felt at 17 again
- not having to deal with anything more than minor aerophagia
- not worrying too much about mouth breathing (I caught myself with minor mouth leaks a couple of times last night, and wouldn't you know it, had the worst desats in a week too, with lows of 93%.)

Bill,

You are right, I 'miss' read one of your comments - the one about using constant pressures, & thus have stumbled on an improvement for myself

Closing the gap between IPAP & EPAP is improving how I feel as well as seemingly eliminating residual aerophagia.

********************

I have obtained an Ohmeda flow monitor & plan to use it to try to measure the leak rates of various masks on my Respironics Bipaps. Am sure I can come up with some very helpful data for Respironics re determining the difference between fixed-leak loss & ending an expiration breathing cycle.

Will keep in touch with you re the experiments.

Cheers

DSM

[rested gal]

Instead, we know that BiPAP induces less aerophagia

Well...dunno if "we know" that. I had extremely painful aerophagia two nights in a row using a ResMed bilevel (VPAP III) set at IPAP 12, EPAP 9. Happened within a couple of hours into the session on both those nights. Less, but still painful aerophagia happened on yet another night when I set the IPAP at 11, EPAP 9.

However, both my autopaps set for a range of 9 - 16 (using any of the three C-Flex settings with one machine and no C-Flex with the other) never cause me any aerophagia. Not even on nights when either autopap sometimes hits 13 or more for half an hour or longer.

I agree absolutely with dsm's statement:

"Undoubtably each individual will have other inherent predispositions to air swallowing that are apart from the points above. It seems it is a quite complicated issue because there are so many variables."

[NightHawkeye]

Interesting stuff, RG, which raises all sorts of possibilities.

I had extremely painful aerophagia two nights in a row using a ResMed bilevel (VPAP III) set at IPAP 12, EPAP 9 . . . happened on yet another night when I set the IPAP at 11, EPAP 9.

My first thought is differences in the algorithms. The differences in pressure are small here. Probably close to what you get from C-flex alone. The algorithm switching times, however, as DSM already commented on are definitely different from machine to machine. My guess is that perhaps the ResMed algorithm doesn't change pressure for you at the optimum time for preventing aerophagia. Just my guess, of course.

It came as somewhat of a surprise to me to learn that BiPAP's are routinely prescribed to folks who experience problems with aerophagia while on CPAP. I am, however, glad I found that out though, as it has made treatment for me markedly better.

I'm still experimenting though. Last night was one of those nights which helped put things in perspective for me. I experienced a string of apneas in the wee hours of the morning indicating that the IPAP setting of 9 isn't quite enough for me. (I suspected it already, as some nights on auto the machine indicated 90% pressure of 11 cm.) More importantly, the leak rate was very low all night, indicating that the apneas occurred without mouth leaks.

It hadn't been clear to me earlier which direction to adjust things, or what to adjust first, but now it is. Hopefully one of these days I'll get it right.

The saga continues . . .

Regards,
Bill

[dsm]

One line of investigation that may well have already been proven (but I don't know where just at the moment), is that those of us with reflux (GERD) are more prone to aerophagia than others.

The other aspect of this, of course, is that (IIRC) is is accepted that OSA & GERD are tightly related.

Not sure which is the horse & which is the cart but I am willing to believe that treatment of reflux is an important aspect of limiting aerophagia.

Anyone have any good insights on this (RG, I bet you can point us to some good links )

DSM

[NightHawkeye]

One line of investigation that may well have already been proven (but I don't know where just at the moment), is that those of us with reflux (GERD) are more prone to aerophagia than others.

In my own case I have no doubt about the connection, DSM. Heredity has predisposed me, I'm afraid, as my father had a hiatal hernia which required surgical repair. I kinda look at as a leaky valve which leaks both ways . . . It lets acid out and lets air in.

Regards,
Bill

[tooly125]

Things I have tried to reduce my aerophagia:

1) lowering pressure to 9 (usual pressure is 19).
2) breathing through nose only
3) breathing through mouth only
4) big fluffy pillow
5) small memory foam pillow
6) no pillow (read somewhere that position of head might have something to do with it)
7) side sleeping
8) back sleeping (hope my doctor never reads this)
9) stomach sleeping
10) all levels of humidity tried (none, passover,1 thru 5 of the heat settings)
11) all levels of c-flex tried (0 to 3)
12) full stomach at bedtime
13) empty stomach at bedtime
14) Prilosec OTC (worked good for reflux no help with aerophagia)

When I lie in bed Waiting to go to sleep I can feel a bubble forming right in the back of my throat. I have two choices burp it up or swallow it. While i'm still on a lower pressure(ramp) i can easily make it come up but when i'm up to full pressure it is much more difficult but still possible.
I'm sure while i'm asleep its much easier for my body to just swallow it.
end result is waking about 5 am every morning with a painful stomach full of air needing to rip the mask of so I can burp!
I have an appointment in june at the sleep center for a "cpap class" they are supposed to let me try out all kinds of masks and answer any questions I might have. If they have anything useful to say about the subject I will post it.

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, aerophagia

[macoil2]

I find that when I am bloated with aerophagia a session the cpap machine alleviates the problem.

I am moat bloated at the end of the day.A night on the CPAP unit brings my abdomen back to normal in the morning.

[rested gal]

Not sure which is the horse & which is the cart but I am willing to believe that treatment of reflux is an important aspect of limiting aerophagia.

Anyone have any good insights on this (RG, I bet you can point us to some good links )

Didn't find that particular kind of discussion re reflux treatment helping to limit aerophagia, but can imagine the possibility.

Did, however, enjoy re-reading some older topics about aerophagia in general. One of them refreshed my memory that I had been using EPAP of 8 with bi-level (and minimum of 8 with autopap) back then rather than the "9" I had mentioned in this thread. My autopap has been set for 9 as the low in its range most of the time since last fall.

viewtopic.php?t=3862

http://www.talkaboutsleep.com/message-b ... php?t=2784

[Guest-DSM]

RG,

That 1st thread has some interesting points. I am tempted to try some experiments but may have to wait a few days.

I just did some recalling of the times I was sure I was aware of Aerophagia.

1) The most obvious recollection I have is when I was using my activa mask & was running my Remstar in CFLE mode & at 15 CMS & was using c-flex of either 2 or 3.

I recall getting what I call 'mouth-pops' - bursts of air popping out my lips. I also recall swallowing many of them, in particular, I noticed them when breathing out. I later put this down to the 15 CMS being pumped in to my nose while I was trying to breathe out against it (thus a compound pressure that could be in excess of 18 or so CMS ?) - from this I deduced that some air, under some circumstances, seemed to be taking a lesser path of resistance, into my mouth, perhaps straight down my gullet as there were times I could feel sensations like bubbles there.

I used to burp (+ expunge) constantly to relieve pressure I was feeling in my stomach.

After some time, & on a hunch I turned off c-flex & the mouth pops & to some degree the aerophagia dropped in magnitude. I was quite surprised because I had the utmost faith in c-flex back then & this shook it a bit. Aerophagia had been a growing cause of anxiety due to the stress it causes in my daily life. But turning off c-flex really didn't reduce the aerophagia as much as I needed.

After my 1st 4 weeks on CFLE I had switched to AFLE mode & set CMS to (IIRC) 12/17, I also found that I was ok with c-flex back on & set to 1.

I also switched to a F/F mask, the aerophagia was still there - lots of swallowing & burping.

Then later when I switched to the PB330, the aerophagia dropped markedly - immediately & became 'manageable' but not gone altogether. The PB330 was set to 8/15.

I am now running it at 10/15 & it seems to me the aerophagia is all but gone. This could be partly due to the changes of machines & settings or partly due to conditioning (growing used to xPAP), but that doesn't seem all that plausible a reason. I have been on reflux medication since the week before I started xPAP. If I miss my daily pariet tablet 2 days in a row, the reflux starts to return.

One test I can try is to revert back to the Remstar set at 12/17 in APAP mode and/or 15 in CPAP mode & see what happens. If aerophagia comes back then there are some useful lines of investigation I could follow. If not then the improvements have to be due to some recent conditioning.

My strong suspicion is that the aerophagia will return if I were to revert to CPAP or APAP.

DSM