I am having a problem with swallowing air

[chikin]

I have a problem that when I use my Phillips respironics system one in that I am swallowing air which fills my stomach.
the problem is that at the required pressure to keep my Co2 levels at the required levels I am bloating badly, as over the years of my problems I have learnt to Diaphragm breath due to limited chest expansion. The problem is that due to the stomach bloating I am unable to diaphragm breath as my stomach bloating prevents me. this as you will understand make breathing normally very difficult. Has anybody had or heard of this type of problem or possible way to get overcome my dilemma your advice would be very welcome

[munkyBeatz]

Two things that will help a lot:

1.] Sleep at an incline, with your upper torso elevated. If you're obese and higher pressures are result of CO2 retention, this can help make exhalation easier.

2.] Use the mask for 20-30min periods every day in the evening, while watching Tv or something else when you do not intend to go to sleep. This will help you to acclimate to the therapy and pressure easier when you're sleeping. Don't just put the mask on at bedtime, as aerophagia is something that can be alleviated with acclimation. Using it for short periods multiple times when you do not intend to go to sleep, will help to adjust to breathing at your optimal pressure.

[avi123]

I have a problem that when I use my Phillips respironics system one in that I am swallowing air which fills my stomach.
the problem is that at the required pressure to keep my Co2 levels at the required levels I am bloating badly, as over the years of my problems I have learnt to Diaphragm breath due to limited chest expansion. The problem is that due to the stomach bloating I am unable to diaphragm breath as my stomach bloating prevents me. this as you will understand make breathing normally very difficult. Has anybody had or heard of this type of problem or possible way to get overcome my dilemma your advice would be very welcome

Comment,

You did not mention the kind of mask you're using. See if you can either keep your mouth somewhat open or loosen the nasal seal to allow some leak of air. This will allow some of your ingested air to leak out during the inspiration stage. There might be a mismatch of air pressures causing a build- up of air volume in your abdomen. You need to let some air go out to the atmosphere either from your nose or mouth or both during the inspiration phase, while the CPAP is pushing air into your body.

I have just rewrote it into a document, is it clear:

As a beginner CPAPer who have low respiratory system compliance, you are likely to develop gastric and intestinal distention with air (its medical term is “meteorism” in contrast to “aerophagia” which is used for intestinal distension resulting postoperatively) . The cause for this distention is because your mouth pressure during CPAPing can be above your lower esophageal sphincter pressure, while your mouth is occluded. You should keep your mouth somewhat open to let some trapped air go out from your stomach to the atmosphere, even if this mouth leak affects somewhat the CPAP’s proper treatment.

[robysue]

chikin,

The bloating is called aerophagia around here.

Some of us have it worse than others. And what works well for one person might not work so well for another person. So try any reaonable sounding idea that gets tossed your way, but if it doesn't work, just move on to other ideas.

Standard tips for trying to deal with it include all the usual home remedies for dealing with GERD issues---like sleeping on an incline and watching what you eat before bedtime. If the C-Flex/A-Flex on your machine is turned OFF, turn it ON because sometimes exhalation relief helps with aerophagia. If the C-Flex/A-Flex is turned ON, then see if a different setting is more comfortable. Also consider turning the Flex OFF because some people find Flex aggravates aerophagia instead of easing it.

For me, the aerophagia problem seems to be part of a bad feedback loop: Arousals lead to unconscious swallowing which lead to aerophagia which leads to more arousals which leads to more swallowing which leads to more aerophagia and so on and so forth. So part of the solution for me is trying to minimize the number of arousals, which we're not always even aware of.

Part of the solution was in figuring out how to sleep in a position that was as close to my favorite pre-CPAP sleeping position as I could. For me, tucking my chin down towards my chest seemed to help. But others have said that keeping the chin up and away from their chest minimizes aerophagia for them. So experiment with sleeping positions.

And a big part of the solution for me was also being switched to an Auto BiPAP running in a very narrow range, which minimizes the mean pressure needed to treat my OSA because the EPAP can be set lower than the IPAP. And (for me) breathing with my System One BiPAP feels more natural than breathing with my previous S9 APAP. For me, I can do some diaphragmatic breathing even with the mask when I'm using the BiPAP. And it seemed much harder to do when I was still on CPAP/APAP.

So my biggest piece of advice is to call the sleep doc as soon as possible and report the problem. Be specific when you're talking to the receptionist---tell her you are dealing with severe aerophagia and you need a call back from the doctor or his nurse or PA. When you talk to the doc, nurse, or PA, tell them exactly what you've told us: You can't easily breath with your diaphragm when using the machine and you need to be able to breath diaphragmatically because of the chest problem. Ask if the doc could order a small decrease in pressure settings. Ask if there's anything else they can recommend that you try. If the problem can't be managed and you're in a lot of pain after a couple more weeks, the start asking whether a switch to a bi-level machine might be reasonable.

[archangle]

How long have you been PAPping? Sometimes this goes away.

One suggestion is to tilt your head forward such that your chin is near your chest. This seems to help some people. It may not be good on your neck. You may be able to rearrange your pillow to help.