Spadin,
Ozij pm'd me asking me to look at your thread since I'm one of the long time posters who had had some pretty severe problems with aerophagia in the past.
You've written the following things:
Spadin wrote: ↑Mon Oct 28, 2024 5:49 pm
I struggled a lot at the begining because I had awful aerophagia, so we put on a 7 fixed pressure and EPR 2 for examples :
Spadin wrote: ↑Mon Oct 28, 2024 5:49 pm
We tried a nasal cushions masks namely the N30i resmed (I still have it), and me and my wife discovered I had massive mouth leaks and I open my mouth to exhale, after that my mouth is just pumping out air non stop for a time and then stopping with an arousal and repeat the whole night
Spadin wrote: ↑Mon Oct 28, 2024 5:49 pm
Then we understood that the aerophagia with the FFM was coming from opening my mouth to exhale, and then the air entered the stomach this way
I saw a tongue specialist that made me place my tongue correctly on the roof of the palate, did a lot of throat exercice
Spadin wrote: ↑Tue Oct 29, 2024 9:35 am
Hello Ozij ! Thanks for your reply, Previous night I tried to understand what was going on, I awakenend very sleepy, Removed the mask, And there terrible stomach pains and burping
Seems like I have the same root problem with FFM or Nasal cushions, my mouth somehow open, and with FFM air goes to the stomach, and with nasal cushion air leak through mouth
Spadin wrote: ↑Wed Nov 06, 2024 8:54 am
We switched to a fixed 7, but I kept getting awokenend by massive aerophagia,
I lost a lot of weight since 5-6 month (93 kg -> 81 kg), maybe that's what provoking the aerophagia ?
Aerophagia is caused by air getting into the oral cavity and then you swallow the air so it gets into your stomach. The tongue and throat exercises you were given by the tongue specialist are designed to train your body to
keep your tongue in the correct place all night long when you're asleep. When the tongue is in the correct position, the nasal cavity is sealed off from the oral cavity and it is (essentially) impossible to swallow the "extra air" in the nasal cavity. At least that's the theory, but not everybody's upper airway has read the textbook.
My first question is:
Are you still doing the tongue exercises? If not, start doing them again. My guess is those exercises will eventually "fix" the aerophagia problem in that if you keep doing them, the amount of time during the night when the tongue slips off the palate and allows air into the oral cavity will decrease. But when your stomach hurts really bad, the last thing you want to be told is that eventually the problem will start to go away. After all, the big question is, "How do I get some rest in the meantime without waking up in pain so often?"
So let's try to do some troubleshooting for what you can do to minimize the pain while your tongue is learning to stay in the right place to keep the air out of the oral cavity.
1) You might want to reconsider using the nasal mask again. Yes, you had some "massive" leaks from when you had your mouth open. But when the air was leaking directly out of your mouth, it was not going down into your stomach. With the full face mask, the air that has gotten into your oral cavity doesn't "escape" when you open your mouth since the mouth is under the mask and the oral cavity is also pressurized. So you may be unconsciously swallowing some excess air in a (futile) attempt to get rid of it. In other words,
if you had less aerophagia when using the nasal mask, then you might be better off using the nasal mask (leaks and all) for a while and seeing if the tongue exercises (eventually) lead to fewer and shorter periods of leaking.
For what it's worth, the mouth leaks on the night of 8/8 that you posted are not the worst examples of mouth leaks that I've seen. Even at their worst, they're still small enough for your machine to not be calling them "official large leaks". So they're most likely not yet large enough to adversely affect the efficacy of your CPAP therapy. However, those leaks went on
long enough to affect the quality of both your sleep and your wife's sleep since those leaks
eventually woke you both up. Still, if you had less aerophagia with the nasal mask, the switching back to it may be a good idea. Keep doing the tongue exercises and give yourself the luxury of just not worrying about the leaks for a week or so. Focus on whether there's less aerophagia when using a nasal mask versus using the full face mask. If switching to the nasal mask brings the aerophagia under control, you can deal with "fixing" the leaks later.
2) Aerophagia is aggravated by many of the same things that aggravate night time acid reflux. So it's worth doing things like making sure you don't eat too close to bedtime. Sleep position is something to consider: If you're a side sleeper, sleeping on the left side is usually more comfortable for both aerophagia problems and acid reflux problems. Stomach sleeping can make both aerophagia and acid reflux worse, but back sleeping can help minimize them. Elevating the head of the bed might help or sleeping on a firm wedge. But just propping yourself up on a bunch of normal pillows might not do much to ease the problem. Some people will claim sleeping with your neck extended (as opposed to having your head curled toward your chest) will help, but that raises the question of whether sleeping in that position is so uncomfortable for you that you can't really sleep or not. I am someone who wants to sleep curled tightly into a little ball (i.e. fetal position), and so I never was willing to try using something like a soft cervical collar to force myself to keep my neck extended.
3) Aerophagia can be worse at higher pressures. Now the pressure you are using, 7cm, is not particularly high. But again, your mouth and stomach haven't read the textbook, and you are having problems with aerophagia at 7cm. You might want to try reducing the pressure just a bit, but that does risk increasing the AHI, potentially significantly. Or you might want to give dynamic mode another try. But if you try dynamic mode, I'd suggest a pressure range of 4-7cm rather than the 7-9cm that you tried before. (If breathing at 4cm makes you feel air starved, then bump that minimum pressure up to 5 or 6, but leave the max pressure at 7.)
4) When you wake up in the middle of the night wanting to take the mask off, ask yourself "What am I feeling? Why do I want to take the mask off?". Ozij has already given you some good advice on how to fight the tendency to just take the mask off and go back to sleep. I will add this, however: Sometimes that feeling of just wanting to take the mask off is triggered by the fear of aerophagia. Even now, I will sometimes wake up in the middle of the night with a stomach sending signals that it feels like it's on the verge of getting aerophagia. What I do when this happen is this: I turn the machine off, sit up in bed, and pull the mask away from my nose and simply relax sitting in bed for a few minutes while breathing through my nose. When I am ready to go back to sleep, it's easy to just let go of the mask and let it settle back on my nose and the turn the machine back on and lie back down to go to sleep. Note: I don't take the mask all the way off my head when I do this. Rather, I just gently pull the cushion far enough away from my face and nose that I can breathe "normally" for the few minutes that it takes my stomach and brain to settle down and decide they both want to go back to sleep.
If you wake up in the middle of the night with
real aerophagia---as in your stomach is already feeling swollen and hurting, the best thing to do sometimes is to just get out of bed. Walk around for a few minutes and go to the bathroom. See if you can force yourself to get some of that excess air out through burping or farting. And go back to bed only after the stomach is feeling a bit better and you feel strong enough to face putting the mask on again. NOTE: This can be very difficult to do, but it's the only thing that I've found that works when I wake up with really bad aerophagia.
5) In general it's important that you are as comfortable as you can be when you are in bed trying to sleep. For some people, adding things like mouth tape, chin straps, soft cervical collars doesn't add any additional "comfort" issues. But for many of us, adding any of these things can make what seems like a difficult bedtime routine even more difficult. Sometimes, it's better to put comfort above the effort needed to reduce leaks to close to 0 or to reduce an already acceptable AHI close to 0. So for each of the things that you are doing or have tried, do an assessment: Does mouth taping add to my anxiety and discomfort? If so, ditch the mouth taping. (Taping the frame to your face to discourage taking the mask off in your sleep is separate from mouth taping.). Does putting on the chinstrap make me more uncomfortable? Is trying to sleep with a soft cervical collar making it more difficult to get to sleep? Only do the things that don't add any discomfort or anxiety at the beginning of your night.
6) You've asked whether turning your humidifier down might help the aerophagia. That's really a personal preference. My nose wants maximum humidification---if I turn my humidifier down, I'm more or less guaranteed to have a badly dried out nose in the morning. But other people find that their noses like a lot less humidification. Some people's noses don't want any additional humidity at all. In general when the humidity is too high, your nose will feel (or become) more congested using the CPAP than without it. And I suppose that if humidifier-induced congestion grows during the night, that might cause some mouth breathing, which requires the tongue to drop down off its proper location on the upper palate, which in turn could aggravate aerophagia. Turning down the humidifier is an easy experiment to try, and your nose will let you know (within a day or two) whether the new humidifier setting is too low for its comfort.
Finally, I want to address two other things you've said:
Spadin wrote: ↑Mon Oct 28, 2024 5:49 pm
Still not feeling that much better, Many of my symptoms have gone away (like sexsomnia, memory trouble, extreme tiredness)
but i still feel horrible waking up, still feeling tired (but way better than before cpap), and mood swing (same, better than before)
CPAP is a process.
It sounds like your body is beginning to detect the benefits of having sleep apnea-free sleep: No sexsomnia, no memory problems, less extreme tiredness. But it's still working on figuring out this new way of sleeping, and because you're not yet sleeping
well with the machine
all night long, every single night, you're still feeling horrible when waking up and you still have more fatigue than you'd like. And you still have mood swings, but they're not as bad as before CPAP.
My guess is that you may never be a morning person who wakes up feeling great and ready to go every morning. As pugsy's signature puts it:
I may have to rise, but I don't have to shine. Some of us are just not cut out to be morning people. But at the same time I think as you learn to sleep well with the machine and as you find a way to manage the aerophagia and keep it under tight control, your remaining symptoms will (slowly) start to get better.
You end your last post with this:
Spadin wrote: ↑Wed Nov 06, 2024 8:54 am
I slept without mask and the day after I felt horrible so I don't think my sleep apnea is cured, but maybe I just need a small pressure with humidity ?
Use this experience to keep yourself motivated: You know that when you sleep without the mask, you feel horrible because the untreated sleep apnea comes roaring back.
Sleeping with the mask is not easy at the beginning for a lot of people. But that single night without the CPAP has demonstrated to you that regardless of how tired or sleepy you still feel, sleeping with the mask makes you feel (at best) better than sleeping without it. When you're tempted to just take the mask off in the middle of the night and go back to sleep, remind yourself that putting the mask back on will make you less likely to feel as miserable as you felt the day after you slept without the mask.
Because the real secret to CPAPing is this simple:
Once you start sleeping with the machine every night, all night long, that's when your body can really start to heal from all the damage the untreated sleep apnea caused.
Sometimes once the body starts to heal, it starts craving sleep and the so the excess sleepiness may stick around for a while. But eventually if a person doesn't give up on CPAPing, the body does start to heal and sleeping with the machine finally becomes second nature. And then you find yourself looking back at the early days of CPAPing wondering just why it took so long for your body and brain to settle down and accept this therapy so that you could get a really decent night's sleep every night.
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