Anyone heard of progressive aerophagia?

Hello ... it's been a while. I've been on cPAP for about 2 years now and find that my abdomen has gotten progressively distended (over time). But it has gotten worse in the last 2 years I have been on CPAP. I have tended to have gastroparesis (slow stomach emptying) for many many years, which has always made me have a distended stomach. I even have photos of myself as a young boy (7 to 8 ... I am now 59) very skinny with a distended belly.

I have read up about aerophagia on the board and archives and not seen anything that doesn't talk about immediate distension in the morning which seems to go away as the day progresses. I seem to be distended all the time.

I guess the question is has anyone seen this happen with CPAP use over a long period of time? Of course my sleep Dr. seems to know nothing of the subject, and the GI Dr.'s all come up with nothing as well, although they can name a million possible causes will take years to rule out. It just seems logical to me that I might be swallowing air each night and stretching my stomach wall over time. Simple answers are sometimes the best. I have a weak esophageal sphincter that is likely to let air into my stomach. The only way to test this would be to stop CPAP for a while, and (as you know) that would just make me tired.

Any ideas? Thanks.

Aerophagia is characterized by GAS.
I mean belching and farting. If this is not happening, the cause is likely something else.
Lean on your doctor a bit (nag, cajole, beg, threaten) This may need attention.
Don't let a busy doc blow you off.

I have very bad gas every morning belching farting , but there's nothing I can do. I do take gas pills if it's particularly bad. I have obstructive and I tend to swallow a lot of air.

Did you ever have a gastric emptying scan? If so, what were the results? Is it above or bellow your belly button that's distended?

SleepingUgly wrote:Did you ever have a gastric emptying scan? If so, what were the results? Is it above or bellow your belly button that's distended?

No, never had one. I know that my stomach empties slowly - it has been going this for at least 35 years. I had a "barium swallow" in 1974 - didn't eat all the night before, and when I went in and took the test I still had food in my stomach. My distension is all over.

I'm beginning to realize that it is not CPAP, and that I will have to see a lot of GI Dr.'s before I get one who can figure it out. Since this has been a problem and just getting worse over 35 years, I think I am just getting fed up with it as I get older. It's funny, though, never had any other symptoms other than distension. The last thing I will do is let a Dr. blow me off - though if one tried he would be a waste of my time anyway. I am very skeptical of physicians and their ability to get things done without killing the patient first.

I cannot diagnose your problem. However, a thought came to mind. For years I have had a type of hernia where nothing bulges through the muscle wall. It is a strain of the muscle probably from lifting something too heavy. It is not noticeable when I stand but when I sit down my stomach looks a bit distended.

The doctor told me the name of this hernia years ago but I don't remember it. It is not a problem for me even when I lift something heavy.

Just a thought.

jonquiljo wrote:

SleepingUgly wrote:Did you ever have a gastric emptying scan? If so, what were the results? Is it above or bellow your belly button that's distended?

No, never had one.

I don't think you diagnose gastroparesis without a gastric emptying scan.

If it was distention from insulflation due to CPAP, it would be worse in the morning and improve as the day goes on. Other things, like Irritable Bowel Syndrome can also cause distention. And then, I'm sorry to say the one thing no one wants to hear...some distention is not distention but is fat.

jonquiljo wrote:Hello ... it's been a while. I've been on cPAP for about 2 years now and find that my abdomen has gotten progressively distended (over time). But it has gotten worse in the last 2 years I have been on CPAP. I have tended to have gastroenteritis (slow stomach emptying) for many many years, which has always made me have a distended stomach. I even have photos of myself as a young boy (7 to 8 ... I am now 59) very skinny with a distended belly.

I have read up about aerophagia on the board and archives and not seen anything that doesn't talk about immediate distension in the morning which seems to go away as the day progresses. I seem to be distended all the time.

I guess the question is has anyone seen this happen with CPAP use over a long period of time? Of course my sleep Dr. seems to know nothing of the subject, and the GI Dr.'s all come up with nothing as well, although they can name a million possible causes will take years to rule out. It just seems logical to me that I might be swallowing air each night and stretching my stomach wall over time. Simple answers are sometimes the best. I have a weak esophageal sphincter that is likely to let air into my stomach. The only way to test this would be to stop CPAP for a while, and (as you know) that would just make me tired.

Any ideas? Thanks.

Your profile shows you're using an APAP. You didn't mention in your post what pressure or pressure range you're using (or any other settings for that matter). That could be a very significant clue as to why this is happening. You also didn't mention whether you were using software to download and view your nightly data. That could also help explain what is happening.

Some of the symptoms and conditions you describe COULD indicate pressures going higher than what they should, which result in ingested air. Using straight pressure or limiting the maximum pressure MAY help. Sometimes, changing the settings on the exhale relief features have been known to help, too.

Doing forum searches on "aerophagia" and "gastroenteritis" may reveal some solutions.


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SleepingUgly wrote: I don't think you diagnose gastroparesis without a gastric emptying scan.

If it was distention from insulflation due to CPAP, it would be worse in the morning and improve as the day goes on. Other things, like Irritable Bowel Syndrome can also cause distention. And then, I'm sorry to say the one thing no one wants to hear...some distention is not distention but is fat.

Well, I had gastroparesis diagnosed before they could scan much. Either way, it takes a normal stomach 2-3 hours to empty after a meal. I am lucky if I wait 7 or more hours. Since I have GERD, I can't sleep until my stomach has emptied - so I have not been able to snack after dinner for many years.

I have thought it could be visceral fat, but I am not fat - and can't pinch much of anything but skin on the outside of my belly. If it is a freak instance of everything depositing internally and in one place ... well .... I would welcome that.

This problem has been a problem for a very long time (my wife says I have been that way sine she has known me - 25 years) - but it seems to have gotten much worse in the last 2. That's when I started APAP. One poster mentioned that my pressures might be too high. They could be. I was set between 7.5 and 13. Lowering the upper limit to 11 didn't change things. But I am one of these "mostly hypopneas" types. My AHI was only about 16 when tested, but now is close to zero - and I get good sleep like I never have before.

Then again when looking at my data, it seems that the machine "chases snores" much of the night. I have pressure blips all night but no events (just snores). I wish I could turn off the snore response. So I am wondering if I could lower the pressure even more. If air is entering my GI system while sleeping, it is entering as the last of the dinner (from 7 or 8 hours prior) is emptying. If I eat on the late side and get only 6 hours for my stomach to empty before sleep, I will likely have at least a few hours of air entering while I digest. That air will not be there in the morning - as it will be in my intestines. That would slow down gastric motility even more and so on. I do notice on nights where I get less than 6 hours between dinner and sleep - I am a bit more distended the next day.

Needless to say, no Dr. is going to pay attention enough to follow this up. I either have some basic (bad or worse) problem - or they will not want to deal with it. It is something I will have to figure out on my own. Dr's are all so specialized that they cannot think beyond their specialty. It's a problem with the system - they don't get paid if they don't test you or treat you. If you add CPAP to gastroparesis or something similar, they will just test me until I get tired of being tested. They will never think about the two disciplines at the same time.

Any ideas? I could "try" to sleep without CPAP for a night and see what happens. I won't sleep as well, but it may tell me something.

Jonquiljo,

I guess I am lucky enough to experience that problem (areophagia) only from time to time, but looking at my data I feel that it is linked with an increase in leaks... Maybe something you want to check?

jonquiljo wrote:Then again when looking at my data, it seems that the machine "chases snores" much of the night. I have pressure blips all night but no events (just snores). I wish I could turn off the snore response.

Could you please post an image of one of your typical nights?
You could change the machine over to straight cpap mode and that turns off the snore response.

I am wondering if you are seeing the regular little pressure probes and thinking they might be chasing snores.
I need to see the graphs to know for sure.

If your AHI is really, really low why not try a really tight APAP mode or straight cpap mode?

Pugsy wrote: Could you please post an image of one of your typical nights?
You could change the machine over to straight cpap mode and that turns off the snore response.

I am wondering if you are seeing the regular little pressure probes and thinking they might be chasing snores.
I need to see the graphs to know for sure.

If your AHI is really, really low why not try a really tight APAP mode or straight cpap mode?

Those are good ideas. I have to figure out what is a good pressure. Perhaps I should lower the upper pressure gradually until I get closer to reality. But I have never been officially titrated (I can't stay away from home as I am needed to help out my wife who is spinally disabled). Once I get a good idea of an upper limit, I can just switch to CPAP mode. The only thing I worry about is not getting enough air.

One more thing - the machine chases flow limitations more than anything. I rarely have "events" any more, but I seem to encounter flow limitations (half dozen of so in the first few hours of sleep). It drives the machine crazy pumping up the pressure! I will post soon. Thanks.