New CPAP user having problems.

There's a link in my signature line to a youtube video about a technique that helps some people with aerophagia.

Thanks! I'll look at that.

Wulfman... wrote:Ingesting air is called "aerophagia"

It is true that ingesting air is called aerophagia.

However, when an outside force, such as a ventilator or a CPAP, blows air into the stomach, it is correctly called gastric insufflation.

Aerophagia typically occurs while one is awake. Gastric insufflation from CPAP can occur while asleep or awake.

The OP could be having aerophagia because he is nervous about the CPAP and is breathing abnormally and swallowing air. But at a pressure of 13, there is a good chance he is experiencing gastric insufflation.

archangle wrote:There's a link in my signature line to a youtube video about a technique that helps some people with aerophagia.

I looked at the video. The problem with that is I have serious issues with my spine. I had a cervical fusion in 2012 and continue to have problems with pain and numbness. There's no way I can do that. And, even if I did, you can't control how you move if you're asleep. In my case, I move around quite a lot and would not stay in that position for long. By the way, I also looked at your link to alternatives to CPAP. I was thinking there would be an actual device. LOL I know that's meant to be serious but I couldn't help laughing. Good one!

Here's an update on what's been going on. I called the therapist from the company that supplied the machine. Is that the DME? She sounded sort of clueless as to what to do but mentioned I could try a chin strap if I thought it would help. Wouldn't she know what to do? Isn't she supposed to? Anyway, I picked one up Monday. I went to bed around 10:30 that night and woke up shortly after midnight with severe chest and stomach pain, burping, and was fighting to breathe. Tuesday night I went to bed without the strap. Woke up shortly after 1am fighting to breathe. Is the pressure maybe to high? I know it is set at 13. The machine starts out at low pressure and builds up gradually. But if you look at the number of incidents I have during the night they can be as many as 8 per hour. Wouldn't that suggest the pressure is too low? Anyway, I called the therapist again and she said she has basically done everything that she can. She didn't offer any other advice so I said I will call the sleep center doctor. I have a call in but have not heard back yet.

Midnight Strangler wrote:

Wulfman... wrote:Ingesting air is called "aerophagia"

It is true that ingesting air is called aerophagia.

However, when an outside force, such as a ventilator or a CPAP, blows air into the stomach, it is correctly called gastric insufflation.

Aerophagia typically occurs while one is awake. Gastric insufflation from CPAP can occur while asleep or awake.

The OP could be having aerophagia because he is nervous about the CPAP and is breathing abnormally and swallowing air. But at a pressure of 13, there is a good chance he is experiencing gastric insufflation.

Exactly what I read when I researched it! Gastric insufflation is what it's called when you swallow air while asleep. And that can lead to other serious problems. I already know I'm somewhat of a mouth breather anyway. I have sinus issues that make me congested at times. I've always had allergies and tried medication. If it doesn't make me feel like a zombie it puts me to sleep. I have been using Zyrtec but it really doesn't help much. My ENT has prescribed nasal sprays but same thing there.

Mike,the problem you describe is shared by a number of members on this forum. It is called the "lower esophgeal spincter (LES) threshold pressure. When CPAP therapy exceeds the LES threshold, air is forced into the stomach, rather than where it belongs. So indeed the root cause is high pressure that you cannot currently tolerate. The solution probably lies in part in finding what pressure threshold you can tolerate without experiencing these symptoms. So you should probably experiment with lower pressures, and carefully observe both the air ingestion and AHI rate and balance those two. You may want to do that in consultation with your doctor, or not. It may also indicate a need for a biPAP type machine which lower the pressure on exhalation. Again, that would require a change in prescription.

There are apparently exercises that can strengthen the LES http://www.ncbi.nlm.nih.gov/pubmed/23026445
This is not a topic I am particularly familiar with, but there are several members that are quite well versed in LES issues.

Sleeprider wrote:Mike,the problem you describe is shared by a number of members on this forum. It is called the "lower esophgeal spincter (LES) threshold pressure. When CPAP therapy exceeds the LES threshold, air is forced into the stomach, rather than where it belongs. So indeed the root cause is high pressure that you cannot currently tolerate. The solution probably lies in part in finding what pressure threshold you can tolerate without experiencing these symptoms. So you should probably experiment with lower pressures, and carefully observe both the air ingestion and AHI rate and balance those two. You may want to do that in consultation with your doctor, or not. It may also indicate a need for a biPAP type machine which lower the pressure on exhalation. Again, that would require a change in prescription.

There are apparently exercises that can strengthen the LES http://www.ncbi.nlm.nih.gov/pubmed/23026445
This is not a topic I am particularly familiar with, but there are several members that are quite well versed in LES issues.

Thank you. This is why I decided to call the doctor. This therapist isn't offering much help. I have read about the biPAP type machine and it's use in similar issues with CPAP.

Mike208 wrote:I called the therapist again and she said she has basically done everything that she can. She didn't offer any other advice

Mike208 wrote:This therapist isn't offering much help.

Unless they are CPAP users themselves, most respiratory therapists (RTs) can't offer much help. This forum exists to help fill the huge gap between doctors/sleep labs/DMEs and CPAP patients.

DME is durable medical equipment supplier and yes they supply CPAP equipment. Each state has DME licensing requirements in order to sell the equipment.

Mike208 wrote:Gastric insufflation is what it's called when you swallow air while asleep.

Technically swallowing is the act of taking something into the stomach by drawing through the throat and esophagus with a voluntary muscular action.

Gastric insufflation caused by CPAP does not have to involve any swallowing.

I have bad gastric insufflation if I roll onto my sides. I have tested if this is caused by swallowing by rolling onto my side and holding my breath and not swallowing. I can feel the air leaking past my LES and filling my stomach. So swallowing in not involved in my problem.

On my back, the problem of gastric insufflation is mild enough to be easily tolerable, so I avoid sidesleeping.

I assume some people can get nervous and bothered by the CPAP process and actually swallow air. If so, this would correctly be called aerophagia.

Mike208 wrote:I looked at the video. The problem with that is I have serious issues with my spine.

LankyLefty has some good videos that help people, but this one is a disaster. Anyone who sleeps with the head propped up at a 45-degree angle, even a young person with a perfectly healthy spine, is setting themselves up for some significant spine problems over time.

Not to mention that with the airway at an angle, many people will find they need a much higher pressure to keep the airway open.

Lefty says he has tons of patients sleeping like that. I wonder if 15 years from now he will have a video saying he has tons of patients with serious spine problems?

No wonder archangle has "not tried it" himself.

Sleeprider wrote:There are apparently exercises that can strengthen the LES http://www.ncbi.nlm.nih.gov/pubmed/23026445

Thanks, I may try that. Looks like I can get a device for no more than $36 - http://www.rakuten.com/prod/respironics ... Au7H8P8HAQ

Midnight Strangler wrote:

Mike208 wrote:I looked at the video. The problem with that is I have serious issues with my spine.

LankyLefty has some good videos that help people, but this one is a disaster. Anyone who sleeps with the head propped up at a 45-degree angle, even a young person with a perfectly healthy spine, is setting themselves up for some significant spine problems over time.

Not to mention that with the airway at an angle, many people will find they need a much higher pressure to keep the airway open.

Lefty says he has tons of patients sleeping like that. I wonder if 15 years from now he will have a video saying he has tons of patients with serious spine problems?

No wonder archangle has "not tried it" himself.

Yeah, I was cringing when I saw him bend his neck like that. I have enough issues I don't need anymore.

Midnight Strangler wrote:

Mike208 wrote:Gastric insufflation is what it's called when you swallow air while asleep.

Technically swallowing is the act of taking something into the stomach by drawing through the throat and esophagus with a voluntary muscular action.

Gastric insufflation caused by CPAP does not have to involve any swallowing.

I have bad gastric insufflation if I roll onto my sides. I have tested if this is caused by swallowing by rolling onto my side and holding my breath and not swallowing. I can feel the air leaking past my LES and filling my stomach. So swallowing in not involved in my problem.

On my back, the problem of gastric insufflation is mild enough to be easily tolerable, so I avoid sidesleeping.

I assume some people can get nervous and bothered by the CPAP process and actually swallow air. If so, this would correctly be called aerophagia.

I think maybe I was gulping some air anyway since I'm a mouth breather. But it never bothered my like this. It looks like I normally get about three hours on the machine before I wake with the belching and pain. I was surprised at the amount of chest pain I had when I used that chin strap though. That scared me.

I had up to 45 sleep apneas per hour with my sleep testing. My machine is set at 19-15 and so I am at the top when it comes to pressures to accomodate my problems. These Cpap machines are only capable of giving a pressure of 25, and so you can see why it is as hard for my mask to stay on my face and not leak as well. I am looking for a gel pad that will fit between the mask and my face to give me a better seal. Take a lid off an empty bottle of water. Stuff a cotton ball in that lid and then place several drops of liquid Vicks vapor Rub or the generic equivelant into that cottonball. Then take the cottonball bottle lid combination and set it right next to the intake for air on the back side of the Cepap machine. The Vicks vapors will open up your sinuses so you will breath through your nose and not your mouth. Because you are breathing through your mouth is why you are getting all that extra air in your stomach causing you to belch. Don't be afraid to set that machine on five with the dial so that you are breathing a lot of moisture. This also helps keep your sinuses open so that you breathe through your nose and not your mouth

stees4 wrote:I had up to 45 sleep apneas per hour with my sleep testing. My machine is set at 19-15 and so I am at the top when it comes to pressures to accomodate my problems. These Cpap machines are only capable of giving a pressure of 25, and so you can see why it is as hard for my mask to stay on my face and not leak as well. I am looking for a gel pad that will fit between the mask and my face to give me a better seal. Take a lid off an empty bottle of water. Stuff a cotton ball in that lid and then place several drops of liquid Vicks vapor Rub or the generic equivelant into that cottonball. Then take the cottonball bottle lid combination and set it right next to the intake for air on the back side of the Cepap machine. The Vicks vapors will open up your sinuses so you will breath through your nose and not your mouth. Because you are breathing through your mouth is why you are getting all that extra air in your stomach causing you to belch. Don't be afraid to set that machine on five with the dial so that you are breathing a lot of moisture. This also helps keep your sinuses open so that you breathe through your nose and not your mouth

I've been using Vicks on my upper lip just under the nose. Doesn't seem to make a lot of difference. I'm hesitant to change any of the settings since I don't know anything about it and I'm having so much trouble. I checked and the climate control is set to auto. Ramp is on auto. Tube temp is 81 degrees.