aerophagia, need help!

Maryb · Post by **Maryb** » Wed Sep 27, 2006 10:35 am

I have been struggling with aerophagia ever since I switched to the hybrid to help with my mouthleaks. With the hybrid, the good news is that my therapy is more effective. The bad news is that now with no way for that air to leak out of my mouth and release the pressure, I end up swallowing air.

I have been slowly dropping my upper pressure to see if that would help (now I’m on 7.4 – 10.6), But I am still getting aerophagia. I wake up in the night with my stomach/intestines all blown up with air (ouch!!) and feel like I am choking on the air being forced into me. I get into this cycle of swallowing air and then burping. To complicate things further, I seem to be getting increasingly more bouts of acidic stomach (GERD). I’ve scheduled an appointment with the doctor for the GERD and have started taking prilosec.

I have been thinking it might help if I had some expiratory relief. Has anyone experienced that if they switched to a biPAP or a machine that had some expiratory relief that it helped their aerophagia? Currently I have a Resmed S8 Vantage and the only way to get expiratory relief would be if I set it on CPAP rather than autoPAP and I don’t want to do that.
Any suggestions?
Help!

Maryb

Mile High Sleeper · Post by **Mile High Sleeper** » Wed Sep 27, 2006 10:44 am

Go to http://smart-sleep-apnea.blogspot.com/2 ... blems.html and scroll down to the last section on aerophagia. The short answer for many folks is to lower your pressure and see if that works, as long as it doesn't adversely affect your AHI.

NightHawkeye · Post by **NightHawkeye** » Wed Sep 27, 2006 12:04 pm

Maryb, I switched to BiPAP from APAP and now experience much less aerophagia than I did with APAP, even though I run the BiPAP at fixed pressure.

Don't be afraid to try EPR with your machine. That would make it a simple BiPAP. It might help you a lot. I kinda think that the exhale pressure determines how much aerophagia you get. With EPR the exhale pressure is much less than your inhale pressure.

I certainly didn't expect to get the relief that I did with straight BiPAP, but I'm glad I switched. YMMV.

Just my personal experience, of course.

Regards,
Bill

bdp522 · Post by **bdp522** » Wed Sep 27, 2006 12:19 pm

Bill, She can't use EPR in apap with her machine. Are you saying that she should use straight cpap? Would that cause other problems for her?

Brenda

rested gal · Post by **rested gal** » Wed Sep 27, 2006 12:28 pm

Maryb wrote:To complicate things further, I seem to be getting increasingly more bouts of acidic stomach (GERD). I’ve scheduled an appointment with the doctor for the GERD and have started taking prilosec.

Mary, I think that is a VERY wise decision you've made to see the doctor about your increasing acid reflux episodes. It may be that you have a weakened esophageal sphincter making it apt to have air pushed down the wrong way, even if you don't actually swallow. GERD can interfere with any kind of xpap treatment, and aerophagia can be painful....so that's something that should definitely be looked into. You're doing a smart thing making that appointment.

bdp522 is right. Mary can't use EPR with her Vantage unless she switches the operating mode to straight cpap.

oldgearhead · Post by **oldgearhead** » Wed Sep 27, 2006 12:34 pm

I think I would try fixed 9.0 + EPR for a few days. For me, C-Flex
was the answer. Therefore, I suggest EPR may be more important than Auto this week. After all insn't the S8 the poor man's Bi-AP?

NightHawkeye · Post by **NightHawkeye** » Wed Sep 27, 2006 12:37 pm

bdp522 wrote:Bill, She can't use EPR in apap with her machine. Are you saying that she should use straight cpap?

Yes, that's what I did. Although I have a BiPAP-auto, I get better treatment in standard BiPAP mode. I can't guarantee that it will help Maryb, but it worked for me, and it's a simple and easy thing to try. Like I said, I get much less aerophagia in BiPAP mode at full therapeutic pressue all night, than I got with APAP which was at much lower pressures for most of the night.

With APAP, some mornings the pain was gut wrenching. I simply haven't had that problem with BiPAP.

Regards,
Bill

Maryb · Post by **Maryb** » Wed Sep 27, 2006 2:22 pm

thanks for all the suggestions. I think I will try putting the S8 Vantage in CPAP mode at 9 with EPR as OGH suggested. We'll see what happens.
At least I'm feeling more hopeful now.

don't know what I'd do without this forum.

Maryb

Snoredog · Post by **Snoredog** » Wed Sep 27, 2006 5:00 pm

Lower pressure seems to be the most effective.

Also consider taking a magnesium supplement, I like Mega Minerals from GNC it gives you all the main minerals.

GI Specialist: If you have had GERD for 5 years or more the GI specialist will suggest a endoscopy exam. This is done as an outpatient usually at a hospital as they have to put you under with general anesthesia due to the gag reflex.

In any case, the GI Endoscopy exam will examine your LES (Lower Esophageal Sphincter valve). If there is any erosion to the LES they may take a biopsy to rule out any H Pylori bacteria along with stomach cancer. Going years with untreated GERD is thought to be one of the leading causes of stomach cancer.

Years of untreated GERD erodes the LES (and the esophagus) where the LES will no longer seal. The purpose of the LES is to act as a valve and keep stomach acid from flowing backwards up the esophagus.

Taking a medication like Prilosec or most likely from your GI specialist a acid pump inhibitor such as prescription PrevAcid for 6-12 weeks. This allows the LES to heal where it starts sealing again (preventing aerophagia).

At this point, the best thing you can do is LIMIT the Max. pressure on your Vantage machine.

I would lower the Min. pressure to 6.5cm and the Max. pressure to 8cm or 9cm. I would also use a 30-minute Settling timer value. The goal is to lower your pressure reducing the aerophagia.

jrgood27 · Post by **jrgood27** » Thu Sep 28, 2006 6:17 am

You may try experimenting with your position. I tried using one thin pillow because this help me keep my mouth closed, but even while awake the air would head straight to my stomach. I slept one night like this and had painful air-swallowing that hurt for days.

But if I sleep with my head elevated more - on 2 pillows - the air swallowing is much - unfortunately the mouth puffs increase, but i'll take that over aerophagia anyday.

I also heard from someone that he only had aerophagia on his side. On his back there was none. That doesn't help for me though.

I have had GERD and occasional ulcer issues for years, but no doctor has suggested I need an endoscope. Do I need to see a GI specialist now? Now I'm concerned that I've done some damage leaving it untreated for so many years.

Jenny

NightHawkeye · Post by **NightHawkeye** » Thu Sep 28, 2006 8:29 am

jrgood27 wrote: . . . unfortunately the mouth puffs increase, but i'll take that over aerophagia anyday.

One of the things I've wondered about for a while now is exactly how the mouth puffs are related to aerophagia. There does seem to be a connection, as if the mouth puffs are the release of air that had been pumped into the gut. With BiPAP, maybe it's as simple as the air goes into the gut during IPAP and then comes out during EPAP.

Bill

Maryb · Post by **Maryb** » Thu Sep 28, 2006 11:44 am

Well, I left it on APAP mode last night and decreased the pressure down another point from 7.4 - 10.6 to 6.6 - 9.6.
I thought I would give lowering the pressure one more try before I tried CPAP + EPR. I still have aerophagia this morning but it's quite a bit less plus my AHI was still below 5. So maybe I'll stick with this a few more days to see what happens.

Bill-
I too have been wondering if the mouth puffs are air returning from the gut. If that's the case it seems to me that some mouth puffs might be acceptable and not interfere so much with our treatment (?).

Maryb

NightHawkeye · Post by **NightHawkeye** » Thu Sep 28, 2006 6:47 pm

Maryb wrote:Bill-
I too have been wondering if the mouth puffs are air returning from the gut. If that's the case it seems to me that some mouth puffs might be acceptable and not interfere so much with our treatment (?).

That seems to be true for me, Maryb. My Encore Pro charts show that I spend a good deal of the night releasing a small but steady amount of air through my mouth. In contrast, if I just open my mouth and let the CPAP air out, then that comes out as a torrent, but the mouth puffs are much less intense. My Encore Pro charts only occasionally show large leaks for short bursts, and my oxygen saturation remains consistently high despite the persistent mouth leaks.

I'm still hoping that some day I'll get over aerophagia. I do seem to be keeping GERD at bay currently, as my GERD has been non-existent for the past month or so, even though I quit taking protein-pump inhibitors.

Regards,
Bill

elliejose · Post by **elliejose** » Thu Sep 28, 2006 10:13 pm

Bill, what is your pressure? I am on straight bipap at 18 Ipap and 14 epap and the early part of the night when I don't need a pressure that high, I cannot sleep. I have terrible aerophagia. My mask leaks and I feel like I am being blown away!!
In the early am when I need the higher pressure it is fine, but I am switching off between my old apap and the bipap, thus not getting enough rest. Hope to change that when I get back to md week after next. I am about ready to give up. Don't feel much better than when I sleep without cpap.

NightHawkeye · Post by **NightHawkeye** » Fri Sep 29, 2006 5:54 am

elliejose wrote:Bill, what is your pressure?

My pressure is much lower than yours, elliejose, only 10/7, and although that pressure mostly controls my apnea, it causes me just enough aerophagia to cut down my sleep time a little. I rarely get more than seven hours of sleep a night, but would sure like to get more.

Running my machine in auto mode hasn't helped, so I keep coming back to straight BiPAP as being the most effective. The thing I plan on trying next is Ramp mode to see if that will let me increase the amount of sleep time I get. Since aerophagia gets worse for me when I'm lying there awake in the wee morning hours, it seems like maybe running the machine then for a short while in Ramp mode at a lower pressure might help.

Regards,
Bill (at nine months and counting of sleeping better with xPAP, but still wanting/needing improvement)

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