Relieving aerophagia when dropping pressure is not an option

My teenage son has been using his APAP machine for about 15 months, his chief complaint is aerophagia. My son recently underwent his 2nd titration study to see if we could drop his pressure and still maintain adequate oxygenation. I don’t have the results of the study yet, but the sleep tech told us that they’re probably going to have to increase the pressure, lowering pressure to help relieve the aerophagia isn’t going to be a viable option. So far the best we’ve come up with to help relieve some of the painful bloating is having him lay on his stomach or sit in a fetal position and taking GasX. We tried a wedge pillow, but my son didn’t find it comfortable. Does anyone have any suggestions of anything to try to help relieve aerophagia?

I am sure people with much more experience than I will come along but as a user who had extreme aerophagia, I can honestly say I have never heard where a 2nd titration was needed to see if it can be lowered. Your sleep tech says they may have to increase the pressure. That's another first. Add more air?? I lowered my pressure and reduced my aerophagia quite well. I also elevated my headboard about 3 inches. I also increased my humidity to 4 which also helped. To get the proper help from this forum it would be best to download Sleepyhead software, and attach a chart to your post. This would give others something to work with and also show what the minimum & maximum pressure is set at, as well as show the equipment, mask etc. he uses. I hope your son gets the proper help he needs and deserves.

Hi there,

I am not one of the experts just a new user myself. I am at a high pressure. Switching to a nasal mask from a full face mask was helpful for me. I didn't swallow nearly as much air.

Thanks Bigmike!
I guess I should add a more detailed explanation. My son's first sleep study resulted in an obstructive sleep apnea diagnoses as well as a diagnosis of hypoxia. His O2 was under 88 for about an hour and his sats dropped into the 70s. Resolving the hypoxia was his sleep doc/pulmonologist's #1 priority. His doctor specified he get an APAP machine and initially titrated the machine by using the machine's data which was sent to the doctor. Once they found a pressure that put his AHI into the "treated" category the doc ordered an in lab titration. The first titration study showed his AHI was good at 6, but he still was having numerous arousal's and his O2 was still low. They continued to titrate up and found that a pressure of 9 resolved the hypoxia and decreased the arousal's. My son is asthmatic and his asthma is now better controlled than it was at the time of his first titration so his doctor ordered a 2nd titration with the hope that the O2 levels might be maintained at a lower pressure now that the asthma is better controlled. My guess is the sleep tech suggested he may need a higher pressure because he still has quite a few events at 9. The first titration was done last summer and for awhile his AHI averaged around 1-2. For some reason the AHI has gradually crept up, his nightly average is now around 5.

You might try a little more Flex exhale relief though I doubt it will do much...but worth trying if there is room to increase the Flex relief settings.

Otherwise.....if it were my son...I would be pushing for a bilevel machine myself.
And don't let them tell you that he doesn't qualify because his pressure needs aren't high enough...they are high enough to create a problem and that's reason enough.

Thanks for the explanation Colomom. That sheds an entirely different light on why decreasing was not an option. The Hypoxia should be the top priority since his Apnea is in the milder stage. I am curious if the "Colo"mom means you are in Colorado? I am sure altitude has some effect as well. Pugsy said to ask for a bilevel machine and I agree with her 100%. I wish you and your son the very best.....Mike

Thank you everyone for the input!
I’ll give bumping flex up a try and I’ll push for a Bilevel. It makes perfect sense that a decrease in the pressure on exhalation should help relieve the aerophagia. Fortunately my son’s sleep doc is great, the biggest hang up in getting a Bilevel likely will be all the roadblocks put in place by the pencil pushers at the health insurance company.

We do live in Colorado and living at altitude of 7,000 feet is definitely a factor. My extended family has a place in the mountains (9500 feet) whenever we go there my son’s AHI skyrockets. When we travel to lower elevations his AHI is much lower than normal.

Hello

I have discovered through time and by accident that if I wear a soft cervical collar it stops me from having gas in my stomach. The collar seems to have no bearing on my AHI numbers which I find surprising as for alot of people, the collar lowers the events by stopping the chin from tucking. Also, masks do make a difference with events for me. For example, nasal pillows = less than 1 AHI (more direct air), Nasal cushion and FFM = 2-3 AHI, and the Tap Pap = 5-7 AHI which is a bummer as it is so comfortable. I don't know if it will make a difference for you're son as each person is different but I wanted to suggest what worked for me as I went through a couple of months of stomach pains and being lightheaded and thought it would never get better. Right around the 4 month mark I noticed if i don't use the collar and have the gas it doesn't hurt like it used as I believe the body starts adjusting. I wish you and you're son the best of luck.

A different mask is a good suggestion. My son currently uses the Wisp, it is a mask that fits over the nose. The main drawback I see with the Wisp is leaks. My son often sleep on his side and when his face pushes against the pillow the Wisp seems to loose the seal. He has tried nasal pillows and was able to tolerate them, he chose the Wisp because it was more comfortable to him. Is the concept behind changing masks based on reducing leaks?

A cervical collar is also a great suggestion. My son has done great with CPAP but to his teenage brain a cervical collar makes him look and feel really sick, so he’s unwilling to use one.

Thanks again for all the great suggestions!

Many of us who have aerophagia also are mouth breathers. Does your son breath out of his mouth? Many who do, use a full face mask. I know he has problems keeping the mask adjusted on his side. Side sleeping can be learned and adjusting the pillow for no leaks is also attainable. I used Wisp nasal masks for quite some time, as well as a soft cervical collar. I bought one called "Dr. Dakota Eliminator" online at Amazon.com for about $24. I used it until I learned to sleep with my mouth closed and now do not need it. (my wife was shocked as she thought it impossible for me to "shut my mouth")

I would like to recommend the P10 pillows as they are minimal contact, extremely light and I have no problem sleeping on my side with my head near the end of the pillow. I use the alternate FFM Airfit when I am congested which is comfortable. Remember going from a full face, to a nasal, to a pillow can up the pressure slightly. Also when using Flex on your Dreamstation remember it reduces pressure on exhale. For example: your son's pressure is set at 9 fixed, So if you use an flex setting of 3- that would be an exhale relief pressure of 6. If flex is set to 2, then exhale relief pressure would be 7. And a flex setting of 1 would be an exhale relief pressure of 8. You will need to keep your sight on the Hypoxia since the flex and masks can change pressures. As I said in an earlier post, that is what your doctor is focusing on. Since you have a great doctor, please keep him informed of your changes, as HE is the professional.

Mike