Aerophagia

I lost weight a few months back. Since the weight loss I have developed severe acid reflux that medication will not control. My hours of sleep have decreased on average by 50%. AHI is way down, even 0 is being recorded. No indication of snoring on report, yet I have been a habitual loud snoring person for decades. I wonder if cpap treatment may be over doing it now.

I wake to aerophagia and acid reflux each day. I have been prone to acid reflux all my adult life (for 50 years), but I have managed to control it with brief use of acid reducers which now are ineffective.

I am suspecting the aerophagia may be exacerbating the acid reflux.

A check of pressure settings found my ResMed Air Sense 10 AutoSet minimum to be 12. That seems way too high for a min. and may be causing the aerophagia.

Any thoughts on my situation?

ejbpesca wrote: ↑

Thu Sep 29, 2022 7:49 am

Any thoughts on my situation?

The best is to post some OSCAR or sleepHQ daily charts in this thread.

Alternately, lower your minimum pressure by 1.0 each night and read the display the next morning to see what your nightly AHI is doing. If your AHI gets too high, you can take the minimum back up.

ejbpesca,

I am so sorry to hear that you are dealing with aerophagia issues.

Severe aerophagia was one of my most significant problems when I was still getting used to CPAP therapy. As in I would wake up with my stomach swollen and rigid. It felt like I'd swallowed a basketball. (And I'm a 5'1" shrimp who weighs about 110 pounds, so it sometimes looked like I had swallowed something not much smaller than a basketball.

You write:

ejbpesca wrote: ↑

Thu Sep 29, 2022 7:49 am

My hours of sleep have decreased on average by 50%. AHI is way down, even 0 is being recorded. No indication of snoring on report, yet I have been a habitual loud snoring person for decades. I wonder if cpap treatment may be over doing it now.
<stuff deleted>
I am suspecting the aerophagia may be exacerbating the acid reflux.

A check of pressure settings found my ResMed Air Sense 10 AutoSet minimum to be 12. That seems way too high for a min. and may be causing the aerophagia.

Yes, too much pressure may very well be aggravating the aerophagia. And the aerophagia is most likely the reason your sleep hours have decreased significantly and your acid reflux has increased.

If I were you, I would lower both the min and max pressures. How much depends a lot on your actually daily detailed data. I would also turn EPR on if it is set to off. Why? Well it turns out that reducing the pressure on exhalation can help reduce the amount of air you are swallowing each night.

Here's my advice as someone who has battled the aerophagia monster:

First, you don't need to chase an extra low AHI. To manage the aerophagia, you have to find a balance between enough pressure to keep your AHI low enough. Practically speaking, for me that means tolerating AHIs in the 2.5 to 3.5 range a lot of the time, rather than trying to keep the AHI below 1.0 or 1.5.

Second, you need to figure out how low you can tolerate the pressure being at the start of the night and set your minimum pressure to something that's pretty low, but easy for you to tolerate. Since your current minimum pressure is set to 12, you probably won't like trying to breathe at 4cm of pressure. But if you can set that minimum pressure down to 8cm and still breathe comfortably when you are trying to get to sleep, that could help significantly.

Third, you need to probably cap the maximum pressure setting as well. Since I haven't seen your daily data, I can't give you any advice on where to set your maximum pressure. For what it's worth: In my case, I have to set my maximum IPAP at 9cm because if I set it any higher than that, the Dreamstation interprets breathing patterns as "flow limitations" and "snores" and keeps increasing the IPAP right up to whatever max I seem to set without actually improving my AHI, the number of FL, and often increasing the number of things it records as snores (VS1s and VS2s). And obviously that excess pressure ends up increasing my aerophagia quite a bit. And as the aerophagia increases, both the quality and quantity of my sleep goes way down. So I've learned (the hard way) that capping my IPAP at 9cm gives a good working compromise between the number of events (AHI is consistently below 3.5 and usually between 1.5 and 2.5, hubby reports little or no snoring and the snoring he hears is quiet rather than loud sawing logs) and my ability to get to sleep and stay asleep without waking up with severe aerophagia.

Fourth, when you do wake up in the night it's reasonable to turn your machine off and then back on. That will reduce the pressure back to your minimum pressure setting while you are getting back to sleep, which in turn will decrease the air you are swallowing and decrease the aerophagia. (But don't stress out over the number of wakes in your data if you don't remember turning the machine off and back on.)

Finally remember that an AHI = 0.0 is not an indication of a great night's sleep. Waking up refreshed and rested is. That means your AHI needs to be low enough to be healthy, but it also means the aerophagia has to not be bothering you up enough to significantly shorten the amount of sleep you are getting in the first place.

Good luck.

ejbpesca wrote: ↑

Thu Sep 29, 2022 7:49 am

ejbpesca » Thu Sep 29, 2022 9:49 am

It's rarely as complicated as robysue makes it.

Try something simple first.

And have you just tried half (or more) of a Tums before bed rather than Rx's or other supposed acid reducers? Works perfectly for me and I actually use just 1/4 most of the time, but I also agree that a lower min. pressure would be helpful for the aerophagia.

You may also need to cap the maximum. What is it now?

Before you make incremental changes, be sure you can read the breakdown of your events on the screen of your machine. You want to know whether changes are to obstructive apnea, central apnea, or hypopnea.

Ideally you could use Oscar and provide a daily chart so people could give you better informed advice. Kind of shooting in the dark here.

Given that OSCAR is the best approach, you may decide to decrease your minimum as suggested above. If you find going from 12 to 8 to be a big change, consider lowering your pressure incrementally and holding for a few days before lowering again. That may help accommodate.

In addition to what RobySue suggested, I also suggest you contact a doctor about your acid reflux.
The aerophagia is a result of the pressurized air breaching the top sphincter of your stomach, and letting air in.
The acid reflux is a result of acid pouring up from that compromised sphincter.
Sometime by the time this happens, the sphincter becomes inflamed and swollen, and can no longer function properly.

When that happened to me - due to Resmed's runaway pressure when the machine was on auto - I was prescribed proton pump inhibitors for a short time (no longer remember how long - and I do rememger the Rx was strong), I drastically limited the top pressure, and gradually tapered off the PPI's.
In my case, the reflux and aerophagia were so bad that the acid shot up to my nose!

For me, a change in my diet also helped with various digestive symptoms. I've been eating low carb since 2009, making sure to avoid gluten and seed oils -- and rarely have those problems now.

OSCAR is great but so unstable on my unstable laptop with touch screen, but doable.

Thanks so much for the advice. I went ahead and did a drastic pressure change on my machine. I woke with less aerophagia today. AHI went from 0 to near 5. I had found my pressure min and max was set WAY too high and I wonder if the AUTOSET function of my machine is very accurate.

I have never once, in over 10 years of CPAP therapy, have had anyone give any examination to my therapy. There are NO technicians available in my area and the doctors, I have seen, have 0 knowledge of sleep therapy. Each yearly visit, I am asked if I use my machine 4+ hours a night and that's it. The sleep lab people do zero follow-up. I have to get my supplies online via Verus, which does not offer any analysis services nor advice, just sales.

Here's a screen shot of last night. I am going to reduce the min. pressure even more. Maybe take max down to 8.

I had no idea OSCAR was so detailed, nor did I know there were so many factors to CPAP therapy... till now.

Well, did a Preview and no attached file. Tried again, says limit has been reached for attached files. Maybe it will show once I Submit.

Trying again to post OSCAR screenshot.

Nope, CpapTalk says my attachment quota has been met, yet I have attached nothing. I am blocked from sending files.

It is a 79KB file. I guess I should report my problem. I'll look for a menu item to do that.

ejbpesca wrote: ↑

Fri Sep 30, 2022 8:37 am

Trying again to post OSCAR screenshot.

Nope, CpapTalk says my attachment quota has been met, yet I have attached nothing. I am blocked from sending files.

It is a 79KB file. I guess I should report my problem. I'll look for a menu item to do that.

Please look over at sleephq.com

I find it takes exactly one minute to upload the data once you set up an account and is easier to share a link to your daily info, where folks can really zoom in and give it a look.

Easy instructions. https://youtu.be/YJojSMC4zQc

lynninnj wrote: ↑

Fri Sep 30, 2022 8:50 am

Please look over at sleephq.com

I find it takes exactly one minute to upload the data once you set up an account and is easier to share a link to your daily info, where folks can really zoom in and give it a look.

Easy instructions. https://youtu.be/YJojSMC4zQc

Sure looks interesting and legit. I would like to tell fellow on YouTube tutorial to please slow down and drop using "uhs," he heh

Thank you linninni.

Julie wrote: ↑

Thu Sep 29, 2022 10:08 am

And have you just tried half (or more) of a Tums before bed rather than Rx's or other supposed acid reducers? Works perfectly for me and I actually use just 1/4 most of the time, but I also agree that a lower min. pressure would be helpful for the aerophagia.

A half of Tums? I am double dosing acid reducer meds, and taking 8 Tums. I have been hospitalized with acid reflux three times over the years so I guess it is a serious case. I've controlled it over the decades with the Zantac that was taken off the market. All other meds are not working. I may be able to get the old Zantac by prescription by a willing doctor though. It originally was by prescription only. It was a miracle drug I used for 35 years.

ChicagoGranny wrote: ↑

Thu Sep 29, 2022 8:59 am

ejbpesca wrote: ↑

Thu Sep 29, 2022 7:49 am

Any thoughts on my situation?

The best is to post some OSCAR or sleepHQ daily charts in this thread.

Alternately, lower your minimum pressure by 1.0 each night and read the display the next morning to see what your nightly AHI is doing. If your AHI gets too high, you can take the minimum back up.

I tried to post a screenshot of an OSCAR report and got this:

ERROR
Sorry, the board attachment quota has been reached.

No attachments have been uploaded. ? ? ?

ejbpesca wrote: ↑

Fri Sep 30, 2022 9:22 am

I tried to post a screenshot of an OSCAR report and got this:

ERROR
Sorry, the board attachment quota has been reached.

No attachments have been uploaded. ? ? ?

You might want to read the response to your thread with the attachment question instead of keeping repeating the same question.

viewtopic/t185182/Attachments---failure.html