Aerophagia only with nasal pad (lips taped) but not with Full Face Mask

I alternately switch between Dreamware nasal pad (NP) with lips taped and full face masks (FFM) , but would prefer to only use the NP as I get a skin rash from the FFM and cannot use liners.

As you can see in linked reports https://imgur.com/a/1uE3dM3 my AHIs are terrific with both options (compared with AHI=30 w/o any therapy); however, I would hugely prefer to use only the NP due to the rashes and comfort, but can’t figure out why I swallow so much air that I wake up with a distended abdomen halfway through the night. I change the clinical settings to “nasal” on the Resmed machine, but am wondering if perhaps the pressure builds up in the nasal that is why I am swallowing air? And why is this never a problem with the less comfortable FFM?

Please let me know if you have any ways you suggest i play with the settings when I use the nasal mask (I have also tried the Pillow setting and same thing happens)

Resmed Air 10
Dreamware Nasal Pad AND/OR Full Face Mask
Lips fully taped since I am a mouth breather

Are you normally a mouth breather? Pressure changes? I also get the same way with my NASAL only mask. Only when I increase pressure though.

Catchsomezzzs wrote: ↑

Tue Nov 29, 2022 5:36 pm

I alternately switch between Dreamware nasal pad (NP) with lips taped and full face masks (FFM) , but would prefer to only use the NP as I get a skin rash from the FFM and cannot use liners.

I'm not quite sure what you mean by a "nasal pad".

Do you mean a nasal cradle mask like this one:


Or do you mean a nasal pillows mask like this one:


The difference is subtle, but important. A nasal pillows mask has two cones and each one fits over one nostril with the tippy-tip of the cone being inserted inside the nostril. But a nasal cradle has a cushion that covers the whole tip of the nose---there are no cones that fit over each individual nostril.

If you are using a nasal cradle mask, the mask setting should be set to "nasal". If you are using a nasal pillows mask, the mask setting should be set to "pillows"

I would hugely prefer to use only the NP due to the rashes and comfort, but can’t figure out why I swallow so much air that I wake up with a distended abdomen halfway through the night. I change the clinical settings to “nasal” on the Resmed machine, but am wondering if perhaps the pressure builds up in the nasal that is why I am swallowing air? And why is this never a problem with the less comfortable FFM?

The major thing the mask setting does is tell the machine what the expected leak rate is for your mask and that allows it to correctly calculate the excess leak rate. (Excess leak = total leak - expected leak rate)

The problem you are having with swallowing air and the distended stomach is referred to as aerophagia. My guess is that this is what is happening:

When you are using the nasal mask with your mouth taped shut, your tongue is moving into a position that allows air to get into the oral cavity. And because your mouth is taped, the air cannot escape from the mouth because your lips are taped shut. When the air pressure in your mouth builds up enough, you unconsciously swallow the excess air to get it out of the mouth. But because the tongue is still resting in a position that allows air to get from the nasal cavity into the oral cavity, more air build up in your mouth and you swallow again. Rinse and repeat all night long until you wake up in pain with a distended stomach (and probably chipmunk cheeks) half-way through the night.

The reason this doesn't happen when you are using a full face mask without taping is that you can open your mouth and any excess air pressure is mixed back into the semi-closed pressurized CPAP system that consists of both your oral and nasal cavities along with the hose & mask, the blower unit, and your upper airway. In other words, if unexpected air pressure builds up in the mouth when your mouth is closed, you can open the mouth and equalize the pressure, which prevents the need to swallow the air to get rid of it.

Please let me know if you have any ways you suggest i play with the settings when I use the nasal mask (I have also tried the Pillow setting and same thing happens)

The only real fix for the problem since you want to stick with the nasal mask is to train your tongue to stay in the correct place where the nasal cavity is totally shut off from the oral cavity.

Here's what I mean: The usual ("correct") resting place for the tongue should be with the tip of the tongue touching the gum line of your top front teeth and the "hump" of the tongue resting on the top of your mouth. In this position you have to breathe through your nose and no air gets into the mouth when you inhale or exhale. For an ordinary human with no serious nasal congestion problems and no mouth breathing problems, the tongue naturally rests in this position whenever you are not talking or eating or yawning or otherwise actually using your mouth.

But many people get into a habit of mouth breathing for all kinds of reasons. And when you mouth breath, the tongue typically is resting in a position that is "lower" in the mouth---i.e. no part of the tongue or only a very small part of the tongue is touching the roof of your mouth when you are mouth breathing. And of course, if you get into a habit of mouth breathing, the tongue can rest in that "lower" position even if you happen to be breathing through your nose. And that's typically not a problem---until you add additional air from an xPAP machine being blown into your nose and upper airway. When the tongue is in that "lower" position, the back of the throat is open enough to allow air from the CPAP to get into the mouth cavity. And if the mouth is taped closed, the only way to get rid of that air is to swallow it.

In order to try to train your tongue to stay put in the correct "upper" position, you need to spend time during the daytime consciously remembering to keep your tongue's hump up there on top of your mouth whenever you are not talking and not eating. You can try to determine if you've got your tongue in the right place by opening your mouth while keeping the tongue in position and seeing if you feel any air blowing through your mouth. You can also even try to consciously breathe through your mouth without moving your tongue off the top of your mouth. If the tongue is in the right place, it should be almost impossible to breathe through just your mouth.

If you spend a week or two really focusing on your tongue's position in the daytime, then the tongue might learn to stay in that position at night when you are asleep. And if the tongue does stay put, then you should have much less aerophagia to deal with when you choose to use the nasal mask and taping.

Good luck!

robysue1 wrote: ↑

Tue Nov 29, 2022 8:15 pm

The only real fix for the problem since you want to stick with the nasal mask is to train your tongue to stay in the correct place where the nasal cavity is totally shut off from the oral cavity.

Another option it to try an FFM from another company and wash it thoroughly before first use.

Thanks to all of you for generously sharing your time and wisdom.
Yes, I have always been a mouth breather with narrow palate, and yes, I have tried both the nasal cradle (with “nasal mask” setting) and the nasal pillows (with “pillows” setting), and wake up with a belly full of air.
Only when I use the FFM do I not swallow air, and I use mouth tape even with the FFM.
I will try to fiddle with the pressure tonight and see if I can perhaps reduce the pressure without increasing AHIs. Will keep you updated, thanks again!

Mystery solved!: Special thanks to RobySue1 who helped me tremendously with insight on the power of tongue placement to keep air directed down the airway. When I wear the nasal cushion I tend to sleep on my side and my tongue drops down letting all the air in. With the FFM I sleep only on my back and my tongue tends to stay up, although I will focus on keep it strong with exercises during the day. Thanks again