Possible Cause of Aerophagia

Here is my theory on Aerophagia, and why some people on CPAP have problems with this while others do not.

In an ideal mouth, the visible surface of the tongue rests against the roof of the mouth all the way from the rugae (hard palate) and back to the soft palate, making a seal with the soft palate that effectively seals off the mouth (oral cavity) from the pharynx and naso pharynx. A person with a strong healthy tongue can breathe perfectly through their nose, even with their mouth open, this is because, as i just said, the tongue seals off the mouth from the throat.

FYI, the muscle that pulls the tongue up to the roof of the mouth is the Styloglossus muscle, it attaches from the styloid process on the temporal bone and pulls the tongue up and back to seal with the soft palate and pull the tongue out of the throat (the airway). People who have speech impediments, mouth breathers, weak tongues that fall into the throat and block airway (apnea), and protruding tongues all have a weak styloglossus muscle and are likely to have apnea. The stronger this muscle, the less it relaxes (as with any muscle the stronger it gets, the stronger the "resting muscle tone" becomes as well).

This leads me to my idea of why Aerophagia occurs.

When you swallow, your naso-pharynx is momentarily sealed off from your pharynx. You can't breathe and swallow at the same time, try it for yourself and you will see what I mean.

This closing off of the naso-pharynx prevents 2 obvious things,

- Swallowing Air (Aerophagia)
- Inhaling food into your lungs (something going down the wrong way)

So what happens is, like a train track, the line is switched.

1) Nasal breathing, mouth sealed from throat, throat and nasal passages
connected and open.
2) Swallowing, mouth no longer sealed from throat, throat and mouth connected and now open, nasal passages now sealed from throat.

So... now if when using cpap your tongue is not sealed with your soft palate (weak styloglossus muscle) and air freely flows over your tongue and into your oral cavity (most likely giving you the blowifsh effect) then when you initiate a swallow, you SWALLOW THE AIR THAT IS IN YOUR MOUTH. Again, ideally your oral cavity is sealed off from the rest of your throat/naso-pharynx (your breathing passages) and no air gets into your mouth, so normally when you swallow you do not swallow any air (or any significant amouth of air anyways).

If your tongue sealed properly to your soft palate (meaning no air in your oral cavity, meaning no blowfish), then there would be no air in your mouth to swallow.

There is only 1 way to solve this problem:

DO NOT SWALLOW when using CPAP if your tongue does not seal your mouth off from your throat/naso-pharynx. Especially if you have the blowfish effect.

Sincerely,
Guest112

Disclaimer: DO NOT, I repeat, DO NOT go around trying to hold your entire tongue up to the roof of your mouth, you will only fatigue and injure the musculature of your tongue and mouth and possibly make your apnea worse.

I want to stress once again,

DO NOT, I repeat DO NOT attempt to use brute force to hold your tongue up to the roof of your mouth or seal off your oral cavity as I described. If your tongue does not already do this then the relevant muscles are weak and any attempt to hold them in a correct posture will injure them and further weaken them and possibly WORSEN YOUR APNEA.

I am being VERY SERIOUS HERE, this is not even a "try at your own risk" this is a "FOR THE LOVE OF GOD DO NOT DO THIS".

Thank you,
Guest 112.

Guestxxx,

Very interesting points - have read quickly once but will read and analyze in detail later.

My own observations (that may be allied to your points - but I do use a full face mask) are that Aerophagia for me occurs mostly when I try to breathe out - the higher the pressure I am breathing out against the more 'bubbles' of air I believe find their way down my throat.

BiLevel operation (using either a BiLevel machine or an EPR enabled machine) has without any doubt to me, reduced the effects of aerophagia to almost non-existant.

Following your points I do find I can hold my mouth open & my tongue out and down & still easily breathe through my nose - throat muscles seem to be able to operate like an open/close valve.

Cheers

DSM

I agree with DSM, the bubbles go down when I am breathing out. EPR has helped a lot.

are there any exercises to strengthen the muscles you mention?

Di

dsm wrote:Guestxxx,
Following your points I do find I can hold my mouth open & my tongue out and down & still easily breathe through my nose - throat muscles seem to be able to operate like an open/close valve.

Yes this is the base of your tongue sealing with the base of your soft palate via the palatoglossus muscle.

Open your mouth, look into the mirror, now watch the back of your throat as you switch between mouth breathing and nasal breathing (with your tongue out and down as you describe). You will see the base of your tongue and soft palate pull away from eachother and then pull towards eachother.

Be careful though, this is not the muscle that you want to use habitually to seal the tongue and soft palate. The muscle for that is the styloglossus, the palatoglossus is a swallowing muscle and should NOT be clenched all day in order to seal the base of the tongue to the soft palate, this can make your apnea worse.

As far as aerophagia is concerned,

You mention that it seems to be caused by attempting to exhale against excessive pressure. I will be honest with you that I have not experienced this yet. I have only experienced the sensation of air moving into my stomach when swallowing in the manner i described in my previous post.

Moby,

As far as exercises go that can strengthen the muscles which I have described (most specifically and importantly the styloglossus muscle) is that Yes There are exercises which you can do to strengthen these muscles and re-establish proper tongue and oral posture. However I do not feel that I should share these publicly until I am sure of their effectiveness. If I am successfull at treating my own apnea and re-establishing a tongue which rests in the roof of my mouth in the manner which I have described then I will most definately share my methods with all of you the second I am sure of that. I feel that to do otherwise would be irresponsible of me.

Strengthening your tongue, from what I have experienced so far is a long process which takes discipline and persistence. As it stands now, I have seen (visually) a definate change in my tongue posture since I started exercising my tongue about 8 months ago. My tongue used to ly completely in the floor of my mouth with the surface of my tongue lying below the tops of my bottom teeth. Now the surface of my tongue lies far above the tops of my bottom teeth and with my mouth closed it is resting just above my top teeth now and starting to just barely touch the roof of my mouth.

Also a huge thing that you have to remember when attempting to exercise and strengthen any muslce (ie the tongue) is that you CANNOT work a muscle every day. This is the secret that body builders and strength trainers know. You must work a muscle every other day at the most, and sometimes only once a week.

I have just recently adopted this philosophy into my tongue exercising (now doing tongue exercises only every other day, but with a high intensity). And hope to see significant improvements in the next few months.

Again, If I successfully strengthen my tongue I will share with you the exercises I have used.

Sincerely,
Guest112

FYI,

re: TMJ

A strong tongue anchors the mandible into the skull and provides the resting muscle tone of the masseter, temporalis, and pterygoid muscles (jaw muscles). This is why many people who have sleep apnea because of a weak tongue also tend to have TMJ.

Sleep Apnea and TMJ are intimately linked, they are both caused by weakness of the musculature in the throat and mouth, most importantly the tongue.

Sleep Apnea, TMJ, and Aeorphagia OH MY!

Guest112.

I need pictures to follow this along,

Pictures:
http://mywebpages.comcast.net/wnor/lesson10.htm

My opinion:

Patients can experience aerophagia for many different reasons, but as we normally see it here (associated with OSA and CPAP therapy), you don't have to "swallow" to experience it.

You don't have to swallow to experience aerophagia because CPAP pressurizes your esophagus all the way down to the stomach, that pressure can over power many of the tongue muscles while in the relaxed state, it is how it splints your airway. While the "effect" may be the same as aerophagia experienced from other disorders/dysfunction such as actual swallowing of air, with CPAP it is from the machine.

Most that have OSA also may have some form of GERD, years of untreated GERD can compromise your LES the valve located at the opening of the stomach. If that valve cannot seal the opening of your stomach then CPAP air pressure is free to enter the stomach where when it makes its way to the intestine it becomes very painful.

So I disagree that aerophagia is caused by a dysfunctional tongue muscle (may be the case with some other disorders/habits) but it is one of the adverse side effects of CPAP if you have a compromised LES. IF that LES is sealing properly and your pressure is not too high then you don't have problems with aerophagia as we know it here.

The problem only surfaces here once patients go on CPAP, then not everyone experiences it.

Thanks snoredog....my sentiments exactly.

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The problem only surfaces here once patients go on CPAP, then not everyone experiences it.
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I agree with what you said 100%, but what I am saying is that, if you are on cpap and you have a strong tounge that prevents you from having the blowfish effect (ie your oral cavity is sealed off from your pharynx where the air is moving from your nasal cavity down your throat to your lungs) then you dont have any air in your mouth, which means that when you swallow you aren't swallowing any cpap air, becuase there is no cpap air in your mouth to swallow.

However for those that do have the blowfish effect because of the fact that their oral cavity is NOT sealed from the pharynx, meaning that cpap air is in their mouth and expanding their cheeks. Then yes, when these people swallow they will swallow cpap air.

Your right, aerophagia is experienced for many reasons, not just this, but I thought I would add my 2 cents on what i have found concerning my own case.

sincerely,
guest 112.

I completely DISAGREE.

I know exactly what you mean and agree with your observation that you can seal the mouth off the circut witht the tongue,

HOWEVER,

I can be laying there with my tongue sealed to the roof of my mouth and FEEL THE AIR bypassing the lower esophogeal sphincter and hitting the wall of my stomach. The problem in my case is a weak Lower Esophogeal Sphincter from years of silent GERD.

This is completely eliminated with lower pressure. My LES just can't stay shut with higher pressure when laying on my side, only on my back. At higher pressures I was forced to lay on my back.

I was fortunate enough to lower my pressure needs by having a tonsilectomy.

Jen

Since I started taping I have had horrible pain in my upper sides. It feels like gas or air bubbles and wakes me up. Last night I even dreamed about it just before I woke up. It usually takes about 6 hours before it hurts enough to wake me up. Before I started taping I would puff air out through my lips, but now that air remains in my mouth ready to swallow.

Could this be aerophagia? I have good numbers when I tape and AHI of 6 to 14 when I don't. Would a FF mask prevent this from happening?

Norseman,

This sounds like you are finally getting therapy--and your body is adjusting to the pressure. The unused muscles in your chest are getting used to breathing against the pressure.

If it doesn't dissipate within a few days, I would see a doctor.


Aerophagia leads to burping and farting and bloatedness (sorry to be so graphic, but hey!).

You probably never experienced it before if you were leaking thru your mouth. You lost most of your therapy thru your mouth and never got your prescribed pressure going down your nose.

Jen

Jen, I was thinking the same thing, but I am very gassy (have been for a long time though). I have been getting this soreness for about a week. I'll wait a bit longer and see how it goes although I don't look forward to waking up like that.

Don't let it go too long, as it could easily be a symptom of something else that may require medical attn. In other words, don't be like MY husband!

Jen