Sleep Doctor Visit: Aerophagia and Changing Our Pressures...

Hi all,
I've learned so much from all of you, so I thought I would share what I learned today at my first follow up visit. My sleep doctor is really good (in my opinion) - very thorough and tries to explain everything (almost to the point that I imagine he's over a lot of folks' heads ---yes...even mine at times...lol). He's a real "scientist" -- friendly, but more clinical than excitable, if that makes sense (let me just say it - he's a nerd/brainiac, but in the best possible way!). So...
I went in with reports and spreadsheets sorted by AHI and Pressures, etc. While I think he was probably mildly amused, I think it allowed him to see that I was open to learning, which is always a good thing.

With regard to changing our own pressures...
1) He told me he preferred that I stay at 11, even though my "evidence showed" that my AHI went down with a 11.6 - 11. 8. He explained that there's a fine line here in that with too much pressure, the lung capacity grows, and this somehow tells the brain to breathe less, thereby causing more Central Apneas (now that's my paraphrasing of what he said). In other words, anything under 5 is good and stop sweating the small stuff... The goal is not perfection or 0, it's to be "normal" which is under 5. And there is often a fine balance. (So I will respect his wishes on this one, unless my data starts showing a problem...)

2) The aerophagia is something he is a bit concerned about. I've read some of the theories here and he shared those with me as well. His first step is to
a) Use 2-3 drops of saline spray in each nostril at bedtime and up the EPR to 3.
b) If that doesn't work, he wants me to call and possibly look into acid reflux meds (ughh...here we go), because, as I've read here, sometimes this is a problem that we may have already had that shows up with CPAP. In any case, I thought plan A might help some of you.

I really love that he gives me so much information, but as I said, I'm paraphrasing and simplifying. Hopefully, however, it will help somebody out there.


Have a great day!
kim

try to sit up in bed when half awake and burp

If anyone encounters any research that shows that PPIs (proton pump inhibitors) helps aerophagia, please send it my way, as I am very curious about this. There may be a correlation between GERD and aerophagia (because aerophagia may exacerbate GERD), but I know of not one lick of data, other than possibly anecdotal, or any mechanism by which PPIs should improve aerophagia. But maybe the information is out there and I just haven't seen it.

And this is the first I have heard about the lung capacity thing. Its an interesting theory, but I wonder how much 'air' it really holds? DSM? _SWS? Muffy?

Good information. Thank you.
Your doctor is right on about your pressure needs. I'm glad he took the time to explain to you about the fine line between very good and causing central apneas.

harry33 wrote:try to sit up in bed when half awake and burp

Oh, if it were only that simple...for me it's pain from my neck down to below my tummy -- like having had surgery, if you know what that's like..., so perhaps a little more of a challenge...

SleepingUgly wrote:If anyone encounters any research that shows that PPIs (proton pump inhibitors) helps aerophagia, please send it my way, as I am very curious about this. There may be a correlation between GERD and aerophagia (because aerophagia may exacerbate GERD), but I know of not one lick of data, other than possibly anecdotal, or any mechanism by which PPIs should improve aerophagia. But maybe the information is out there and I just haven't seen it.

It is hard to think of any possible way PPIs could improve aerophagia, isn't it? I wonder if maybe the doctor is worried that if klgm326 cannot control his aerophagia, then it means that his lower esophageal sphincter is compromised, and that he ought to be treated with PPIs for GERD. In other words, the doctor doesn't think that PPIs can help the aerophagia, just that aerophagia is a sign that maybe klgm325 needs to get his stomach acid down for the sake of his esophagus.

PST wrote:

SleepingUgly wrote:If anyone encounters any research that shows that PPIs (proton pump inhibitors) helps aerophagia, please send it my way, as I am very curious about this. There may be a correlation between GERD and aerophagia (because aerophagia may exacerbate GERD), but I know of not one lick of data, other than possibly anecdotal, or any mechanism by which PPIs should improve aerophagia. But maybe the information is out there and I just haven't seen it.

It is hard to think of any possible way PPIs could improve aerophagia, isn't it? I wonder if maybe the doctor is worried that if klgm326 cannot control his aerophagia, then it means that his lower esophageal sphincter is compromised, and that he ought to be treated with PPIs for GERD. In other words, the doctor doesn't think that PPIs can help the aerophagia, just that aerophagia is a sign that maybe klgm325 needs to get his stomach acid down for the sake of his esophagus.

There you go....I think that's the idea...that I may have a problem that hasn't shown up until now (with CPAP), so that Acid Reflux meds (funny....I had to look up proton pump inhibitor...lol!...I thought that was yet another type of equipment!! ) [/color]might be helpful! Wow...you guys sure keep me on my toes!! I love this...keeps my brain cells alive

Please let us know if the PPIs improve your aerophagia. It will be interesting to see if there's even anecdotal support for the supposition that aerophagia can be improved with PPIs (although hopefully from more than one person)... and yes, I get that your doctor may not have been suggesting that, but I have heard it before and at one time looked for support for it, and couldn't find it.

klgm326 wrote:With regard to changing our own pressures...
1) He told me he preferred that I stay at 11, even though my "evidence showed" that my AHI went down with a 11.6 - 11. 8. He explained that there's a fine line here in that with too much pressure, the lung capacity grows, and this somehow tells the brain to breathe less, thereby causing more Central Apneas (now that's my paraphrasing of what he said).

I'm surprised to hear that since increased lung volume is thought to be beneficial. Perhaps he was talking about CompSA or even the Herring Breur Reflex. These days few doctors theoretically equate CPAP-induced central apneas with the Herring Breur Reflex, however. Most doctors now equate CPAP-induced central apneas with CompSA and resulting CO2 imbalance.

I'm the anecdote you were looking for.

A new auto raised my pressure in a way that caused aerophagia. Bad.
Started having heartburn. Then I got 2 terrrifying reflux attacks with acid simply pouring up.
Dropped pressure after first one but that didn't help, and I had the second within a week or so.
I dropped the pressure a lot.
Large (now diminishing) doses of generic Prilosec have let me built my pressure up again to where it was when the second attack occured.
Hardly any aerophagia now.

Yes, I am more careful about not eating late, and try not to spend much time on my right side -- but without the PPI's it wouldn't have helped.

I take PPI's and I still have aerophagia, although it's pretty mild. I am no good at burping, but I can relieve the pressure "at the other end" well enough LOL--it's as loud as my snoring used to be, but not as constant.

The theory that the sphincter between the stomach and esophagus (it's been 30 odd years since I took anatomy and physiology, but isn't that called the "cardiac sphincter" because of its' proximity to the heart?) sounds about right. The very nice part of CPAP for me is that I have no GERD as long as it's on and I get to sleep flatter--my neck and shoulders are much improved since I started CPAP and I think it's because I no longer have to sleep on "pillow mountain".

ive been on a strong prescription strength ppi eleven months now for LPR (larynx reflux..)
Im supposed to be done with the treatment next month, as doc says it takes a year to heal LPR.... I didnt believe her so I went back
after six weeks.. NO, still got it! okay, three months.. NO still got it!, Crap! okay six months.. NO still there, but better!
nine months.. NO, still got it but much better! come back in three months! Darn, I hate to admit it, but I think she was right!

when I started with my at home titration, I had a terrible time with swallowing air, but I learned how to relax, and get into
different positions, and that was the end of it. I was on ppi's at the time.

It only happened to me a few nights..

did you see the youtube video on how to take care of it?

elena88 wrote:did you see the youtube video on how to take care of it?

On how to take care of what?

ozij wrote:I'm the anecdote you were looking for.

A new auto raised my pressure in a way that caused aerophagia. Bad.
Started having heartburn. Then I got 2 terrrifying reflux attacks with acid simply pouring up.
Dropped pressure after first one but that didn't help, and I had the second within a week or so.
I dropped the pressure a lot.
Large (now diminishing) doses of generic Prilosec have let me built my pressure up again to where it was when the second attack occured.
Hardly any aerophagia now.

Yes, I am more careful about not eating late, and try not to spend much time on my right side -- but without the PPI's it wouldn't have helped.

Once you are off the Prilosec, if that's your intention, it will be interesting to see if your aerophagia returns (for your sake, I hope not).

take care of the air swallowing, unless I misunderstood what that was all about..

anyway, if thats it, this has no doubt been posted a million times..

the lankylefty Jason, on how to deal with it.. maybe a newbie will find it useful.


https://www.youtube.com/watch?v=lL0Gndb ... re=related