Finally slept for 7 hrs. but aerophagia is unbearable

Always tired wrote:Quick question re flex 1,2,3 and my PRSQ 1
In my provider manual it shows me how to adjust flex--no problem and the current setting is 2, but unless it's just massive sleep debt I could swear that I read, maybe in another manual, that pressure had to be a min of 6 to use flex.
My pressure is 5-8 and I have been burping, passing gas since starting PAP. I always thought it just came with the territory. Does flex mean that it's easier to exhale? Just bump it to 3 and see what happens?

Any of the Flex options will reduce the pressure upon exhale but it is no where like what EPR does.
It's not a 1 cm drop per setting like EPR is. Instead it is based on your own air flow...force of your own breathing.
While a setting of might offer a little more reduction than a setting of 1...it isn't like EPR. The amount of reduction is based on the flow
http://aflex.respironics.com/
If you look at the bottom of the graph in little letters it says minimum pressure of 6 cm to enable AFlex.
I don't see a mention about CFlex though.

It's really hard to explain but to me it felt more like a rhythm thing. Setting of 3 made me feel like the machine was wanting me to breathe too fast...almost like I was on the road to hyperventilation. A setting of 1 made me feel like the machine was dragging up the rear...too slow. A setting of 2 was just right...felt like normal breathing rhythm..barely noticed the pressure. This was AFlex. Now CFlex...I couldn't tell it did a darn thing no matter what I set it on. So I just turned it off. This Flex stuff is really going to vary with an individual...what feels great to me someone else might hate.
But don't confuse it with EPR because it is totally different.
I have tried EPR on my VPAP in straight CPAP mode.....it is totally different feel on exhale...big drop on exhale.
Not uncomfortable different from AFlex...but different.

Always tired wrote:My pressure is 5-8 and I have been burping, passing gas since starting PAP. I always thought it just came with the territory. Does flex mean that it's easier to exhale? Just bump it to 3 and see what happens?

With minimum of 5...I don't think you are getting any exhale relief. It isn't enabled unless minimum is 6 cm. At least AFlex.
There is a demo available of each of the Flex options in the menu under Flex...try each one at each setting to see which one feels the best to you.

Always tired wrote:My apologies to the OP, for the hijack.

Actually...let's leave it right here. This is something every PR S1 user should understand.
They assume it is like EPR with a straight across the board reduction but it is more complicated than that.
Both EPR and the Flex forms of exhale relief get the job done...but they go about it in totally different ways.

No apologies needed. Trust me, I am very comfortable "letting it go". Been married for 25 years, and anything goes. And i work from the home, so it's easy. I belch quite a bit, but I still seem to always have that feeling of "fullness" in my upper abdomen. As stated earlier, I did have an xray (several), but I neglected to mention, I had an upper GI, colonoscopy, and blood work. Everything came back negative. The bloat only started when I started using the machine. So after making sure everything else checks out ok, I'm most confident it's air in my belly, that doesn't move too much. I'm not a "farter", only belch. Thankfully, our kids are at college, because I don't know how they would react to my belching! I've got to the point where I've joked and said to my husband, "do I have to say excuse me after every "burp"...it was getting getting to the point where I was saying it every 10 min.! lol...but I still do say excuse me! I will get to the bottom of it and reach out to my doctor yet again. The "auto position" does not seem to be working. I can't give up the machine, as my days are so much happier because I am not sleep deprived. So I know it's doing it's job. But wow, this bloat has to go. Thanks for listening and again, no worries about the post. It's a journey and I'm staying.

Have to say...having difficulty getting to know the "CPAP" lingo. All the initials and scientific talk, and how to read the charts, adjust the machines. It's hard.

dlr0212 wrote:Have to say...having difficulty getting to know the "CPAP" lingo. All the initials and scientific talk, and how to read the charts, adjust the machines. It's hard.

One step at a time. It definitely can be overwhelming at first. When you're feeling up to it, you can start exploring how to go about looking at the data that is collected every night from your machine.

khauser wrote:

Pugsy wrote:This is the one situation I wish a person had the S9 and EPR....
The AFlex on the Respironics machine is good...but it just doesn't drop the pressure like EPR at 3 does.
But do play around with the AFlex setting it might just do the trick and be super comfortable to boot.

He could use CFlex, which I believe DOES drop the pressure more like EPR (but I don't have EPR to try, so that's a bit of a guess).

I found CFlex to cause my airway to collapse while AFlex does a great job of letting me exhale without the collapse.

AFlex, CFlex+, and EPR are fairly similar. Sort of a "square wave" pressure thing a bit like limited bilevel.

CFlex is a bit different from the other three. Sort of a pulse at the start of inhale and exhale.

Lots of people don't realize that there is a Cflex and a Cflex+ and that they're different.

Neck angle may help. Stand up, and tip your head forward until your chin touches your chest. Think of it like you're trying to look at a spot on your chest just below your throat.

Now try to adjust your pillows or sleeping position such that your head and neck is at the same angle. Some people find this helps, some don't. It may be too uncomfortable or too hard on your neck.

Here's a Youtube video. https://www.youtube.com/watch?v=-65JWNBttnE

Gas-x or similar concoctions may help because they prevent foam and you may be able to belch it back up more easily. These things don't prevent gas, they just keep bubbles from forming.

sleeping on your side reduces sleep apnea events
does cpap work for central apneas? I don't think it helped mine but my resmed asv only has a ramp in cpap mode and I get bad aerophagia

"Neck angle may help. Stand up, and tip your head forward until your chin touches your chest. Think of it like you're trying to look at a spot on your chest just below your throat."

Can someone help me. I've been hearing 2 different ways of neck angle to help prevent the air getting into my stomach. I've heard many times that I should doing the above, but I have also heard I should be doing the opposite. That my neck should be extended back to open the airway more. Any thoughts. Thank you.

archangle wrote:Neck angle may help. Stand up, and tip your head forward until your chin touches your chest. Think of it like you're trying to look at a spot on your chest just below your throat.

Now try to adjust your pillows or sleeping position such that your head and neck is at the same angle. Some people find this helps, some don't. It may be too uncomfortable or too hard on your neck.

Here's a Youtube video. https://www.youtube.com/watch?v=-65JWNBttnE

Gas-x or similar concoctions may help because they prevent foam and you may be able to belch it back up more easily. These things don't prevent gas, they just keep bubbles from forming.

That position would cause be AHI to skyrocket. I'm surprised it doesn't cause your throat to close off easier...

sickwithapnea17 wrote:sleeping on your side reduces sleep apnea events
does cpap work for central apneas? I don't think it helped mine but my resmed asv only has a ramp in cpap mode and I get bad aerophagia

Probably should start another thread, but the short answer is CPAP (not APAP, not ASV, but just CPAP) does not help central apneas.

I don't know why one would run the ASV in CPAP mode though.

I had aerophagia at first too. Like you, I started out with the Mirage FX for Her nasal mask (although any nasal or nasal pillows mask can cause this problem. I now use nasal pillows.). I found the problem of gas and a bloated stomach unbearable too, and resolved to fix it, which I did. Here's what I did.

First, I found that if I opened my mouth at all with the machine on, I instantly got gas in my stomach. My husband, as he always did, wanted to say good night to me, or talk a bit, as we were getting into bed. If I answered him, instant gas, pain, bloating, etc. So I had to tell him that once the mask and machine went on, I could not talk at all. I had to keep my mouth closed because of gas. He was fine with that, and understands.

Then it was a matter of stopping my mouth from falling open while I was asleep. That was more difficult, but I found a way to do it too. I can't tape, since the adhesive gives me a rash. So I started out with a chin strap. But found that most of them are hugely inadequate to keeping the mouth closed. Most of them are made of stretchy material which "gives" or stretches. The jaw is MUCH stronger than any strap, so it sags open anyway, particularly with a stretchy chinstrap on. Then I read on this forum about the Ultimate Chinstrap. http://ultimatechinstrap.com/ It was designed by a fellow cpap-er who was looking for a better solution for keeping the mouth closed. It's made of non-stretchy cloth which wraps around the mouth and chin. You could buy one of these (they're expensive though). Or you could try what I did. First I used the chinstrap I already had, Ruby-style chinstrap https://www.cpap.com/productpage/ruby-s ... strap.html, or you could try the newest one, https://www.cpap.com/productpage/ruby-s ... strap.html. Then I cut a piece of an old towel (non-stretchy) about 4" high x 10" wide. I tucked this under the chinstrap so it went across my mouth and wrapped under my chin. The whole cloth was under the chin strap against my skin, with the chin strap holding it in place. Then I tugged on the sides of the cloth so it was pulled as tight as possible across my mouth. I'd make sure that my lips were closed and positioned kind of bull-dog fashion on top of my front teeth. With the pressure of the cloth holding my lips closed on top of my teeth, and the straps of the chin strap holding it in place, there was little chance of my mouth opening during the night.

This worked like a charm. I had my first nights without gas and bloating. Because I sew, and I'm cheap, LOL, the next thing I did was make myself a chinstrap very much like the Ultimate Chinstrap, but using my measurements and made out of the same towel (which is washable). I put velcro on the ends of its straps and have used it ever since (for about 7 of the 8 months I've been on cpap).

The third thing I did was something I learned here too. I keep my tongue locked up tight against the roof of my mouth, so that no air goes into my mouth (and inadvertently down into my belly too). It's something you have to train yourself to do each night, but eventually it just comes naturally, a habit you learn.

I hope you try some of this and it helps you. It completely took away my gas problems.

I sleep on my back about 90% of the time and I have had some severe aerophagia and for me sleeping on either side makes it worse. For methe solution has been a second pillow and a slightly modified position as described above. I rotate my head forward until my chin touches my chest and then relax and allow my head to rotate slightly back to a more comfortable position. This doesn't seem to affect my AHI but that doesn't mean it wouldn't affect yours. I still have an occasional bout of aerophagia, usually if I lay awake hosed up for a long time. If I fall asleep in my normal few minutes after hosing up it's never a problem.

dlr0212 wrote:"Neck angle may help. Stand up, and tip your head forward until your chin touches your chest. Think of it like you're trying to look at a spot on your chest just below your throat."

Can someone help me. I've been hearing 2 different ways of neck angle to help prevent the air getting into my stomach. I've heard many times that I should doing the above, but I have also heard I should be doing the opposite. That my neck should be extended back to open the airway more. Any thoughts. Thank you.

People don't agree on this. Some say aerophagia was improved by tucking chin, others say it's improved by not tucking the chin...

I never saw your post that someone referred to where you said that you went off CPAP and still had the bloating. That would be surprising.

You can get aerophagia with your mouth sealed, and even without actually swallowing per se. That said, mouth opening is a significant risk factor for aerophagia. In my opinion that happens for two reasons (this is just my hypothesis): (1) mouth open, swallow air and (2) mouth openings lead to arousals (whether you remember them or not), which cause swallowing.

It would be worth making sure your mouth really is staying shut, IMO.

ReadyforRest wrote:Then I read on this forum about the Ultimate Chinstrap. http://ultimatechinstrap.com/ It was designed by a fellow cpap-er who was looking for a better solution for keeping the mouth closed. It's made of non-stretchy cloth which wraps around the mouth and chin. You could buy one of these (they're expensive though). Or you could try what I did. First I used the chinstrap I already had, Ruby-style chinstrap https://www.cpap.com/productpage/ruby-s ... strap.html, or you could try the newest one, https://www.cpap.com/productpage/ruby-s ... strap.html. Then I cut a piece of an old towel (non-stretchy) about 4" high x 10" wide.

Thank you so much for this information. I just ordered 2nd and 3rd you mentioned. The ultimate chin strap looked so confining. I had trouble with the full face mask, so I know I wouldn't like my mouth to be wrapped up, not to mention I am always hot...as in hot flashes if you get my drift. But thank you, I am going to give the strap a try. I am truly, truly desperate. I don't think I can go on like this. It's extreme discomfort. I am also going back to my doctor to see if he can reduce my numbers even less on my machine, but I just want to make sure I benefit from it too. Thanks to everyone for all your help and tips. I appreciate it more than you know.

The best way to get rid of air that is already in my stomach is to walk. Probably best to get rid of a bunch of it early in the morning with a walk around the block, or its equal.

One of my sleep docs gave me a long explanation that my problem is likely a weakened valve between the stomach and esophagus, which was damaged by stomach gas being "sump pumped" up when I gasp for breath because of my apnea. That a health valve is nearly always strong enough to resist air pressure up to 20. Some individuals get a bit of relief with a ramp; That is the valve will close up better if the patient starts with a lower pressure and then the machine builds the pressure up.

In my case, my use of auto aggravated the problem. A bit of a leak with the mask would cause the pressure to go higher, which brought on more leaks and made the pressure higher. Further as the air packed into my stomach, and pressed up on my lungs, and I needed more pressure to breath.

Now I have a Bi-Level machine because of the Aerophagia. Mine is an Resmed S 7 Malibu, which I got with low hours some months ago, but I guess it is 6 or 7 years old. For a used machine, http://www.secondwindcpap.com/Used_CPAP.html.

I notice the more reasonable priced ones are Respironics, which I feel are solidly built machines. I have some doubts whether the algorithm for a Respironics would work as well for me as the Resmed.

Then again, might not matter for some, some individuals prefer the way that the Respironics machines work. On the forum some have said that there is not a dimes worth of difference between the two manufacturers.

I was told that the first thing that a Gastroentrologist would do is put the patient on a good Proton Pump Inhibitor, even if the person did not seem to have gastric problem.

I now love my bi machine. I sleep well, have almost no air in my stomach.