Aerophagia, aerophagia ugh

[zzzdeprived]

Hi again,

I am posting a new thread about this topic, as aerophagia continues to be the main issue that keeps me from using the CPAP as much as I would like to, to get better sleep. I find in most cases a kind of push-me pull-you thing happens in my dealings with aerophagia -- whenever I take an action to counter aerophagia, if it improves or eliminates aerophagia, it also inversely increases some other painful side effect. For example, I sleep with a wedge pillow and a few other regular pillows on top, due to frequent GERD. I start each CPAP session on my back sort of sitting up. During the night my body will slide down quite a bit, to where I am often almost flat on my back by early morning, except for my neck which is bunched forward due to the angled pillows. This hurts my neck, but seems to also close off my UES so much that no excess air can get in. But it also seems to close down the airway a lot, and cause breathing to be worse. So something that helps to eliminate aerophagia gives me a sore neck and worse breathing.

Another thing that has helped alleviate aerophagia is to lower the baseline of my auto pressure setting. I usually have it set between 10 and 16, though at moment it is 10.8 at the bottom. Lowering it to 10 or below definitely helps with the aerophagia, but I often sleep worse, as my body feels like it is not getting enough air. And often the automatic shifts upwards don't happen as fast as my body requires, so I wake up more often.

As a result, I find I am using the CPAP no more than 4 hours a night, and lately more like 1.5-2 hours max. My body just can't take all that bloating and gut pain day after day. But I don't end up getting a great sleep, and most days am tired and low energy.  I can post some Oscar results if people want. In summary, I only have about one night a month with over 7 AHI, most nights are under 4. Most CAs happen about 30 minutes after falling asleep. Very few OAs. Occasional leaks. I use an Air Fit N20 nasal mask, and tape my mouth shut when on the CPAP. I tend to clench, so I either use a bite guard or folded Kleenex as a shock absorber. I wonder if having my jaw slightly propped open by those affects my UES in any way. Clenching has often pulled cervical bones out of alignment causing great pain, so I have to take great care to minimize that. I often take Calm magnesium at night which helps a bit. I also started using a dog-bone shaped neck pillow with my other pillows, that helps.

i used to use EPR a lot, but I only have it set at 1 currently, as I find when it is at 2 or 3, my body doesn't feel like it is getting enough air. Like the shift to more pressure as I breath in is not happening quickly enough for my unconscious body's needs. So again, I wake up more often, and sleep is worse.  The equation for me for several years now has been: CPAP = good sleep and CPAP = painful gut. It then becomes a balancing act between sleep and pain.

On another thread I just read for the first time about V-COM, so I might try that to see if it reduces aerophagia.

It has been a very tough sleep year. Oh yes, I am 61 and have been using a CPAP since about 2007. Over the years have gone from pressure setting 6 to 8 to 9 to 10 to 12 to an autopap setting as mentioned above.

Any suggestions or other ideas would be greatly appreciated, thanks! 

zzzdeprived

[OpalRose]

Post a couple updated OSCAR charts.

I had to search for your previous thread where you received advice and didn't return to the thread. So going forward, it would be helpful for those that wish to respond to see your history in one place. Thanks.

https://www.apneaboard.com/forums/Thread...apy-thread

[Jay51]

Please post some OSCAR charts like OpalRose says.  

Concerning the sleeping on an incline and sliding down (due to gravity) during the night, I sleep on a 45 degree upper body wedge.  To keep from sliding down, you could put something heavy in front of your feet anchor you can keep you from sliding.  It would need to be large enough for the bottom (soles) of your feet to push against it.  Also, it would need to fit in your bed (or be situated right next to the end of your bed.  You could also increase the height of your head a bit more (if you back and hips can take it) to keep from sliding down so much.

[zzzdeprived]

Hi,

Thanks for the response. Here are three days from earlier in the week.

[Jay51]

Thank you for posting those charts.  The most common solution for decreasing aerophagia is usually decreasing the pressure. You could reduce your Epap min.  but it looks like you have you epap max set just right (you get very closet to it, but don't overshoot it).  You don't really have any significant OA clusters that would call for a soft cervical collar.  Reducing your pillow height a little bit or even trying sleeping on your side instead of your back may enable you to reduce your pressure a little bit (and reduce some aerophagia).  

You have some CA's.  A few CA clusters also.  Leaks kind of vary from not many to some.  Your GERD may have possibly affected your esophageal sphincter's ability to stay closed and block off cpap air from going into your stomach.  

Do you like the Apap mode (epap min and epap max that fluctuates during the night)?  Or do you think you might like a static pressure better?  Less fluctuations might reduce aerophagia.  You would need to experiment with regular cpap mode and a static pressure to see if it helps your aerophagia (and balance that with the therapeutic effectiveness of your settings).

[zzzdeprived]

Thanks for the reply. Unfortunately, experience has taught me that sleeping on my side with the CPAP, or even slightly turned from on my back make the aerophagia MUCH worse. I have only been on the autopap for a few years. Was at steady pressure for over ten years. Didn't have any problem with aerophagia until my pressure setting hit double digits. I got plenty of excess air with a static setting of 10 and 12. I seem to average about 13 during the night, but a large portion of the night is below that number, so I think the adjustable pressure is a good thing. I seem to need the highest pressure during longer periods of dream sleep, probably because that chemical that paralyzes the muscles is in effect then, and that seems to make my breathing more difficult. 

I think before I started CPAP therapy in the mid-2000s, I already had a weakened UES. My docs don't think that is the case, but I know I have spent a lifetime burping out air and gas due to highly sensitive stomach/digestive system. I think I unconsciously burp all the time to relieve pressure, so the flap get a lot of outward opening. Can't say for sure if that makes it looser to the incoming air.

During the periods when i am not using a CPAP, I sleep on my side. This worked quite well when I was at pressure 8 or 9, but the last several years my side sleeping without CPAP has gotten much more problematic.

I had my thyroid removed in 1999, and believe the trauma to my neck area had something to do with the onset of night breathing difficulties (wasn't diagnosed until about 6 years after surgery, but had problems starting a couple of years after. Prior to the surgery I always slept on my back all night without problem. I don't know any workable way of pulling the loose skin around the scar tighter, without using my hands and a lot of pressure, but doing that does seem to ease some closed off sensation in the lower airway. Of course, I can't sleep like that. No doctor I have ever worked with agrees with this notion of mine, that the surgery had anything to do with apnea. My first diagnosis was for hypopnea only, and if I am reading my data correctly, that is still my main issue. I think I still need to learn a lot more about the entire subject.

I do know that two other things exacerbate the problem - increased acid reflux, and SIBO. I got cured of the latter a few months ago, but it might come back, so I have to watch what I eat. And most of the time I have a handle on GERD, but sometimes the acid reflux does get quite bad. Unfortunately, excess air in the gut just adds to the digestive woes of those other two things.

I might try a single setting for a week to see if there is any improvement, and also hope to get V-Com. I will have to keep experimenting until things get better.

zzz

[Sleepster]

Have you tried a soft cervical collar to keep your chin from collapsing towards your chest?

[zzzdeprived]

From the standpoint of aerophagia, my chin to my chest is a good thing, as it reduces aerophagia down to nothing. But it causes neck pain, so I can't do it often. It also doesn't happen very often, so I don't think I need the cervical pillow. It is just another example with me of how what is good for sleeping is bad for aerophagia, and what reduces aerophagia is bad for sleeping. It is this seesaw I am trying to get off of.

[Jay51]

Here is a thread that has a possible solution to aerophagia caused by cpap, apap, etc.  It is not that long a thread and can be accessed by typing key words into the search engine on the main page here at Apneaboard.  

(Link to thread)
CPAP since March 22, still dealing with aerophagia, wakings, and heart rate problems

[zzzdeprived]

Thank you for posting the link!