Aerophagia and nausea

[rpierce]

So far, I’ve been acclimating rapidly to CPAP, and it’s making a difference. I’m staying on the mask for the full night, and I’m trying to reduce the times I have to take off the mask and get up.

My biggest complaint so far is aerophagia, and I’m looking for more info about it and what, if anything, I can do to control it. Specifically, how great are its affects throughout the day? I’m trying to figure out how much of my experience is psychosomatic vs. physical, e.g. how much air I likely have in me at various times of the day.

I don’t mind the burping or passing gas. My primary concern is nausea and what it’s doing to me.

I usually wake up around 2 am for the first time, take off the mask, use the bathroom, and take care of what burping and passing gas I can accomplish. But I think what’s happening is that my stomach feels uncomfortably full and bloated. That usually only happens on rare occasions where I grossly overeat and eat too late. So I think I’m not OK, and the thought of going back on the machine triggers anxiety / panic. (Incidentally, going back on the machine after subsequent mask sessions, or going on the machine at the start of the night, doesn’t trigger this.) Also, when I get up in the night, I can’t really drink water to hydrate because it feels like I’m too full.

I wake up in the morning and feel simultaneously nauseous and ravenous. But eating a normally sized breakfast is a challenge, and I frequently can’t drink all the fluids I normally do. I know I should hydrate, but it’s hard.

For lunch, I usually have a normal appetite, and in the afternoon, I can usually drink plenty of fluids, assuming I remember.

Dinner is a challenge. Now I’m making better decisions about eating early, and not overeating. But I frequently feel too full while eating dinner and am concerned I’m undereating. This leads to me feeling ravenous in the morning.

I am burping and passing gas all day, although I'm not sure how much of that is aerophagia and how much is normal. In general, I feel very hungry going into mealtimes, and am looking at healthy snacks if I need something sooner. But I want to stay hydrated and don’t want to whipsaw my blood sugar around, so this leaves me concerned. Additionally, I associate nausea in the mornings with periods of my life where things were bad, so this has been triggering.

I'm wondering if anyone has any thoughts.

[staceyburke]

Usually that is caused by high pressure. If you would put up your OSCAR chart we could take a look at it and see if we could help. OSCAR is totally free to download and use. The link to the software is at the top of the site. You do need a computer and a SD card. The card has to be in the machine when you sleep...

[rpierce]

My chart from last night is attached. My diagnosis is CSA-CSR.

Also, I have a long history of acid reflux, treated with omeprazole. My esophageal sphincter probably isn't in the best shape.

[Jay51]

Turning down your max pressure could both help eliminate the aerophagia and some/most of the central apneas you are having.  As a person starts breathing better at night, they exhale more CO2.  CO2 in the blood is the main driver to "take a breath".  With less CO2 in the blood (chemorecptors), the brain doesn't try to breathe as much.  You are hitting 13.75 or so for 99% max pressure.  Start at 13 as your max pressure.  Then try to lower it more and more (as much as you can to help keep the OA's and H's, etc. down).  You may even want to try a lower pillow height (and possibly later a soft cervical collar) to prevent chin tucking.  You don't have any huge clusters of OA or H's in your chart you posted, but when you turn down the pressure, you may starting getting them.  These 2 things could help prevent this.  

I had a small problem with acid reflux maybe 15 years ago.  I started taking a quick nap at lunch after eating.  Big mistake.  Stopped that habit and no more acid reflux.  Try to eat your last meal as early as possible at night.  And stay upright as much as you can before you go to sleep.  That should help.  

My ENT told me about "Shaker" exercises.  In theory, they are supposed to help strengthen the upper exophageal sphincter to help prevent aerophagia (and also help with swallowing problems).  Can try doing an internet search on these exercises and try them.  I don't know if they work or not.  

A last resort could be to put some blocks or something to raise the height under the 2 legs of the head of your bed to create a small incline.  That is supposed to help with acid reflux also.

[staceyburke]

CSA is central apnea and that is the type you have on your chart. I hate to say this but they gave you the wrong machine. You need a Resmed AirCurve 10 ASV.  
The machine you have does not treat central apnea. You can search the site about the ASV 

[Jay51]

Stacey is right.  You have way too many central apneas for your current machine to treat you sufficiently.

[rpierce]

That is good to know. Thanks.

That said, I’m now really confused. During my sleep study, they were observing 112 events / hour. They woke me, put me on a mask for the first time, did a titration, and my AHI dropped to 4.2 at 14 cwp. How is that possible? I thought they were using an APAP machine comparable to what I now have?

Also, it seems I have the vast majority of my CA events when I’m kind of awake. I actually am semi-conscious of them at first. It’s like…hey I haven’t breathed in a while, OK I need to breathe… 

Looking at last night’s chart, second mask session, it took me from 1:32 to 1:48 am to really fall asleep, and it seems I’m largely ok, right until I woke up on the mask around 3:02 am. I remember waking up twice during that session, being on the mask, and successfully fighting the urge to take it off. At points I believe I was conscious enough to touch the machine’s screen and read the pressure, check the time, and at one point I rolled over. So it’s possible I was vaguely awake 3:02 to 3:55 and 4:20 to 5:14 with actual sleep after these, which are largely event free. So I figured my main problem is just being able to go to sleep quickly and also go back to sleep quickly after waking on the machine, and the machine handles things well when I’m really asleep. Then again, I’m very new to all this and have had the machine for a little over a week.

[rpierce]

Here is my chart from last night. In general, it's better.

First session, I managed to wake around 12:25 am but was able to relax and go back to sleep without taking off the mask. But around 1:15 am I woke, felt like something was wrong,  that my stomach was too full, got off the mask and went to the bathroom. I had anxiety about getting back on the machine. This really seems to be an indigestion-related trigger. I'm feeling very much like I grossly overate, am having indigestion, and vomiting is forthcoming. In reality, my dinner was on the small side of moderate, early enough, and my acid reflux was under control, so it's just the air.

Second session: I recall waking twice, which I see around 2:35 and 3:45, but was able to stay on the mask and go back to sleep.

Third session was cut way too short by almost an hour by an Amazon overnight driver buzzing my door and calling my phone. I didn't bother using the mask for the remainder of time.

On one hand, it's looking like I actually got about 5 sleep cycles and was working on a sixth, with little interruption by apnea. On the other, when I had apneas, I had a lot. AHI is 15. So I have the wrong machine? Would ASV help me? Does ASV feel different?

[staceyburke]

With this chart I am questioning if all of those were centrals.  The way the machine tests if it is a central is when an apnea happens the machine sends a series of small bursts of air and if it encounters a blockage it is an O or H events and if there is no blockage then it is a central.  It is not as precise of a prediction as in a sleep lab with all the wires and belts they use.  That is way we ask if you had those during the sleep study.  In you first post you said you did have centrals during your sleep study.  And on the OSCAR it showed centrals all night long.

This OSCAR shows long periods where this is NO centrals - which does not happen very often.  Instead you show groups of centrals then a long period of none and then a group of centrals.  Grouping of O or H events shows positional apnea which can be treated.  If they show up as central but are really O and H events then getting a new machine is not needed.

Now what is positional apnea?  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

So let's try and see if these are positional!  I would suggest a collar they are inexpensive and a night or two could show us what is going on.  To get the right fit you need to measure the distance between your chin and sternum that will give you the size you need.  You can buy one at a Walgreens or most grocery stores in the med section.  I sure hope this is what it is, many people here have had great success with the Soft_Cervical_Collar.

[rpierce]

I had a full sleep study done in a lab with all the cords, wires, tubes, etc. Out of 152 events, 102 were central apnea, 38 mixed apnea, 4 obstructive apnea, 8 hypopnea, 0 central hypopnia. Total AHI was 112.6. So I'm inclined to believe the OSCAR data that these really are central. I'm also a side sleeper, which I know helps.

During titration, they noted on AHI of 4.2, which 4 events, 3 central and 1 hypopnia.

Also, I'm frequently conscious of central apnea events happening when I'm falling asleep.