Aerophagia

[c0reDump]

Am I right in thinking EPRx2 means my exhale pressure is half my inhale pressure and EPRx3 means my exhale pressure in one third my inhale pressure?

On the S9's, the EPR setting lowers the pressure by X cmh2o when you exhale, hence the name Expiratory Pressure Relief. If the machine is currently at pressure 10, then with an EPR=3 setting, when you exhale the pressure will drop to 7 (10-3=7). If the machine is at 16, then when you exhale the pressure will be 13 (16-3=13). The point us to make it easier for you to breathe/exhale.

I don't know what is causing your aerophagia, but for me it was because the sleep study machine was RAISING pressure when I was still exhaling (the exact wrong thing to do) causing an unnatural breathing rhythm and me swallowing a lot of air.

I have not had this problem with the S9s EPR algorithm. The S9 EPR will wait until you start inhaling before it raises the pressure -- quite impossible for it to cause the problems I had with the other machine.

[c0reDump]

Let me add a bit more: I have noticed that if I try to "nose-breathe" with my full-face mask (FFM: mask covers your nose and mouth) that the S9 machine does get confused. I can feel it doing the "apnea detection oscillation pulses" on each exhale. If you are a mouth-breather, use a FFM. If you are a nose-breather, best to stick with a nose-mask/pillow (don't recommend nose breathing with a FFM).

[Antisocialist]

I've been on CPAP for a couple of years and have had little problems prior to the last few days. I also was diagnosed with GERD about a year and a half ago, but have been symptom free (and not taking meds for it) for many months.

The last few days my stomach, my stomach began making this awful and loud gurgling noise - much more fierce than typical "stomach growling". The last two nights, I woke up over and over and over again burping what seemed like large volumes of air from my esophagus or stomach. It got so annoying I removed the mask - something I've rarely done. I've been bloated with air since.

I've also lost a lot of weight in the past nine months and am convinced the machine is blowing too hard based upon how it feels. I just lowered the pressure in my CPAP dramatically and we'll see how the night goes (hopefully my wife we'll be alert to notice if I suffer any problems). I plan to go to the doctor as soon as my work responsibilities allow if the issue persists.

Side note: I've also been battling some sort of respiratory infection - nasal/sinus congestions, burning eyes, cough, elevated body temperature/low fever. It may be a contributing factor to the aerophagia, although I've had similar infections from time to time yet never experienced aerophagia before.

[c0reDump]

Welcome to the forums Antisocialist!

I'm no doctor, but sounds like you need to drop pressures significantly. I think aerophagia takes a few days to clear, might want to consider skipping CPAP a day or two and give your doctor a call.

Hope you feel better soon.

[trish6hundred]

Hi Antisocialist,
WELCOME! to the forum.!
Hopefully, things will be better since you adjusted your pressure and that you get to feeling better, soon.
Hang in there for more suggestions and best of luck to you.

[Antisocialist]

Welcome to the forums Antisocialist!

I'm no doctor, but sounds like you need to drop pressures significantly. I think aerophagia takes a few days to clear, might want to consider skipping CPAP a day or two and give your doctor a call.

Hope you feel better soon.

Thanks for the welcome and well wishes!

I did drop the pressure from 9cm to 5cm a little while ago (haven't gone to sleep with the new setting yet). Now I'm deliberating on whether to use it or just skip it altogether for a few days first. Hopefully I can see the pulmonary doctor early next week.

---

Hi Antisocialist,
WELCOME! to the forum.!
Hopefully, things will be better since you adjusted your pressure and that you get to feeling better, soon.
Hang in there for more suggestions and best of luck to you.

Thanks much for the welcome and well wishes!

[JimZZZ]

Let me add a bit more: I have noticed that if I try to "nose-breathe" with my full-face mask (FFM: mask covers your nose and mouth) that the S9 machine does get confused. I can feel it doing the "apnea detection oscillation pulses" on each exhale. If you are a mouth-breather, use a FFM. If you are a nose-breather, best to stick with a nose-mask/pillow (don't recommend nose breathing with a FFM).

Very interesting thought c0reDump. I had given up on the nasal mask because air comes out my mouth but perhaps I'm better off with air coming out than with air coming in. I still have a Mirage FX from my first sleep lab. Maybe I'll add a chin strap and see whether I stop swallowing air.

PS: Going forward, I will confine my thoughts on aerophagia to this thread versus the "War on APAP" thread.

[c0reDump]

Hi JimZZZ: Since I can feel the AutoSet doing the "oscillation pulses" on each breath, that is more likely than not to have the APAP increase pressure up to the max setting. It should not be going into "apnea identification / pressure oscillation" mode while laying awake and trying to nose breathe -- so it is detecting something it doesn't like (for me, dunno about you) and typically it's solution to that is to increase pressure. Too high pressure may lead to aerophagia in some people.

Keeping the max pressure setting under the point where it causes aerophagia for you is important (would think concerns about AHI numbers would be 2nd to the aerophagia problem -- but I'm not a doctor, you might want to ask one).

If you do decide to switch back to a nasal mask, you need to change the "Mask Type" setting in your S9 as well.

Good luck and hope you figure out a solution.

[JimZZZ]

Hi JimZZZ: Since I can feel the AutoSet doing the "oscillation pulses" on each breath, that is more likely than not to have the APAP increase pressure up to the max setting. It should not be going into "apnea identification / pressure oscillation" mode while laying awake and trying to nose breathe -- so it is detecting something it doesn't like (for me, dunno about you) and typically it's solution to that is to increase pressure. Too high pressure may lead to aerophagia in some people.

Keeping the max pressure setting under the point where it causes aerophagia for you is important (would think concerns about AHI numbers would be 2nd to the aerophagia problem -- but I'm not a doctor, you might want to ask one).

If you do decide to switch back to a nasal mask, you need to change the "Mask Type" setting in your S9 as well.


Good luck and hope you figure out a solution.

Thanks again c0reDump. I am trying the nasal mask starting tonight and will experiment with lowering the pressure next week if needed. I have reset my S9 to nasal. I understand that you're not a doctor nor are you offering medical advice.

[Sleepster]

Some people have very sharp cutoffs in the pressure needed to induce aerophagia: They'll do ok at n cm of pressure, but have serious aerophagia problems at n+1 cm of pressure.

My value of n is 11. That's CPAP pressure. I can tolerate 12 cm of IPAP as long as the EPAP is set lower than that.

I actually feel the air being pushed into my esophagus. As a newbie I was belching and farting, and had a lot of pain. Now it's rare that I even feel the air, let alone those other symptoms.