Aerophagia

[robysue]

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.

Your n value is higher than mine: If the EPAP is 5 or lower I can tolerate an IPAP of 8 or 9, but not 10. (And 9 is problematic). If my EPAP is at 6 for really long stretches, however, I'm likely to have a rock hard belly that's visibly distend from the basketball of air that I swallowed through the night. Fortunately most nights my EPAP only flirts with 6cm for short periods of time.

[robysue]

In the War on APAP thread, JimZZZ wrote:

Hi Jimzzz, I was thinking the other way around. Lower the max down to 6, and then raise by 1 cmh20 every week until you start experiencing aerophagia again. Much slower process than herbm would recommend, but still much faster than what your doc wants.

Since you have an AutoSet, the unit will automatically seek the optimum pressure in the allowed range. What you need to do is find the maximum pressure that causes your aerophagia, and then back off from that. And, who knows, this process might give your body the time needed to adapt and never experience aerophagia again.

Thanks c0reDump. Help me understand; my autoset keeps the pressure at an average of 10+ presumably because that's what it takes to stop events. Last night my max pressure was 15.86. So...it seems almost dangerous to lower the max to 6, a pressure well below that called for by the S9 AutoSet feature. Are you thinking I should accept more events in exchange for less aerophagia?

What does your AHI look like right now? And what's the distribution of events?

If your AHI is super, super low with the pressure allowed to go up to 15 or 16, then you might be more comfortable with lower pressures and a (slightly) higher AHI.

But I'm not sure that I'd recommend changing the max pressure to 6 either. That may allow way to many events through the defenses.

Do you know if the aerophagia is any easier to tolerate on nights where your pressure never gets above 10 or 11cm? In other words, if you're planning on experimenting, I'd start by limiting the max pressure to about 11cm or 12 cm: A bit above what your median or average pressure level currently is. If there's a big decrease in aerophagia and only a minor increase in events, you have your answer as to where the max pressure setting should be.

If there's still too much aerophagia with a max pressure setting of 11 or 12 cm, then lower the max pressure setting by 0.5 or 1.0 cm and leave it there for a few days. If there is no decrease in aerophagia lower the max pressure setting again. During the experiement, I wouldn't get too worried about the AHI going up, unless it leaps way up past 5 at a certain pressure level. The point of the experiment is to try to determine what is the maximum pressure your stomach can seem to handle.

Once you've identified that pressure, you can then play with the EPR setting to see if you can get the AHI down to an acceptable amount. Or if you find breathing with EPR = 3 is soooo much more comfortable than breathing with EPR at 1 or 2, then slowly start raising the max pressure setting back up (by 0.5cm at a time) to see if you can build your aerophagia tolerance up enough to tolerate the pressure needed to keep the AHI under 5.0

[Sleepster]

This thread could serve as a good resource for people looking to DIY. You never know what kind of machine you'll need. Auto machines and bilevel machines have features that are sometimes needed, and the only way to find that out is to start without those features.

[JimZZZ]

In the War on APAP thread, JimZZZ wrote:

My autoset keeps the pressure at an average of 10+ presumably because that's what it takes to stop events. Last night my max pressure was 15.86.

What does your AHI look like right now? And what's the distribution of events?

I'd start by limiting the max pressure to about 11cm or 12 cm: A bit above what your median or average pressure level currently is. If there's a big decrease in aerophagia and only a minor increase in events, you have your answer as to where the max pressure setting should be.

If there's still too much aerophagia with a max pressure setting of 11 or 12 cm, then lower the max pressure setting by 0.5 or 1.0 cm and leave it there for a few days. If there is no decrease in aerophagia lower the max pressure setting again. During the experiement, I wouldn't get too worried about the AHI going up, unless it leaps way up past 5 at a certain pressure level. The point of the experiment is to try to determine what is the maximum pressure your stomach can seem to handle.

Once you've identified that pressure, you can then play with the EPR setting to see if you can get the AHI down to an acceptable amount. Or if you find breathing with EPR = 3 is soooo much more comfortable than breathing with EPR at 1 or 2, then slowly start raising the max pressure setting back up (by 0.5cm at a time) to see if you can build your aerophagia tolerance up enough to tolerate the pressure needed to keep the AHI under 5.0

My experiment with the nasal mask failed again so last night I tried the ffm with a chin strap to keep the pressure from entering my mouth. That seemed to help a little but I'm going to take your suggestion on fine tuning the max pressure and watching the AHI. My AHI is averaging 1.31 with my current pressure setting of 8/16 so I have some wiggle room as you suspected.

As always, thanks for being such a valuable resource.

[Antisocialist]

So... Just a recap and update if anyone is interested. My stomach was full of air. I dropped the pressure on my CPAP machine from 9cm to 5cm, but decided to forgo using it for a few nights and let the air clear (all while battling a sinus infection). I could still feel air rumbling in my gut after a few nights, but it had lessened considerably.

Last night, my wife was having an awful night due to my snoring. So I put on the mask for the first time at the reduced pressure. I slept well afterwards and didn't experience any additional/increased aerophagia symptoms. This morning I asked her about any snoring after I put on the mask. She said I didn't snore at all once I put on the mask.

I'm speculating that a perfect storm of too much CPAP pressure and a bad sinus infection caused me to experience aerophagia. I don't really want to mess with a pulmonary doctor visit at this point unless aerophagia becomes a problem again. Otherwise, I think I'll leave the CPAP at the new lower setting and adjust it upwards as necessary if snoring or signs of disruptive sleep apnea reemerge. Any thoughts on if this seem sensible or if it seem like a bad plan?

[robysue]

I'm speculating that a perfect storm of too much CPAP pressure and a bad sinus infection caused me to experience aerophagia.

Quite likely.

I don't really want to mess with a pulmonary doctor visit at this point unless aerophagia becomes a problem again. Otherwise, I think I'll leave the CPAP at the new lower setting and adjust it upwards as necessary if snoring or signs of disruptive sleep apnea reemerge. Any thoughts on if this seem sensible or if it seem like a bad plan?

Sounds like a plan. If I were you, I would look at the data in SleepyHead everyday for a while to monitor that AHI pretty carefully for the next couple of weeks.

If it becomes clear that your current pressure is not controlling the OSA (the AHI > 5 on multiple nights) or wife starts saying you are snoring again, then SLOWLY increase the max pressure up---I'd say increase it by no more than 0.5cm at a time and leave it at each new pressure for at least 4 or 5 days before then next increase. Stop increasing the pressure when the AHI drops below 5 OR when the aerophagia returns. And if the aerophagia returns, drop the pressure back down by 0.5 cm until the tummy is happy enough again.

[c0reDump]

Thanks for the update Antisocialist, glad to hear that the aerophagia is clearing up . robysue: that sounds like a good plan to me too.

[Sleepster]

Otherwise, I think I'll leave the CPAP at the new lower setting and adjust it upwards as necessary if snoring or signs of disruptive sleep apnea reemerge. Any thoughts on if this seem sensible or if it seem like a bad plan?

Use software to monitor your leak rates and your AHI. Also, don't sleep without the CPAP machine. That'll make adapting more difficult. Aerophagia is usually an adaptation difficulty.

[c0reDump]

Otherwise, I think I'll leave the CPAP at the new lower setting and adjust it upwards as necessary if snoring or signs of disruptive sleep apnea reemerge. Any thoughts on if this seem sensible or if it seem like a bad plan?

Use software to monitor your leak rates and your AHI. Also, don't sleep without the CPAP machine. That'll make adapting more difficult. Aerophagia is usually an adaptation difficulty.

I think aerophagia is also cumulative: it can take a few days for it to clear up on its own, and if you don't "cure" it by halting CPAP use, you might never be free of it.

Of course you need to weigh the risks of not using CPAP temporarily -- versus the benefit of hitting reset and curing the aerophagia and starting over (I'm not a doctor and suggest asking one if you have aerophagia).

robysue: my recommendation to JimZZZ to lower his max pressure to a '6', was based on his doctor wanting him at a '4' for 90 days (sorry I didn't make that clear). I think he jumped the gun and increased pressure to quickly without adapting first, hence started experiencing the aerophagia too.

[Sleepster]

I think aerophagia is also cumulative: it can take a few days for it to clear up on its own, and if you don't "cure" it by halting CPAP use, you might never be free of it.

I've never heard of that. You're right in that no doctor would likely recommend doing that.