Recommendations for aerophagia?

[always_tired]

Hey everyone,

Conclusion up front:  I have pain every night and usually throughout the day - accompanied by a ton of burping - located in my mid-back and left front rib (And that generally aches around my side), bloating, and general discomfort.  Assuming I have aerophagia, should I try a different mask?


Here's my history. 
Used to smoke.
Diagnosed with OSA (severe) back in 2008.  Sleep study showed AHI of 70-80.
Titration was painful - tons of reflux that night and the psa tech almost didn't get enough reading b/c I didn't sleep.
Started therapy w/ ResMed S9 at pressure 11 w/ nasal mask.
Asked a question about reflux/aerophagia on this board.  Was recommended to turn off EPR (because at the time I was complaining about not liking the pulsation) and reduce the pressure.  I did that.  But the general discomfort issues persisted:  reflux, burping, farting, etc.
2015 Went to GI - got on a prescription reflux med.

2018 Came to find out I have a pretty serious dairy intolerance.
Cut dairy out of my diet and various symptoms improved (e.g. less dry mouth, less hoarse voice, less throat pain = less reflux).  
That then made me realize I could stop my reflux medication.
With respect to CPAP, felt that the pressure was too strong.  Advised by sleep doctor to try a different mask, try reducing pressure, and got a new S10 Autoset.  He would not order new sleep study.  Advised to put the machine on auto.

2019-Present - using nasal pillows, have the machine on auto (low of 4.0 or 5.0 and high of 12.0).  Generally was doing pretty good.  OSCAR shows AHIs consistently less than 5, some nights less than 1.  BUT. wasn't feeling great.  My complaint has always been "my insides hurt."

Present:
2020 - for some reason began to really have a ton of pain.
Started taking reflux medication again.  Doesn't help at all.  And when I was taking it before it never really did either.

My symptoms now - and the point of this thread - I wake up within 1-2 hours of going to sleep in really severe pain - I sit up and burp and burp and burp and burp - rip my mask off throw it on the floor - curse the world, etc.  This pain starts almost immediately upon putting the mask on - within minutes.  Goes away in about 15-20 minutes of taking it off.

Dec 2020 - got new sleep Dr. at UTSW.  New sleep study.  AHI of 28.7
In Jan 2021 - Dr advised to try sleeping without your CPAP.  I did that for several nights Dec 6-7, 9-11. 
First morning of first night - I shot out of bed and felt that life was worth living again.  I was so excited.  I wasn't tired and I had no pain.
Day 2 - I'm a little tired and I have that tense feeling in my body.  I'm NOT bloated.  I don't remember the last time my stomach was so flat.
Day 3 - used CPAP and liked it.
Day 5 - didn't use CPAP and was mildly tired
Day 6 - didn't use and was tired
Day 7 - went back to CPAP

For several months was feeling pretty good w/o much pain.  But starting around March, I'm back to my pain.

Mar 2021 - saw GI doctor.  Had endoscopy and imaging.  All clear - no hernia, no pancreatitis, no ulcers, etc.  He recommended a pain specialist.  The point of going to the GI was to determine if I was having reflux or any GI issues and he sees no evidence of anything.

My theory:
I used to have dairy intolerance.  That caused the reflux.  That was the reason for the bad AHI at the study in 2007, and the past hoarseness, etc.  
Presently my apnea is "moderate".  And presently, I need to find a solution for AEROPHAGIA.  The aerophagia is causing bloating that is pushing on my ribs and making my ribs/back hurt.  Maybe also aerophagia is causing some reflux, but I don't feel heartburn, really.

Present sleep actions:
1) I sleep on a wonderful mattress and an adjustable bed and have the head raised.
2) I can sleep either flat on my back or on my side.
3) If I run the pressure low (4-7) and use pillows  OR run the pressure low (4-7) and use nasal - OSCAR shows AHIs low.  But I have pain.
4) If I run the pressure high (11-12) and use pillows OR run the pressure high (11-12) and use nasal - OSCAR shows AHIs of 10-20.  I have worse pain.

My question:  assuming I am trying to do the chin tuck, assuming I'm sleeping elevated, assuming I'm taking reflux medication - HOW DO I STOP THE AEROPHAGIA?
I'll try a different mask.  Which mask tends to work best for helping with aerophagia?
Could I be a mouth breather?  I do have dry mouth when I use NASAL at high pressure.


Next steps:

Talking with my sleep doctor - She wants to do a Titration w/ a Bi-Pap and see how I do because she agrees that I probably have aerophagia.

[S. Manz]

Tape your mouth but not with any old tape and certainly not Duck Tape.
Choose a medical grade tape and maybe even go to a pharmacy and try a few medical grade tapes that are specifically designed for CPAP use and aerophagia because different skin types have a different reaction to these tapes.
These tapes are designed to come off easily while you are asleep and say, your nose gets plugged up and you must breath through your mouth.
I have no idea why a "doctor" is treating this, because the answer is simple...You swallow air while on CPAP with your mouth open.

Click HERE for an example of these tapes/strips: [DME Link Removed] Search Supplier #10 for somnifix mouth strips

-----
Moderator Action: DME Link Removed

To maintain our status as an educational organization, links to DME-owned or DME-operated websites and links to pages that sell prescription-required items are prohibited in forum posts.  This is stated in the Apnea Board Rules.

-----

[RNeil]

Taping your mouth will not help aerophagia.

When you open your mouth with CPAP, air does not go in, it goes out, from high to low pressure. This is bad because it lowers the pressure in your throat and you are not getting CPAP benefits. It can also cause severe dry mouth.

I think that taping might increase aerophagia. I use a F&P Brevida nasal pillow. I have used tape to eliminate mouth leaks, but I found that stopping that helped the aerophagia. I would sometimes get a mouthful of air from my throat. With the tape, I would swallow the air. Without the tape, I would open my mouth and expel the air.

You mentioned doing the chin tuck. I understand that tucking your chin will encourage apneas. I use a cervical collar to prevent chin tucking and discourage mouth opening.

I am hoping that someone more knowledgeable than me can make recommendations on settings.

[S. Manz]

Taping your mouth will not help aerophagia.

Swallowing air is the number 1 cause of Aerophagia among CPAP users according to all online data available:-)
It also makes sense why it would be.
I suppose people may react differently to mouth taping however, without swalloing air there would be no aerophagia, s9o naturally keping your outh shut would be the logical step.

[pholynyk]

From following ApneaBoard for the last five years or more, the usual cures for aerophagia are the following:

1. Lower the average pressure. This means make the EPAP just high enough to control OA, and IPAP just high enough to control Hyponeas, without forcing air down the oesophagus.
2. Raise the head of the bed 2 to 4 inches.

The mouth cavity and the nasal cavity are connected at the back of the mouth, so taping the mouth shut cannot prevent air from entering the oesophagus; the oesphogal sphincter does that - unless it is weak or injured (from acid reflux).

[RNeil]

"without swallowing air there would be no aerophagia, so naturally keeping your mouth shut would be the logical step"

Unless you are using a full face mask, aerophagia with CPAP is not caused by opening your mouth. If you open your mouth, air goes out, not in. The air goes from high pressure to low pressure.

[koala1]

It doesn’t matter if I have Fullface mask or nasal mask, if I tape my mouth completely or just a little.
I swallow air anyway.

[Cpapian]

It's all about the tongue. It belongs at the roof of your mouth a little back of your teeth. It is the gatekeeper.

Test this out. With machine and mask on, open your mouth. Air escapes. Now move tongue into position and slowly slide it back until air no longer escapes. Use a little suction if necessary.

Practice during the day until it becomes a habit. Then your airway can work as intended and you can say goodbye to chipmunk cheeks and aerophagia