Bad Aerophagia - Help

[cyberfiche]

Hello all,

I have been on BiPAP since July 27 of this year (2024). I am experiencing a lot of aerophagia. I was also having a lot of mouth leak at times, which eased the aerophagia, but of course that caused other issues. I purchased a Knightsbridge chin strap to stop the mouth leak, and it seems to have fixed the leak issue. However, I'm back to having a lot of bad aerophagia. Last night, I woke up with such bad bloating and belching that I actually thew up.

My prescribed titrated pressures on BiPAP are 13/9, and I'm using a ResMed Aircurve 11. I think these are good numbers to help with the apnea, but maybe they are too high for my esophagus. I'm really clueless as to where to start with adjusting my pressures for aerophagia. I'm happy to try VAuto (auto adjusting BiPAP pressures) on the machine as well, but again, I don't know what values to start with.

I read on another thread that position could possibly make a difference with aerophagia as well. I sleep on both my right side and left side. I have not noticed if one side or the other causes more aerophagia, but I'll try to investigate that more if I can. I do sleep with two pillows to try to prop my head up a little. When I would sleep with only one pillow, the aerophagia would be present even with the mouth leak present. With two pillows, usually only the mouth leak was present. This leads me to believe that the aerophagia was worse with only one pillow, and so I've deduced that propping up helps ease the aerophagia. I came to this conclusion before fixing the mouth leak with the chin strap, so feel free to let me know if this idea is bonkers. Keep in mind that I was using two pillows when I woke up last night from the severe aerophagia. So, propping up on an extra pillow is not going to be enough by itself. I might try propping up even more to see if that helps, although it's really hard for me to sleep completely propped up. 

Also, I am being treated for esophageal cancer. The cancer is in the lower portion of my esophagus, where the esophagus connects to my stomach. Not sure if this might make a difference, but I figured I'd mention it.

I've attached an OSCAR screenshot showing about 40 minutes of sleep last night before waking up because of the aerophagia. Thanks for any help!

- cyberfiche

[Jay51]

The esophageal cancer that you are being treated for might well be contributing to your aerophagia.  The ability of the sphincter to close tightly and efficiently affects aerophagia.  GERD can affect if as well.  

A few things that you might try:  lowering your pressure.  Lower pressure usually decreases aerophagia.  

This one it kind of a longshot, but possibly lowering your pillow height, trying side sleeping instead of back sleeping, and possibly trialing a soft cervical collar might enable you to lower your pressures more (even though you don't have positional apnea from your OSCAR chart.  

Try 12/8 and see if you start getting more events in your OSCAR's.  You can keep decreasing until you start getting too many events.

[cyberfiche]

Thanks for the advice! I'll lower my pressures to 12/8 and see how that goes.

[Phaleronic]

Jay has some good advice for you cyberfiche, try the new settings for a few nights like he suggested please. I would also lower pressure support to 3, and verify what mode the machine is using, s-mode will lock your epap pressure to the value assigned on the aircurve, which will be what you need to keep the aerophagia down.

[cyberfiche]

Update

I tried the pressures at 12/8. I still woke up in the middle of the night with really bad aerophagia and couldn't finish wearing the mask for the remainder of the night because of how bad I felt. The next day I lowered the pressures to 11/7 and tested that for about 15 minutes lying down in bed awake. I still felt like I was getting some aerophagia. I then lowered the pressures to 10/7. (At the suggestion of Phaleronic, I set the difference between IPAP and EPAP to 3 instead of 4. I wanted to make sure my EPAP was still high enough to provide support.) I tested that for about 15 minutes, and I didn't notice any aerophagia at those pressures. 

I tried out the 10/7 pressures last night and woke up after about 2 hours with some slight aerophagia. I was really happy I didn't feel terrible. I got out of bed and burped a few times and let my stomach settle. For the first time, I felt good enough to continue the PAP therapy for the remainder of the night.  
 
My AHI score was very good at 0.58. I've attached the OSCAR results from last night. I will continue at the 10/7 pressures for a while and make sure my AHI remains low and to evaluate how I feel overall. 

- cyberfiche