[Pressure] Aerophagia when sleeping on side - help?

[imazombie]

I'm hoping that someone might have some ideas for me -- I keep waking up with a stomach uncomfortably full of air in the morning if I have spent time sleeping on my side. I prefer to do a mixture of sleeping on back and side, but sleeping on my stomach is not comfortable. I saw a thread from 6/25/2018 "Aerophagia when sleeping on side only" which I am too new to link to, and it sounded like his aerophagia was helped by lowering his CPAP pressure and also sleeping on his stomach, but I'm hoping there might be yet another option that could help me sleep on my side sometimes without gulping air as I sleep, because I don't think lowering the pressure would work for me and I've never been a stomach sleeper. 

More context: I was recently diagnosed with moderate sleep apnea, and started using an AirSense 11 APAP machine in April 2023. I haven't gotten too much face time with a sleep doctor but I'm guessing that my apnea is at least somewhat related to a deviated septum where I have a hard time breathing even when awake and lying on my left side (left nostril basically closes when I breathe in sharply). So I can't wear nasal pillows (don't fit well) but the ResMed N30 nasal cradle mask is reasonably comfortable. I can breathe pretty well sleeping on my back or side when the machine is at my min pressure of 11 cmH20, but can't breathe at all if the mask is on but the machine is not blowing any air, so any ramp period is very unpleasant. It took about two weeks to figure this much out and start to experience restorative sleep again. This is why I don't want to try lowering the pressure if there's something else that might work -- when I was using my prescribed min of 9 cmH2O, I kept feeling like I was trying to breathe through a coffee stirrer and it was tough to fall asleep (even though my AHI tended to be slightly lower -- say 0.5 rather than 1 or 1.5). I sleep much better at the slightly higher minimum pressure of 11 cm H2O. For whatever reason, when I am lying on my back, my tongue will stay up at the top of my mouth blocking any air from my trachea, but when I am on my side my tongue must fall to a different position as I sleep.

I have attached 3 screen shots -- two recent "regular" nights where I slept fine but woke up with a stomach full of air. And a third is just interesting -- it's from when I first started using the machine and was still sleeping horribly, feeling like I wasn't getting enough air when awake, so I was using a pulse oximeter to try to see if CPAP was doing anything. It shows that when I ripped off my mask in frustration at 5:40am and then immediately fell asleep with just the pulse oximeter measuring data, my Sp02 started to drop right away ... I guess I really do have to keep using a CPAP ;)

Please let me know if anyone has advice to help with the aerophagia ... thanks in advance

[G. Szabo]

Because you are using an Autoset, you can reduce the minimum pressure setting of your device to a significantly lower figure than 11 cm. The instrument might want to go below 11 in the long periods of your sleep (see your data) when the 11 cm was held, but it could not because of its current setting. And it causes aerophagia.
I bet your sleep study was done while you were on your back. The needed pressure is significantly higher in this position than the side position, per your comments about your tongue position.

[Sleepy Quixote]

@imazombie

Like G. S said, lower the minimum pressure some. For side sleeping sleep on the left side rather than right, sleeping on the right puts your stomach high relative to your esophagus. Set your self up to sleep with an incline starting mid torso elevating your upper body and head. You can build a ramp with pillows to see if the position will work for you before buying an expensive wedge pillow.

Overall your numbers look pretty good, sleeping inclined may help alleviate some of the positional flow limitations you are getting, allowing you to reduce the minimum pressure even further than you may think possible and still maintain good therapy. Getting the pressures down all around helps in reducing aerophagia.

Good luck, keep at it, that's how we get good at it!

[imazombie]

Thanks to you both for the suggestions -- I will have to try lowering the minimum pressure setting back to, say, 9 cmH2O for a few days, and try to sleep mostly on my left side rather than my back, and see how that goes. I was finding the lower pressure uncomfortable when I first started using the machine, but maybe it will be different now that I am more used to wearing the mask. And yes I was on my back for my sleep test; I didn't realize that the ideal pressure settings might change depending on your body position. I appreciate the tips!

[imazombie]

I just wanted to follow up with some mostly good news -- I changed my pressure range from 11-15 cmH20 to 10-15 cmH20, and have been using that for about a week. And even with just a 1 cmH20 decrease in the minimum pressure, there has been a very large decrease in the aerophagia! Hooray! It's also noticeably less comfortable for me to breathe at the lower pressure when I am awake and wearing my mask, but nowhere near as bad as with my original pressure range of 9-15 cmH20 (and not waking up with a belly full of air is worth it). There was effectively no change in my AHI from this pressure change. I am surprised that you can have such a big impact on comfort from these small pressure changes. I may experiment with sleeping on an incline next. Thanks to G. Szabo and Sleepy Quixote for encouraging me to try the lower setting.

[G. Szabo]

I am happy for you, Imazombie!

I was titrated to 15 on my back. But now I am a side sleeper, and I set my current minimum pressure to 5.4 (it is too low, I believe) and let the autoset find the proper pressure for me, which is changing sustainably overnight.

As for the incline: I have been trying it. Make sure that it will not change your neck position (bending, chin tucking) because it might lead to obstruction. Consider a collar too.