[Symptoms] Is it aerophagia?

[csl1]

Hi all

Since starting APAP in January I have had periods of general discomfort in my abdomen and chest area which is relieved when I eventually pass gas.  When I am wearing the mask there are often times when my mouth fills with air, pushing my cheeks out e.g. if my mouth opens a little when I am trying to sleep (and probably when I am asleep too) and I have found myself swallowing.  Given this I have assumed that the my symptoms above were due to aerophagia. 

Recently though I have been getting fairly persistent pain in my upper right abdomen.  Nothing too severe but still unpleasant.  I had my gallbladder removed by keyhole surgery 18 months ago and the pain is in the same place as it was prior to my surgery.  There are no apparent reasons for it and no other symptoms and doc isn't worried but I would still like to know what is causing it and what I might do to stop it.  I was wondering whether this sort of pain might also be typical of aerophagia and if so, what I might do to prevent it.

[RNeil]

Yes, it sounds like aerophagia. It is a problem with CPAP because the pressure in the mouth and nose is greater than the pressure in the stomach. Perhaps you should try reducing the maximum pressure.

[kwhenrykerr]

I agree on reducing the pressure may help. What does OSCAR say is your pressure needed to open the airway when you have an event ?

[csl1]

I've looked at Oscar but struggle to see the correlation between the obstructive events and increases in pressures.  Most apneas and hypopneas don't have a corresponding increase in pressure.  The pressures just roam up and down between the minimum of 7 and a maximum of 11 and mostly hovering around 8 or 9 and the events don't seem to have any effect.   Not quite sure what to do about that

[SarcasticDave94]

It's possible your therapy does not require the high of 20 to be set as you list on your left panel. Put up an OSCAR chart and let's look to see if you can lower that some to help out.

[Sleepster]

The pressures just roam up and down between the minimum of 7 and a maximum of 11 and mostly hovering around 8 or 9 and the events don't seem to have any effect.   Not quite sure what to do about that

Do you have C-Flex set at 3? If not, I would recommend doing that as well as lowering your maximum pressure.

[csl1]

           

These are the most recent.  Forgot to put card back in on Monday.

[csl1]

Flex was set at 1.  Will try at 3. Thanks

[Sleepster]

Flex was set at 1.  Will try at 3. Thanks

Note that your pressure rarely goes above 9.0. I would suggest that you set the maximum pressure at 9.0 I know the general consensus around here might be that if you raise flex you need to also raise the maximum pressure, but that is not what I found when treating my aerophagia. Setting the maximum pressure at 9.0 and C-Flex at 3 may raise your AHI a bit, but let's wait and see if that happens. Treating the aerophagia was far more important to me because it was so painful and uncomfortable. If necessary, you may have to switch to bi-level therapy (e.g. BiPAP). But let's not get ahead of ourselves.

Another issue is that aerophagia tends to subside as we adapt, so settings that you can't tolerate today may be perfectly satisfactory three weeks from now. Some people, though, never adapt. And some adapt much more slowly. Either way, the condition can be treated.

Positional therapies are another way to attack the problem. For example, wearing a soft cervical collar may help keep you from swallowing air by keeping your airway aligned. But it could also make it worse because it could keep your esophagus better aligned. You just have to try different things to find what works for your anatomy.

[Gideon]

I've looked at Oscar but struggle to see the correlation between the obstructive events and increases in pressures.  Most apneas and hypopneas don't have a corresponding increase in pressure.  The pressures just roam up and down between the minimum of 7 and a maximum of 11 and mostly hovering around 8 or 9 and the events don't seem to have any effect.   Not quite sure what to do about that

Look at snores.  On PR machines snores are the major driver of pressure.