CPAP gas problem - aerophagia?

by Mel
(Ft Lauderdale)

I get a tremendous amount of gas every morning from my cpap machine, so much so that I do not want to continue using it. Neither the company I got the machine from nor my doctor has heard of this complaint before.

Do you have any solutions to my problem? Or should I stop using the cpap machine even though I do sleep better.

Answer

Dear Mel,

You are likely experiencing aerophagia - the swallowing of air. This is a common problem for people new to CPAP. Although aerophagia is a medical term for this problem, I call it CPAP gas.

The cause of CPAP gas

Aerophagia is caused when air enters the esophagus and down in to the digestive system rather than the airway in to the lungs.

Either the air is being forced by cpap pressure ( possibly set too high) or you are gulping air which might be caused by having a pressure TOO LOW.

If the CPAP pressure is high enough, eventually, your esophageal sphincter will not be able to resist the air pressure, and its seal will open up , allowing your gastro-intestinal system to literally inflate with air. When it's bad, it'll come out of both ends...

It can happen simply because our pressure setting is not accurate.
It can also happen if we have an ill fitting mask that leaks, which then does not allow the delivery of the proper pressure.

Have you been checked for a hiatal hernia? If not, have your doctor check you out. It seems that acid reflux can cause some really intense pain, often mimicking a heart attack. The CPAP causes the flap (already weakened by the hernia) to open and gas pours into your stomach.

You could also be having esophageal spasms (caused by both the hernia and reflux). These can really be painful, too.

Bottom line... If the cause of aerophagia is purely related to CPAP use, then it happens simply because the air pressure against the esophageal sphincter muscles is great enough to overcome the esophageal closure that normally seals off the stomach. Other non-CPAP physiological factors may contribute as well, as aerophagia is not at all exclusive to CPAP use.

Treatment for CPAP gas

The obvious treatment is to run at lower pressure. Lower pressure can be effective in treating apnea when you lose most, if not all, of your body fat (which will remove the little fatty deposits from your throat/airway), and when you consider the use of a jaw positioner to elongate the airway and increase its opening.

Obviously, a polysomnogram to measure AHI, post- weight loss, and a retitration need to be done before reducing the CPAP pressure.


The good news is that for many of us, CPAP-induced aerophagia seems to disappear over time. Perhaps the esophageal sphincter muscles gradually strengthen with nightly "resistance workouts" introduced by Positive Air Pressure therapy.

In the meantime, some strategies can help such as:

• using your CPAP machine's ramp button,


• sleeping at an incline,


• avoiding food and beverages late in the day.


• Don't be ashamed of burping and farting in the morning, if you can, that's the EASIEST way to relieve the pain. The air is largely odorless since it's room air.

Mel, here is an interesting video about how to treat CPAP gas or aerophagia:



So experimentation with sleeping position may be in order as well.


CPAP patients who seem to suffer from intolerable aerophagia (or aerophagia that does not eventually go away on its own) usually have to solve this problem by having their physician lower their air pressure and/or change PAP machine type.

For many, an AutoPAP will help with aerophagia simply by reducing the mean airway pressure (MAP). For others, BiPAP or C-Flex, which reduce exhalation pressure (EPAP) seems to be in order. Pressure against the esophagus is greater during exhalation (EPAP) than during inhalation (IPAP).

Unfortunately, anti-gas or anti-bloating tablets will not help with CPAP-induced aerophagia, although other contributing gastronomical sources of gas may be helped by these medicines. However, Gas-x Tablets can ease the pain.

Conclusion, in the evening and before going to bed, you should:

• Not eat less than 2 hours before bedtime.


• Use an acid reducer (if you don't already).


• Keep Gas-x Tablets in your nightstand for those nights when you wake up with a problem. It does seem to help bring those bubbles up. You need to sit up take a Gas-X, and stay upright for a few minutes until the air comes up.


• Keep Pepto-Bismol in your nightstand for final back-up if you continue to be uncomfortable. But read the instructions carefully about how LONG you can take them.

Consider the possibility that your pressure might be too high, and discuss it with your doctor. If your pressure is high, ask about changing to a BiPAP. This will require another titration, but is much more comfortable.

Why do so many medical professionals seem to be completely unaware of the link between CPAP and its resulting aerophagia?

I think it's absolutely amazing how many of us have posted that our own medical professionals are completely unaware of the link between CPAP and aerophagia.

My own guess is that it has to do with the fact that aerophagia does not normally manifest during a one-night PSG sleep study.

Perhaps enough patients are not educating their own medical professionals about their experiences with aerophagia, since the symptoms so very often gradually disappear on their own. Perhaps it has to do with how new sleep medicine is or how vast and overwhelming the entire field of modern medicine has become.

I really don't know, and your guess is at least as good as mine, if not better. CPAP-induced aerophagia ignorance within the medical field stumps me to no end.

If your medical professional seems unaware of this medical fact, and it happens to prove both relevant and crucial to you, be sure to print plenty of reputable references from the Internet to show them.

As always, consult with your physician if you notice any new or unusual symptoms when starting CPAP, including discomfort.

Good luck, Mel!


I hope it helps. Don't be afraid to comment back.




Remy
www.sleep-apnea-guide.com

Please remember...what is posted on these forums are our experiences, thoughts and opinions...it is not always 100% accurate.