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Air in Stomach
#1
Question 
Hello All,

This is my first post here and I am only on my second night with my ResMed S9 VPAP S. My pressures are set to 25/21.

So far the machine and I are getting along great (even with a full face mask) until 3 or 4 o'clock in the morning. I wake up with a moderately sharp discomfort in my stomach. It feels as though air has been forced into my stomach and I end up passing this excess air through my system. Basically I lay in bed and fart A LOT. After I take the machine off The condition clears itself in less than 30 minutes. This has happened both nights. Has anyone experienced anything similar? Or could it be something else that I am mistaking such as diaphragm pain?

I am only going to give it another night or two to try to confirm the issue before I go to the doctor.

Can this be caused by the pressure being set too high? I have concerns that my sleep study may not be accurate due to mask leakage caused by facial hair... Wish they had told me shave it off or at least trim it before the titration study. Anywho....

Thanks,
Jett
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#2
Well with some researching I found a page on here for Aerophagia. (Can't post link because I don't have enough posts)

Still looking for anyone with experience that may have advise on how to alleviate this problem.

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#3
(08-07-2013, 07:08 AM)jettman96 Wrote: ...
I wake up with a moderately sharp discomfort in my stomach. It feels as though air has been forced into my stomach and I end up passing this excess air through my system. ...

I am only going to give it another night or two to try to confirm the issue before I go to the doctor.

Can this be caused by the pressure being set too high? I have concerns that my sleep study may not be accurate due to mask leakage caused by facial hair... Wish they had told me shave it off or at least trim it before the titration study. Anywho....
Jett,

First, welcome. Smile

You are experiencing aerophagia or "air eating". It's fairly common, especially for people with high settings. Since you're on a BIPAP with your Inhale Pressure (IPAP) set to 25 (the highest setting possible on an S9) you probably are experiencing a good deal of discomfort related to your pressure settings.

During the titration, they're supposed to pick up on aerophagia. Many of us instinctively burp when we feel like air is being forced down the gullet even during sleep, but some of us don't, so they didn't pick up on the aerophagia during your titration.

Your facial hair is not a likely culprit for aerophagia.

In a typical sleep apnea patient using cpap, not bipap, there is a sweet spot where you can get your lowest AHI without experiencing aerophagia. Here's a graph I made showing my understanding of some of the variables that can affect the "sweet spot".
[Image: example_titration_finding_the_sweet_spot_b.jpg]

There are some things you can try:
  1. Lower your Exhale Pressure (EPAP). Since you have a bipap, with two pressure settings, lowering the EPAP will most likely be the first a most useful way to start. I'm not an expert in this, but there are likely people here who may have suggestions.
  2. Lower your Inhale Pressures (IPAP). Again, this may or may not help, and I'm not an expert.
  3. You may have positional aerophagia. If you only get aerophagia when you're on your back/right/left side, try to find a way not to sleep on that side.
  4. You may have positional apnea. For instance, you may find that if you never sleep on your back, you can significantly reduce your pressure. There are people who make belts and other devices that will keep you off your back during sleep if this would work for you. That way you could experiment with lowering your pressure settings and hopefully also reducing aerophagia. Again, I have not expertise in this, but there may be other people on the forum who do.

Lab titrations are not perfect, and it often takes our bodies time to adjust to the new sleep hygiene regime (mask, pressure, etc.) As you suspect, the titration is their best guess - not a perfect solution. Many of us end up self titrating because it's almost impossible to get it perfect in a single titration.

Your mission is to find the sweet spot between lowest AHI and reduced or no aerophagia.
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#4
The only reason I bring up the facial hair is because it caused a significant leak during the Titration study. (I have since trimmed it to eliminate the leak) So, I wonder if this caused the technician to raise the pressure significantly to compensate for the leak while trying to "find" the optimal settings. Now that I have eliminated the leak I now have too much pressure thus resulting in Aerophagia.

I do seem to experience more apnea and aerophagia in certain positions (pretty sure it is the supine position). I do try to sleep on my side most of the time so that may be a contributor to my aerophagia problem.

I'm going to leave everything as is for another night or two (maybe longer, now that I know it is not a huge threat). But I'm leaning towards lowering the EPAP gradually and keeping an eye on my data using Sleepyhead to see how my AHI is doing.

Thanks for the help.
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#5
Never hurts to mention it to your doc, and it should be mentioned if pain and arousals are caused by aerophagia. The body can and should be able to acclimate over time. I had aerphagia pretty bad at first, but it gradually went away over the course of a couple of months. Some find it beneficial to temporarily reduce pressure, thereby reducing the severity of aerophagia, then gradually return to the higher pressure in small increments over the course of a few weeks. Keep in mind that the effectiveness of therapy will be compromised until a full return to titrated pressure is reached (assuming an accurate titration was done); but that needs to be balanced with the fact that arousals caused by aerophagia compromise sleep quality.

Just a hunch with no real evidence to back it up - but I lean toward thinking that sticking it out at a set pressure allows the body to adust more rapidly. I'm also of the opinion (with absolutely no evidence to back it up) that variable pressure (variance between ipap and epap) makes it harder for the body to adjust - but I'm sure there are many who disagree.
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#6
(08-07-2013, 07:08 AM)jettman96 Wrote: After I take the machine off The condition clears itself in less than 30 minutes. This has happened both nights. Has anyone experienced anything similar?

This is a common problem. As others have explained, the CPAP machine is forcing the air into your stomach.

There are two pieces of good news for you. First, this is a temporary condition that will subside as you adapt to the CPAP therapy. Secondly, you're lucky in that it doesn't last all day like it did for me.

While it's true the pressure can be lowered to help get relief, in your case I wouldn't recommend it. Keep the pressure settings where they are and if the problem continues to bother you discuss it with your equipment provider and your doctor.

Being new to CPAP therapy it's important to allow yourself time to adapt. If you go changing your pressure settings you may end up in a situation where you are having problems and you're in your doctor's office trying to explain why you didn't stay with the setting prescribed by that doctor.

After you've been on CPAP therapy for a month or two, and you've got your leaks and your AHI under control, you can consider fiddling with your pressure settings. By then the aerophagia will be a thing of the past.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
Hi jettman96,
WELCOME! to the forum.!
What everyone has said so far, Hang in there for more suggestions and best of luck.
trish6hundred
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#8
Thanks everyone!

The discomfort has eased off but I still experience a lot of flatulence from the air that is being forced into my stomach. So, I will just keep an eye on things for now. If it doesn't completely go away in a month or so, I'll talk to the doctor.

Now just to find a good solution for the dry mouth... Biotene gel = yuck!!!

Thanks again,
Jett
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#9
With respect, I will disagree somewhat with Sleepster. If your aerophagia continues to be a source of discomfort for you, you may want to speak with your doctor about _temporarily_ reducing your treatment pressures until you become more accustomed to the pressure. As others have mentioned, you are starting off on the highest pressure that the common CPAP/BPAP devices can produce. That is one heck of a change to acclimate to. I am of the opinion that it would be better to spend a few weeks at sub-optimal treatment pressures than to risk having you quit your treatment altogether because you cannot tolerate it.

It does get better. And yes, I got it too. Just like you, from both ends of the GI tract, as it were.
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#10
(08-09-2013, 04:39 PM)RonWessels Wrote: If your aerophagia continues to be a source of discomfort for you, you may want to speak with your doctor about _temporarily_ reducing your treatment pressures until you become more accustomed to the pressure.

I agree. I should have been more clear about that.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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