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Need help with Aerophagia
#1
Need help with Aerophagia
Hi all and thanks for the previous help getting major mask leaks under control. Today I am frustrated and tired and hoping for help with aerophagia.

Here is the situation...
I have GERD, treated with medication, and I sleep on a wedge to prevent night time reflux. It is about 6" high, just enough to let gravity help keep stomach contents below the LES. I sleep exclusively on my back. This last week, in attempting to solve my mask leak problems, I started using a soft cervical collar. The collar prevents my jaw from relaxing too much while asleep and this seems to have stopped a lot of mask leaks. My AHI went down when I started using the cervical collar too, probably because my airway is more open with my chin propped up all night. The collar provides support to the back of my neck and I have not used a pillow with it. Unfortunately, I have experienced an increase in aerophagia, which has been bad enough the last few nights to get me up and keep me up for awhile during the night. Last night, in the middle of the night, I decided to try adding a pillow to see a slight head flexion might reduce or stop the aerophagia. So now imagine me on the wedge, with a pillow and the cervical collar. It did not feel like my chin tuck was very extreme ..after all the collar is there between my chest and chin, but my AHI and clear airway apneas skyrocketed after this! Here is a snapshot of the whole night and another of just the last two hours after adding the pillow. Any explanation of what is happening here and/or ideas about how to stop the aerophagia would be most welcome!

       
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#2
RE: Need help with Aerophagia
you shouldn't be getting any clear airway events with the asv and I see only unclassified apnea and hypopnea in your posted charts. it's generally thought that UA are obstructive with this machine. I wonder if the pillow offset the benefit of the collar and you had more obstructives as a result? maybe others can help with aerophagia. the only thing that worked for me was to keep my pressures as low as possible. it's weird but I can get similar ahi results at a variety of pressure settings so the trick is to find the lowest one that works.
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#3
RE: Need help with Aerophagia
I'll tell you what I did.
I put bricks under the head of the bed, so I slept on a slope. It does the same as your wedge, but possibly a bit more comfortable, because it does give the option to side sleep.

I went on a LCHF Keto type way of eating, Google: Gerd keto lchf, there should be enough to consider it. It did resolve my gerd and I have discontinued meds. FODMAPS is also another gut related way of eating. Also worth looking up.

The chart looks very positional. I think the Aerophagia is because of the high pressure all night and from the inflamed response to gerd, on the stomach sphincter and air bipasses. I started cpap after my gerd was fixed and I did have bouts of Aerophagia, it has since resolved, It seems my body got use to the pressure. Sphincter muscle toned up and sealed better?

If your head is in the right position and the throat is open. It may be that the jaw is dropping back, taking the back of the tongue with it. It would be worth trying a boil and bite mouthguard with a hole in it to allow you to breathe. If it does help, then you can work out what is the best one for you, they come in different sized holes primarily. If you go this way, I can help you fit it/ buy 4 becuae you mess up the first 2 and you will be left with a spare, they are $3 each. When I use it for my sore tooth, it does reduce my pressure. I block on exhale and need 12 cm to keep my throat open on exhale, I can cut that back to 10 with the mouthpiece and it also reduces my ipap spikes quite a bit.
If you look on ebay or amazon
[Image: pCeAOuz.png]
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap from machine data, or software. Set the min pressure at 'med' median pressure or 90% OR 2cm below 95% pressure. max pressure at 20cm for now. Forum will help you fine tune settings
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#4
RE: Need help with Aerophagia
Thank you for your response, Sheepless. I should hope I would not get any clear airway events with the ASV as it is responding breath by breath. It's my understanding that a clear airway event is another way of saying it's a central apnea. Here is a quote from sleepyhead:

"ResMed and Philips Respironics CPAP machines use (different) proprietary algorithms to test the patency of the airway and use the result to classify each apnea as a clear airway apnea (CA) or an obstructive apnea (OA).

"A CA scored by either the ResMed or Philips Respironics CA algorithm is very likely to be a "real" CA in the sense that the airway is clear (open). As such, a real OA is not very likely to be mis-scored as a CA on either a ResMed or Philips Respironics machine."

There are only three categories in Sleepyhead: hypopnea, OA or UA. If I were having CAs, they would have to be listed as UAs and if ResMed can be trusted the UAs are actually CAs. Does this make sense? I might be a little too tired to understand this right now.

However, reading further, the sleepyhead manual states

"When the data from the algorithm leads to an ambiguous result, the apnea may be scored as an unknown apnea (A or UA). Both ResMed and Philips Respironics Auto machines will increase the pressure in response to clusters of OAs, but they will not increase the pressure in response to apneas scored as CAs."

So assuming the ASV algorithm works this way, the clue should be in the pressure response, and there certainly is pressure response! It was blowing me off the planet! Still not sure I am thinking about this the right way, but it would make more sense that all the events are obstructive and that the pillow actually caused the whole mess.

Still don't know what to do about the aerophagia though. Help! Help!
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#5
RE: Need help with Aerophagia
The ASV will only score UA and H, CA aren't scored because there is no FOT, to see if the airway is open. Resmed say there are no CA with ASV, because all are treated, any UA is obstructive. It's whether there is enough PS available to treat it properly and you need to look at tidal flow to see.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap from machine data, or software. Set the min pressure at 'med' median pressure or 90% OR 2cm below 95% pressure. max pressure at 20cm for now. Forum will help you fine tune settings
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#6
RE: Need help with Aerophagia
Thanks, Ajack. Your response is very thoughtful. Do you think a six inch wedge is too low? I am stuck with back sleeping, which I know is not best but unavoidable.The GERD is pretty well controlled with diet (LCHF diet helped me with this also) and medication, but it is acting up at night with the aerophagia.  I'm thinking the pressure is just too high for my poor LES. My titration was done without the cervical collar, on the wedge without a pillow and my chin was somewhat tucked, jaw dropping open. The sleep techs complained of leaks all through the study. Now that I have the leakage under control, maybe my pressure could be lower-- especially using the collar .. but obviously not on this wedge with this pillow! 

I have not heard of anyone using a mouthguard with hole to breathe, but thanks for mentioning it to add to my bag of tricks. I could see laying flat how the tongue might drop back during sleep. Does it seem likely with head elevated on the wedge? Also, do you have any trouble with mask fit using the mouthguard? Anything that allows you to reduce pressure seems like a good thing.
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#7
RE: Need help with Aerophagia
Ajack, Thanks for the added info about about all UAs being obstructive with ASV. That has not been made clear to me and is very reassuring. These apneas actually look obstructive as they don't have the Cheyne-stokes formation and the machine is responding with pressure. It seems now that the pillow/wedge/collar combination brought them on and that suggest a simple fix to stop the excessive apneas. Now I need to stop the bloating!
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#8
RE: Need help with Aerophagia
I have some teeth missing and the mouthguard actually makes it easier to fit. It's better to fix the positional pressure rises, including jaw position and let the machine use the required treatment pressure. You can choke the machine back and it will reduce the pressure, it does impact on treatment. So if you decide to restrict the max PS, be aware it need to go back up later, I wouldn't leave it low in the long term.

Better is to fix the positional.

6 inches is fine, the only issue I have with a wedge is the pressure it puts on your butt, you need to watch out for pressure damage, leading to sores.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap from machine data, or software. Set the min pressure at 'med' median pressure or 90% OR 2cm below 95% pressure. max pressure at 20cm for now. Forum will help you fine tune settings
Post Reply Post Reply
#9
RE: Need help with Aerophagia
I obviously haven't observed you while you sleep, but based on what you have described, my suspicion is that your wedge and collar are fighting one another, and between them and your back-sleeping, you are getting the obvious and typical clustering of obstructive apneas that we see.  Your AHI, as you must understand, is quite a bit too high to be good for you, and the aerophagia is robbing you of sleep if it causes too many arousals at about the time you should be getting into the essential REM stage where you dream.

I don't seem to get aerophagia except when I sleep on my back for a good chunk of the night, and for me that means I get bloated and belch about every second or third day.  If I must awaken, I try to turn on my left side, which I dunno what a wedge does for easing that position, …  Sleeping on the left, in a fetal position, knees drawn up, is how we are positioned when recovering from endoscopy and proctoscopy/colonoscopy because on that side we easily clear gas at either end.  If you can't find a pressure or treatment regimen that mostly eliminates aerophagia, you may have to train yourself to sleep at least 'some' of the time on your left side.
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#10
RE: Need help with Aerophagia
find a good GI surgeon and ask them about doing a Nissen Fundoplication or preferably a LINX device a.k.a Magnetic sphincter augmentation device. With nissen come some risks like having it done too tight. With LINX/MSA its metal so no more MRI's for you.
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