Never ending Aerophagia, please help!

[trish6hundred]

Hi sarahfv,
WELCOME! to the forum.!
Good luck to your husband with CPAP therapy, and also with finding a solution to his aerophagia.

[Sleeprider]

Just so it isn't missed, Bonjour mentioned that this appears to be a positional issue. I agree. The clustered events occur when your husband tucks his chin toward his chest and obstructs the airway. The most comfortable and effective solution is a soft foam cervical collar to prevent that chin tuck. This can be comfortable and effective even when he sleeps on his side. It may easily reduce his peak pressure need significantly. He doesn't do badly at a pressure of 9.0, except when he doesn't, and we're suggested that is when his head and neck are mis-aligned in a way that restricts his airway.

[pdeli]

I had posted the following on another forum but got no replies.  Paragraph 5 may be helpful to your situation.

"I've been sailing along with my settings at 10.5 for IPAP & 4.5 for EPAP for maybe 2 years or so. Then I started to noticed that I was getting air in my stomach (aerophagia). Nothing had changed as far as I could tell, but the experience was quite uncomfortable and resulted in lots of discomfort.

I don't believe that my mouth is open.

My first question then is, how does air actually get into the stomach? Does it mean the pressure is too high & it has no where else to go?

Along the thinking that pressure might be too high, I first tried to correct the problem by reducing the settings from 10.5 to 10.0 and then to  9.5 for IPAP and from 4.5 to 4.0 (Lowest possible) for EPAP.  I got some relief, but still not reliably resolved.

Then I stumbled onto "Mode", & w/o knowing what the results might be, I turned on "Bi-Level" or maybe it was "Auto Bi-level. I also turned "Flex Type" to "Bi-Flex " and then set Bi-Flex to 3. I am unclear what any of these terms mean, or more to the point, what they actually do.

I have no idea why things changed, but the IPAP suddenly seemed more gentle, more evenly delivered, although I had returned to the original 10.5 & 4.5 on my pressure settings.

So I went back to the "Provider Guide" for my Respironics Bi-Pap, Auto Bi-Flex  machine to look up the definition of these terms as I would like to understand what's going on and why things changed &  improved.

Long ago I decided that often, unless one is in a specific business, &  completely understands the verbiage in: a legal document, an insurance policy, a medical diagnosis, or other technical arenas, the likelihood of really understanding what you are reading may be close to zero even though you may vaguely know the meaning of each word in another context. IOW, in order to know what a document or a definition says, you have to know what it says.

So after I read the definitions of Biflex & BiLevel & Auto Bi-Flex, I thought I might vaguely understand the terms.  But not really, and I'm still  totally confused.

So now my real question here is: what do these terms do & how they impact the therapy?  IOW, what's going on!"

Phil

[Sleeprider]

Phil, the way most people have air go the "wrong way" is a weakness or incomplete closing of the Lower Esophageal Sphincter (LES). This muscle works to prevent movement of gases and liquids both ways. Rather than try to guess how this applies to you, read some of the entries here, and ask questions from there: https://www.google.com/search?rlz=1C1CHB...aYHPoxIETs

[pdeli]

Thank you.  Now if I can only sort out these crazy terms I'll be fine.

Phil

[Sleeprider]

This link may work better as it focuses on issues with LES and CPAP: https://www.google.com/search?rlz=1C1CHB...Eb6a_hl5-8

[VisitorX]

Sarahfv -

The position of the esophagus in the body is not symmetrical with respect to the stomach. There are reasons to expect that sleeping on the right side would allow air that enters the stomach to escape back out through the esophagus, instead of being trapped there and having to enter the small intestine, which is what causes gas to become trapped in the body, forcing it to pass downward.

It's not important that you understand the anatomic details, but briefly, the esophagus enters on the left side of the stomach, so that when you sleep on the right, the air bubble of swallowed air would tend to form on the "top" and thus be able to exit through the junction where esophagus meets stomach, which is also on the "top." I put "top" in quotes because it is really the left side of the stomach, but when you sleep on the right side, the left is the top.

Don't worry if you don't follow that; it's hard to "get it" without looking at a good picture, and even so it's not clear to everyone.  I would just do a trial. See if he can sleep exclusively on the right side for a few days and see if that makes a difference. It makes a big difference for me. If it is successful, it means not that he's swallowing less air, but that the air is escaping back out through the esophagus gradually, just as it enters.

He will likely need to put a pillow between his knees and if he happens to be skinny he may experience some pressure on his right him, depending on the firmness of the mattress. But those issues can be worked out if the basic approach succeeds. Good luck. If it doesn't work, keep looking. Either way, I'd be interested in hearing how it goes.

[VisitorX]

Sorry, that should have said "hip," not "him" in the last paragraph.

[Kryogen]

What is your husband bmi? If he is overweight, loosing weight will help reduce pressures and reduce aerophagia.

[VisitorX]

On the subject of reducing pressures, I have not read all the above posts, so maybe this has been suggested already--and for that matter you probably have already thought of this a million times already, but just to be sure: Have you tried (1) different sleeping positions to see if one is better than the others and thus might let him reduce his pressures (or in rare instances be off CPAP altogether--I have a cousin with highly, highly positional apnea, severe on his back but totally cured on his side using just Zzoma) or (2) using both a mandibular advancement device (mouthpiece, oral appliance) while also using CPAP?