You need to report the aerophagia to your sleep doctor instead of just the DME. There are a number of things that can be done to try to minimize the amount of air you swallow, but like so many CPAP related things, which ones work depends very much on the individual patient.
Some things to consider and try:
Your pressure settings
. In general, the higher the pressure, the more likely a patient is to develop aerophagia. But simply lowering the pressure is not an answer because that leads to more events. In other words, if you are working with high pressure settings, you may need your doc's involvement in figuring out whether the pressure(s) can be reduced and by how much. For many people using a bi-level of some sort (like your VPAP Adapt), the EPAP pressure may be more directly related to the aerophagia than the IPAP.
GERD and acid reflux type conditions
. Some people with serious aerophagia problems also have acid reflux at the same time---either GERD or a version of acid reflux called "Silent GERD." Some people have silent GERD without being aware of it. It's worth talking to your primary care physician about whether you might have GERD. The problem in GERD is that the lower sphincter of the esophagus has problems staying tightly closed. In classic GERD, the weak sphincter allows stomach acid to back up into the esophagus, but when a person with GERD uses CPAP, sometimes that weak sphincter also allows air to leak into the stomach.
GERD self-help techniques
. These are sometimes useful when you are fighting aerophagia even if you don't have GERD. In particular, the following GERD self-help tips often help relieve some of the aerophagia and its bloating and pain:
Head position when sleeping
- Raise the head of the bed by about 4 inches. It's better to put the bed on blocks than it is to simply try to raise the head by using a massive amount of pillows. Sometimes, however, a sleeping wedge (a very firm triangular wedge that goes on top of the mattress) is enough and you don't need to put block under the bed feet.
- Watch what you eat and when you eat it during the evening hours. A smaller supper meal may help. Eliminating any foods that cause you problems can help. No food for 3-6 hours before bedtime can help. Limiting liquids right before bedtime can help.
- Sleeping position. For many people with GERD and or areophagia, sleeping on the left side tends to cause much fewer problems than sleeping on the right side or back. It has to do with where the stomach lies inside the body.
. This is a highly individual thing, but for some of us, certain head positions tend to lead to more problems with areophagia. I am predominantly a side sleeper and I prefer sleeping on my left side. For me, I found that if my head is tipped back away from my chest, the aerophagia tends to be worse, sometimes much worse. If I tilt my head down where my chin is a close to my chest as possible, that usually helps minimize the problem with swallowing air. But other people are just the opposite and find they swallow less air when the chin is pointed away from the chest. So experiment with head position.
. Sometimes there's a nasty "positive feedback loop" involved with aerophagia and arousals: Humans have a tendency to swallow a bit whenever they first wake up or arouse from a sleep. And so in some people (I'm one of them) the aerophagia is part of a cycle that feeds on itself:
... arousals lead to swallowing which leads to areophagia which leads to more arousals which leads to more swallowing which leads to more aerophagia which leads to more arousals, which leads to more swallowing .....
In this situation the long term fix is to try to reduce the number of night time arousals and night time awakenings. Fewer arousals means less swallowing of air, which means less aerophagia, which reduces the chances of the feedback loop from becoming firmly established. In my case that means I have to be able to get to sleep within about 10-15 minutes of masking up or I start swallowing air while I'm awake, but very drowsy, which will immediately increase the chances of a bad aerophagia night. It also means not lying in bed when I know I'm extremely restless for long periods of time. If I find myself tossing and turning for what feels like 30 or more minutes, I really try to get up and go into a different room until I'm both sleepy and settled down.
Embrace the burping, belching, and farting needed to get rid of the aerophagia
. Guys tend to have fewer problems with this than women do. There is this cultural expectation that we should try hard to hold in offending gasses trapped in our gastric-intestinal system, but burping, belching, and farting are really good ways of getting rid of the excess air. (And the excess air usually is oderless, so the main problem is noise, not smell.) When you wake up with the pressure from serious aerophagia, you need to take the mask off for several minutes and move around and try to burp or belch if possible. If the air pressure is further down the GI track, then moving around can encourage some badly needed farting to take place. If necessary, get out of bed and move around until the belching, burping, and farting relieves enough of the pressure so that you can lie back down with the mask on and still be reasonably comfortable.