Aerophagia Symptoms and CPAP: Key Facts to Know
Continuous Positive Airway Pressure (CPAP) therapy is used in the management of obstructive sleep apnea (OSA). A machine is used to deliver pressurized air – through a face mask or nasal mask – which keeps the upper airway open, allowing you to breathe comfortably while you sleep. It is a highly effective and established form of therapy for OSA and other types of sleep apnea.
One of the common side effects of CPAP is aerophagia. Aerophagia is the unintentional swallowing of excessive air, which can be uncomfortable and affect your daily life. Symptoms include bloating, increased belching, or flatulence. Other symptoms include a loss of appetite, abdominal pain or discomfort, heartburn and acid reflux.
These symptoms can affect your overall health and well-being. They can also be distressing, especially if you are unaware of what may be causing them. It is reassuring to know that you are not alone. Many different factors, such as the settings of your CPAP machine, can contribute to aerophagia and its unpleasant symptoms. By identifying these factors you can manage your symptoms and enjoy optimal CPAP therapy.
In this article, we will explore aerophagia and its symptoms in more detail. We will discuss how CPAP can cause these symptoms and look at practical strategies to manage and alleviate the issue.
What is Aerophagia?
Aerophagia is when you swallow excessive air, and it goes to the stomach rather than your lungs. It is often associated with the use of CPAP, and common symptoms include repetitive burping, excessive flatulence, gas, and bloating as well as abdominal pain and discomfort.
Other causes of aerophagia include physical habits such as eating too quickly, chewing gum, smoking or consuming fizzy drinks. Psychological factors such as anxiety and depression are other possible causes.
How CPAP Can Cause Aerophagia
Aerophagia is a common side effect reported by patients on CPAP therapy. CPAP machines provide a continuous stream of pressurized air to keep the airway open during sleep. Often excess air can pass to the gut rather than the lungs, resulting in discomfort such as bloating or flatulence.
This occurs if the pressure setting is incorrect or not adjusted properly. If the pressure setting is too high, it is likely to cause symptoms of aerophagia. Other factors which can result in swallowing of excess air include nasal congestion. To compensate for nasal congestion, you may resort to mouth breathing, increasing the amount of air entering the mouth or throat. A mask leak can also cause aerophagia by disrupting proper airflow and pressure delivery.
Common Symptoms
There are many symptoms of aerophagia, whether caused by CPAP therapy or other factors. One of the most common symptoms is bloating, accompanied by belching or flatulence, as the body attempts to release excess air from the stomach and intestines. This may be accompanied by gurgling stomach sounds and hiccups.
Another common symptom is loss of appetite or early satiety. Patients feel full after eating only a small amount of food or before finishing a normal meal. Abdominal pain or discomfort is also common, as well as nausea and general discomfort.
Although less common, some patients experience heartburn and acid reflux. Excess air pushes the stomach upward, causing stomach acid to rise into the esophagus. This can be particularly uncomfortable.
Identifying Symptoms Specific to CPAP Therapy
A key indicator of whether or not you are suffering from CPAP-related aerophagia is the timing of your symptoms. If the symptoms occur immediately after CPAP use, then it is highly likely that the therapy is contributing to your symptoms. Excess air is entering the gastrointestinal system and indicates that the settings on your machine may need to be adjusted or there is another underlying issue. Difficulty breathing due to high-pressure settings can cause excess air to be swallowed during therapy.
Mouth breathing during CPAP therapy can also contribute to aerophagia. If you breathe through your mouth due to nasal congestion or an improperly fitted mask, it can lead to swallowing excess air.
Your sleeping position can also increase your risk of aerophagia. Back sleepers are more prone to swallowing air because gravity causes the tongue and soft tissues to fall backward, partially obstructing the airway. This increases the pressure required to keep the airway open, which can force more air into the esophagus.
Adjustments in CPAP Settings
To effectively manage aerophagia, adjusting the CPAP settings is often an important first step. As mentioned, high-pressure settings are one of the most common causes of aerophagia. You can speak with your Healthcare provider to find out if the pressure setting can be lowered, depending on your unique requirements. Small adjustments can significantly reduce the amount of air that you swallow, helping to manage your symptoms and improve therapeutic effect.
You may also speak to your Healthcare provider and find out if it is suitable for you to switch from CPAP to an automatic positive airway pressure (APAP) device. APAP machines automatically adjust air pressure throughout the night based on your needs. This helps maintain effective airway pressure while minimizing the risk of aerophagia. Studies have shown that APAP can reduce symptoms of aerophagia without compromising the treatment of obstructive sleep apnea.
Bi-level positive airway pressure (BiPAP) machines may also reduce the risk of aerophagia. BiPAP devices offer two distinct pressure settings: a higher pressure for inhalation and a lower pressure for exhalation. This difference in pressure makes exhalation more natural and comfortable, reducing the likelihood of swallowing air.
Mask Fitting and Alternatives
Your CPAP mask must fit correctly for optimal therapeutic effect but also to reduce the likelihood of aerophagia. A mask that fits correctly promotes nasal breathing and there should be no air leaks, reducing the amount of air entering the esophagus.
Full-face masks, which cover both the nose and mouth, may be more likely to cause aerophagia due to potential leaks and higher pressure requirements. A nasal mask, which only covers the nose, may be more beneficial.
Mouth breathing increases the likelihood of swallowing air, so keeping the mouth closed during sleep can help mitigate this problem. The use of a chin strap can be useful for this.
Lifestyle and Dietary Changes
Lifestyle and dietary changes can also be effective in managing aerophagia. Sleeping on your back promotes aerophagia.
Sleeping on your side – or using a pillow wedge to elevate your head by 30 to 40 degrees – can reduce air flow into the stomach and subsequently reduce symptoms.
Dietary adjustments are equally important. Fizzy drinks, drinking through straws, and chewing gum can increase the likelihood of aerophagia. These should be avoided as much as possible.
Eating slowly and avoiding meals close to bedtime can further reduce aerophagia symptoms. Additionally, avoiding substances like caffeine and nicotine, which relax the lower esophageal sphincter (LES), can lower the risk of air entering the stomach.
It is essential to establish a consistent bedtime routine. This includes maintaining a consistent sleep schedule and engaging in relaxation techniques to reduce stress and anxiety, both of which may contribute to aerophagia. By recording your symptoms and identifying which factors help reduce those symptoms, you can alleviate the discomfort and enjoy the therapeutic effects of CPAP therapy. Speak to your healthcare provider who will be able to advise you accordingly.
Taking Charge of Aerophagia
Aerophagia is a common side effect of CPAP therapy. It can cause significant discomfort and disrupt your daily life. Common symptoms include bloating, belching, and flatulence after CPAP therapy as well as abdominal pain and discomfort, heartburn and acid reflux. By identifying that CPAP therapy is the likely cause of your symptoms, you can speak to your healthcare provider and find out how your therapy can be adjusted.
Incorrect pressure settings, an ill-fitting mask or the wrong type of mask are all factors that can contribute to aerophagia. You can speak with your healthcare provider to determine if the pressure setting on your machine can be adjusted, as this may reduce the amount of air swallowed. You may consider different types of masks or machines to help reduce your symptoms. APAP machines and Bi-PAP machines have been found to reduce the amount of air swallowed. You may also consider changing your diet or lifestyle where necessary.
By identifying the cause of aerophagia and acting promptly, you can reduce and alleviate any uncomfortable symptoms and side effects, allowing you to enjoy the full benefits of CPAP therapy and improve your health and well-being.
