Continuous positive airway pressure (CPAP) therapy is a widely used and effective treatment for sleep apnea, helping to maintain open airways during sleep. However, some individuals using CPAP machines experience a common and uncomfortable side effect known as aerophagia, the swallowing of air. This condition can lead to various gastrointestinal symptoms, including bloating, burping, and abdominal discomfort. Understanding the reasons for CPAP-induced aerophagia helps find effective solutions and improve comfort.
Why CPAP Users Experience Air in the Stomach
The pressurized air delivered by a CPAP machine can sometimes find its way into the stomach, leading to aerophagia. CPAP pressure settings that are too high or too low are a common reason. If the pressure is excessively high, the force of the air can push past the esophageal sphincter, directing air into the gastrointestinal tract. Conversely, if the pressure is too low, the body may instinctively gulp for air to compensate for inadequate therapy, inadvertently forcing air into the esophagus.
During sleep, muscles, including esophageal muscles, naturally relax. This relaxation can weaken the separation between the windpipe and the esophagus, making it easier for air from the CPAP machine to be pushed into the stomach. Another contributing factor is a poor mask fit, which can lead to air leaks around the mask. When air leaks, the body might try to compensate by breathing through the mouth, causing additional air swallowing.
Nasal congestion also plays a significant role in CPAP-induced aerophagia. When nasal passages are blocked, individuals may resort to mouth breathing. This mouth breathing, especially with CPAP pressure, can result in more air being swallowed. Difficulty coordinating breathing with continuous pressure, particularly at mid to high settings, can also lead to inconsistent breathing patterns and air swallowing.
Effective Strategies to Reduce Aerophagia
Optimizing CPAP pressure settings minimizes aerophagia. Working with a healthcare provider to fine-tune the pressure ensures it is effective for sleep apnea without being so high that it forces air into the stomach. Switching to an auto-adjusting positive airway pressure (APAP) or bilevel positive airway pressure (BiPAP) machine can be beneficial. These devices adjust pressure throughout the night or provide different pressures for inhalation and exhalation, which may reduce air swallowing.
Many CPAP machines also feature a “ramp” setting that gradually increases pressure as you fall asleep, easing adaptation and potentially reducing initial air gulping. The Expiratory Pressure Relief (EPR) feature, available on many machines, also lowers pressure during exhalation, making breathing more comfortable and decreasing the likelihood of aerophagia.
Improving mask fit and selecting an appropriate mask type can significantly reduce air swallowing. A properly fitted mask prevents air leaks, which often trigger compensatory mouth breathing and air gulping. While full-face masks cover both the nose and mouth, nasal masks or nasal pillows are often recommended for individuals experiencing aerophagia. For those who tend to breathe through their mouths, a chin strap can help keep the mouth closed during sleep, preventing air leakage and subsequent air swallowing.
Addressing nasal congestion is another important step to prevent mouth breathing and aerophagia. Keeping nasal passages clear allows for more natural nasal breathing during CPAP therapy. Saline rinses or nasal sprays can effectively reduce congestion and keep nasal passages moist. Using a CPAP machine with a heated humidifier or heated tubing also adds moisture to the air, which can soothe airways, thin mucus, and alleviate dryness that might otherwise encourage mouth breathing.
Adjusting sleeping position can also help manage air in the stomach. Sleeping on one’s side, rather than on the back, can reduce the likelihood of air swallowing by better aligning the airway and alleviating pressure on the stomach. Elevating the head or upper body can also help to prevent air from entering the stomach and may reduce gastroesophageal reflux, which can worsen bloating.
Beyond CPAP adjustments, lifestyle and dietary considerations can play a role. Avoiding carbonated beverages, chewing gum, and large meals close to bedtime can help reduce overall gas production and the amount of air swallowed. Eating slowly can also minimize inadvertent air intake.
When to Seek Medical Advice
While many instances of CPAP-induced aerophagia can be managed with adjustments to equipment or habits, there are situations when consulting a healthcare professional is advisable. If symptoms of aerophagia, such as bloating, burping, or abdominal discomfort, are persistent or worsen despite trying various home remedies, seek medical guidance. This persistence could indicate that the current CPAP settings are not appropriate or that other underlying factors are contributing to the issue.
It is also important to seek medical advice if severe abdominal pain, significant changes in bowel habits like diarrhea or constipation, or blood in the stool occur alongside aerophagia. These symptoms could suggest other gastrointestinal conditions that require diagnosis and treatment. If aerophagia significantly impacts the ability to consistently use the CPAP machine, a doctor can help find solutions to improve adherence. A healthcare provider can assess the situation, rule out other potential medical conditions, and offer personalized adjustments to the CPAP therapy or suggest alternative approaches.