Continuous Positive Airway Pressure (CPAP) therapy is a widely adopted treatment for sleep apnea, effectively maintaining an open airway during sleep. However, some individuals experience a common side effect known as aerophagia, or air swallowing. While this can lead to discomfort, various practical strategies often provide relief.
Understanding Swallowing Air with CPAP
Aerophagia, or air swallowing, is the unintentional swallowing of excessive air, leading to its accumulation in the gastrointestinal tract. This can cause symptoms like bloating, abdominal discomfort, frequent burping, and flatulence. Approximately 16% to 50% of CPAP users experience aerophagia.
This phenomenon occurs during CPAP therapy because the machine delivers a continuous stream of pressurized air to keep the airway open. During sleep, the esophagus muscles relax, allowing pressurized air intended for the lungs to enter the stomach instead. Factors contributing to this include excessive air pressure from the CPAP machine, breathing through the mouth during therapy, or leaks around the mask.
Adjusting Your CPAP Setup
High pressure settings on a CPAP device can force more air into the esophagus, potentially leading to aerophagia. Consulting a sleep specialist to evaluate if a slight pressure reduction is appropriate can be beneficial, ensuring effective sleep apnea treatment.
Many modern CPAP machines include comfort features like ramp time and Expiratory Pressure Relief (EPR) or C-Flex. The ramp feature gradually increases pressure, allowing for easier adjustment to therapy at the beginning of the night. EPR and C-Flex reduce air pressure during exhalation, making it more comfortable to breathe out against incoming airflow. Activating or adjusting these settings can help prevent air from being forced into the stomach.
The fit and type of your CPAP mask also play a role in aerophagia. A mask that does not seal properly can lead to air leaks, causing the machine to deliver higher pressure to compensate and increasing the likelihood of air swallowing. Ensuring a snug, but not overly tight, mask fit is important. Nasal masks may also cause less air swallowing compared to full-face masks, as they promote nasal breathing.
Dry air from the CPAP machine can irritate nasal passages and the throat, leading to mouth opening and subsequent air swallowing. Utilizing the humidifier on your CPAP machine adds moisture, reducing dryness and discomfort. Proper humidification helps maintain comfortable airways and prevents mouth breathing.
Modifying Your Habits and Sleep Position
Addressing mouth breathing during CPAP therapy is a common strategy to reduce aerophagia. For nasal mask users who open their mouths during sleep, a chin strap can help keep the mouth closed, preventing air from escaping and being swallowed. Alternatively, switching to a full-face mask, which covers both the nose and mouth, can be effective for mouth breathers.
Your sleeping position can influence the likelihood of air swallowing. Sleeping on your back may increase the risk of air entering the stomach due to gravity and potential airway obstruction, which can necessitate higher CPAP pressure. Trying a side-sleeping position can help reduce aerophagia, potentially reducing the pressure level needed to keep the airway open. Elevating the head and upper body slightly with a wedge pillow can encourage air to stay in the lungs.
Certain eating and drinking habits before bed can exacerbate gas and bloating, potentially worsening aerophagia symptoms. Avoiding heavy meals, carbonated beverages, and gas-producing foods close to bedtime can reduce overall stomach gas. Eating slowly and avoiding talking while eating can prevent swallowing excess air throughout the day.
When to Consult Your Doctor
While many self-adjustments can help manage aerophagia, it is important to consult a healthcare provider when symptoms persist or become severe. If significant bloating, belching, or flatulence persists despite various solutions, medical advice is warranted. A doctor can assess whether your CPAP pressure settings need fine-tuning or if an alternative type of positive airway pressure (PAP) device, such as an auto-adjusting positive airway pressure (APAP) or bilevel positive airway pressure (BiPAP) machine, might be more suitable for reducing air swallowing.
Seek medical attention if aerophagia is accompanied by concerning symptoms like chest pain, blood in stool, vomiting, diarrhea, worsening heartburn, or unexplained weight loss, as these could indicate other underlying health issues. A sleep specialist can provide personalized guidance, adjust therapy parameters, and rule out other gastrointestinal conditions, ensuring effective and comfortable CPAP therapy.