Continuous Positive Airway Pressure (CPAP) therapy is a widely used treatment for sleep apnea, a condition where breathing repeatedly stops and starts during sleep. While CPAP machines are highly effective in maintaining open airways and improving sleep quality, some users may encounter side effects. One such side effect, often referred to as “CPAP belly syndrome,” involves uncomfortable abdominal issues.
Understanding CPAP Belly Syndrome
CPAP belly syndrome is bloating, gas, or abdominal discomfort that can arise from using a CPAP machine. Users frequently report symptoms such as a distended abdomen, fullness, burping, and flatulence, particularly upon waking or during the night. This accumulation of excess gas in the digestive tract can lead to stomach pain. While generally not dangerous, these symptoms can be bothersome.
Why CPAP Belly Syndrome Occurs
The mechanism behind CPAP belly syndrome is aerophagia, or involuntary air swallowing. When using a CPAP machine, a continuous stream of pressurized air is delivered to keep the airway open. However, during sleep, the muscles in the esophagus can relax. This relaxation can allow some of the pressurized air meant for the lungs to be inadvertently pushed into the esophagus and into the stomach and intestines.
Several factors can contribute to this air swallowing. Incorrect CPAP pressure settings, whether too high or too low, can play a role. If the pressure is too high, excess air may be forced into the esophagus. Conversely, if the pressure is too low to adequately resolve apnea events, individuals might gulp air in an attempt to breathe more deeply, also leading to air being swallowed. Mouth breathing during CPAP use and certain sleeping positions can further increase the likelihood of aerophagia.
Strategies to Alleviate CPAP Belly Syndrome
Addressing CPAP belly syndrome often involves adjustments to therapy and lifestyle. Consulting a doctor to review CPAP pressure settings is a good first step. An optimal pressure setting is necessary to effectively treat sleep apnea while minimizing air swallowing. Your doctor may suggest a new titration study or consider switching to an auto-adjusting positive airway pressure (APAP) machine, which automatically adjusts pressure throughout the night, potentially reducing overall pressure exposure. Bilevel positive airway pressure (BiPAP) machines, which deliver different pressures for inhalation and exhalation, can also be easier to tolerate for some users.
Ensuring a proper mask fit is also important to prevent air leakage. Exploring different mask types, such as switching from a full-face mask to a nasal mask or nasal pillows, may encourage nasal breathing and reduce the risk of aerophagia. For those who habitually breathe through their mouth, a chin strap can help keep the mouth closed during sleep.
Adjusting sleeping positions can also offer relief. Sleeping on one’s side or elevating the head of the bed to about 30 degrees can help reduce the likelihood of air entering the stomach. This can be achieved with a wedge pillow or by raising the head of the bed with blocks. Additionally, avoiding certain foods or drinks before bed that contribute to gas, such as carbonated beverages, alcohol, and heavy meals, may help reduce symptoms. If symptoms persist or become severe, including chest pressure or pain, blood in stool, vomiting, diarrhea, worsening heartburn, abdominal pain, or weight loss, it is important to consult a doctor to rule out other underlying conditions.