CPAP Therapy Tips

BiPAP May Offer Relief for Aerophagia Sufferers

After using your CPAP machine overnight, do you sometimes feel bloated? The cause may be aerophagia, a condition that happens from swallowing air while getting your CPAP therapy. Did you know that BiPAP machines can be used to help relieve the symptoms of aerophagia? This article will show you how some people are having success with BiPAP machines as a way to prevent aerophagia, creating a more restful sleep.

Since it was first introduced in 1980, continuous positive airway pressure, or CPAP, has revolutionized the treatment of Sleep Apnea, reducing the serious risks associated with the condition as well as helping millions of men and women get restful, restorative sleep. Still, as helpful as CPAP therapy can be in alleviating the symptoms of Obstructive Sleep Apnea and ensuring normal breathing during sleep, the therapy does have a few side effects – and sometimes, those side effects can be bothersome enough to interfere with the therapy itself.

Getting used to the feeling of the mask is one side effect that most patients are able to overcome with just a little patience. But other CPAP side effects can be more long-lasting – and more uncomfortable. One of the most annoying CPAP side effects is aerophagia.

What is Aerophagia?

Aerophagia is a condition that occurs when air enters the gastrointestinal tract, including the stomach and intestines. As air builds up, it can cause considerable discomfort in the belly and bowels. The most common symptoms of aerophagia include:

  • belly bloating
  • stomachache
  • burping
  • flatulence
  • an uncomfortable feeling of being distended or “full”
  • acid reflux and “heartburn”

Anyone can experience aerophagia, including people who aren’t using CPAP and people who don’t have Sleep Apnea. Aerophagia can also occur if we eat too quickly and swallow a considerable amount of air along with our food. It can also occur when we talk while we eat if we’re breathing heavily from anxiety or exercise, or even as a side effect of smoking. In these instances, modifying our habits – eating more slowly, giving up smoking and avoiding talking while eating, for instance – can reduce symptoms and eliminate the problem entirely. But for those using CPAP, aerophagia typically occurs as a result of the therapy itself, as air from the CPAP machine enters the esophagus during sleep, resulting in bloating, discomfort and other symptoms.

CPAP and Aerophagia Treatment

Aerophagia doesn’t occur in all people who use CPAP, but it’s not an uncommon side effect either. And for those who experienced aerophagia – especially on a regular basis – as a result of their CPAP therapy, it can become a serious problem, not only interfering with quality of life, but also making it far more likely the patient will stop using their CPAP machine or use it only intermittently, significantly increasing their risks of apnea-related health problems.

In some cases, aerophagia symptoms may be eliminated by adjusting the machine’s pressure – either increasing it or decreasing it, depending on your symptoms – or by using a different mask, especially if you tend to be a mouth-breather and your machine is equipped with a standard nasal mask. But for many patients, aerophagia symptoms persist despite these changes.

The good news: A recent study published by the Sleep Research Society shows that for patients who suffer from aerophagia, the solution could be as simple as swapping out the CPAP machine for a BiPAP machine.

In their study, the researchers looked at a group of 14 patients who used CPAP and experienced aerophagia regularly as a result of their therapy. When these patients were “switched” from CPAP to BiPAP, nearly all of them – roughly three-quarters – experienced resolution of their aerophagia symptoms. What’s more, the mean number of apnea events (designated by AHI or apnea-hypopnea index) also decreased, from 7.25 (indicating mild apnea) to 2.71 (indicating normal).

CPAP vs BiPAP

Why is BiPAP associated with fewer symptoms of aerophagia? The study results suggest it most likely has to do with the way air is delivered during therapy. Just like CPAP, BiPAP is designed to provide positive airway pressure to help keep the airways open during sleep. The primary difference between CPAP and BiPAP is the way the airflow is delivered to the patient.

While a CPAP machine delivers a steady stream of air at roughly the same pressure level, regardless of whether you’re inhaling or exhaling, a BiPAP machine automatically senses inhalation and exhalation, adjusting the airflow and pressure to suit. That means that when you exhale, the machine adjusts airflow automatically, decreasing the airflow while still providing enough pressure to prevent the airway from collapsing. As with CPAP, BiPAP settings can be adjusted specifically for each patient to decrease apnea events while also optimizing airflow for maximum comfort.

For people suffering from aerophagia as a side effect of CPAP, the bilevel delivery system of the BiPAP machine means there’s less air being “pumped in” during exhalation – and that means it’s less likely air will enter the esophagus instead of the trachea, or windpipe.

 

Is BiPAP right for you?

Every medical treatment has one thing in common: In order for treatment to be effective, you have to be compliant. If you suffer from aerophagia symptoms or if you have other issues with your CPAP therapy, call your doctor’s office and schedule an appointment to learn about options that can make your therapy more comfortable – and more effective. Sometimes, the solution you need could be as simple as a pressure adjustment – other times, a different mask or an entirely different machine may be just what you need.

David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.

13 Comments

  1. I, on the other hand, was not aware of aerophagia until I was on a Bi-Pap machine.

  2. Thank you so very very much. I have bloating almost every morning or it actually awakens me during the night and I must remove my mask. I will notify my doctor. Thanks again. NN

  3. would I call where I get my supplies from my doctor would not know much about my machine she is just my family doctor please get back with me I think I have this problem because I know my mask is not fitting right on me I hear the air leaking out of my mask and it is getting in my eyes every night and then I get sore eyes discomfort in my belly I have reflex stomachache I wake up every morning with a dry mouth and I have been on my machine for a long time never tried to many mask maybe like 3 or 4 please get back with me thanks so much hope you can help me out here.

    • To reduce the amount of air blowing in your eyes, you can look for a product called an eye mask, that shields your eyes from the exhaust from the mask. It’s normal for a mask to vent air. Where you should be concerned is if the air is shooting out the sides of the mask. The easiest solution is to try tightening and repositioning the mask, and if that doesn’t work consider getting a different mask. If you have more questions, consider reaching out to our team of CPAP experts at 1-800-356-5221. They’re available to help answer questions about your treatment, and help solve CPAP problems.

  4. I began using a CPAP machine the end of June. I was doing pretty well with it, but my doctor wanted to reduce the number of apnea incidents per hour. I switched to a Bipap machine in October. It is now almost the end of the year. I have experienced so much more abdominal pain, bloating, gas and change in bowels. I have even woken up a number of times coughing and gagging, belching, and thought I was going to throw up in my mask. I last saw my doctor the first part of December and he lowered the pressure. This has not helped In the last 5-6 weeks I soiled my undies a number of times as I thought I was just passing gas. Yesterday was a horrible day as I had diarrhea all day into the evening. I’m to the point where I either want to go back to the CPAP machine or forget it all together.

    • Hi Melissa, I am very sorry to hear that you’re having some problems with getting use to your BiPAP machine. Even though you had a visit with your doctor at the beginning of December, I would encourage you to speak with your doctor once again about your concerns. Your settings may need to be adjusted again.

      We wish you the best

  5. I’ve been on a BiPap for severe apnea for almost 3 weeks….and it’s been pretty miserable! Some nights I swallow so much air…others are not too bad. I wear a cotton eye mask to protect my eyes and have tried a cheapie mouth night guard, but think I’m going to have my dentist make a custom one. Not only is the gas an issue, but my mouth is so terribly dry (I’m a mouth breather) that I have a hard time even puckering up to drink from my straw to lubricate my mouth. I tried the spray…that does nothing. I have a humidifier on my machine, but if I set it high, it runs out. I haven’t had more than 2 hrs. sleep at a time since I drug this machine home! The sleep doctor says I can’t use the nasal pillows because of mouth breathing, but I think I’ve read that is not necessarily true.
    He had my pressure very high and I couldn’t tolerate it, so I’m to 12/8, but he keeps telling me he’s only 1/2 treating me. I’m on my third mask. My current one pushes up against my nose and goes just under my lip. It’s very flexible. (That does not translate to very comfortable) Here’s a tip a friend gave me: wet your finger and lightly wet the edge of the mask all the way around and you get a better seal. That really helped.
    So my sleep doctor says we are running out of options and I am very frustrated because I must make this work for my health sake. I would welcome any suggestions…especially for the dry mouth. Thanks!

    • Hi Katie, I am sorry to hear that you are having some difficulties with your Sleep Apnea Therapy. It does take some time to get use to your Sleep Therapy, but the issues that you are having usually gets better.

      Normally, when you experience severe dry mouth, it is an indication that your mouth is falling open during your sleep. If you are already using a full face mask, please make certain that your mask is a good fit and does not have any leaks.

      Also, if you are not able to get use to the full face mask, there are other options, such as trying a Nasal, or Nasal Pillow Mask in conjunction with a Chinstrap, or an Oral Mask.

      If you are not already using a heated hose, you may want to consider getting one. This may help lessen your dry mouth symptoms also.

      Please let us know if there is anything further that we can assist you with. We can be reached at: 1-800-356-5221, or via e-mail: cpap@cpap.com.

      Enjoy your weekend!

      Carol M.

    • Katie, Your comments could have so easily been written by me…I think I may be a clone of you or vice verse. I went through three full-face masks and was totally, completely miserable. Sleep doctor set pressures at 18/12 on my BiPap. I could not tolerate it that high. Finally convinced him to lower twice to 12/8 which works well for me.
      Got the PA to listen to me and let me try the pillow mask I think you have which fits under my nose. When I feel air leaking, I pull the back strap a bit tighter at the back of my head and it helps. I’ve done the wetting thing, too, but don’t seem to need that anymore. For me, having the hose connect at the top of my head is so much better than the elephant trunk hose. The doctor told me I couldn’t use that type of mask because I am a mouth breather, too. I do have a pretty strong chin strap and that helps. Are you using a chin strap?
      I’ve gone from 63.3 episodes of stopping breathing per hour to 10.9. That’s a pretty major improvement. You have to be persistent with these doctors. I was told I was only being 1/2 treated. Also kept telling me we were running out of options. (I call baloney on that…there are many options to try!!) Do these guys have a manual of what to say??? I told him 1/2 was better than not at all! At three weeks, I was still miserable….it takes more time to adjust. I’d say it took me a couple of months, mostly because of the masks he insisted I had to use. Hang in there.
      The spray did not help and my mouth still gets dry, but it’s not as bad as the full face masks. I couldn’t pucker to drink from a straw, either. I am seeing the dentist about getting an appliance made next week. I think you are on the right track and it will just take more time. If you aren’t using a chin strap that will hold your mouth fairly closed, I would add that. I have the mask, a chin strap and an eye mask at night.
      My issue is the gas now. I had an Upper GI barium swallow and all was ok except for acid reflux, so I will try taking meds. at dinner time and see if that helps. You will conquer this, Katie. Just allow yourself a longer adjustment period. Everyone tells me it takes 2-3 months to acclimate yourself to it.
      You got this, Katie!!
      PS. I just saw your post was two months ago, I hope you are doing better by now!!

  6. I have been using a ResMed BiPAP machine for more than 18 months and find an occasional episode where I feel as though I am blown up like a balloon. This happened last evening which caused me to awaken and stop using the equipment. I find when this occurs, I have to sit on the commode flatulate plus burp for a half hour to get rid of the chest pain. When this first occurred, I felt as though I was having perhaps a heart issue. I just learned of the term arephasia. I’ve spent several hours reading up and find it what I’m experiencing perhaps is a common problem.

    Since I am on a BiPAP machine, what is recommended I do. This occurs probably once every 3 or 4 weeks. Also, are there serious consequences for when this occurs if not properly addressed?

    • Hello James, i’m sorry that you are having bloating problems. You are correct, it certainly sounds like the condition that you are experiencing is Aerophagia. I would recommend that you speak with your doctor to let him know that this is happening. Your doctor may choose to decrease your pressure settings.

      Also, you may try sleeping in a different position to get relief from the bloating. When possible, try to lay in a position which allows the chin to remain above the torso.

      Please feel free to contact us with further questions, or concerns at: 1-800-356-5221.

      We wish you the best!

  7. JAMES‼️ I cannot tell you How Much I Appreciate this article & your research & your knowledge & the ‘miracle’ of my Finding this Today‼️

    I had asked my Sleep Apnea Dr. if I could Switch to a BiPap Machine from my CPAP I’ve Been using for 4 Years!! First, they told me “I Had to ASK”—✔️, I DID THAT”!!!

    Then, they said I had to Take Another Sleep Test—“✔️✔️, I DID THAT”!! I even Told & ASKED my Technician, Paul, WHY I was there (Because I believed my CPAP was Causing my Continual & Painful Belly Bloating & Burping & Flatulence, I ASKED Him—IF I Could TRY a BiPap for Part of That Night!!✔️✔️✔️

    He Never answered me—That’s Truly Frustrating & Demeaning!! So, after waking me up (& Yes, I was Confused—where I was; where were my Husband & doggies, my bed, my bedroom, etc.—I answered All his questions—…TRUMP IS OUR PREZ!!!) I asked WHY
    He had NOT woken me up to Try a BiPap—To which he said, “I HAD TO ASK!”!!! I DID/HAD‼️✔️✔️✔️✔️

    Then, Today, I got a call from their Office, saying, “I had passed the CPAP Test & So, Medicare would NOT Pay For (I’m 66 yo—Medicare or my Supplemental Insurance has Always Paid for Everything since I turned 65–Just like it’s Supposed to!!!!) a BiPap Machine, “THE ONLY WAY TO GET/TRY ONE IS FOR ME TO BUY IT, MYSELF”‼️‼️😱😱😱

    Well, all I could find Online, at First, ranged from $1,100 to $1,800!!!!! Are You kidding me???!!!

    Then, I went to Amazon Prime & there, it said I Could Get One FREE, IF I paid for using a Kindle (which I Already have!). WHAT A DEAL!!!!

    Thing is, one person on the phone today told me I STILL Would Need a Prescription from my Dr.—Well, IF I could Get That, Medicare Would Pay For it, Right??!!!✔️✔️✔️✔️✔️

    What a Ridiculous “Catch 22”‼️ SO, NOW, my sweet Hubby, Mel, Copied this article & I’m Taking it to my Dr. Tomorrow!!!! I will Update you when I get one…..

    BUT, THANK YOU SO VERY MUCH FOR YOUR RESEARCH, KNOWLEDGE, EFFORTS & POSTING THIS ONLINE‼️ I Will Forever be Indebted to you‼️🙌🙌

    Honestly, GOD BLESS YOU FOR ‘Saving (Making it a LOT BETTER) My LIFE’‼️❤️❤️🙌🙌🙌🙌🙏🙏🙏

    WELL, WHO & HOW MANY MORE TIMES???!!!!!

    • Hi Rosemary, it sounds like you have had a really tough time getting the service that you need and deserve. I am very sorry to hear about the frustrations that you have faced.

      I am however, very happy to hear that you found the article helpful and we hope that with you being able to provide your doctor a direct source from where you are receiving your information, that he will consider providing you with a prescription, so that you may get the treatment that may be beneficial to you.

      If you ever have any questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      We wish you the very best!

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