Continuous positive airway pressure (CPAP) therapy provides a consistent flow of air to help keep your upper airway open to prevent it from collapsing while you’re sleeping. When tolerated and patients are compliant, it’s extremely effective for preventing Sleep Apnea.
Some people experience CPAP-related gas due to aerophagia, which is one of a handful of common CPAP side effects you should be aware of when starting therapy.
What is Aerophagia?
Aerophagia is excessive air swallowing. It’s a condition that occurs when you have air entering your gastrointestinal tract, including your intestines and stomach. As this air builds up, it can cause significant discomfort in your bowels and belly. The most common aerophagia symptoms are:
- Belly bloating
- Heartburn and acid reflux
- An uncomfortable “full” feeling
Anybody can experience aerophagia, even individuals who don’t use CPAP and those who don’t have Sleep Apnea.
Causes of Swallowing Air with CPAP
Some causes of aerophagia may include:
- Pressure is set too high: Your CPAP pressure could be set too high or higher than you need. The extra air you get has no place else to go, but to your esophagus and then belly.
- Pressure is set too low: You may have your pressure set too low where it’s too inadequate to resolve your apnea episodes. As you’re trying to obtain more air in your lungs, you end up quickly gulping air which is forced into your esophagus instead.
- Nasal congestion: You could have nasal congestion from allergies, a cold or the flu. When you have a stuffy nose, you might not be able to get the right CPAP air pressure you require, therefore you gulp the air by mouth and there it goes, down into your esophagus.
- Mouth breathing: You might be a mouth breather and wears a traditional nasal mask. When your mouth opens up while you’re sleeping, the CPAP machine may not be able to deliver the air to your longs, but rather the air escapes through your mouth. Your apnea episodes aren’t being corrected, therefore in your unconscious panic; you could suddenly experience a choking sensation and gulp the air in rapidly, forcing it into your esophagus.
- Exhalation problems: You might be having trouble exhaling over the consistent air pressure CPAP delivers. This is particularly hard for individuals using mid- to high-CPAP pressures. When you inhale high pressures, it might be simple, but exhaling might cause panic, anxiety and a feeling of choking or suffocation. When this occurs, you might fall out of your natural breathing rhythm and start hyperventilating. This may lead to quickly gulping or sucking in air, forcing it into your esophagus instead of your lungs.
Solutions for Swallowing Air with CPAP
If you’re swallowing air with CPAP, here are some aerophagia solutions you can try:
1. Check the Pressure Settings
If you think your CPAP device’s air pressure isn’t adequate (too low or too high), talk with your doctor or sleep professional about a pressure change. Confirm the machine is set correctly per your doctor’s prescription with your CPAP provider. Occasionally, mistakes can occur and your CPAP won’t be set correctly.
2. Check Your Mask
Figure out if you’re using the wrong mask. For instance, a nasal mask isn’t the best choice if you’re a mouth breather. Your mask might not be the best style or size for your face. If you’re experiencing pressure point soreness from the straps being too tight or a frequent mask leak, consider picking a different mask.
Ensure you know how to fit and adjust your mask properly for the best seal. Once you’ve selected the best mask style and size for your face, you need to properly adjust it before going to sleep. Turn your machine on and put the mask on your face with loose straps. Lie down in the same position you normally do when sleeping with head on the pillow. Then, pull the straps slowly until you acquire a good seal. If there’s a dual cushion in your mask, it will need to be seated.
Once you’ve adjusted and fitted the mask, you’ll pull the mask out gently and away from your face to “seat” it and allow the dual cushions to properly inflate. Gently place the mask back onto your face. You should know by how it feels if it’s a comfortable seal.
3. Obtain Expiratory Pressure Relief
Most CPAP machines today have expiratory pressure relief features. They may be called BIFLEX or AFLEX, depending on the machine brand. This feature reduces air pressure automatically upon exhalation and could help decrease or eliminate aerophagia. Talk with your CPAP provider to see if you have this feature enabled on your machine. You need to control this feature manually, so be sure you ask how to use it.
4. Adjust Your Sleep Position
Your sleep position is another essential factor. If you normally sleep on your back, it might be better to sleep at an incline which can prevent a “kink” in your esophagus that could cause it to easily allow air flow into your stomach. Many individuals find sleeping with their head up at a 30 to 40 degrees angle to be helpful. You can use a pillow wedge to accomplish this.
5. Try a BiPAP Machine
Bilevel positive airway pressure machines, or BiPAP machines can help relieve aerophagia symptoms. For individuals suffering from aerophagia as a CPAP side effect, the BiPAP machine’s bilevel delivery system means you’ll have less air during exhalation being “pumped in” and this means it’s less likely you’ll have air entering your esophagus instead of your windpipe.
6. Try an APAP Machine
Automated positive airway pressure, or APAP machines, connect with a non-invasive mask connected to a pressure generator designed for delivering air pressure to maintain open airways while you’re sleeping.
In one study, switching from a CPAP machine to an APAP machine led to reduced aerophagia symptom severity. The group of patients being treated with APAP saw substantially decreased median therapeutic pressure levels when compared with the patients using CPAP.
Figuring out what’s causing your aerophagia is essential to resolve it. Extreme air swallowing can be very uncomfortable, particularly if your CPAP settings aren’t optimized. Be sure to talk with your CPAP sleep doctor about this problem to help determine the causes and solutions unique to you. You can also call us here at CPAP.com at 1-800-356-5221 or use our live chat feature to talk to one of our CPAP experts.
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.
28 thoughts on “Swallowing Air with CPAP (Aerophagia): Causes and Solutions”
I am using Res med cpap machine air sense 10 and air touch F-20 large mask. My problem is with the mask. I wake up middle of the night and my mask is leaking and dry mouth. I tried using the medium size but it give me the same result. My cpap machine is set to 12% air flow. How can I solve this problem, please help!
Hi Cesar, I am sorry to hear that you are having a problem with your mask leaking. Have you been fitted for the correct size mask? Also, have you tried any other full face masks? Keep in mind that not all masks will work for everyone. You may want to try a different mask if you are not able to get a good fit and keep a seal with the AirFit F20.
If you would like assistance with troubleshooting your mask leak, or maybe selecting a different mask we will be more than happy to assist you. We can be reached at: 1-800-356-5221.
Enjoy your day!
Hi, I am a 2 year CPAP user. Approximately 1 year, or so, ago, I began having stomach aches, every morning after 6–8 hours of sleep. They are above my belly button side to side. No belching, maybe a hiccup once and a while and gas only from time to time. My pressure was lowered from 14 to 12. No relief. The ache goes away a few hours after I’m upright for the most part. I’m seeing a specialist soon to see what’s up. My events are still below .5. I use full face mask. Amara View. Very limited moisture due to sinus stuffiness at high moisture.
Hi Thomas, i’m very sorry to hear that you are experiencing some discomfort during your therapy. I hope your specialist is able to make adjustments to your settings to provide you some relief.
We’d love to hear what advice your specialist gives you, if you’d like to share!
Enjoy your day!
A couple of times I have awakened to an extremely dry mouth and throat and my heart pounding. My throat and mouth are so dry I cannot swallow without water. Scary!
Hi Debra, I am sorry to hear that you are experiencing some side effects while treating your Sleep Apnea. The symptoms that you are having with dry mouth and throat, is an indication that your mouth is falling open during your sleep. What type of mask are you using? If you are currently using a Nasal, or Nasal Pillow Mask which is comfortable for you, I would encourage you to use a Chin Strap also. You may also consider changing to a Full Face Mask, this will allow your nose and mouth to be covered during your sleep. Are you using a humidifier? If not this could possibly decrease the dryness that you are feeling. If you are using a humidifier, you may need to increase the humidity.
Please see the link below for other FAQ’s to other side effects that you may experience with the use of CPAP Therapy.
If you would like to go through troubleshooting over the phone, or need assistance with adjusting your settings to your comfort, please feel free to reach us at: 1-800-356-5221.
We wish you the best!
I have a respiring sure dream station biosphere machine. Have used it for about 4 years. Hugely improved quality of my sleep. However I’ve had tremendous difficulty swallowing air. Terrible pain. Some adjustments in pressure make it worse some only slightly better. In the last 2-3 months I’ve had aching in the left side of my chest. Worse in the morning, better as the day progresses, gone by nite. I tried all kinds of things to see what might be causing it. Finally 2 nites ago slept without using my machine and the aching was essentially gone. So I’m pretty sure it’s related to swallowing air. Should I be concerned. What are my options? Would an APAP machine be better for me? Thanks
Hey Lisa, i’m glad to hear that your therapy has improved your sleep quality. Swallowing air during CPAP Therapy is a common problem. Please see the link below for information on the effect that you are experiencing.
Also, if you are currently using a CPAP Machine (single pressure) and it is providing more pressure than you feel is needed, an APAP machine could help solve the problem. This is a machine that will provide the amount of pressure that you need on a breath-by=breath basis.
I would encourage you to speak with your doctor about how you are feeling, this will ensure that you are being provided proper guidance and getting the most optimum treatment catered to meet your needs.
For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or e-mail us at: email@example.com.
Have a wonderful day!
I got my cpap machine just recently. Have only one lung and find that am unable to use is as my abdomen is so distended and hard within 10min. Do you think having only one lung is causing the air to go via oesophagus in abdomen. I had to rip it off after 15mins.
Hi Gail, my apologies, but i’m not certain. My suggestion, would be for you to speak directly with your doctor. Your doctor, may find that an adjustment to your settings is required. Also, keep in mind, that it may take more time for you to become acclimated to using CPAP Therapy.
We wish you the best!
I a a brand new CPAP user. The first few night were fine. Then, I began to be awakened by my mouth being full of air to the point where I have to expel it in a big burst of an exhale. I keep my mouth closed while I sleep, so it is like a balloon bursting.
Hi Joanne, my apologies for the delay. There are a few suggestions you may consider. You may try sleeping in a different position such as, lay on the left side or rotate to the right side. Incline with pillows or lay flat. Also, you may want to speak with your doctor, as they may make a medical decision to lower your pressure. A lot of customers benefit from using an APAP, this is a machine that auto-adjusts your pressure on a breath-by-breath basis.
Please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: firstname.lastname@example.org, with any further questions, or concerns.
We wish you the best!
I have been using my Resmed 10 CPAP Machine off and on for about 6 weeks. Tried many different masks and adjustments.
But one problem remains: about 1 1/2 – 2 hours into the therapy every night, I am suddenly awaken by a confusion of air pressure in my full face mask. I suddenly feel as though I’m not getting enough air or I’m getting an influx of too much air. The best sleep I’ve ever done without pressure interruption is about 4 – 5 hours. Yet to have a full 8 hour sleep.
I immediately remove the mask and do not use it CPAP for the remaining night.
I don’t think it is a mask leak issue because most of the time my machine registers a green face indicating a good seal most of the time after one of these episodes.
I tried adjusting the ramp pressure with mixed results.
I should mention that I am a side sleeper and mouth breather. I was told only a full mask will work best for me.
Your thoughts on this.
Hi Wayne, i’m sorry to hear that you’re having problems with your CPAP Therapy. Unfortunately, I am not certain as to what may be causing the issue with too much, or too little pressure.
I would recommend you speaking with your doctor about your concerns since they are able to analyze your data and determine if a setting adjustment, or another change of mask is warranted.
We wish you the best!
I have extreme bloat and gas from using my c-pap machine. I’ve just started using it. My stomach is very extended all day and night. So uncomfortable I have to wear stretch pants because my stomach is so big. What should I do?
Hi Martha, my apologies for the delayed response. It sounds like you are experiencing a common symptom in using CPAP Therapy, called Aerophagia. This means that you are basically swallowing too much air.
I would definitely, recommend you speaking with your doctor, as they make a decision to adjust your pressure setting. Also, you may try laying in a position that allows your chin to remain above the torso. You can try sleeping in different positions from your normal routine such as, laying on your left side, rotate to the right side, incline with pillows, or lay flat.
Another option is, if you are currently using a CPAP, your doctor, may make a medical decision to switch you to an APAP (auto-titrating) machine. The APAP, will allow the machine to adjust to the pressure that you need on a breath-by-breath basis.
For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: email@example.com.
We wish you the best!
I just recently started c-pap therapy and had to go to the hospital for excruciating abdominal pain from c-pap use I could barely walk and screamed out with each agonizing step I took to get dressed and into the vehicle…. after arriving and awaiting the doctor to come in and examine me.. I had 6 or 7 episodes of passing gas and by the time the ER doctor saw me I was my old self again. This pain was worse than having twins which I have.. I’ve tried the full faced mask and the nasal mask and wake up to rip it off my face. I’m a left side sleeper and just don’t know what to do. I’m awaiting to see my doctor. I will not use this machine if I’m going to be swallowing air… it’s too painful
Hi Ruby, i’m sorry to hear about the excruciating pain that you had to endure. It sounds like you were experiencing Aerophagia, which is exactly what you stated, swallowing too much air.
A visit to your doctor is very important as they may make a decision to lower your pressure settings to help improve your comfort. Some CPAP users, are able to notice some improvement by changing their sleeping position to keep the air out of the stomach.
You may try laying flat, switch from the left to the right side, or try to incline using pillows. There is no certainty that changing sleeping positions will help you, but it’s worth a try!
Please feel free to reach us at: 1-800-356-5221, with any further questions, or concerns.
We wish you the best!
I recently started using a CPAP machine and am having very uncomfortable symptoms of Aerophagia. I don’t have an appointment with my Dr. for a month. How can I relieve this pain? Is it dangerous? The pain is in abdomen stomach and chest up into throat. Should I stop using the CPAP? Norma
Hey Norma, i’m so sorry that you are experiencing problems with your CPAP therapy. We definitely, would not suggest that you stop your CPAP therapy and yes, if left untreated, Aerophagia, could be dangerous.
We would recommend you speaking with your doctor, but since your appointment is a month out, you may try sleeping in a position other than the one you are now. For instance, try sleeping in a position that allows your chin to remain above your torso. You can try laying on your left, or right side, incline with pillows or even lay flat.
If changing sleeping positions doesn’t provide you with any relief, your doctor may choose to decrease your pressure setting.
For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: 1-800-356-5221.
We wish you the best!
I have GERD reflux and have been using a CPAP machine for 5 years. I am on medication for the reflux but recently experienced burping and flatulence with increased reflux problems. I recently had a gastroscopy to investigate the reflux problems and the doctor said my symptoms were typical to aerophagia. I remember increasing the pressure on my CPAP 3 months going because of breathing problems with the mask and thought that may have been the problem. I have since turned the air pressure down but I still have the reflux issues. Do you have any tips to help reduce the reflux and aerophagia?
Hi Gary, i’m sorry to hear about the problems you are experiencing with your CPAP therapy. There really isn’t an easy, or for sure fix to Aerophagia, but there are a couple of things you can try.
Please try sleeping in a position to keep the air out of your stomach. Try to lay on your left side, rotate to the right side, incline with pillows, or lay flat. With changing sleeping positions, try to lay in a position which allows your chin to remain above your torso.
I understand that you’ve lowered your pressure, but you may want to speak with your doctor, so that they can view your sleep data and determine if your pressure should be lowered even more. Your doctor, may suggest that you switch to an APAP (auto-adjusting machine), as this will allow your pressure to change to what you need on a breath-by-breath basis.
Please feel free to contact us at: 1-800-356-5221, with any further questions, or concerns.
We wish you the best!
Hi I’m new to cpap therapy only started 2 weeks ago.
First week was great now into the second week and I’m wanting to give up as I’m waking up with excruciating pain across my shoulder blades.
I then struggle to go back to sleep as pain to bad
Once up pin does lesson but have an ache in my shoulders all day.
Any advice appreciated.
Hi Jennifer, i’m sorry to hear about the shoulder pain that you are experiencing. Unfortunately, I am not able to give a for certain response as to what is causing the pain.
You may try changing the position that you sleep in, you may benefit from the use of a CPAP pillow. Please see the links below to view a couple of the pillows that we stock.
This pillow is sold with free 45 day returns, less shipping, so if you try it and for any reason, choose not to keep it, simply return the pillow for a refund, or a different pillow.
This pillow isn’t sold with any trial period, but it does have great reviews.
If your shoulder pain persists, please contact your doctor for further guidance.
We wish you the best, have a great weekend!
Could aerophagia be linked to improved health? I’ve been using a C-PAP for about 12 months, and dropped from 38 episodes an hour to now usually less than one, certainly less than two. In recent weeks I’ve been waking feeling quite bloated, have a very big burp which tastes quite unpleasant, it’s not painful but it can be uncomfortable if it goes on a while, and sometimes I’ll have quite a loose bowel movement, as if my poo is aerated! I haven’t tried adjusting the pressure settings on my machine as it’s a relatively new issue. But I wondered if it could be linked to the general improvement in my sleep? Or are the two things likely to be unconnected?
Hi Richard, I’m sorry to hear that you are experiencing some difficulties with your CPAP therapy. I have no information to support the development of Aerophagia is due to improved health, but it is a common side-effect during CPAP therapy.
I would recommend you speaking with your doctor to see if a pressure setting adjustment is warranted. Also some CPAP users find it helpful to change their sleeping position. Try laying on the left side, or rotate to the right. Also, you may try inclining with pillows, or laying flat.
As the chin of a CPAP user nears the chest, air has a greater chance of entering the digestive tract. When possible, try to lay in a position which allows the chin to remain above the torso.
For further questions, or concerns, please give us a call at: 1-800-356-5221.
Hi – been reading all the comments here, and it’s confirming that I too have been suffering from Aerophagia with my machine. I recently had the pressure lowered to a 6 and the difference is incredible. On a two-week trip to Israel, with more fresh fruits and veggies, lots of walking and no more bloated feeling every day, I lost 12 pounds. Right before our trip I showed my doctor what appears to be a hernia in my belly – and it’s still there but reduced in size. I hope it wasn’t caused by Aerophagia, but the bloated feeling was just awful. Only problem now is that my apnea is back up to a 12-incident, so my sleep provider wants to raise the pressure. I’m so worried about gaining back this weight, being bloated or doing some other damage to my stomach. Advice? thanks!
Hey Peggy, i’m sorry for the delayed response. I’m sad to hear about the difficulties your experiencing with bloating. It sounds like lowering your pressure really helped with the bloated feeling you’re experiencing. What type of mask are you currently using (full-face, nasal, or nasal pillow)? Sometimes using the wrong type of mask, for your needs can cause therapy discomfort. If you’re a mouth-breather, and using a nasal, or nasal pillow mask, you should do so in conjunction with a chinstrap, or you must switch to a full-face mask.
In some cases, changing your sleep position, can provide some relief with Aerophagia. When possible, try to lay in a position which allows your chin to remain above your torso. You may try to lay on your left side, rotate to the right side, incline with pillows, or lay flat.
There isn’t an easy fix for complications with Aerophagia, its trial and error. The most important point is to remain open to speaking with your doctor about your symptoms and if you would like to speak with us, please feel free to call: 1-800-356-5221, or you may e-mail us at: firstname.lastname@example.org.