So, you have sleep apnea...
Every night, you strap a wind-tunnel to your face in the hope it will cut down the number of times you stop breathing during sleep.
Now, although PAP therapy is undoubtedly a life-extender, there are a bundle of side-effects you could experience… and bloating is just one of them.
Swallowing air (coz that’s all aerophagia is) can be a right pain in the… well lots of places actually. But what causes it?
For us sleep apnea patients, aerophagia usually comes down to why air gets into the foodway instead of the airway. A few key culprits include:
High CPAP Pressure Settings:
The most common cause of aerophagia is excessive air pressure from a CPAP/BiPAP/APAP (you get the idea) machine. If the pressure is too high, some of the air intended for your lungs can be forced down the wrong hole and into the stomach.
It’s exactly the opposite from when you drink something and start coughing when the liquid tries to get into your airway. Because breathing foreign stuff into your lungs can be fatal, we have evolved a great life-saving reflex… the cough.
Not so when it’s the other way around. Unless it’s something your body finds truly disgusting, such as nasty tasting or smelling toxins, it will just accept it at the door.
After all, eat a tin of baked beans and much of what you swallow is air… except it is a tiny amount of air when compared to the thousands of litres being force into you by a CPAP machine over the course of a night.
Dodgy Mask Fit:
If your mask doesn’t fit properly, air can escape around the edges and force you to swallow to compensate. Over time, this swallowing can lead to aerophagia.
However, it isn’t a case of just tightening the straps until your eyes pop. This can cause its own set of issues such as pressure marks on the skin, rosacea/rash, headaches, sore neck… and the list goes on.
My sleep clinic once described a good mask fit as being similar to a hovercraft. It should be tight enough to float on the surface but not too tight that it sinks-in. Finding this sweet-spot is often an ongoing task as both masks and headgear straps degrade over a few months on the path to replacement time.
Body Position During Sleep:
The way you sleep, especially if you’re lying flat on your back, can make it easier for air to enter your stomach. Certain sleeping positions can increase the likelihood of air swallowing. Other positions are not recommended by those in the know for other spine and neck issues.
So far, the only sleep position I’ve been able to identify as positive for sleep apnea users is to lay on your side and have something soft – like a pillow – between your knees.
Swallowing Reflex:
Some people naturally swallow more air due to involuntary habits or nervousness, which CPAP therapy can make worse. If this is you, it may be time to speak with your doctor.
Underlying Conditions:
Conditions like acid reflux (GERD) or a hiatal hernia (more on these below) can increase the likelihood of air entering the stomach. These conditions weaken the barrier we discussed earlier between your stomach and airway, making it easier for air to slip in.
Symptoms of Aerophagia
If you’ve been experiencing aerophagia, you might notice the following symptoms, especially in the morning or after waking up:
Bloating
Feeling overly full or tight in your abdomen, even if you haven’t eaten much.
Excessive Gas
Frequent belching or farting as your body tries to expel the extra air.
Abdominal Pain or Discomfort
Cramping or sharp pain in the stomach or guts, which can range from mild to severe.
Nausea
A queasy stomach or even vomiting due to the air buildup.
Difficulty Breathing or Chest Discomfort
Some people mistake the pressure of trapped air in the stomach for heart or lung issues. A happy moment ahead when they discover it isn’t so serious, but a pain none the less.
How Big Can You Go?
Not all bloating is created equal. Depending on how much air you are swallowing, the severity can range from mild puffiness to looking like there’s a balloon being blown up inside:
Mild Bloating:
This might feel like you’ve eaten a big meal, even if you haven’t. It’s usually manageable with simple adjustments and doesn’t significantly interfere with your day.
Moderate Bloating:
Your stomach might feel tight or even visibly swollen. You could experience cramping or pain that makes it hard to sleep or concentrate.
Severe Bloating:
In extreme cases, your belly may feel rock-hard, and the discomfort can be intense enough to mimic a more serious medical issue. Severe bloating can also lead to trouble breathing, as the pressure from your stomach pushes against your diaphragm.
Medical Conditions That Increase the Risk of Aerophagia
Certain pre-existing conditions can make you more susceptible to aerophagia:
GERD (Gastroesophageal Reflux Disease):
GERD weakens the lower esophageal sphincter, allowing air to enter the stomach more easily.
Hiatal Hernia:
This is when part of the stomach pushes up through the diaphragm, disrupting the normal flow of air and food.
Anxiety or Stress Disorders:
Stress can lead to habitual air swallowing, which CPAP therapy can make worse.
Obesity:
Extra abdominal fat can increase pressure in the guts, making it easier for air to get trapped.
Oesophageal Dysmotility:
More big words, but these conditions affect the oesophagus’s ability to move food or air efficiently and can increase the likelihood of aerophagia.
Tips for Avoiding Aerophagia
Preventing aerophagia often requires a combination of CPAP adjustments and lifestyle changes. In addition to the CPAP pressure settings, mask fit and sleeping position, mentioned earlier, lowering stress levels – perhaps through some relaxation techniques – and avoiding gassy drinks and food can help. And, yes, this does include Baked Beans!
Recovery Tips
If you’re already dealing with aerophagia, here are some steps others have found to ease the discomfort:
Release Trapped Air:
- Gentle yoga poses like child’s pose or the wind-relieving pose (aptly named!) can help expel excess gas.
- Light abdominal massage can also encourage trapped air to move through your digestive system.
Use Over-the-Counter Remedies:
- Simeticone-based products (like Wind-eze) can help break down gas bubbles in your stomach, making them easier to pass. This is the stuff given to babies for colic.
- Activated charcoal supplements can absorb excess gas, although research says they should be used sparingly.
Stay Hydrated:
- Drinking warm water or herbal teas like peppermint or chamomile can help soothe your digestive system and encourage air to pass.
Avoid Tight Clothing:
- Loose, comfortable clothing can reduce pressure on your abdomen, which might help with bloating.
Check if a Break from CPAP is Doable:
- This is definitely one for your sleep clinic to advise on, but if they are okay with you taking a CPAP break this could provide a window of opportunity to clear the tubes without being reset every night when that wind-tunnel gets strapped-on again.
See a Doctor if Necessary:
- If your symptoms are severe or persistent, consult a healthcare professional… which could be your normal doctor or possibly your sleep clinic. Further tests may be needed to help rule out underlying conditions like GERD or a hiatal hernia.
So, while aerophagia is often manageable with self-care, there are times when it deserves a trip to the doctor, such as:
- Severe abdominal pain that doesn’t improve.
- Vomiting or inability to keep food or water down.
- Difficulty breathing that feels worse than usual.
- Persistent or worsening bloating despite adjustments to your CPAP therapy.
Listening to your body, and working closely with your healthcare peeps to find a solution that works for you, could make all the difference between suffering and cure. Managing sleep apnea is a marathon, not a sprint and aerophagia is just one of the many hurdles you are equipped to overcome.
Cheers,
Alan
P.S. I have taken to creating various bits on sleep and sleep apnea. If you would enjoy hearing more and find out where else you can find stuff like this, you can get my weekly Triple Whammy email, which has 3 short topics each week. Some written or recorded by me and others I’ve found out there in the strange world we live in.
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