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Lots of posterior gaseous emission and burps - solutions?.

Posted by rjjacobsen @rjjacobsen, May 21 10:53am

Experiencing lots of posterior gaseous emissions and burps with CPAP, possibly caused by allergies plugging my nose and forcing mouth breathing?

I've tried multiple OTC antihistamines (Cetirizine, Fexofenadine, and Diphenhydramine) without significant relief. Nose runs so much it drips into the mask. I also do not have a colon so passing gas at night in bed can be a risky/messy proposition, so it's forcing me to get up 3-4 times a night to pass gas/burp/bathroom stuff and blow my nose.

My CPAP AHI is very good - usually well under 3, currently running a pressure range of 18.6 to 20, so I'm thinking of trying lowering that lower pressure to 17.0 to see if that helps. Also will look into yet another OTC anti-allergy med and resupply my fluticasone spray.

Besides seeing an allergy specialist, any suggestions?

Thanks in advance/

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gloaming | @gloaming | May 21 2:05pm

There is a surprisingly common phenomenon with CPAP users called 'aerophagia', or simply 'eating air'. It is often caused by supine sleeping...on your back. You may also have a very common problem, if it can be called a problem, of having a lot of the volume circulating in your mouth, and if the sensation alerts you a bit, raising your awareness level, but not quite to consciousness, you may swallow some of the mouth's circulating air.

Avoid back sleeping, but also learn to keep the middle-to-rearward portion of your tongue tucked up, tightly, against the roof of the mouth and the pharyngeal tissue behind the hard palate. It's a learned technique, but it becomes a habit eventually if you practice it often for a week or more, especially during the day !!

Your pressures: I don't have access to your AHI, minute vent, flow limitations, max and low pressures and how long they persist according to the machine's sensing of your need, etc. But...I'm gonna guess that it's a tad high. That high number is your 'inspiration' or inhalation pressure, and most CPAP users run between 10-15 cm H2O.
My own range is 5.6-8, quite modest, even low by many standards, but it's all I seem to need these days with my AHI for the last two months being an embarrassingly good, and low, 0.1.

By all means, experiment, but keep a sharp eye on flow limits, and don't make large adjustments in a few days. Make smaller, 2 cm, changes and then see what changes in your reports happen over about four (4) days. Give you and your machine some time to figure out if the new flows are going to work.

Do you know about EPR? Expiration Pressure Relief? Almost all users need at least one cm of it, many need two, some three. Most machines that are not special machines like ASVs can only offer the user up to 3cm of relief when they exhale. This is a comfort setting, but key is that the reduction still has enough flow to keep your airway 'splinted' when your diaphragm relaxes and you exhale.

I'll stop here, but do please consider a site dedicated to helping people with their CPAP therapy. It's free, extremely rigorously monitored and managed (!!!!), and the membership includes some very dedicated and highly skilled people. It is apneaboard.com. No interest of any commercial kind....I'm an advisor over there, not a monitor or moderator/admin.

REPLY
1 reply
rjjacobsen | @rjjacobsen | May 21 7:03pm
In reply to @gloaming "There is a surprisingly common phenomenon with CPAP users called 'aerophagia', or simply 'eating air'. It..." + (show)
@gloaming

There is a surprisingly common phenomenon with CPAP users called 'aerophagia', or simply 'eating air'. It is often caused by supine sleeping...on your back. You may also have a very common problem, if it can be called a problem, of having a lot of the volume circulating in your mouth, and if the sensation alerts you a bit, raising your awareness level, but not quite to consciousness, you may swallow some of the mouth's circulating air.

Avoid back sleeping, but also learn to keep the middle-to-rearward portion of your tongue tucked up, tightly, against the roof of the mouth and the pharyngeal tissue behind the hard palate. It's a learned technique, but it becomes a habit eventually if you practice it often for a week or more, especially during the day !!

Your pressures: I don't have access to your AHI, minute vent, flow limitations, max and low pressures and how long they persist according to the machine's sensing of your need, etc. But...I'm gonna guess that it's a tad high. That high number is your 'inspiration' or inhalation pressure, and most CPAP users run between 10-15 cm H2O.
My own range is 5.6-8, quite modest, even low by many standards, but it's all I seem to need these days with my AHI for the last two months being an embarrassingly good, and low, 0.1.

By all means, experiment, but keep a sharp eye on flow limits, and don't make large adjustments in a few days. Make smaller, 2 cm, changes and then see what changes in your reports happen over about four (4) days. Give you and your machine some time to figure out if the new flows are going to work.

Do you know about EPR? Expiration Pressure Relief? Almost all users need at least one cm of it, many need two, some three. Most machines that are not special machines like ASVs can only offer the user up to 3cm of relief when they exhale. This is a comfort setting, but key is that the reduction still has enough flow to keep your airway 'splinted' when your diaphragm relaxes and you exhale.

I'll stop here, but do please consider a site dedicated to helping people with their CPAP therapy. It's free, extremely rigorously monitored and managed (!!!!), and the membership includes some very dedicated and highly skilled people. It is apneaboard.com. No interest of any commercial kind....I'm an advisor over there, not a monitor or moderator/admin.

Jump to this post

Been using OSCAR for probably 4 months with the guidance of the sleep apnea board and using cautious trial and error. Sleep med doctor looked at the reported data, was pleased with it and noted no problems - except the facial irritation/dermatitis. Last week's AHIs were 1.79. 0.71, 0.54, 2.18, 2.40, 2.41, 1.93.

For that, I could find a liner/strap cushions for my mask so made my own. I recent bought a liner for my other mask. Also tried the cortisone-10 cream treatments.

One of first things I did was turn EPR on. Started at 1, moved to 2 after a few weeks, then moved to 3 a few weeks later and left if there.

I started with an auto-adjust on with a low range and gradually moved it upwards every 5-7 days until I could see the auto-adjust not bumping the pressure higher to handle an apnea event. I still had events that pushed the CPAP to > 19 so I made 20 the high. For the low, I analyzed the events and the pressure at which they started for a week then adjusted the pressure high enough to prevent some/most of them, then repeated the process trial and error. 16 seemed to be reasonably effective.

My sleep doc wants me to sleep on my back as much as if possible and I do too because of arthritis in my neck, shoulders and hips which side-sleeping seriously aggravates. I do sleep some of each position every night because of the pain and I do use a soft-collar to minimize/prevent chin-tucking.

The nose plugging and the gas passing/burps weren't a problem until the last week where some local pollen source went crazy.

Thanks for your reply.

REPLY
1 reply
rjjacobsen | @rjjacobsen | May 25 11:08am
In reply to @rjjacobsen "Been using OSCAR for probably 4 months with the guidance of the sleep apnea board and..." + (show)
@rjjacobsen

Been using OSCAR for probably 4 months with the guidance of the sleep apnea board and using cautious trial and error. Sleep med doctor looked at the reported data, was pleased with it and noted no problems - except the facial irritation/dermatitis. Last week's AHIs were 1.79. 0.71, 0.54, 2.18, 2.40, 2.41, 1.93.

For that, I could find a liner/strap cushions for my mask so made my own. I recent bought a liner for my other mask. Also tried the cortisone-10 cream treatments.

One of first things I did was turn EPR on. Started at 1, moved to 2 after a few weeks, then moved to 3 a few weeks later and left if there.

I started with an auto-adjust on with a low range and gradually moved it upwards every 5-7 days until I could see the auto-adjust not bumping the pressure higher to handle an apnea event. I still had events that pushed the CPAP to > 19 so I made 20 the high. For the low, I analyzed the events and the pressure at which they started for a week then adjusted the pressure high enough to prevent some/most of them, then repeated the process trial and error. 16 seemed to be reasonably effective.

My sleep doc wants me to sleep on my back as much as if possible and I do too because of arthritis in my neck, shoulders and hips which side-sleeping seriously aggravates. I do sleep some of each position every night because of the pain and I do use a soft-collar to minimize/prevent chin-tucking.

The nose plugging and the gas passing/burps weren't a problem until the last week where some local pollen source went crazy.

Thanks for your reply.

Jump to this post

The nose has cleared some, but the burps/gas passing continue, so I've backed down the pressure range top and bottom a bit to see if I can find a balance between acceptable AHIs, aerophagia and sleep position.

REPLY
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