Have CPAP? Now you have Stomach Bloating? Solution is here
We get a fair consensus about bloating during CPAP use. And we often have reasonable solutions. Today we’ll explore bloating and CPAP in a two part series. The first part will detail the most common question, explain the context of the issue and set up a solution. The second part will dig a bit deeper into practical solutions. Let’s get started.
Here is a common complaint among CPAP users:
I get discomforting gas from my overnight use of my CPAP machine, so much so that I do consider halting my therapy.
Do you have any solutions to my problem?
The uncomfortable nature of gas during PAP therapy is called aerophagia– i.e the consumption of air during CPAP use.
For many, CPAP gas is common for people new to CPAP. There are reports that over 52% of patients with obstructive sleep apnea (OSA) experience symptoms of aerophagia(1) during CPAP therapy.
There are other discomforts associated with the aerophagia, which includes stomach pain, belching, bloating, flatulence, low appetite, and CPAP avoidance.
Aerophagia is defined as what?
Aerophagia is a complication in which some air is entering the esophagus and stomach rather than the lungs(2). This occurs during sleep for someone treating obstructive sleep apnea.
Symptoms and Side Effects of Aerophagia
When the pressurized air from CPAP enters the stomach, common complaints can appear:
- gastric or stomach distension or bloating (1).
- flatulence (passing wind or letting a few go),
- belching (burping),
- pain in the stomach (severe pain in rare cases),
- vomiting (rare cases)
- gastric insufflation (very rare – the risk exists in patients with COPD and Pulmonary Edema) (3).
Causes of Aerophagia
Why Does a CPAP unit Gives the user Gas?
There is nothing more upsetting than waking to a bloated stomach and involuntary farting and burping all day.
The key understanding is that if you have weak esophagus muscles, then the esophagus won’t close off like it should and the air from the CPAP enters your stomach.
Since esophagus and its anatomy is fairly complex to illustrate by description, we’ll keep explanations to a minimum and focus on a basic overview.
Human anatomy has detailed two esophageal sphincters which may be guilty for contributing to CPAP gas the in stomach:
- upper esophageal sphincter (UES) – represents a bundle of muscles positioned on the top of the esophagus. The UES prevents food from dropping down the trachea (your airway)
- lower esophageal sphincter (LES) – these muscles are situated at the low-end of the esophagus, which prevents stomach content going upwards.(4)
- So, the inevitable question is which esophageal sphincter is guilty of CPAP induced aerophagia?
- Recent studies suggest (despite recent debates) that upper esophageal tone, rather than the LES, is the one that causes the CPAP gas(1).
- This explains that once the air passes the UES and enters the esophagus, the lower esophageal sphincter relaxes (as a reflex), allowing air to enter the stomach.
So now that we have an explanation about why bloating occurs during CPAP use, the necessary examination of solutions, treatments, and techniques is next. Look for these techniques in our next post.
Edited by Bill Bistak B Sc.,SEO/SEM Spc, CRT
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1. Symptoms of aerophagia are common in patients on CPAP therapy and are related to the presence of nighttime GER (Kelly Shepherd, Ph.D)
2. Aerophagia and GERD in Patients using Continuous Positive Airway Pressure: A Preliminary Observation (Watson NF)
3. CPAP in the Treatment of Pulmonary Edema & COPD By James F. Goss, MHA, MICP and Jonathan Zygowiec, BS, EMT-I, EMD
5. Modulation of upper and lower esophageal sphincter tone during sleep
6. GER in patients with sleep apnea syndrome.Graf KI, Karaus M, Heinemann S, Körber S, Dorow P, Hampel KEZ Gastroenterol. 1995 Dec; 33(12):689-93.)
7. Ing AJNgu MCBreslin AB Obstructive sleep apnea and GER. Am J Med. 2000;108(suppl 4A)120S- 125S
8. Kerr PShoenut JPMillar TBuckle PKryger MH Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome. Chest. 1992;1011539- 1544
9. CPAP-Related Aerophagia: Awareness First!