How can I stop swallowing air when I use my CPAP?

June 7, 2008 12:59 PM

I have severe sleep apnea (apnea/hypopnea index 66). I've tried various CPAPs (currently a REMstar Auto M Series with C-Flex) and masks (full-face, nasal pillow, currently a nasal mask). The problem is that for every combination of machine and mask, I wake up in an hour or two, generally having swallowed a lot of air, and stop using the CPAP for the night. The respiratory tech says that it's working when I use it - index as low as 6, which is well within the normal range - but I'm so uncomfortable when I wake up that it's very hard to put the mask back on. Suggestions?

Once or twice I have managed to use the CPAP all night, and I have not felt better than when I don't use it. The doctor's latest idea is for me to take a sleeping pill right before I put on the mask.

posted by lukemeister to health & fitness (14 comments total)

I am not a respiratory tech, but also have sleep apnea.

You have used various CPAP's, have you tried a bipap machine yet?

I just started using the BiPAP Auto M Series with Bi-Flex (using a nasal pillow) and have found it takes some getting used to. I am finally getting to the point where I will keep it on all night but at first I was seriously considering getting the chin strap to keep my mouth closed. It also has a humidifier built in, which keeps your nose from drying out and makes things a lot more comfortable.

Have you tried the chin strap to keep from mouth breathing? Do you have a long enough air tube so that you can move while you sleep and have enough slack? Are you going through a provider like Apria to get your equipment? They might be able to work with you to get a different sized harness for the mask and the chin strap.

Has the tech suggested programming other airflow settings? It sounds like you've had a followup study that might allow them to reduce the airflow a bit.

And it took me about a week to start to feel the positive effects from wearing the device. The most important thing for you to do is to keep working with your doctor/tech/insurance to make sure you get the care you need.
posted by sciatica at 1:26 PM on June 7, 2008 [1 favorite has favorites]

sciatica,

Thanks for your suggestions. I have a chin strap. I have not used a BiPAP, but the machine I have dynamically adjusts pressure (maximum 14), so it's kind of like a BiPAP. I think the air tube is long enough. I haven't had a followup study since the diagnosis of severe apnea. What the tech said is based on reading the memory card that's in the machine. Good luck!
posted by lukemeister at 1:32 PM on June 7, 2008

I actually like sciatica's advice. I'm not familiar with your particular CPAP device, or at least this "C-flex feature" enough to know how similar it is to BiPap, but in your case, Bipap may make some theoretical sense. You can imagine that perhaps while you involuntarily swallow or your esophagus is kept artificially open by a high baseline positive pressure (the CPAP), you may develop this sort of gas and abdominal distention. By lowering the CPAP level you resolve this, but perhaps fail to correct for the OSA. Consequently, BiPap may be useful in triggering an elevated level of inspiratory pressure support just when you may need it to keep your airway patent without constantly filling your stomach with air. It may not work for everyone, but in my experience folks with your complaints often seem to derive some benefit from the BiPap approach.
posted by drpynchon at 2:32 PM on June 7, 2008 [1 favorite has favorites]

Is surgery an option for you? If an enlarged soft palate is the problem, there are less invasive/painful procedures these days, including I believe, some sort of needle insertion into the soft palate with a short application of radio frequency energy that shrinks the soft palate and opens up the airway a bit.
posted by paphun123 at 4:34 PM on June 7, 2008

drpynchon,
C-Flex appears to have a smaller range of pressures than Bi-Flex, but I should ask my pulmonologist what the real difference is.

paphun123,
I was evaluated for surgery, and it didn't appear that surgery was likely to help. I think it's more of an option for milder cases.
posted by lukemeister at 5:45 PM on June 7, 2008

As always, YMMV, but...

Post-sinus surgery, I've been using the BiPAP Auto M Series with Bi-Flex as well, going on almost six weeks now. Since I've spent my entire life sleeping on my stomach, getting used to wearing the mask (a comfort gel version that covers my nose) was (and to some degree is) the most difficult part. You mentioned sleep aids; my sleep specialist prescribed Lunesta, which has helped--I take the Lunesta, read a bit, find myself getting sleepy, immediately find a comfortable position...and, for the most part, that's it. The Lunesta is more for the purpose of relaxing me to the point where I'm not fighting the machine than anything else; I spent several days "telling" myself to stop breathing through my mouth, thinking through the entire CPAP process, et cetera. Finding a proper angle using my pillow (a Tempurpedic) has helped. (And that--having to think about all of this--was/is also frustrating. Whatever happened to just going to sleep?) It does take getting used to--I've had my share of "This isn't all that different than the sleepless nights I've had before" evenings--; but I can honestly say that the overall experience has been such that I'm finding myself thinking more clearly, more often recognizing that feeling of clarity, than I have in years, largely if not entirely because I'm sleeping better.

Good luck.
posted by t2urner at 7:48 PM on June 7, 2008 [1 favorite has favorites]

My partner, who has used a BiPAP for over 16 years, swears by her heated humidifier. She says she'd be dead without it.

For what it is worth, she never could get used to the ones that ramp up, and she has nothing but magic 4 letter words for the people who talked her in to trying the surgery.
posted by QIbHom at 8:48 PM on June 7, 2008

The advice above sounds solid ... I'd raise it by saying you might want to experiment with using a Breathe Right strip in addition to the mask, and/or a night guard. (link is to Target, as an example; I'd talk to a dentist first). The night guard might align your mouth/tongue to prevent you from swallowing air. Either idea won't hurt to try, it seems.
posted by Cool Papa Bell at 10:22 PM on June 7, 2008

My mom had sleep apnea, and when she had problems using the CPAP, the doctor told her it doesn't work for X percent of patients (and I forget what number X is). You might consider the surgery to remove your tonsils, uvula, and some tissue at the back of your throat. My mom had it and has been sleeping great ever since. Side effect: She chokes a little more easily now.
posted by IndigoRain at 10:45 PM on June 7, 2008

Use your ramp setting if you're not already (i.e. the function that gradually increases the pressure instead of starting at full blast), and then buck up and give it about 2 weeks of NOT pulling off the mask after an hour or two. The only way out of aerophagia can be through: it can go away as you give your body time to adjust, but you're not giving your body a chance to acclimate.

Other random points:

1) CFLEX can make some folks worse in this area because it's not timed to your own natural breath

2) DO NOT take sleeping pills of any sort with your apnea index unless you are absolutely not going to pull the mask off after an hour (they depress respiratory effort in everyone, which can make them dangerous all the way to lethal for folks with severe apnea, like yours)

2) Go to cpaptalk.com and apneasupport.org for message boards of hundreds of folks (not just a dozen or so like here on askme) who have been on CPAP (or had surgeries). Search the archives, but also jump in and ask there too.
posted by availablelight at 6:11 AM on June 8, 2008 [1 favorite has favorites]

Everyone, thanks for all the helpful comments. The machine I'm using has a built-in heated humidifier, but it doesn't seem to work as well as the external humidifier in the CPAP I was using before.

The doctor who's treating me said that many people can learn to keep their mouths closed while sleeping. I'm having a hard time grasping this concept!
posted by lukemeister at 9:52 AM on June 8, 2008

Just a vague memory here of a dental dam kind of CPAP mask. Also, you should go to CPAPTalk and ask the same question.
posted by WCityMike at 2:01 PM on June 8, 2008

One more followup-- if you're leaking through the mouth but don't want to deal with a full face mask, the Hybrid (or Resmed's knock-off, the Liberty) mask is not a perfect solution (but none of them are, heh), but still pretty good.
posted by availablelight at 6:51 PM on June 8, 2008

I don't know anything about it (other than hearing their constant radio ads), but this place advertises the "Pillar Procedure" as a new sleep apnea breakthrough: http://www.snoringcenter.com/at/pillar-procedure.html
posted by erikgrande at 12:51 PM on June 9, 2008