Swallowing Air and Wake Up with Distended Abdomen! Help!!

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Swallowing Air and Wake Up with Distended Abdomen! Help!!

Postby Laurie1041 » Wed Oct 20, 2010 12:53 pm

Dearest Friends,

Help! Last night was Day 6. For the past 2 or 3 nights I am evidently swallowing air and I wake up during the night needing to. . . I think in ladies we call it "burp" and my stomach begins to hurt from all the swallowed air and the only relief is. . .(there is no delicate term for this) flatulence. So that's what I did ALL NIGHT LONG. I woke up with a rock-hard, distended, painful belly.

The honeymoon is over! Although I keep the mask on during the night, I am not sleeping well due to the following:

1. Swallowing air and the discomfort from doing so.
2. Mask Leak (just started)
3. Wake up suddenly and realize my pressure seems like it is going "full throttle".

Oh and I have a red area on the bridge of my nose that does not get better - even though I am not aware of any pressure points.

I know that my mask probably needs to be tightened because it's getting loose so that may solve the air leak.

My APAP is set for 4-12 (doc wants to download 7 days of data on Friday to see what pressure requirements I need - he doubts that I need 12 cmH20 as indicated on the split study.

Help! The swallowing of air is the exact same thing I could not tolerate back in 2002! It's happening again and I am
freaking out! I really NEED to be successful at this for my health and wellbeing.

Any and all suggestions are welcome and appreciated. I really need the support.

Thank you very much!

:-( Laurie
Sleep Studies, 2002, 2004, 2005 - I was an xPAP "drop-out"!
Split Study on 10/5/10 - DX: Severe OSA - AHI 43.9
APAP: Resmed S9 Autoset/H5i Humidifier/Climateline heated tubing
Mask: Going back to nasal pillows - Current Pressure Settings - 4-12cm
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Postby Mrs Rip Van Winkle » Wed Oct 20, 2010 8:56 pm

Swallowing air is called aerophagia. A friend with SA suggested I treat my acid reflux... which is not all the bad so I never really took anything for it...WELL, I started taking omeprazole...and it HELPS! I also switched to a BiPAP a few years ago...that helped a little but the Omeprazole helped alot.

All issues typically have solutions.. it is important to determine the issue, find the solution(s) and work on them. Many people think that due to an issue they can not use xPAP... untrue...they just never reached out to find a solution....giving up on your health, your life, is not a solution.
I'm only a sufferer, not a medical pro. What I post are my thoughts as a sufferer, not that of the ASAA. As a moderator on these forums I oversee the posting rules. This is the internet, always discuss what you read with your medical team.
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Postby Laurie1041 » Wed Oct 20, 2010 10:35 pm

Mrs Rip Van Winkle wrote:Swallowing air is called aerophagia. A friend with SA suggested I treat my acid reflux... which is not all the bad so I never really took anything for it...WELL, I started taking omeprazole...and it HELPS! I also switched to a BiPAP a few years ago...that helped a little but the Omeprazole helped alot.

All issues typically have solutions.. it is important to determine the issue, find the solution(s) and work on them. Many people think that due to an issue they can not use xPAP... untrue...they just never reached out to find a solution....giving up on your health, your life, is not a solution.


Hi Mrs. RVW. I can always count on you to help people such as me not only ask questions, but to hunt for answers!

What a coincidence! I actually started treating my GERD (gastroesophageal reflux disease - or acid reflux) about 2 weeks before I started CPAP. I am taking a proton pump inhibitor (meds like omeprazole) every morning and within 72 hours I had complete relief. I am having an upper and lower endoscopy in 2 weeks just to make sure I don't have a hiatal hernia and that my esophagus does not reveal any signs of damage from the acid. The colonoscopy is purely for screening as I just turned 50.

I knew it was aerophagia but I don't know what to do about it. I will do some research on aerophagia this evening so that I can understand the causes of swallowing air while using PAP and the possible solutions. I see my sleep specialist tomorrow and I am very confident that he will explain this phenomenon and give me solution(s).

You are absolutely correct, Mrs. RVW, giving up is just not an option! I will post my doctor's advice concerning this most annoying and bothersome problem. Thank you!
Sleep Studies, 2002, 2004, 2005 - I was an xPAP "drop-out"!
Split Study on 10/5/10 - DX: Severe OSA - AHI 43.9
APAP: Resmed S9 Autoset/H5i Humidifier/Climateline heated tubing
Mask: Going back to nasal pillows - Current Pressure Settings - 4-12cm
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Swallowing Air (Aerophagia) with your CPAP?

Postby Laurie1041 » Wed Oct 20, 2010 11:03 pm

I knew there had to be an underlying mechanism to cause aerophagia (swallowing air) while using PAP. Here are some things I learned on a different website after doing a google search (aerophagia and CPAP).

"First on the list is the position of the head, and how the position affects the trachea. If the trachea is not fully opened and is not able to accomodate the amount of pressure being delivered by the CPAP machine, then the overflow is going to get pushed into the esophagus. Did you ever take a CPR class? The key to blowing air into someone's lungs is to properly align the neck and head. If you don't do this - that is, if you don't fully open the airway - then you'll be blowing air into the esophagus and stomach. The same principle applies to other non-invasive ventilation techniques, including CPAP therapy.

Second on the list of reasons also has to do with basic fluid dynamics. The CPAP machine might be delivering too much air for your trachea and lungs to handle. This is very closely related to the head position, but it's a little different because the problem could potentially occur when the head and neck are properly aligned and when the trachea is wide open. Remember the last traffic jam you were in? Cars started to leave the jammed up street to take a different route. The same thing happens with gases like air. If the air doesn't fit in the trachea, it's going to go somewhere else. Too much air can cause you to swallow involuntarily (like an uncontrollable gag, really), opening the epiglottis. If you have a high pressure setting, this could be an issue.

Third on the list of reasons is air leaks. No matter your level of CPAP pressure, if air is going in through your nose and is leaking out of your mouth, you will undoubtedly swallow involuntarily. If the leaks are bad enough you'll probably end up ripping your mask off your face during the night without even knowing it. Leaks out the mouth when using a nasal mask are very uncomfortable and bascially intolerable, and can definitely contribute to aerophagia.

If you're experiencing the symptoms of aerophagia, you can try to address the issues accordingly:

* Adjust the position of your head so that it's not tilting forward while you sleep - keep the airway wide open
* Talk to your prescribing doctor about reducing the pressure setting on your CPAP machine
* Consider an automatic CPAP machine - they generally deliver much less than prescribed pressure
* Consider a machine with exhalation pressure relief - this will help prevent involuntary swallowing; in conjunction with an automatic machine your aerophagia days may be over rather quickly.

I can't stress enough the importance of visiting your doctor if you continue to experience negative side-effects while using your CPAP machine. If you continue to experience aerophagia while using your CPAP machine even after trying some of the tips above, then you need to determine once and for all the cause of your problem. Perhaps the cause is unrelated to CPAP therapy. Get to the bottom of it". Retrieved October 20, 2010 www dot cpap dot supply dot com/Articles.asp?ID=170

Bottom line dear readers. . . if you are experiencing a problem or "negative side effect" with your CPAP, do a little research on the internet to see if it is a common problem and then see your doctor to discuss a treatment plan. I think my pressure is too high and that I have the "air leak" from my mouth as described above. I see my sleep specialist tomorrow and you can bet this will be the first thing we talk about. Hugs, Laurie
Sleep Studies, 2002, 2004, 2005 - I was an xPAP "drop-out"!
Split Study on 10/5/10 - DX: Severe OSA - AHI 43.9
APAP: Resmed S9 Autoset/H5i Humidifier/Climateline heated tubing
Mask: Going back to nasal pillows - Current Pressure Settings - 4-12cm
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Postby N1IWR » Thu Oct 21, 2010 7:29 am

Look at you!!! Researching & teaching/educating others with what you found!!! Go You!!!! Thanks for the info! I'm new too, total of 3 weeks & much like you, I'm seeking info & support here, as well as reading anything I can get my hands on. I don't know you...yet! But I'm so proud of you for 'taking the bulls by the horns" & doing it with such a positive attitude!! I'm betting you'll have this problem and any others that come down the pipe, figured out & back on your way to more rested sleep!!

Thanks for being so inspiring!! I'm only having 2 small issues, but it's been a bad week & I've sooo wanted to give up! You & the immensely supportive guru's here have given me courage & hope to keep on keepin on!! I really appreciate your positive attitude!!

Good luck at the docs & let us know how you make out!! Hang in there!
Sandy
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Postby Laurie1041 » Thu Oct 21, 2010 1:17 pm

N1IWR wrote:Look at you!!! Researching & teaching/educating others with what you found!!! Go You!!!! Thanks for the info! I'm new too, total of 3 weeks & much like you, I'm seeking info & support here, as well as reading anything I can get my hands on. I don't know you...yet! But I'm so proud of you for 'taking the bulls by the horns" & doing it with such a positive attitude!! I'm betting you'll have this problem and any others that come down the pipe, figured out & back on your way to more rested sleep!!

Thanks for being so inspiring!! I'm only having 2 small issues, but it's been a bad week & I've sooo wanted to give up! You & the immensely supportive guru's here have given me courage & hope to keep on keepin on!! I really appreciate your positive attitude!!

Good luck at the docs & let us know how you make out!! Hang in there!
Sandy


Hi Sandy,

Thank you for the very positive feedback from one newbie to another!

In all honesty, I am a PAP "retread" starting back in 2002 at the age of 42. My then husband told me I should see a doctor because he said I "gasped, snorted, and stopped breathing during the night". I honestly believed that my husband was making a big deal over "a little snoring". Finally, after he threatened to sleep in the guest room and "hoped he would not wake up to find me dead", I said I would see my GP. My GP told my husband and I that "a little snoring is not a big deal" and "we only see sleep apnea generally in males who are overweight". I only received an order for a sleep study because my husband was hell-bent on finding out what was wrong.

At that time, I was diagnosed with "moderate OSA". Back then, my GP simply handed me a prescription that read, "CPAP at 9 cmH20" and told me to call my insurance company to get a list of providers. I do not recall my GP giving me any information/education concerning the importance of treating OSA!

To illustrate how much OSA knowledge and treatment has changed from 2002 to 2010, I showed my sleep study to one of the Cardiologists that I worked for (I am an RN). He said, "that's impossible, you are female, young, and thin." Basically this very smart Cardiologist told me that my report was a load of rubbish! Research has certainly come a long way!

I did some research about machines and interfaces before speaking to my DME so that I could at least make some type of educated guess as to what might work for me. Back then, the rage was "C-Flex" with something called "ramp". So that's what I got. I went through about 10 masks before I found something that was barely tolerable. Masks back then were horrible (IMO).

I made it approximately 30 days with a mask that leaked all night (because my DME told me that if I had air leaks to simply tighten the mask - wrong!), my machine alarmed all night, and by 3:00 AM I was completely frazzled and ended up ripping the mask off so I could get at least 3 hours of sleep. Mr. CPAP machine and mask ended up in my closet for many a year.
:-x

This type of indifference continued through my sleep studies in 2004 and 2005. In 2005, I dusted off my CPAP machine and tried again. Same problems and no help from my GP - more importantly, no referral to a sleep specialist. My sleep studies - all 3 of them at this point were essentially dismissed because I was female, youngish, and thin. I was exhausted all the time and was told by my GP that I simply needed more exercise. Of course, I had the same problems with the mask leaking, etc. and I simply gave up.

So fast-forward to 2010. I could not get out of bed, I was so exhausted. My daughter came to live with me and told me that I sounded horrible when I was asleep. The light-bulb went on and I showed my new and much improved GP copies of my prior studies and she was quite alarmed. She referred me for a split-night study which I had on October 5, 2010. When I went back for my follow-up, my GP, simply said, "You, my dear, are going to see a sleep specialist". The world of sleep medicine has certainly changed!

So, I can't wait to see my sleep doc this morning and see what I can do about swallowing air. I'll keep everyone posted. Hugs, Laurie
Sleep Studies, 2002, 2004, 2005 - I was an xPAP "drop-out"!
Split Study on 10/5/10 - DX: Severe OSA - AHI 43.9
APAP: Resmed S9 Autoset/H5i Humidifier/Climateline heated tubing
Mask: Going back to nasal pillows - Current Pressure Settings - 4-12cm
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Postby robysue » Thu Oct 21, 2010 3:39 pm

Please post any tips you get on how to minimize the swallowing air problem. It will be appreciated by many.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Saw Sleep Doc re Aerophagia

Postby Laurie1041 » Thu Oct 21, 2010 6:03 pm

robysue wrote:Please post any tips you get on how to minimize the swallowing air problem. It will be appreciated by many.


Here's what I found out about swallowing air (aerophagia):

Just got back from my sleep doc's office. First of all, he said that he is not too concerned about me having swallowed air for 1 or 2 nights out of my first 7. He asked me if I sleep on my back and I said no. My sleep doc said that some cases of aerophagia are caused by the position of the head and neck and a repositioning can help to keep air from being pushed into the esophagus and into the stomach. Then he asked me how uncomfortable the abdominal distention was. I told him on a scale from 1-10, 10 being the most painful, I would rate my discomfort at a "7". He was concerned by the intensity, but asked me to continue with the CPAP and to call him if the aerophagia becomes consistent.

My sleep doc said that if I have consistent problem with aerophagia, that he would advise that I try BIPAP. He said that BIPAP was not a 100% solution for those who swallow air, but it does work for certain people with this problem.

Lastly, my sleep doc said that if I still had consistent and enduring aerophagia on BIPAP, then my next alternative would be an oral appliance. He said that unfortunately some patients cannot tolerate CPAP or BIPAP because of persistent swallowing of air. My sleep doc said that some people simply swallow air while on CPAP. He said it could be mild, some burping, etc., to extreme abdominal distention.

Because my doc and I were discussing abdominal discomfort and because I have been recently diagnosed with gastroesophageal reflux (GER) and am taking Dexilant (a proton pump inhibitor like Prilosec, Nexium, Protonix, Aciphex, etc), I asked him if taking an anti-reflux medication may help with the swallowing air. My sleep doc said that swallowing air or aerophagia has nothing to do with the loosening of the lower esophageal spincter (LES) which allows stomach contents to flow from the stomach to the esophagus. He said that taking the Dexilant was important to reduce stomach acidity thereby protecting the esophagus from the caustic effects of the stomach acid. Unfortunately, it won't help me to stop swallowing air!

I am determined to make this work even if I have to invest in a Bi-Level machine! I'm hanging in there for the long haul! Hugs, Laurie
Sleep Studies, 2002, 2004, 2005 - I was an xPAP "drop-out"!
Split Study on 10/5/10 - DX: Severe OSA - AHI 43.9
APAP: Resmed S9 Autoset/H5i Humidifier/Climateline heated tubing
Mask: Going back to nasal pillows - Current Pressure Settings - 4-12cm
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Postby White Beard » Sun Oct 24, 2010 12:54 pm

Laurie allot of times the bloated feeling from swallowing air will just go away as your body becomes adjusted to the PAP. Try giving it a few weeks. I do know the first few weeks on PAP can be very trying, allot of people including myself have had the same problems that your experiencing, also some of us have went through the experience of having some chest wall pain and discomfort, primarily from not being use to using the breathing muscles so much, especially with exhaling. But that to passes as the body adapts to using PAP. You are right things have changed allot over the years, and hopefully they will continue to improve and get better! When I was first diagnosed with Sleep Apnea, at the time un-be-known to me, my sleep center recommended me to be put on the ASV machine because of my centrals, but the sleep Doctor thought the ASV machine was to new and he didn't feel the technology was proven enough, so he refused to put me on it. For a year and a half I went through H*** and was just getting worse! Anyway after 6 sleep studies and going from CPAP to CPAP with supplemental O2 to BiPAP with O2 and numerous titration studies to increase the pressure, ( which I might add just made my centrals worse) My sleep doctor got sick and could not see his patients for and extended period of time, I kept complaining and told them I needed to see some body, so after all my continous complaints, they sent me to another sleep doctor, and he reviewed everything and immediately had me get a ASV titration study and put me on the VPAP Adapt SV machine and the rest is history! It completely changed my life! So it is not just the GP's that were not educated about sleep apnea, but there is allot of Sleep Specialist that are not up to speed too! Even over the last two or three years more and more Doctors are more aware of the dangers of untreated sleep apnea! That old myth of slim fit young ladies can not possibly have sleep apnea, is finally fading away! Anyway you definitely have the right attitude, and I have frequently said on the forum that knowledge is power and the more you know about your sleep apnea and your treatment the more likely you will be successfull with it! From one nurse to another I do wish you well and hope they you are successfull with your treatment this time! Good Luck to You!..........White Beard
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Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
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Postby White Beard » Sun Oct 24, 2010 12:54 pm

Laurie allot of times the bloated feeling from swallowing air will just go away as your body becomes adjusted to the PAP. Try giving it a few weeks. I do know the first few weeks on PAP can be very trying, allot of people including myself have had the same problems that your experiencing, also some of us have went through the experience of having some chest wall pain and discomfort, primarily from not being use to using the breathing muscles so much, especially with exhaling. But that to passes as the body adapts to using PAP. You are right things have changed allot over the years, and hopefully they will continue to improve and get better! When I was first diagnosed with Sleep Apnea, at the time un-be-known to me, my sleep center recommended me to be put on the ASV machine because of my centrals, but the sleep Doctor thought the ASV machine was to new and he didn't feel the technology was proven enough, so he refused to put me on it. For a year and a half I went through H*** and was just getting worse! Anyway after 6 sleep studies and going from CPAP to CPAP with supplemental O2 to BiPAP with O2 and numerous titration studies to increase the pressure, ( which I might add just made my centrals worse) My sleep doctor got sick and could not see his patients for and extended period of time, I kept complaining and told them I needed to see some body, so after all my continous complaints, they sent me to another sleep doctor, and he reviewed everything and immediately had me get a ASV titration study and put me on the VPAP Adapt SV machine and the rest is history! It completely changed my life! So it is not just the GP's that were not educated about sleep apnea, but there is allot of Sleep Specialist that are not up to speed too! Even over the last two or three years more and more Doctors are more aware of the dangers of untreated sleep apnea! That old myth of slim fit young ladies can not possibly have sleep apnea, is finally fading away! Anyway you definitely have the right attitude, and I have frequently said on the forum that knowledge is power and the more you know about your sleep apnea and your treatment the more likely you will be successfull with it! From one nurse to another I do wish you well and hope they you are successfull with your treatment this time! Good Luck to You!..........White Beard
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 14.0, min PS 14.0, max PS 24.0, FitLife Mask
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Postby White Beard » Sun Oct 24, 2010 12:58 pm

Laurie allot of times the bloated feeling from swallowing air will just go away as your body becomes adjusted to the PAP. Try giving it a few weeks. I do know the first few weeks on PAP can be very trying, allot of people including myself have had the same problems that your experiencing, also some of us have went through the experience of having some chest wall pain and discomfort, primarily from not being use to using the breathing muscles so much, especially with exhaling. But that to passes as the body adapts to using PAP. You are right things have changed allot over the years, and hopefully they will continue to improve and get better! When I was first diagnosed with Sleep Apnea, at the time un-be-known to me, my sleep center recommended me to be put on the ASV machine because of my centrals, but the sleep Doctor thought the ASV machine was to new and he didn't feel the technology was proven enough, so he refused to put me on it. For a year and a half I went through H*** and was just getting worse! Anyway after 6 sleep studies and going from CPAP to CPAP with supplemental O2 to BiPAP with O2 and numerous titration studies to increase the pressure, ( which I might add just made my centrals worse) My sleep doctor got sick and could not see his patients for and extended period of time, I kept complaining and told them I needed to see some body, so after all my continous complaints, they sent me to another sleep doctor, and he reviewed everything and immediately had me get a ASV titration study and put me on the VPAP Adapt SV machine and the rest is history! It completely changed my life! So it is not just the GP's that were not educated about sleep apnea, but there is allot of Sleep Specialist that are not up to speed too! Even over the last two or three years more and more Doctors are more aware of the dangers of untreated sleep apnea! That old myth of slim fit young ladies can not possibly have sleep apnea, is finally fading away! Anyway you definitely have the right attitude, and I have frequently said on the forum that knowledge is power and the more you know about your sleep apnea and your treatment the more likely you will be successfull with it! From one nurse to another I do wish you well and hope they you are successfull with your treatment this time! Good Luck to You!..........White Beard
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 14.0, min PS 14.0, max PS 24.0, FitLife Mask
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Postby White Beard » Sun Oct 24, 2010 1:06 pm

Sorry for the triplicate post but it came up as an error and said it could not post my reply and then it done it in triplicate, and it would not let me delet one of them.......White Beard
White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 14.0, min PS 14.0, max PS 24.0, FitLife Mask
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Postby chungler » Wed Jan 26, 2011 11:02 am

I am glad to hear that I am not the only one with the problem of swallowing air. I switched to a bi-pap approx 1 yr ago due to my pressure being so high. I am not sure of the correct terminology but inhalation is a 16 and exhalation is a 12. I have been diagnosed with mild apnea but I hold my breathe for some reason. I am fine in the middle of the night (with the exception of very loud burps and occational flatulence, thank god my husband works nights!) but a couple of times a week I wake up in the morning with abdominal distention that is painful. The usual symtoms, looks like I'm 5 months pregnant, cannot get my pants buttoned and in extreme pain. Sometimes I can't even stand up straight due to the pain. I am taking Omeprazole 200mg 2x's a day due to acid reflux. I do have an appointment with a Gastro Dr next week and an appt with my Sleep Dr on Valentine's day. If I can wait that long.

My friends, co-workers, and family do not understand what I am going through and it is frustrating. I'm miserable sleeping with the BiPAP due waking up with this problem, and I am more miserable if I sleep without it for obvious reasons. I work 12hr shifts at a job positions that requires me to be alert and very focused. A difficult task for a sleep deprived employee.

I also have gained about 15 pounds in the past year. I thought I was supposed to gain weight with untreated sleep apnea not treated sleep apnea!

I also had to look elsewhere for a sleep study. My GP also looked at me and told me that I was too young (at the time I was 39) and not overweight (about 130 at the time) and female to have sleep apnea. He told me it was allergies and small nasal passages and told me to take nasal steroids. My father has had apnea/CPAP for years and I knew what to look for. I was at a ENT appt for my son and spoke to his Dr. He set me up with a sleep study immediately and the rest is history. So for those women out there don't take "no" for an answer from you General Practitioner. It could mean the difference of life or death. If the Dr still says "no" find another Dr!

Thank you for listening.....
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Re: Swallowing Air and Wake Up with Distended Abdomen! Help!

Postby rswood62 » Wed Apr 24, 2013 11:55 am

I have been on Bi-pap for almost 2 years, had all different pressure settings and still have terrible swallowing of air and distended stomach and pain. I am only able to wear mask for 2 hours before I wake up in pain and take mask off for rest of night. It is very frustrating and my doctor doesn't really give me any answers - just keeps changing pressure settings. I'm at 19 & 15 right now and am only using it for 2 hrs a night. Go to dr tomorrow so I'm going to make sure he knows how frustrated I am.
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