What to Do When CPAP Makes You Swallow Air

Do you use a continuous positive airway pressure (CPAP) machine? Have you experienced any of the following since you started CPAP?

• Excessive belching
• Bloating in the belly
• Ongoing problems with gas, sometimes with sharp pains

If this sounds like you, then you might have something known as aerophagia, or air swallowing.

What is aerophagia?

Aerophagia is when, instead of breathing air into your lungs, you swallow it into your stomach. We’ve all swallowed air at least a few times. Causes include eating, drinking, hyperventilating, chewing gum, smoking cigarettes, exercising, and even talking too fast.

Aerophagia by way of CPAP occurs when pressurized air – meant to be drawn into the lungs after helping to prop the airway open – is swallowed instead. Trapped inside the belly, its only way out is through belching or passing gas.

Swallowing air with CPAP

Not all CPAP users swallow air, but if they do, it’s usually attributed to the following causes:

Nasal congestion

People with chronic allergies, a deviated septum, or seasonal congestion due to colds and flu often breathe through their mouths in order to get adequate air when the pressure from CPAP doesn’t fully prop open the airway.

Pressure setting too high

Sometimes the sleep specialist sets your machine to a higher pressure than you need. The extra air delivered has nowhere to go and is ultimately swallowed.

Pressure setting too low

For similar reasons, low pressure settings can cause you to swallow air. In an effort to inhale more air, you may end up gulping for it, leading to aerophagia.

Mouth breathing

Some people who’ve lived with sleep apnea for a long time compensate for poor nasal breathing by breathing through their mouths. Oral or mouth breathing often starts in early childhood or as the result of living with frequent nasal congestion and blockage.

Breathing through your mouth while using CPAP not only “breaks the seal” critical to delivering positive airway pressure (PAP), but may result in improper breathing patterns. This is because the lost pressurized air can trigger the body to take extra breaths to maintain proper blood oxygen. This can cause you to gasp for air, which is eventually swallowed rather than inhaled.

Inability to coordinate CPAP breathing

With CPAP, the stream of pressurized air remains the same for both inhale and exhale. People using mid- to high-pressure settings may have trouble coordinating inhalations and exhalations using CPAP. This can lead to inconsistent, even panicked, breathing patterns that cause air swallowing.

How to stop swallowing air with CPAP

• Talk about a pressure change with your sleep specialist. If you’re new to CPAP, it may take a little tweaking of machine settings to find the “just right” zone. Even long-time CPAP users may need to adjust from time to time.
• While checking your pressure settings, your sleep specialist may discover your machine was set incorrectly. Don’t hesitate to confirm your machine is set as prescribed.
• Anxiety about using CPAP can cause aerophagia. Using tools from cognitive behavioral therapy – also called CBT – can help you find calm at night, preventing panic attacks and possible hyperventilation from using CPAP.
• Think about changing mask styles or adding a chin support if you find you’re breathing through your mouth.
• Consider mask fit. A too-tight mask can be just as bad as a too-loose one. If you awaken with red marks on your face or have high leak ratings on your morning report, it is likely that there are problems with your mask fit. Visit your sleep specialist to review your mask fitting.
• Ask your sleep specialist about a CPAP machine comfort setting known as expiratory pressure relief, EPR, or "Flex." Adjusting this setting automatically drops air pressure during exhale, which can reduce or eliminate aerophagia. You can adjust this setting yourself, but if you’re not sure how to, get assistance from a sleep specialist.
• CPAP is just one PAP therapy for people with obstructive sleep apnea (OSA). Bilevel PAP delivers 2 different levels of pressurized air during inhale and exhale. AutoPAP describes an automated “smart” CPAP machine that delivers pressurized air within a “window” of settings based upon your breathing patterns. Either can help reduce aerophagia.
• Sometimes people who sleep on their backs find aerophagia improves if they sleep on a 30- to 40-degree incline (such as what a pillow edge provides).
• Gastroesophageal reflux disease (GERD) and OSA often occur together. GERD exacerbates air swallowing. Why? The sphincter ring that’s the “doorway” between the esophagus and the stomach has weakened, allowing air into the stomach. Talk to your sleep specialist about treating your GERD.
• If aerophagia only seldom occurs, try drinking sparkling spring water in the morning to release trapped air in the body. Some yoga stretches (general squats or twists, Chair Pose, Child’s Pose, or Happy Baby Pose) can also bring relief for gas.

Interested in reading more about getting the most out of your CPAP? Explore our featured collection on tips and tricks for CPAP users.