Why Can CPAP Cause Gas or Stomach Bloating? And How to Prevent It

If you are suffering from sleep apnea, a CPAP machine can improve your sleeping habits and your quality of everyday life dramatically. The CPAP machine will counter the harmful effects of sleep apnea that includes oxygen level to drop and awakenings by sending positive airflow pressure through a CPAP mask to keep the air passages open during sleep.

When tolerated, CPAP therapy is very effective in preventing sleep apnea. However, it is not always without side effects. A common complaint associated with using a CPAP machine is swallowing air, which can lead to a feeling of fullness and discomfort, including unwanted gasses that cause belching and farting. This air in the stomach is also called aerophagy, literally means “swallowing air” or “eating air”.

Why your stomach can fill with air using a CPAP machine

CPAP works by providing a constant flow of air that keeps your airways open by pushing soft tissues aside, especially in the soft palate, tongue, and upper throat. The lower part of the airway is supported by bony structures and cartilage and includes the trachea leading to the bronchi and lungs.

Right next to the entrance to the trachea is an opening leading to the esophagus and stomach. Therefore, if excess air is misdirected, the stomach can fill with air, which can lead to increased gas formation.

What are the symptoms of air swallowing?

If the pressurized air of CPAP gets into your stomach, you may experience discomfort, including burping or belching, farting, a full or bloated stomach, sometimes with stomach pain. In rare cases, you may vomit of air.

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These symptoms can be relatively minor and tolerable. Most people can notice relief in the first hour of the day by passing the gas. However, it can also be quite severe and worrying. Fortunately, the risk of permanent damage to your body is considered low. Nevertheless, it may be desirable to look for ways to make this less troublesome by reducing the frequency and degree of air swallowing.

What are the possible causes of swallowing air using a CPAP machine?

Possible causes of aerophagy include:

The pressure is set too high: Your CPAP pressure may be set too high or higher than you need. The extra air you get cannot go anywhere but into your esophagus and then into your stomach.

The pressure is set too low: Maybe your pressure’s set too low if it’s not enough to fix your apnea episodes. If you try to get more air into your lungs, you end up swallowing air quickly, which is forced into your esophagus instead.

Nose congestion: Allergies, a cold or flu, can cause nasal congestion. If you have a blocked nose, you may not be able to get the right CPAP air pressure, so swallow the air with your mouth, and it will go down your esophagus.

Mouth breathing: You may be a mouth breather and wear a traditional nasal mask. If your mouth opens during sleep, the CPAP device may not be able to deliver air to your lungs so that the air will escape through your mouth. Your apnea episodes are not corrected, so in your unconscious panic, you may suddenly feel a choking sensation and inhale the air quickly and push it down your esophagus.

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Problems exhaling: You may have difficulties exhaling above the constant air pressure that CPAP provides. This is especially difficult for people who use medium to high CPAP pressures. If you inhale high pressures, it might be easy, but exhaling can cause panic, anxiety, and a feeling of suffocation or choking. In this case, you could fall out of your natural breathing rhythm and start hyperventilating. This can cause you to swallow or suck in air quickly and force it into your esophagus instead of your lungs.

Other possible reasons for excess gas formation in your stomach

Even if you’re using a CPAP machine, the cause for increased gassiness may be different from that of the CPAP therapy. It is often associated with food, especially if you eat too fast.

Also, if you drink carbonated beverages such as soft drinks containing carbon dioxide, your stomach can fill with air. Other causes could be chewing gum or smoking.

Excess gas in your stomach can also occur with hyperventilation from anxiety, from chewing gum, smoking cigarettes, during strenuous exercising, and even when talking too fast.

 

What helps to prevent swallowing air with CPAP

If you swallow air with CPAP, here are some solutions you may want to try:

Check the pressure settings of your CPAP

If you feel that your CPAP device’s air pressure is not adequate (too low or too high), talk to your doctor or sleep physician about changing the pressure. Confirm with your CPAP provider that the device is set correctly according to your doctor’s prescription. Occasionally, errors may occur, and your CPAP device may not be set correctly.

Check your mask

Find out if you are using the wrong mask. For example, a nose mask is not the best choice if you are a mouth breather. Your mask may not be the best style or size for your face. If the straps are too tight or the mask leaks frequently, you should choose another mask.

Make sure you know how to fit your mask properly and how to adjust it to get the best seal. Once you have chosen the best mask style and size for your face, you will need to adjust it properly before going to bed. Turn on your device and place the mask on your face with loose straps. Lie down in the same position you usually sleep with your head on the pillow. Then slowly pull on the straps until you achieve a good seal. If there is a double cushion in your mask, it must be put on.

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Once you have fitted and put on the mask, gently pull the mask away from your face to “put it on” and allow the double cushion to inflate correctly. Gently place the mask back on your face. You should be able to tell by how it feels whether it provides a comfortable seal.

Obtain expiratory pressure relief

Most CPAP devices today have expiratory pressure relief. They can be called BIFLEX or AFLEX, depending on the brand of the device. This feature automatically reduces the air pressure when exhaled and could help to reduce or eliminate aerophagy. Check with your CPAP provider to see if this feature is enabled on your device. You must control this feature manually, so be sure to ask how to use it.

Try a BiPAP machine

Bi-level devices with positive airway pressure or BiPAP devices can help alleviate air swallowing symptoms because the BiPAP device’s bi-level delivery system means that less air is “pumped in” during exhalation, making it less likely that air will enter the esophagus rather than the trachea.

Try an APAP device

Automatic positive pressure ventilators (APAP devices) are connected to a non-invasive mask that is connected to a pressure generator that supplies air pressure.

It automatically adjusts to compensate for light or heavy breathing, rolling over while sleeping and more. The APAP device precisely delivers the pressure needed to prevent the airway from collapsing during sleep and can, therefore, help avoid swallowing of air.

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Keep in mind that CPAP machines share similarities, but also vary technologically. Not everyone requires the most advanced device machine! Consult with your doctor or CPAP supplier to find the machine with the best value that suits your needs.

Adjust your sleeping position

Like with snoring, your sleeping position is another crucial factor. If you sleep on your back, try sleeping at an incline. This position prevents a “kink” in your esophagus, which can cause air flowing easily into your stomach.

Also, it may be helpful to sleep with the head at an angle of about 30 degrees to 40 degrees up. This can be achieved by sleeping on a wedge pillow. The wedge can be placed on or under the mattress, depending on the design. You should also make sure that a stack of cushions does not simply move your head forward. Your head, neck, shoulders, and upper body must be fully supported in a neutral position.

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Some people opt for an adjustable bed, but this can be expensive and often costs thousands of dollars. Another option would be to lift the bed as a whole. You can use books (e.g., old telephone books) or even cinder blocks to support both feet at the head end of the bed. This keeps the entire bed in a slightly sloping position. Usually, this is well tolerated by a bed partner, and there is little risk of slipping out of bed at the right angle.

Final thought

As you can see, the reasons why CPAP can cause gas or stomach bloating if you are a CPAP patient can differ. Many people do not feel comfortable talking about it. However, keep in mind that this side effect of CPAP use is not only very common, it is also an important issue that should be discussed, and with appropriate changes in therapy, it can be corrected.