How to Reduce CPAP-Related Air Swallowing Side Effects

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Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea, but it is not without its side effects. One of the most common complaints with its use is CPAP-related gas, including excessive air that enters the stomach and leads to increased burping, belching, farting, and bloating after use.

What causes CPAP gas side effects? Are there effective treatment options to avoid its occurrence? Explore some of the symptoms related to CPAP gas and what can be done about it to reduce air swallowing.

Ways to avoid CPAP-related gas
Illustration by Brianna Gilmartin, Verywell.

What Causes CPAP Gas or Air Swallowing to Occur?

Air swallowing is one of the most common symptoms associated with CPAP therapy for sleep apnea. It leads to bloating, unwanted gas causing burping and farting, and discomfort. This air in the stomach is sometimes called aerophagia, which literally means "air swallowing" or "air eating." What causes this air swallowing to occur?

CPAP works by providing a constant flow of air that keeps the upper airway open and prevents its collapse during sleep. When tolerated, it is highly effective for preventing sleep apnea, a condition characterized by repeated collapse of the soft palate and tongue into the throat that leads to oxygen level drops and awakenings.

This airflow can be problematic, however, especially if the air is excessive and goes where it's not wanted.

If you envision a tube running from the tip of your nose to your lungs, the pressurized airflow of CPAP keeps this tube open. It will push soft tissues aside, especially in the area of the soft palate, tongue, and upper throat. The lower part of the airway is supported by bony structures and cartilage and includes the trachea, which leads to the bronchi and lungs.

Right near the entrance to the trachea is an opening that leads to the esophagus and stomach. Therefore, if excessive air is misdirected down the esophagus, the stomach may fill with air and this could lead to increased gassiness. 

When not associated with the use of CPAP therapy, aerophagia may be caused by other phenomena. It is frequently associated with any sort of eating, especially when someone eats too fast. Aerophagia often results from drinking carbonated beverages such as soda pop or fizzy drinks that contain carbon dioxide. It may also occur when chewing gum or even while smoking. There are rare conditions that may be associated with aerophagia, such as an anxious behavior in those with a brain injury from birth.

Symptoms of Air Swallowing

When the pressurized air from CPAP improperly enters the stomach, it leads to a few common complaints. These include:

  • Burping or belching
  • Farting (flatus or flatulence)
  • Full or distended stomach (bloating)
  • Vomiting of air (rarely)
  • Stomach pain

These symptoms may be relatively minor and tolerable. Most people may notice relief in the first hour of the day by passing the gas. However, it can also be quite severe and distressing. The fortunate thing is that there is little risk of permanent damage to your body. Nevertheless, it can be desirable to seek out ways to make this less troublesome by decreasing both the frequency and degree of air swallowing.

Treatments to Reduce CPAP Gas

There are ways to decrease CPAP gas depending on what the underlying cause is. The good news is that the inconveniences related to CPAP gas can usually be overcome and the effectiveness of the therapy can be enjoyed. Consider these options: 

Adjust the Pressure Settings

One of the most common causes of CPAP gas is that the pressure setting of the machine is simply too high. If the pressure was not set as part of a titration study, if the device delivers solely a fixed pressure, or if you have lost at least 10 percent of your body weight, this is more likely.

By turning down the pressure, or setting a range of pressures that includes a lower setting with AutoCPAP, the air swallowing may improve substantially.

In some cases, it may be necessary to switch to bilevel therapy, a device type that drops the pressure during exhalation and that will make it easier to breathe out against the airflow.

Adjust Your Sleep Position

Another important factor is your sleep position. If you sleep on your back, it can be helpful to sleep at an incline. This will prevent a "kink" in the esophagus that may lead it to more easily allow the passage of air into the stomach. Most people find it helpful to sleep with the head up at an angle of about 30 degrees to 40 degrees. This can be accomplished by sleeping on a wedge pillow. The wedge may be placed on top of or under the mattress, depending on its design. You should also be certain that a stack of pillows does not simply move your head forward. It is really about your head, neck, shoulders, and upper body being fully supported in a neutral position.

Some people opt for an adjustable bed, but this can be expensive, often costing thousands of dollars. Another option would be to raise the bed as a whole. With the use of books (such as old telephone books) or even cinder blocks, you can prop up the two feet at the head of your bed. Therefore, the entire bed will be kept at a slant. This is usually well tolerated by a bed partner if you have one, and there is little risk of sliding out of bed at the proper angle.

Address Heartburn

It is fairly common for the cause of aerophagia and CPAP gas to be related to untreated heartburn or gastroesophageal reflux disease (GERD). Heartburn, especially when it occurs at night, can exacerbate the air swallowing.

The lower part of the esophagus has a muscular ring called the lower esophageal sphincter. This ring closes the esophagus off from the stomach. This prevents the contents of the stomach, including stomach acid, from splashing up into the esophagus. However, in people with GERD or heartburn, the sphincter becomes weakened. It does not close off the esophagus as well as it should. This allows reflux of the stomach acid into the esophagus, but it also can allow air to get into the stomach with the use of CPAP.

Some people will find the use of medications for GERD to be helpful in preventing CPAP gas, including over-the-counter options such as:

  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)
  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)
  • Calcium carbonate (Tums)

It may be important to speak with your doctor if these are required for long-term use.

Over-the-Counter Medication Options

An additional treatment option can be the use of Gas-X (sold over-the-counter under the generic name of simethicone). This may provide some relief, but if the amount of air swallowed is significant, it may not be adequate.

Though potentially unpleasant, a greater relief may be to simply pass the gas out naturally through burping or farting.

Does Your Mask Play a Role?

Finally, people often ask if the type of CPAP mask has a role in worsening air swallowing. For example, if the mask is just over the nose as compared to covering the nose and mouth, does this make a difference?

The short answer is no. Whether the pressurized air is being delivered through the nose or mouth, it ultimately comes to the same passage at the back of the throat. The problem lies farther down in the airway and not at the nose or mouth where a mask could be applied differently. Therefore, it won’t likely make a substantial difference which mask you choose to use.

A Word From Verywell

It can be very uncomfortable to experience extreme air swallowing, especially with the use of CPAP settings that are not optimized. Don't suffer in silence! It is advisable to immediately stop the use of your CPAP machine. Reach out to your CPAP equipment provider to get the pressure lowered. It is likely that you will also need to involve your sleep doctor about any setting changes, as this is a prescription change. Fortunately, with a few phone calls, you can get on the right track. What a relief.

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Article Sources

  • Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 6th edition, 2017.