How to Reduce CPAP-Related Air Swallowing Side Effects

Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea. But you can expect some side effects.

One of the most common complaints is CPAP-related gas. As excess air enters the stomach, it can lead to burping, belching, farting, and bloating.

This article will explain how to treat these symptoms and what you can do to reduce the amount of air you swallow in the first place.

Ways to avoid CPAP-related gas
Verywell / Brianna Gilmartin.

Air Swallowing With CPAP Symptoms

Sleep apnea is a serious disorder that causes pauses in breathing during sleep. It could happen once, several times, or even hundreds of times per night.

Left untreated, sleep apnea can do more than leave someone feeling tired and irritable during the day. It can lead to high blood pressure, heart attack, stroke, or diabetes.

One way to treat sleep apnea is with a CPAP machine—a mask and hose that is worn over the nose and/or mouth. An air blower gently forces air through the nose and/or mouth.

The air pressure is set to prevent the upper airway tissues from collapsing during sleep. Patients often report that they look and feel "funny" wearing a CPAP machine. But they usually learn to deal with it. The treatment works.

A downside to all that pumped air is that it enters the stomach, leading to a few common complaints. These include:

  • Bloating
  • Burping or belching
  • Farting (flatulence)
  • Stomach pain
  • Vomiting of air (rarely)

These symptoms often are minor and tolerable. Many people feel relief in the first hour of the next day by simply passing the pent-up gas.

But, for some people, the symptoms can be severe and troubling.

Fortunately, the extra gas poses no danger to your body. But if it continues, you'll probably want to find ways to manage it.

Causes

CPAP therapy is a little like using a tire pump. The air has to go somewhere. And if there is a slit in the tire, the air will escape.

The therapy is more complex than this, of course. But the idea is the same.

When air is pumped into the digestive tract, it is 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. It also pushes soft tissues and the tongue aside. The air also prevents the person's oxygen levels from dropping, which causes someone to awake from sleep.

Sleep apnea is more common than you may realize. Ten percent of women and 25% of men deal with it.

The lower part of the airway is supported by bony structures and cartilage. It includes the trachea, which leads to the bronchi and lungs. The opening that leads to the esophagus and stomach sits near the entrance to the trachea.

So when excess air is pushed into the esophagus, the stomach may fill with air. And this can lead to gassiness. 

You may experience aerophagia in other ways in your daily life. Drinking fizzy, carbonated beverages can cause you to swallow too much air. So can eating too fast, chewing gum, and smoking.

Treatments to Reduce CPAP Gas

There are ways to decrease CPAP gas. Consider these options: 

Adjust Your Sleep Position

Sleeping at an incline may help. This position should prevent a "kink" in the esophagus that may ease the passage of air into the stomach.

Many people find it helpful to sleep with their head up at an angle of about 30 degrees. A wedge pillow can help. It can be placed on top of or under the mattress, depending on its design.

Some people opt for an adjustable bed, but this option can be expensive. Another idea: Raise the head of the bed with blocks.

Whatever you do, make sure to fully support your head, neck, shoulders, and upper body.

Address Heartburn

Consider the possibility that you may have untreated heartburn, or gastroesophageal reflux disease (GERD). Heartburn, especially when it occurs at night, can cause you to swallow more air.

The lower part of the esophagus has a muscular ring called the lower esophageal sphincter. This ring closes off the esophagus from the stomach. And this prevents the contents of the stomach, including stomach acid, from creeping up into the esophagus.

The sphincter becomes weak in people who deal with heartburn. It does not close off the esophagus as well as it should.

This allows reflux of the stomach acid into the esophagus. It can also allow air to get into the stomach with a CPAP machine.

You may find relief in some over-the-counter heartburn remedies, including:

  • Prilosec (omeprazole)
  • Nexium (esomeprazole)
  • Tagamet (cimetidine)
  • Tums (calcium carbonate)

Speak with your healthcare provider first. None of these options is meant for long-term use.

Take an Over-the-Counter Medication

Your provider may recommend an over-the-counter (OTC) remedy such as Gas-X (simethicone). It may bring some relief.

In the end, you may find the greatest relief after resigning yourself to spending a little more time in the bathroom each morning. Passing gas naturally (through burping or farting) often solves the issue.

Does Your Mask Play a Role?

People who undergo CPAP therapy often ask if the type of mask they use plays a role in the amount of air they swallow. They want to know: Does it make a difference if the mask covers only my nose instead of both my nose and mouth?

The short answer is no. Whether the pressurized air is sent through the nose or mouth, it ultimately comes into contact with the same passage at the back of the throat.

Summary

Living with sleep apnea can be difficult, but CPAP therapy can help. However, it can pump air into the stomach, which is called aerophagia. This literally means "air swallowing" or "air eating."

This extra air must go somewhere, and it usually escapes through burping, belching, or passing gas. If these symptoms are bothersome, consult your healthcare provider for several ways to treat these symptoms. These could include sleeping at an incline, treating acid reflux, and taking OTC medications for relief.

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. Stop using your CPAP machine and contact your CPAP equipment provider to get the pressure lowered. You also should consult your sleep healthcare provider since setting changes represent a prescription change.

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15 Sources
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  1. Orr WC. CPAP and things that go "burp" in the night. J Clin Sleep Med. 2008;4(5):439–440. PMID: 18853701. doi:10.5664/jcsm.27279

  2. Cleveland Clinic. Sleep apnea.

  3. Shepherd K, Hillman D, Eastwood P. Symptoms of aerophagia are common in patients on continuous positive airway pressure therapy and are related to the presence of nighttime gastroesophageal refluxJ Clin Sleep Med. 2013;9(1):13–17. Published 2013 Jan 15. doi:10.5664/jcsm.2328

  4. Sullivan SN. Functional abdominal bloating with distentionISRN Gastroenterol. 2012;2012:721820. doi:10.5402/2012/721820

  5. de Jesus LE, Cestari AB, Filho OC, Fernandes MA, Firme LH. Aerofagia patológica: uma causa rara de distensão abdominal crônica [Pathologic aerophagia: a rare cause of chronic abdominal distension]. Rev Paul Pediatr. 2015;33(3):372–376. doi:10.1016/j.rpped.2015.01.003

  6. Harding SM. CPAP-related aerophagia: awareness first!J Clin Sleep Med. 2013;9(1):19–20. doi:10.5664/jcsm.2330

  7. Schwab RJ, Pack AI, Gupta KB, et al. Upper airway and soft tissue structural changes induced by CPAP in normal subjects. Am J Respir Crit Care Med. 1996;154(4 Pt 1):1106-16. PMID: 8887615 

  8. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea [published correction appears in Physiol Rev.2010 Apr;90(2):797-8]. Physiol Rev. 2010;90(1):47–112. doi:10.1152/physrev.00043.2008

  9. Cuomo R, Sarnelli G, Savarese MF, Buyckx M. Carbonated beverages and gastrointestinal system: between myth and reality. Nutr Metab Cardiovasc Dis. 2009;19(10):683-9. doi:10.1016/j.numecd.2009.03.020

  10. Souza FJFB, Genta PR, de Souza Filho AJ, Wellman A, Lorenzi-Filho G. The influence of head-of-bed elevation in patients with obstructive sleep apneaSleep Breath. 2017;21(4):815–820. doi:10.1007/s11325-017-1524-3

  11. Goyal RK, Chaudhury A. Physiology of normal esophageal motilityJ Clin Gastroenterol. 2008;42(5):610–619. doi:10.1097/MCG.0b013e31816b444d

  12. Chait MM. Gastroesophageal reflux disease: Important considerations for the older patientsWorld J Gastrointest Endosc. 2010;2(12):388–396. doi:10.4253/wjge.v2.i12.388

  13. Watson NF, Mystkowski SK. Aerophagia and gastroesophageal reflux disease in patients using continuous positive airway pressure: a preliminary observationJ Clin Sleep Med. 2008;4(5):434–438. PMID: 18853700

  14. National Library of Medicine. Simethicone.

  15. Donovan LM, Boeder S, Malhotra A, Patel SR. New developments in the use of positive airway pressure for obstructive sleep apneaJ Thorac Dis. 2015;7(8):1323–1342. doi:10.3978/j.issn.2072-1439.2015.07.30