Aerophagia on CPAP: Bloating, Burping and Swallowing Air

What aerophagia feels like

Aerophagia means swallowing air. On CPAP, some of the pressurised air goes down the oesophagus into the stomach instead of the lungs. People describe waking with a tight, bloated stomach, frequent burping, passing gas, and sometimes stomach pain or a feeling of fullness.

Common contributing factors

• Pressure that is higher than you need at certain times of the night.
• Mouth breathing or mouth leaks.
• Nasal congestion, which makes you work harder to breathe.
• Sleeping position, particularly lying flat on the back.
• Acid reflux, which some people find worsens bloating.
• Anxiety or gulping air while trying to get used to the mask.

Things you can try

• Raise your head and upper body slightly with a wedge pillow, which some people find reduces air swallowing.
• Try sleeping on your side.
• Make sure your mask fits well and address mouth leaks.
• Avoid large meals, carbonated drinks and alcohol close to bedtime.
• Use ramp so you fall asleep at a lower pressure.

What your clinician may consider

Because pressure plays a role, your sleep clinician may review your data and consider a change such as adjusting the pressure, enabling an exhalation relief feature, switching to an auto-adjusting machine so pressure is only high when needed, or occasionally trying a bilevel machine. These are prescription decisions. Please do not change your pressure yourself, because too little pressure can let apneas return.

If you also have reflux, your doctor may want to treat that too.

When to get checked

Contact your doctor if you have severe or worsening abdominal pain, vomiting, or blood in vomit or stool, as these are not typical of aerophagia and need assessment.