Bloating? Understanding CPAP’s Gassy Side Effects

While continuous positive air pressure (CPAP) is an effective way to treat sleep apnea, there are potential CPAP side effects to consider. One of these is bloating and gassiness caused by aerophagia, which can see excess air reaching the stomach.

What Is Aerophagia?

Aerophagia is the term used to describe excessive air swallowing, one of the likely CPAP side effects. Air swallowing is nothing unusual -- and most of us will swallow a minimal amount of air during the course of the day. This can be when eating too quickly, drinking fizzy drinks or smoking. When you belch it’s a good sign that you have swallowed air.

However, CPAP therapy can cause you to swallow excessive levels of air. When you are gassy you can experience the following symptoms:

  • bloating
  • flatulence
  • belching
  • stomach discomfort

For most people, bloating is a minor inconvenience, one which will naturally pass within an hour or two in the morning as the excess gas is released. Not necessarily pleasant, particularly to those closest to you, but a tolerable side effect for the benefits CPAP provides in countering sleep apnea.

Without treatment, sleep apnea increases your risk of serious health conditions including heart disease, stroke, high blood pressure and diabetes. 

However, for some people, the CPAP side effects can be more severe and harder to bear, at which point they will want to consult with their healthcare provider on ways to counter CPAP bloating. Compliance with the treatment is key and therefore you want to address any issues that threaten compliance as soon as possible.

How Does CPAP Cause Air Swallowing?

The CPAP device delivers air to a sleep apnea patient every night to help prevent their airways from collapsing. The air is delivered via tubing connected to a mask worn over the nose or mouth. 

In passing through the upper airways, the air stops the relaxed soft tissues collapsing into the throat and obstructing the flow of air to the lungs.

The pressurized air heads into the lungs through the trachea. In an ideal world, all the air would make its way down the trachea. However, the esophagus sits close by, and some of the air meant for the lungs can enter the esophagus and travel down into the stomach and digestive tract instead.

The stomach can then begin to fill with air that will need passing, hence the morning bloating, belching, flatulence and possible stomach discomfort or pain. 

Air swallowing does not impact the effectiveness of your sleep apnea treatment, and for the most part, does not place your body at any additional risk. For most people the impact, while not ideal, will be tolerable and passes within the first couple of hours awake.

However, some people can find gassy effects a lot less tolerable and suffer the side effects of bloating considerably more. Regardless of the degree to which bloating affects you, there are ways to help prevent or reduce the effects of such CPAP-related gassiness.

Three Ways To Manage and Reduce Bloating

Although CPAP bloating may be tolerable for most people, it is still worthwhile exploring possible ways to reduce your gassy side effects. The following are three suggestions.

1. Discuss With Your Healthcare Provider

Occasional bloating is to be expected, but if you are experiencing consistent CPAP-related gassiness, chat with your healthcare provider for advice. 

A sleep study is used to diagnose OSA, and the severity of the disorder and how many apneas you experience every sleeping hour help determine the air pressure setting on your treatment device.

The air is set at a pressure to prevent the collapse of the soft tissues in the throat. However, continued bloating may be a result of a pressure setting that is too high. Your healthcare provider can arrange a further test to see if the air pressure needs adjusting to a lower rate. 

Ultimately, the pressure of the air has to ensure the airways remain obstruction-free for a clear flow of the air to the lungs.

2. Adjust Your Sleeping Position

Another contributing risk factor to air swallowing is your position when you sleep. Sleep apnea patients are often advised to sleep on their sides rather than their backs to reduce the effects of gravity pulling the soft tissues of the throat down and blocking the airways.

If bloating is one of the PAP side effects you experience then raising your head to an angle of around 30 degrees may also prove beneficial. This can be achieved using a wedge pillow or simply by placing blocks under the mattress to help raise the head of the bed.

Inclining the head as you sleep can reduce the amount of air entering the esophagus, although always ensure the head and neck are suitably supported.

3. Treat Potential Heartburn

Adjusting your sleeping position can also address heartburn, a condition that can also see air entering the stomach. This could compound any CPAP bloating you already experience.

Heartburn occurs when stomach acids enter into the esophagus due to a weak sphincter. There are over-the-counter medications that can help relieve heartburn and any associated gassiness. Indeed, your healthcare provider may recommend over-the-counter medication to address your CPAP gassy side effects even where heartburn is not a factor.

Although extra air from CPAP can cause discomfort and bloating, remaining compliant with the therapy is crucial for the effective treatment of obstructive sleep apnea. The pressurized air prevents the collapse of the airways, and air swallowing can occur regardless of the type of mask you wear.

While CPAP bloating will be minor for many people and the excess gas released soon after starting your day, your sleep healthcare provider can help recommend ways to mitigate CPAP side effects like bloating and gassiness.