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HOW TO MANAGE BLOATING AND FLATULENCE ON CPAP

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Does CPAP make you fart? Many suffer silently from gas and feeling bloated. Most are far too embarrassed to bring this up to their DME or sleep provider.

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Why Does This Happen?

As an online sleep doctor, with sleep telemedicine services in Georgia, Florida and Virginia, I have seen many patients struggling with this issue. Common causes of CPAP bloating and gas in my practice are:

Mask. The type of mask you wear may cause gas and bloating. A full-face mask (covers mouth and nose) requires a higher pressure to keep the airway open, leading to pressure transmitted to the stomach.
Head of Bed. The higher the position of your head (more pillows) relative to the rest of your body, the lower the pressure required to keep your airway open. The pressure tested during a sleep study may differ from your home needs as a result of changing the head elevation. This is especially true if using a CPAP instead of an Auto-CPAP.
Expiratory Pressure Release/C-Flex. This setting allows the CPAP to drop its pressure when you exhale. High pressures to keep your airway open (when inhaling) may be too high when breathing out.
CPAP. A continuous PAP (or CPAP) provides one set pressure, which is usually set at the highest pressure needed to keep your airway open. This occurs mainly when we sleep on our back or are in deep sleep (REM sleep). Since we have different sleep positions and sleep phases, the CPAP set pressure may be too high for most of the night.

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Weight Loss. The popularity of diet plans and bariatric surgery has led some to lose significant weight. This may cause previous pressure settings on CPAP to be too high, which may result in bloating.

What Can I Do About It?

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Below are some steps to address CPAP gas and bloating:

Switch to a nasal mask. You may need a chin strap if you tend to mouth breath. If you wake up with a dry mouth on CPAP using a nasal mask, then you definitely need a chin strap.
More head pillows. If you have an Auto-CPAP this may be an easy fix. Make sure your torso (not just your neck) is elevated, which may require a wedge pillow + regular pillow.
Auto-CPAP. If your machine has the auto-titrating CPAP feature, use it. If your CPAP is over five years old, you could benefit from an upgrade to a new APAP device.
EPR/C-Flex. Have your equipment provider adjust this setting (or YouTube it).
Gas-X. Some of my patients have benefitted from using this medication.
Confirm pressure settings. I have come across this mistake on many occasions. The settings prescribed by your provider is not what is currently used on the device.
Sleep study. An in-laboratory sleep study with CPAP titration (to assess best pressure). This will allow for insurance coverage if a switch to an advanced device like Bi-Level is needed to address this problem.