Waking up bloated, burping or with stomach pain after a night on CPAP has a name: aerophagia, literally “air swallowing”. The AASM describes it as air passing into the throat and stomach, producing “bloating, belching, and/or flatulence” (AASM PAP troubleshooting FAQ).
What the guidance says to try
| Approach | Source | Who changes it |
|---|---|---|
| Treat nasal congestion | AASM | You and your clinician |
| Try a full face mask, which allows mouth breathing | AASM | You and your supplier |
| Switch from a face mask to nasal pillows or a nasal mask | ATS | You and your supplier |
| Change sleep position and/or number of pillows | ATS | You |
| Use expiratory pressure relief | ATS | You (on many machines) |
| Lower overall pressure, or expiratory pressure on BiPAP | AASM | Your clinician |
| Ask whether auto-PAP or bilevel suits you better | ATS | Your clinician |
| Over-the-counter or prescribed gas/bloating remedies | AASM | You and your clinician |
Sources: AASM PAP troubleshooting FAQ, American Thoracic Society tip sheet.
The two societies point in opposite directions on mask type: the AASM suggests a full face mask, the ATS suggests nasal pillows or a nasal mask. Which helps depends on how the air is getting in, so try one change at a time and note the result.
Comfort settings you can usually change yourself
On the ResMed AirSense 11, two comfort settings are in My Options (ResMed AirSense 11 user guide):
- Expiratory Pressure Relief (EPR). “When EPR is enabled, you may find it easier to breathe out.” Your care provider must have enabled it on the machine.
- Ramp. Starts at a lower pressure and rises to your prescribed pressure over Off, 5–45 minutes, or Auto. That helps you fall asleep, but it doesn’t change the pressure later in the night.
Changes your clinician must make
Your treatment pressure is prescribed. If aerophagia continues after the self-help steps, ask your clinician to review your therapy data. Depending on your case, they may lower or narrow the pressure range, switch you to auto-PAP, or consider bilevel. Under Medicare, a bilevel device without backup rate is covered for OSA only after CPAP has been tried and proven ineffective (LCD L33718). Our Medicare CPAP guide explains the rules.
Self-check before your appointment
- When does it happen? Every night, or only at higher pressures or in certain positions?
- What mask? Bring the mask, or its name, to the appointment.
- Is your nose blocked? If so, see nasal congestion.
- Bring your data. Usage, leak and pressure from the machine or its app.
When to call your doctor promptly
Stomach pain that is severe, gets worse, or comes with vomiting isn’t something to troubleshoot alone. Contact your healthcare provider.
Verdict
Start with what you control: sleep position and pillows, expiratory pressure relief if it’s enabled, and any nasal congestion. Then try a different mask style. If bloating continues, take your therapy data to your clinician and ask about pressure, auto-PAP or bilevel. Don’t stop using CPAP while you work it out unless your clinician agrees.