My wife told me that i sometimes sleep with my mouth open.

I did some digging around on Google and found taping ones mouth shut may help with better sleep, then I found there is a link between sleep-disordered breathing and AF. [www.ncbi.nlm.nih.gov]

Previously my average fitbit sleep score was 75, after taping my mouth shut last night my score went up to 86. I have never had a score of 86, ever.
????
Has anyone had any experience with taping ones mouth shut before sleep.

I recall seeing some discussion about that on another forum. It's basically a poor man's treatment for sleep apnea.

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colindo
Has anyone had any experience with taping ones mouth shut before sleep.

I've done it for years. There are PowerPoint presentations showing apnea patterns in beat to beat heart rate (RR) vs time graphs. I could see these patterns on data captured with my Polar strap. Subsequent to taping at night, these patterns disappeared.

The issue is blowing off CO2 because of overbreathing. CO2 is essential not a waste gas (they used to carry CO2 tanks on the ambulances in the 20's & 30's). Serum CO2 levels generally & not O2 trigger your urge to breathe. The level at which this is triggered is changeable with training (or overbreathing). Paradoxically, because of the Bohr Effect, the less your serum CO2, the less O2 gets to the cells. Essentially, hemoglobin has a very high affinity for O2 and higher levels of CO2 (in the form of serum pH) reduce this affinity, thereby allowing more O2 to get into the cells.

I've posted about breathing a lot over the years: [www.afibbers.org]

I try to always breathe through my nose, whether asleep, awake or exercising (even at 13,000', 3,960m).

Breathing instructor Patrick McKeown has many books on the topic, this is one: [www.snoring.ie]

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Carey
I recall seeing some discussion about that on another forum. It's basically a poor man's treatment for sleep apnea.

I would suggest it actually addresses the root cause, whereas things like a CPAP address symptoms. When I observe people's breathing, the healthy ones are breathing through their noses diaphragmatically, gently and quietly.

Mike Mutzel is an expert on this also. I tried it for a while - didn't like it.

[highintensityhealth.com]

I did get one of these devices and used it to detect hypoxia in myself and several others.

[www.amazon.com]

It can be set to alarm at many levels of O2 as well as upper and lower HRs. Has vibration and records data for several nights in a row. Great little device.

I've been sleeping w/o cpap recently and maintaining 93% avg with less than 2 minutes in total below 90%

If you've been snoring and hypoxic for some time check your hsCRP levels - major contributor to AF.

Also read the work of Prash Sanders (adelaide)

That sounds like torture to me, Colindo.

/LarryG

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LarryG
That sounds like torture to me, Colindo.

/LarryG

No it wasn't, I used 3M micropore tape. I have since found chin up strips. [britishsnoring.co.uk]
I understand you need to do it for a week, so if it helps to stop afib and give a better sleep then I'll give it a go.



Edited 1 time(s). Last edit at 09/20/2020 04:30AM by colindo.

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GeorgeN
I would suggest it actually addresses the root cause, whereas things like a CPAP address symptoms. When I observe people's breathing, the healthy ones are breathing through their noses diaphragmatically, gently and quietly.

How many of those people did you observe while they were sleeping? Most people with sleep apnea breath perfectly normally while awake.

Hi Colin - From long ago, there are numerous posts about Eucapnic breathing and the Buteyko method... Back then,
I took took the training to the technique and found it useful. There's info about mouth taping etc.

Here are a few links and if you want more, just type buteyko into the search feature:

[www.afibbers.org]

[www.afibbers.org]

[www.afibbers.org]

Jackie

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colindo

I used 3M micropore tape.

If you purchased this off of Amazon, you likely received a Chinese knock-off. I know this from experience buying this product via Amazon, for it's marketed purpose.

I bought this one - Nexcare Strong Yet Pain Free Tape,

This also saved my cheese when I flew to Europe in Feb.

No N95s could be found anywhere. I bought some N95 filter paper - cut it into a triangle and then taped over mouth and nose. Also wore 3m safety goggles (turns out a good idea)

For a long trip I'd do the same now. While odd looking the solution is far better than a mask.

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Carey
How many of those people did you observe while they were sleeping? Most people with sleep apnea breath perfectly normally while awake.

Depends on how you define "normal." Have a breathing instructor observe them, while awake, and they'd tell you a different story. Most, if not all, are overbreathing. I'm far from an instructor, but can observe it in many.

Give them a "control pause" aka BOLT Score test.

Prof. Buteyko developed a test to measure depth of breathing and consequent retention of carbon dioxide, resultant oxygenation and health. He named it the ‘Control Pause’ breathing test. Get yourself a clock or stop-watch & try for yourself:

Sitting down, close your mouth and breathe normally through the nose for 30 seconds

Take a normal breath in through your nose

Allow a normal breath out through your nose

Gently close your nose with thumb & forefinger and start to count the seconds on the clock or stop-watch

When you first feel the need to breathe, release the nose and take a breath through the nose – remember to keep your mouth closed throughout (this is not a maximum breath hold, only till the first need to breathe, your next breath and follow on breathing should be completely normal, not big breaths).

The number of seconds that elapsed is your Control Pause. Less than 10 seconds, and you have health problems. Less than 25, your health needs attention. 30-40 seconds is satisfactory, while 60+ seconds is excellent.



Source: [www.buteyko.co.uk]

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AB Page

If you purchased this off of Amazon, you likely received a Chinese knock-off. I know this from experience buying this product via Amazon, for it's marketed purpose.

Thanks to Jackie for alerting me to the importance of correct breathing many, many years ago!

I purchase strips, made for the purpose, from Jackie's breathing instructor, Carol Baglia. I've found they work very well.

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NotLyingAboutMyAfib
No N95s could be found anywhere. I bought some N95 filter paper - cut it into a triangle and then taped over mouth and nose.

KN-95 masks are readily available on Amazon and elsewhere at reasonable prices. KN-95 masks are the same specification as N-95 masks but they carry the European certification so they've kind of flown under the radar of the hoarders. They are functionally the exact same thing.

If you're smart enough to wear a mask in public, I recommend that you buy KN-95 masks.

For those who are concerned about the breathing limitations of N-95 masks, I had a recent opportunity to find out just how much they reduce my ability to breathe. I developed an infected tick bite so I had to visit a walk-in clinic for some antibiotics. Naturally, I was required to wear a mask for the exam. When the nurse put a pulse ox on me after having spent 5 minutes waiting and wearing that mask, my O2 sats were 96%. Normally, my sats are in the 98-99% range, so the mask dropped my O2 sats 2 percentage points. That's an absolutely nothing unless you have very serious lung disease, in which case you shouldn't be out in public in the first place.

(no n95s) This was in late February when I went to Europe to scatter my father's ashes and fulfill his last wishes. Luckily, I was able to do this at that time. Not sure when the next chance would have been.

Glad you got to make that trip when you did. Where did he want his ashes spread?

But you did note the difference between N-95 and KN-95 masks, right? You can't get N-95s but you can get KN-95s.

George, I'm skeptical that the BOLT test says much about sleep apnea. Seems to me it's more of a general cardiovascular fitness test. There are all sorts of reasons someone might feel air hunger after less than 60 seconds that have nothing to do with breathing problems. Your last paragraph pretty much says that exact thing. It's a measure of general health and fitness. You can be generally fit and healthy and yet still have sleep apnea.

As I remove my mask this morning after nearly 8 hours of uninterrupted sleep thanks to the latest technology in sleep therapy, I wont look back at all those alternative methods I tried for over a decade, which failed me. Oh sure there were some successes and slight improvement after Buyteko and many other methods, including taping the mouth, but never could quite get the Nocturia relieved. Yes there were many to tell me I simply wasnt practicing correctly and it was my fault. Gee, where have we heard that before Dr John? To simply not get up 4-5 times per night, is all I need to know about my physical limitation for a restful nights sleep. When you wake up with your mouth taped shut gasping for air, HR around 44 and cant remember your middle name, and possibly in afib, you ll realize sleep issues might be above the alternative pay grade.

From the BOLT score test:

"When you first feel the need to breathe, release the nose and take a breath through the nose – remember to keep your mouth closed throughout (this is not a maximum breath hold, only till the first need to breathe, your next breath and follow on breathing should be completely normal, not big breaths).

The number of seconds that elapsed is your Control Pause. Less than 10 seconds, and you have health problems. Less than 25, your health needs attention. 30-40 seconds is satisfactory, while 60+ seconds is excellent."

Crazy - after 30 seconds of light breathing through your nose, then after you exhale, holding one's breath for 60 seconds will be very, very uncomfortable for 95% of the population assuming they could force themselves to go that far. "Feeling the need to breathe" is very subjective and by no means a viable measure, and I would guess that the average healthy person would begin to feel a need to breathe in 10-15 seconds.

I think it's a matter of training and perhaps a parlor trick. I only got 20 seconds on first attempt and then 45 on 2nd.

Sidenote - a friend of mine that went to keto diet increased his ability to swim underwater from 35 yards to nearly 70 in a few weeks.

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hwkmn05
As I remove my mask this morning after nearly 8 hours of uninterrupted sleep thanks to the latest technology in sleep therapy,

What mask are you using? Is it an improvement to mouth taping?

CPAP mask.

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hwkmn05
CPAP mask.

Yep, and until there's a better way, I'm just fine with this. Accept, adapt and reap the benefits.

Consideration should be given to the potential for sleep apnea and to rule that out officially. Here are a few study resources:

Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc. 2004;79:1036-1046.

Goyal SK, Sharma A. Atrial fibrillation in obstructive sleep apnea. World J Cardiol. 2013;5:157-163.

Schulz R, Eisele HJ, Seeger W. Nocturnal atrial fibrillation in a patient with obstructive sleep apnoea. Thorax. 2005;60:174.

Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107:2589-2594.


Bratton DJ, Stradling JR, Barbé F, Kohler M. Effect of CPAP on blood pressure in patients with minimally symptomatic obstructive sleep apnoea: a meta-analysis using individual patient data from four randomised controlled trials. Thorax. 2014;69:1128-1135.

Calik MW. Treatments for obstructive sleep apnea. J Clin Outcomes Manag. 2016;23:181-192.


Jackie

If you ask me - sleep studies are way too elaborate and designed to fail (meaning ensure you're categorized as a patient by loading enough monitors and equipment on you to ensure you can't sleep normally).

It's as simple as this - are you hypoxic (O2 < 90) while sleeping? And if so how often and how long.

This device from Amazon (unaffiliated) - Wellue O2Ring Wearable Sleep Monitor - will enable you to capture your O2 data, motion and HR by just wearing a ring on your finger.

I bought one and saw that I was often in the 80s for O2 and then went to WalMart.com and bought a Philips CPAP w/o a prescription. Not a problem at all. Solved my issue in days vs the weeks and sometimes months it takes to go through insurance.

Since then, talking with friends I've learned that snoring or appearance doesn't always equal OSA. I've lent my ring out to others for 3 nights and an overweight friend that snore like a long shoreman has O2 in the mid 90s. While a very fit and thin woman that snored had a O2 in the low 70s most of the night! I lied (said I didn't really need mine) and gave her my CPAP that day and ordered a new one for myself.

I used this same device to see that my AF events were vagal in nature and even capture the vagal dip data to prove that point (this was before I went persistent).

I also use this device nightly because I have set vibration alerts for O2 levels (also does HR) that alert me when I am not using CPAP that I need to.

Some nights I can sleep all night long without CPAP and maintain 93% avg with less that a few minutes total under 90%. Other nights, just rolling from one side to the other ends up generating an alert and on goes the CPAP.

There are exercises you can do to help with OSA. [www.cpap.com]

Do you have OSA? Get one of these devices, Use it 3 nights (2 work nights and one weekend night) and see if you below 90% often enough to warrant getting a CPAP.

If you're borderline on the data, start doing some things that will help you - cooler room, gentle fan that exchanges the stale air around your head when you're asleep, the exercises for your fat lazy tongue , and better sleep positioning, (semi-reclining helps).

If you're hypoxic - realize this is a serious issue - kills brain cells, costs deep sleep and restoration, and raises hsCRP which has AF consequences (among many others). Don't be vain. Get a CPAP and use it and monitor your sleep often.

I might have saved myself some trouble if I took my advice today 3 years earlier when sleep study determined me 'borderline'. Vanity kept me from getting a CPAP. Bad choice.

Learn from my mistakes - good luck.

I think you're being too optimistic about O2 sats. The low 90s are not good. You should be in the mid- to upper-90s throughout the night. Being in the 80s is definitely not good, and the 70s is getting into dangerous territory.

I used the guidelines and research I found online - most of them draw the line at 90%.

As I sit here right now I'm at 99.

At sea level, a normal blood oxygen level (saturation) is usually 96 - 97%. Although there are no generally accepted classifications for severity of oxygen desaturation, reductions to not less than 90% usually are considered mild. Dips into the 80 - 89% range can be considered moderate, and those below 80% are severe.



Edited 1 time(s). Last edit at 09/23/2020 03:55PM by NotLyingAboutMyAfib.

I assume those guidelines refer to sleep apnea, not during waking hours. So not less than 90% is mild OSA, which sounds about right. Someone without OSA should be 95% or better almost all the time while sleeping. When I wore a recording pulse ox for 3 nights in a row, I saw only a single brief dip to 93% and the rest of the time I was in the upper 90s. That's about what I would expect for someone without OSA. Awake numbers should usually be 98-99% for a healthy person.

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Carey
Awake numbers should usually be 98-99% for a healthy person.

If you are at elevation, rather than sea level, normal numbers for healthy people can be lower. I'm sitting at 7,500' with 94% SpO2 as I type this. This reasonably agrees with this graph:

Source: [www.high-altitude-medicine.com]

Oh yeah, absolutely. I left the assumed "at sea level" unspoken.

How long have you been at 7500? I would think SpO2 would climb once you've been there a few weeks and fully acclimated and made a bunch more red cells.

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Carey
How long have you been at 7500? I would think SpO2 would climb once you've been there a few weeks and fully acclimated and made a bunch more red cells.

Just been here a few days, and staying a few more on holiday. I normally live at 5,500' and spend a lot of time at elevations up to 13,000'. However, usually don't sleep above 10,500' and more likely 7,000' to 9,000' for sleeping when away from home. I do a lot of breathing exercises, and can put my SpO2 in many different spots. For example, doing Wim Hof technique (3 rounds of 30 rapid, hyperventilation breaths followed by 90 second exhaled breath hold, followed by a 15 second inhale breath hold), I can drop my SpO2 into the 50's or 40's. Now it doesn't stay there long & will recover to the 80's quickly and then the 90's. During the hyperventilation, I'll get SpO2 at 98 or 99%. At home, my normal range is 93-97 or 98.

Above in the thread, you made a comment about your SpO2 after wearing an N95. One breathing instructor, in a "how to breathe with a mask" video noted that an N95 might retain a little CO2, so your serum CO2 may increase, and per the Bohr Effect, your O2 utilization might go up. Hence the observed drop in SpO2 might be increased O2 utilization rather than lower O2 coming in.

A note about the Control Pause (in a post of mine above) and NLAMA's comment about how much he could make it change in several attempts. It is not a contest, it is trying to ascertain a signal of the first urge to breathe on an exhaled breath hold. It is best to close your eyes and open them when you perceive a signal, so you aren't "trying for time." Should not vary too much in repeated attempts close to one another in time. Also about his friend who increased his underwater distance on a low carb or keto diet. CO2 production is less on these diets (about 0.7 for fat consumption vs glucose), so not surprising since the urge to breathe is almost always from CO2, not O2. Also dangerous to practice breath holds underwater, especially if you hyperventilate beforehand as this can lead to shallow water blackout and drowning death (happened to a local military guy training for Navy SEAL Selection in my locale). If you do want to train breathing underwater, you need to do it with a trained spotter.

So a quick read through this thread has me now ask: presumably mouth breathing during sleep isn't good for the heart all?

I had a study done for sleep apnoea last year but it was only mild so I didn't need a cpap.

However, I have a chronic breathing dysfunction and mouth breathe a lot. As that became worse my heart became more active, i.e. lots more ectopics and palps.

On top of that, I had a septoplasty with turbinates last week so have been exclusively breathing through my mouth 24 hours a day until it clears and is no longer blocked up. But like clockwork, my heart has started acting up a lot again.

Never considered the impact mout breathing could have before. Its something to ponder. But I can't change it right now, while nose is swollen...

Mouth breathing in and of itself isn't a problem for the heart. The problem is the anatomical structure of your throat and/or obesity. If tissues in your throat "collapse" during sleep and block your airway, that's going to happen whether you're breathing through your mouth or your nose. If you don't have OSA then you don't. If you do, perhaps mouth breath exacerbates it, but breathing through your mouth isn't a cause.

Common sense will tell you that those who use a cpap nasal pillow arent mouth breathers who benefit from the therapy. And many more using cpap full face masks breath thru their mouths, successfully treating their OSA.

People should solve their apnea however they can, it is very important to solve that. Some people with mild to moderate apnea can do that by taping their mouths shut.

Beyond that, however, training themselves to breathe slowly and lightly can also be of benefit. Not just overbreathing at night, but during the day. This podcast with host UK doc Rangan Chattergee MD and author of "Breath", James Nestor, goes through this in depth [youtu.be] Below the video, Dr. Chattergee has many other resources. They even discuss how proper chewing can change and enlarge your airway.

One breathing technique that has been demonstrated to low blood pressure materially is to breath 6 easy diaphragmatic breaths
per minute for 5 minutes or more. There is an FDA cleared device to help you lower your blood pressure, RESPeRATE, [www.resperate.com] All it does it time your breathing to this rate.

Here is a free breathing anxiety reducing session by breathing instructor Patrick McKeown. [buteykoclinic.com]

Over breathing lowers serum CO2 levels this reduces oxygenation because of the Bohr Effect. Also, CO2 is a vasodilator, so if there is more CO2, the blood vessels relax.



Edited 1 time(s). Last edit at 12/07/2022 01:05AM by GeorgeN.

I woke up Saturday night with the cpap tube snapped off the mask and my full face mask pulled up so my mouth was exposed. It’s a problem if you flop from side to side and the hose snaps off...my unconscious reaction must had been for me to unsnapped one side and pull the mask up to breathe. Apparently from the time stamp, I was wearing it like that for 4 hours.

How can you tape your mouth if your nose is stuffed?

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susan.d
How can you tape your mouth if your nose is stuffed?

Suggestion would be to start during the day and adjust. Nose has been a "use it or lose it" proposition in my case as well as others. With nasal congestion from birth, I would have never thought I could do this. I have now for years (thanks Jackie!) and I don't have issues.

Bottom line in all this is, fixing any sleep issues should be a priority for optimum health, but using conventional or alternative therapy will NOT cure afib. Im not even certain if lessens our burden. As a mild OSA person, I will strive to correct my breathing naturally because it is most likely beneficial and will strive to use cpap as little as possible without jeopardizing my health. The benefits of cpap for me are multiple however, so that could take some time to transition off. I wont be taping my mouth shut anytime soon.

DO these exercises to help fix your fat lazy tongue.

They've helped me be able to sleep many nights not without a cpap and maintain 93% avg at minimum with less than a few total minutes over 8 hours under 90%

[www.cpap.com]

Thanks, George. For those interested in the Buteyko breathing method, do a search here for that term...lots of info provided by George dating back 10+ years on the benefits. Important to understand about functional CO2 levels and it's not all just about sleep apnea.

Here's one link: [www.afibbers.org]

Jackie

I did an inadvertent experiment last night.

I went sleep with a Polar beat to beat recording heart rate monitor on. These are graphs of heart rate vs. time. I did not tape up initially, woke up after a few hours with dryness in my mouth, taped up and continued sleeping. To put on one image, the resolution isn't great, but you can see the issue. Top graph is about a 6 hour section (major X-Axis divisions an hour apart). I taped up after about the first third of the graph. Second graph zooms in on about 30 minutes of the first third. The heart rate pattern is an apnea pattern. Third graph is also without tape. 4th & 5th graphs are 30 minute zoom after taping up (major X-Axis divisions 5 minutes apart). On the 4th graph, the sharp spike down about 20% from the left is a PVC, the sharp spike up near the right side is a PAC. Even though I've been taping for years, I obviously need to continue. The Y-Axis scale is the same on each graph. The major divisions on the Y-Axis are 10 BPM. The bottom number on the Y-Axis (coinciding with the X-Axis) is 20 BPM.


Solving apnea may not "cure" afib, but it may remove one trigger. Apnea is highly associated with afib and a host of other maladies. "And patients with sleep apnea have four times the risk of developing AFib."

This is the tape I use. The tape my 34 year old daughter uses is 1" 3M Micropore.



Edited 7 time(s). Last edit at 10/16/2024 12:39AM by GeorgeN.

George, our sleep is different during the first hours of the night than in the late hours. Afib often comes in the hours after midnight, while our brain activity is different. Is our breathing different too? Emotionally, we're in a different state, as we're dreaming a lot more in the second part of the night. Are we more subject to sleep apnea in this part?

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Pompon
George, our sleep is different during the first hours of the night than in the late hours. Afib often comes in the hours after midnight, while our brain activity is different. Is our breathing different too? Emotionally, we're in a different state, as we're dreaming a lot more in the second part of the night. Are we more subject to sleep apnea in this part?

We could all be different. In my case, whenever I don't tape up at night, I get apnea patterns in my heart rate (I don't were a chest strap monitor all night frequently). In the above example. I got no REM or deep sleep, according to my Oura ring, during the first part of the night when I wasn't taped and the heart rate patterns were apnea & ugly. After I taped up, I got both.

As JohnnyS posted here [www.afibbers.org] I'm sure there are positional issues for many people. If these can be solved, the apnea goes away and sleep is better. As Johnny also mentions, evening eating can be an issue. I've posted about using Dr. Coca's pulse test before (quick version ). When I eat food that spikes my pulse, my heart rate stays high and I have less deep & REM sleep. I used to eat once a day, at 6PM, but found if I ate more "questionable" foods, from a pulse perspective, earlier in the day, sleep is better and heart rate lower. My heart rate varies on what I eat, not on exercise. If I'm very "clean," my average heart rate during sleep is in the low 40's. If I'm not clean, it can be in the 50's or even 60's. When I first got the Oura ring in Jan 2019, my deep sleep was 0-3 minutes/night. When I eliminated foods that spiked my pulse, it went to 30-90 minutes. My average heart rate went from 63 to the low 40's.



Edited 2 time(s). Last edit at 10/01/2020 10:28PM by GeorgeN.

Thanks for your explantions, George.
As my HR troubles are mostly generated while digesting or resting (and, of course, both), I avoid late meals. I usually eat around 6 PM and go to bed between 9:30 and 10 PM. A late meal highly increases the risk having afib and, in this case, it's going to strike shortly after laying in bed.

I regret I haven't got the Heal Force EKG monitor making continuous (->10h) recording instead of 30sec sequences. The model I own can't be used while sleeping, so, I don't know what really happens then.
I don't know why I often wake up while dreaming (no nightmares). Maybe a couple ectopics can do this. I never wake up in afib. Never. But afib may start a couple minutes later... or not. In the latter case, I soon go back to sleep.

I've been tested for sleep apnea. The result was "very mild SA that don't explain AF".

Pompon,

If your afib is triggered by digestive issues you might want to add ginger extract to your diet. Not only does it enhance digestion but also improves stomach acid and has other anti-inflammatory benefits. I use ginger extract whenever eating any big meals and one side effect is that you’ll never feel full. I also have a friend with afib in his late 30s that used to trigger afib after any big meal, he had no other issues other than slow stomach digestion so I told him to try and introduce ginger extract about 1250 mg during big meals and he hasn’t had any afib for months, and now he swears by it. I asked him to post here but his English isnt all that good so I’m just posting this out there for all those with digestive issues that trigger afib.



Edited 1 time(s). Last edit at 10/03/2020 12:02AM by johnnyS.

Thanks, JohnnyS.
I've tried a lot of diets and supplements, but no ginger extract to date, so I'll have a try. Nothing to lose.

I'm sure there's no stomach acid issue for me. This is likely fine. I've a weak LES, so some reflux especially if I lean forward early in the morning or soon after meal.
No heartburn except with very acid food like oranges and tomatoes, or if I try to supplement with BetaineHCL (as I did some time ago after I stopped taking a PPI).

More than the "weight" of a meal, the kind of food and what I do while digesting is crucial. Laying down is bad, sitting down may be bad if my stomach is somewhat compressed, a quiet walk is the best option.
Bread is bad, so I tend to stay gluten free, but I've no bowels issue. Eating 100g of fresh bread is enough to give me ectopics and even afib some ten minutes later. It usually doesn't last more than 30 min.

I've an appointment in november for colonoscopy and gastroscopy, but I would be highly surprised if the results differ from those I got three years ago (weak LES). Wait and see...

Thanks again for your suggestion. Ginger extract is on my shopping list.