GERD, Allergies and Apnea - Are they related?

[mithreesons]

I was recently diagnosed with mild sleep apnea. I was also recently diagnosed with GERD and severe allergies. I am wondering if the GERD and allergies can cause sleep apnea, and then if so - can it be reversed if the underlying problems are treated? I am hoping that if I can get my allergies under control and also the GERD (using Nexium which is helping ALOT) that the sleep apnea will go away. Is this just wishful thinking - or is this possible? I just finished my first week on CPAP and it went fairly well. I honestly do not see this as a long term solution. Anyway, I was just wondering if anyone else has experience with GERD and allergies. I did my sleep study and was diagnosed before I started on the Nexium and allergy meds. Is sleep apnea always caused by the soft tissue in the back of the throat closing off, or can it be caused my other things, such as extreme nasal congestion, etc? If I treat my allergies and can breathe better through my nose, will help prevent apnea episodes, or is all of this unrelated?

[Slinky]

Oh, yeah. They most certainly CAN all be related. However, which came first, the chicken or the egg, is an entirely different matter.

Most of us had "silent reflux" long before we actually got full symptoms and a Dx of GERD. Allergies most certainly can affect our breathing and our nasal passages.

BUT whether successfully treating the first two eliminates OSA is an entirely different story. Probably not.

I'm just a patient, not a medical professional, so don't take my prognosis that successful treatment of the allergies and GERD will not eliminate the OSA. I'm only going by all that I've read thru the years about the three issues.

[robysue]

BUT whether successfully treating the first two (GERD and allergies) eliminates OSA is an entirely different story. Probably not.

As another patient, I agree with Slinky---successfully treating GERD and allergies probably won't eliminate the apnea.

BUT---successfully treating the GERD and allergies will go a long, long way towards making the CPAP therapy much easier to tolerate.

[dsm]

My Dr (s)said the GERD was a significant contributor to SDB. The Gerd symptoms had been creeping up on me for years (over 20 ago) before SDB symptoms became obvious. Worst case too was Dr(s) expressing the opinion that it was considered largely irreversible (at my age) & to stick with the GERD meds.

So when we discover we have GERD & also Silent Gerd (which can be just like allergies with cronic nasal congestion & throat aches) - SDB is the next step/stage.

A tough realization.

DSM

[Slinky]

Boy, we are an optimistic bundle of joy and good news, aren't we? I'll betchya what we have to say is NOT what you really wanted to hear. Ah well. Knowing that treating the GERD and allergies makes acclimating to and using CPAP therapy so much easier and more successful should cheer you up. We hope!

[BlackSpinner]

For me treating my OSA just about eliminated the GERD and reduced the allergies dramatically. It is now August, I have a mildly drippy nose, I don't need major antihistamines like I used to to survive August.

[jabman]

Starting Cpap for my apnea has vurtually eliminated my GERD, But I still need to use my machine and will for the rest of my life. But at least I don't have to deal with the Gerd any more.

[Pugsy]

Boy, we are an optimistic bundle of joy and good news, aren't we?

And to add my little tidbit. Using CPAP has not improved my GERD at all. I still pay dearly for that forgotten Prilosec. Which reminds me, better go take that little pill......

[archangle]

By the way, do some Googling on Nexium vs. Prilosec. They're very similar medications with vastly different price tags. There's quite a controversy.

[zeeclass]

I have silent reflux and sometimes get a stuffed-up nostril or two. I can tell you for sure that these two things contribute to sleep apnea.

Since I have been on CPAP, I have become much more aware of when I'm not breathing well through my nose, and when I have reflux. One or the other will actually wake me up at night. Sometimes I have to spray a little Afrin in my nose to keep my nostrils clear so I can breathe well through my mask. I plan to get a full-face mask to use during times when this is a bad issue. Currently I just have a nasal mask, which I really like.

A few nights ago, I had stupidly eaten shortly before bed. Two hours later, I woke from a sound sleep with a slight burning in my chest and a slight irritation at the back of my throat. Reflux!!! I was so uncomfortable that I got up and took a Zantac. I had to finish the night without my mask on. But that taught me a lesson: no food at least 3 hours before bed.

I think that when you're on CPAP, these little things become magnified. You become more aware of them and how they can affect your sleep.

[zeeclass]

BTW, I want to add that doctors are now saying that it's not a good idea to stay on a PPI drug like Prilosec or Nexxium long-term. I had used them for a couple of months, a few years ago. I had an upper endoscopy and everything was OK. I was taking Aciphex and got off it. Now I just take some Tums or Zantac as-needed. Truthfully the reflux usually doesn't bother me unless I eat and then lie down. But I suppose if you have a really bad chronic problem, your experience might be different. But you should find out about the risks of staying on PPI drugs long-term.

[Slinky]

I know many GIs will start you on a PPI and just keep renewing the script for you. However, the literature that comes w/them suggests only 2 months of use. 2 months has always done me just fine and lasts for a couple of years before I might find the need for another 2 months of use. And IF I behaved myself I probably wouldn't have to "do" another 8 weeks of them on occasion - but I'm a mere human. I screw up once in a while.

[robysue]

I have silent reflux and sometimes get a stuffed-up nostril or two. I can tell you for sure that these two things contribute to sleep apnea.

and a bit later you write

A few nights ago, I had stupidly eaten shortly before bed. Two hours later, I woke from a sound sleep with a slight burning in my chest and a slight irritation at the back of my throat. Reflux!!! I was so uncomfortable that I got up and took a Zantac. I had to finish the night without my mask on. But that taught me a lesson: no food at least 3 hours before bed.

Are the stuffy nose and reflux really directly worsening the apnea---in the sense of making your (untreated) AHI worse? Or are they causing problems with discomfort when using CPAP, which leads to you choosing to not treat the OSA occasionally? Or both?

There is a difference here:

• If these things genuinely make the apnea worse in some way, that should imply that your AHI tends to increase even if you use the xPAP all night long as usual. Or perhaps, if you use an APAP, that the pressure level is higher than normal.
  
  If the issue is these things make it more difficult to use the machine, addressing them makes it easier to be compliant.

And it seems to me that if reflux made it impossible to put the mask back on, then it's more likely the reflux is simply making it harder to appropriately treat the OSA than directly making the OSA worse. Of course, reflux leads to no mask leads to a night full of apnea events. So in that sense I follow your reasoning.

Since I have been on CPAP, I have become much more aware of when I'm not breathing well through my nose, and when I have reflux. One or the other will actually wake me up at night. Sometimes I have to spray a little Afrin in my nose to keep my nostrils clear so I can breathe well through my mask. I plan to get a full-face mask to use during times when this is a bad issue. Currently I just have a nasal mask, which I really like.

Do be careful with that Afrin. It can trigger rebound congestion if used to often.

I think that when you're on CPAP, these little things become magnified. You become more aware of them and how they can affect your sleep.

We do seem to become much more in tune with our bodies while on CPAP. I find myself much more conscious of my airway in the daytime. And I've noticed funny breathing patterns almost akin to snoring/purring when I am super relaxed, but not asleep---particularly when I'm flat on my back at the end of a yoga class when the focus is on deep relaxation. I wonder if it's because of:

• A) Now that we're not arousing ourselves all the time to restart the breathing, we notice wakes/arousals due to other causes that were there all along, but got lost in the "noise" of the frequency of the OSA related arousals
  
  B) The tremendous and varied sensory stimuli caused by slapping the hose on makes us more aware of these things because every small change directly affects the comfort of wearing the mask when awake and trying to fall asleep.
  
  C) Or both A & B.

[zeeclass]

Thanks for your reply. Yes, I'm aware of the consequences of using Afrin too often. Mainly I notice some congestion at the beginning of the night and I try to clear it up before I put my mask on. Saline spray usually doesn't do much for it, and I can't use a spray bottle or Neti pot because the saline solution somehow gets stuck up in my sinuses and winds up giving me an infection if I'm not careful. I had sinus surgery a few years ago, btw, so I'm well acquainted with all that stuff. I had a benign tumor removed from my sinuses. So if using steam and saline don't unstuff me, my last resort is to use Afrin. Otherwise I can't use my nasal mask because I feel like I'm being a bit suffocated because I can't breathe as well as I should! However, as I said, I'm planning to get a full face mask to use in situations like this, so that I won't necessarily need to unstuff that one nostril to use my CPAP successfully.

Regarding the reflux -- on that night that I mention above, I was just extremely uncomfortable and having air blown into my nose/throat made it feel worse. I needed to get up early the next morning and I knew that I'd be able to get back to sleep more easily without the mask that one night.

However, I have had a bit of reflux previously and have felt that it was waking me up. It was probably waking me up before I started on CPAP but I didn't realize it.

Most nights lately, I'm using the CPAP all night long. I'm actually beginning to feel very comfortable with it on. When I wake up with it on in the morning, I actually find it RELAXING, believe it or not!

[mithreesons]

Thanks for the info everyone. Not want I wanted to hear, but appreciate the truth. I guess that means that I have to get used to this blasted machine and mask.
Someone mentioned this ...what is SBD?