Does CPAP cause acid reflux?

[zoocrewphoto]

I had really bad acid reflux before I started cpap treatment. I would wake up with choking fits, and if I didn't get upright and stop the choking spasm, I would get sick. I would also drink water right away to try to get any acid in my throat to go back down.

When I started cpap treatment, it stopped completely for several months. I was even able to stop taking zantac.

Not sure, why, but it has started up again, but not as bad as before treatment. And no choking fits. Just some mild burning in my throat that goes away with zantac. I haven't determined what has changed, but don't think it is cpap related. I've been on cpap for 8 months, and it went away when cpap treatment started and only started coming back in the last month.

In general, cpap treatment seems to help acid reflux problems, not make it worse. Has anything else changed? Different foods, different meal time? Different bed? Any chance that something that didn't bother you before bothers you now? I used to drink chocolate milk before bed every night without any problems (years ago). Now, i have a tendency to get acid reflux AND get sick if I drink it too close to bed time. I remember thinking my dad was overdoing it by refusing to eat chocolate after 5pm. But now chocolate bothers me at night too, so I understand. I just had a bad night last week because I ate ice cream with hot fudge before bed. I was up for 2 hours with severe acid reflux. I totally caused that myself.

[Todzo]

I think that acid reflux comes into the use of PAP through the associated carbon dioxide maintenance issues. PAP's constant pressure tends us to breath more. When we do breath more we wash out more carbon dioxide (CO2). That reduces circulation and frustrates metabolism.

The brain in particular despises CO2 washed out blood.

The stomach is rather neuron dense. And indeed I have noted the following:

Blood oxygen saturation (SpO2) vs Stomach symptom:

99% Stomach in a knot, heartburn, nausea
98% Stomach in a knot, possible heartburn
97% Stomach has bloated feeling
96% Stomach beginning to relax
95% Stomach relaxed, digestion continues

I have seen you post this many times. Perhaps I am misunderstaning your terminology, but when I have my oxygen checked at the hospital or sleep study, they want it above 96%. Are you saying that it is BAD for it to be at 96% of above? It seems like you are saying that when we have what is considered a good level of oxygen, that this is bad. Is that what you are saying?

This is simply my observations from experiance.

There is a lot that medical people assume based upon what they think. This is what I know from experiance. FWIW

[zoocrewphoto]

I think that acid reflux comes into the use of PAP through the associated carbon dioxide maintenance issues. PAP's constant pressure tends us to breath more. When we do breath more we wash out more carbon dioxide (CO2). That reduces circulation and frustrates metabolism.

The brain in particular despises CO2 washed out blood.

The stomach is rather neuron dense. And indeed I have noted the following:

Blood oxygen saturation (SpO2) vs Stomach symptom:

99% Stomach in a knot, heartburn, nausea
98% Stomach in a knot, possible heartburn
97% Stomach has bloated feeling
96% Stomach beginning to relax
95% Stomach relaxed, digestion continues

I have seen you post this many times. Perhaps I am misunderstaning your terminology, but when I have my oxygen checked at the hospital or sleep study, they want it above 96%. Are you saying that it is BAD for it to be at 96% of above? It seems like you are saying that when we have what is considered a good level of oxygen, that this is bad. Is that what you are saying?

This is simply my observations from experiance.

There is a lot that medical people assume based upon what they think. This is what I know from experiance. FWIW

Could you please answer the specific questions? Did I understand correctly what you said, or am I misunderstanding it? I have dismissed yours posts because they don't make sense to me. I am trying to find out if I am misreading them or not.

Most people, when awake have oxygen levels above 96%. Are you saying that this is a problem?

[Todzo]

I think that acid reflux comes into the use of PAP through the associated carbon dioxide maintenance issues. PAP's constant pressure tends us to breath more. When we do breath more we wash out more carbon dioxide (CO2). That reduces circulation and frustrates metabolism.

The brain in particular despises CO2 washed out blood.

The stomach is rather neuron dense. And indeed I have noted the following:

Blood oxygen saturation (SpO2) vs Stomach symptom:

99% Stomach in a knot, heartburn, nausea
98% Stomach in a knot, possible heartburn
97% Stomach has bloated feeling
96% Stomach beginning to relax
95% Stomach relaxed, digestion continues

I have seen you post this many times. Perhaps I am misunderstaning your terminology, but when I have my oxygen checked at the hospital or sleep study, they want it above 96%. Are you saying that it is BAD for it to be at 96% of above? It seems like you are saying that when we have what is considered a good level of oxygen, that this is bad. Is that what you are saying?

This is simply my observations from experiance.

There is a lot that medical people assume based upon what they think. This is what I know from experiance. FWIW

Could you please answer the specific questions? Did I understand correctly what you said, or am I misunderstanding it? I have dismissed yours posts because they don't make sense to me. I am trying to find out if I am misreading them or not.

Most people, when awake have oxygen levels above 96%. Are you saying that this is a problem?

I am saying that for me with my pulse oximeters at my desk I find the minimum heart rates (possible indicator of optimum or at least most efficient blood gas levels) at an SpO2 reading of 95% and that the symptoms noted above were noted at the SpO2 readings as noted above.

If a pulse oximeter could and did read an SpO2 of 100% would that mean that absolutely no metabolism took place? If so, would that be a good thing?

[zoocrewphoto]

Todzo,

your posts imply that people will have problems with good O2 numbers. Maybe you don't feel good with good numbers, but most people do. Most people are above 96 most of the time, yet they don't suffer those problems. And then way you post them to new members makes it look like a standard that people should aim for. You talk about over breathing, while most of us are oxygen starved. We need to improve our oxygen, and you are telling us that we are taking in too much oxygen. Sometimes, you list the things you do and how they help, and you don't list cpap. It makes it look like you aren't using it. Or that it is not helping you. It really makes it confusing to follow your posts.

[RandyJ]

If cpap therapy is successful (good AHI and leak numbers), I would look to diet to make sure that is not the issue. For at least a week or two I would eliminate any foods known to cause acid (tomatoes, citrus, fried food, etc) and see if the reflux persists with no change.

Also, eat the evening meal at least 4 hours before bed and avoid lying down between evening meal and bedtime.

If this is inconclusive, further dietary investigation might be in order, such as food sensitivity testing (IBA panel).

[sylvie]

Yet another reason to get that pressure low. That is exactly why I use an oral appliance with the cpap. It is a miracle cure in that regard.

[Todzo]

Todzo,

your posts imply that people will have problems with good O2 numbers. Maybe you don't feel good with good numbers, but most people do. Most people are above 96 most of the time, yet they don't suffer those problems. And then way you post them to new members makes it look like a standard that people should aim for. You talk about over breathing, while most of us are oxygen starved. We need to improve our oxygen, and you are telling us that we are taking in too much oxygen. Sometimes, you list the things you do and how they help, and you don't list cpap. It makes it look like you aren't using it. Or that it is not helping you. It really makes it confusing to follow your posts.

If O2 is above 93% - who cares?

If CO2 too low you should care!

Please take some time to learn about CO2.

Perhaps you can start with the search "sleep apnea CO2 reserve"

[davelikesbeer]

I have seen you post this many times. Perhaps I am misunderstaning your terminology, but when I have my oxygen checked at the hospital or sleep study, they want it above 96%. Are you saying that it is BAD for it to be at 96% of above? It seems like you are saying that when we have what is considered a good level of oxygen, that this is bad. Is that what you are saying?

His CO2 talk is mostly nonsense.

I was thinking the same thing.

For me, the acid reflux went away when I started using CPAP. Acid reflux as a result of OSA is kind of obvious once it was pointed out to me.

Basically, your diaphragm is forcing your lungs to suck. Since the passage between your lungs and the outside world is blocked, this suction goes to the next channel and that is to your stomach. Your lungs are literally sucking your stomach contents out of your stomach.

Regarding CO2, my doctor suspected my high pressure was preventing my CO2 from being exhaled so put me on a BiPAP from APAP.

[SusieG]

In my case it is the exact opposite - My apnea was causing my reflux to be so bad that I was actually sucking stomach acid (and who knows what else) into my lungs! That caused very bad lung problems, a night in the hospital, two inhalers, antibiotics and 3 missed days of work (glad my boss is also my best friend!). I finally got my CPAP and have been using it for less than a week with good results. 2013 is going to be a way better year for me!
Good luck and be healthy!

[lostsheep]

I can share the input of my ENT on this topic.

Background: I have problems with aerophagia ever since starting on CPAP, then again with BiPAP (although marginally better than CPAP), and now ASV. The higher the pressure, the worse my gas symtoms. The ASV max setting is the highest pressure I've been subjected to so far, and with this device there are times that I wake up in pain and a distended belly. It first happened during lab titration of the ASV. The symptoms are irregular, but then so is the position of my body. I think it is worse when I sleep on my back, and I assume that is because my throat is closing more, and subsequently the ASV pressure goes up. Sometimes I feel like the aerophagia is starting up before I even fall asleep. It doesn't seem to involve any "swallowing" per se.

The sleep doctor suggested I be checked for "silent GERD" by an ENT, so I went for a consult. She routed an optical device through my nose and had a look at my throat. She quickly said "no" to the silent GERD hypothesis. According to her, a history of silent GERD condition would leave visible tissue inflammation from chronic acid exposure. I guess if that condition existed, it would indicate a leaky stomach sphincter.

Silent GERD definition: http://www.webmd.com/heartburn-gerd/gui ... ent-reflux

Then she added that the PAP pressure can actually induce secondary GERD along with aerophagia, as pressure can splint open one's stomach in a similar way as it does with the airway. In her words, "there are only 2 places for the air to go". She claims that an open stomach provides the possibility of transport both ways - air can go in and stomach contents can seep out. The situation sounds to me like it should be classified as PAP-induced GERD!