Poll: GERD and Sleep Apnea

[One Tired Puppy]

FWIW - I take Pepcid every night before bed otherwise heartburn keeps me awake at night. Have been doing this for a couple of years now. It went away when I started drinking more water during the day and not eating too heavily for dinner but has returned. I wonder if that has anything to do with some of the back pain I've been having...

Alpha,

Your back pain, particularly if it is upper back pain, may be caused by GERD. My pain radiates from the centre of my chest out and even reaches to my underarm area and also radiates through my upperback. I also take Prevacid just before going to bed, as well as through the day. I am still worse at night. When it is very bad, as lately, the only time I get relief is by walking around. If I sit or lie down it aggravates it much more. I generally am getting up at night to take Gaviscon.

Get it checked out with your doctor and have him refer you to a GI specialist.

Anne

[JohnBFisher]

GERD and Sleep Apnea often seem to be comorbidities of each other...

In fact it is one way I know if my pressure effectively treats the obstructive part of my apnea.

...I have wondered about a number of possibilities:

1. The sleep apnea causes the GERD. Could the repeated apneas somehow cause the sphincter to stop working correctly?

2. The CPAP treatment causes the GERD. ...

3. Maybe GERD and Apnea have an underlying root cause? ...

I would add a fourth option. That is, when I obstruct and my body attempts to draw air anyway, it creates such a vacuum it draws fluid from my stomach back into my esophogas. When bad, I can even aspirate it. No fun! Based on the pain from that I have little doubt that that would also damage the sphincter at the top of the stomach.

However, when the pressure properly set, this no longer happens. So, I would probably add that:

4. The effort of the body to breathe against an obstruction of the airway can cause gastric reflux, which can lead to GERD and ongoing problems.

[Scarlet834]

So... looking at those poll results, I'm thinking there's a potential lesson hiding in that data: if you have an apnea diagnosis but not a GERD diagnosis, you just might want your doctor to look a little harder.

Silent GERD is a definite possibility---but a hard type of GERD to properly diagnose. I only had my "silent GERD" diagnosed after an unexpected trip to the ER. Food was literally stuck in my acid-deteriorated and swollen esophagus. I probably had apnea at the time. But the apnea diagnosis didn't come until a few years later.

Now, my PCP did suspect possible silent GERD interrupting my sleep, but at my follow-up visit today he asked me to stop taking my acid blockers to see if they can be eliminated. I've never had any recognizable heartburn-like symptoms except maybe twice in my life. Thanks for the links and heads up on silent GERD. I'll be reading up more on it, as I do still wake up several times in the early morning and it's not clear why. A different link lists some suspicious symptoms that I have but was told is an allergy (which there is also evidence of certain times of year). I have to say I'm not very happy with these silent diseases. Note that none of the above changed a whit while I was taking acid-blocking medication. I'll have to think about this a while.

In the meantime I will continue to sleep on my wedge pillow and follow much of the common directives to controlling acid reflux.

[Gerryk]

I was thinking of my gerd just this morning. Actually I was thinking of all the signs and symptoms of OSA that I have had since my late teens with gerd popping up in my early 20's. It's a shame I wasn't diagnosed with this problem all those years ago. I think back on what more I could have accomplished if i hadn't been so tired.
I was thinking about my gerd and all the sings and symptoms of OSA that I had for years and began wondering if my successful cpap treatment would allow me to not need to take the purple pill. I have not had any problems with gerd since I have been on cpap. Although I was on the purple pill before cpap and still had occasional problems, I have not had one since I have been on cpap. I will be descussing this with my doc on my next visit.

I read a book by a Dr. Park and he says talks about so many people who have OSA also having gerd and that the OSA causing it in many of those people. The body tries to breath but the airway is blocked which causes the stomach contents to be drawn up. I had asked my doc about this and his answer was of course OSA can cause gerd.

Gerry

[jskinner]

I would add a fourth option. That is, when I obstruct and my body attempts to draw air anyway, it creates such a vacuum it draws fluid from my stomach back into my esophogas. When bad, I can even aspirate it. No fun! Based on the pain from that I have little doubt that that would also damage the sphincter at the top of the stomach.

However, when the pressure properly set, this no longer happens. So, I would probably add that:

4. The effort of the body to breathe against an obstruction of the airway can cause gastric reflux, which can lead to GERD and ongoing problems.[/quote]

Agreed. In fact this might turn out to be the most important option. Dr. Steven Park makes a good case for it in his book Sleep Interrupted. This seems to have been an important factor in my situation. I was not aware of it at all but now I have an ulcer on my vocal cord from GERD. I too had it get into my lungs during really bad spells, very painful (I didn't know what was causing the chest pain for a long time)

[Mac33]

5 years ago I had very severe erosive esophagitis with an ulceration. Now sleep apnea....somebody shoot me.
Actually I was drinking heavily on weekends, stuffing my face before fall8ing asleep and popping aspirins too. I had very bad heartburn and went to an GI.

[tattooyu]

5 years ago I had very severe erosive esophagitis with an ulceration. Now sleep apnea....somebody shoot me.
Actually I was drinking heavily on weekends, stuffing my face before fall8ing asleep and popping aspirins too. I had very bad heartburn and went to an GI.

Mac33, have you had any improvement with your GERD with apnea therapy?

Last night, I must've had a doozy of an episode of reflux. We left our infant loss support group (we lost our baby son, Andrew, last year) late and had to get something to eat. I tried not to eat too much since I knew I was going to bed shortly thereafter. When I got home, I took a Pepcid and a Gas-X and went to sleep. At around 2:30 a.m., I awoke to a dry mouth, burning sinuses and a weird string-like burning/itching in my throat. My sinuses and throat must have been inflamed which caused them to close, hence the mouth-breathing dryness. After a couple glasses of water and a few minutes of choking and catching my breath, I went back to bed. My leak rate was 0.36 L/s... horrible, my usual is 0.0 0.08 L/s! It also said 0.0 apneas, but I don't believe it since the leak rate was so high.

This morning, my leak was still 0.3 L/s, so it must have come back during the night. Today, I feel pretty bad, but certainly better than I would without the therapy at all.

Lesson?

If you eat late, stay up an extra hour or two to allow your food to digest. You might get less sleep, but it will probably be of better quality!

[Mac33]

Tattoo,
I really haven't been taking my PPI's (previcid/protonix) for months now. I had read that the pressure of CPAP keeps the acids down. I had t go for a 3 year followup endoscopy 6 months ago then I got hit with AFIB and severe sleep apnea so I've been dealing with that. I have a great GI who really cares and actually spends quality time speaking about your conditions and never rushes you out of the office. I'm curious to see what his thoughts on GERD and sleep apnea are? He was be pissed with me if I quit taking my meds and have erosions again. I don't feel anything and I do always eat late before bed. Last week I did feel something like heartburn but I also caught the FLU and dealing with that. I'll let you know probably after the holidays I'll set up a scoping.

[Scarlet834]

Changing my vote. After 3 nights without acid blockers I had definite symptoms of reflux and really choppy leak nights the past two nights. I assume my doctor will concur that we continue the prescription when I update him. I find it interesting that pre-CPAP I never recognized heartburn or anything like it in myself. I appreciate the posts about the "silent" symptoms of GERD. I think I simply didn't notice because it didn't overtly annoy me--it's not like I experience a lot of pain or discomfort. It would never previously have prompted me to take an over-the-counter or any other remedy. But I certainly don't want long-term damage from the condition.

[jskinner]

I find it interesting that pre-CPAP I never recognized heartburn or anything like it in myself.

Same here...

[Julie]

Scarlet - I wonder if your problem is something like osteoporosis having messed up a thoracic vertebra (as I've had for a long time), and the wedge pillow possibly even aggravating it?

[Scarlet834]

Scarlet - I wonder if your problem is something like osteoporosis having messed up a thoracic vertebra (as I've had for a long time), and the wedge pillow possibly even aggravating it?

I have minor arthritis in my neck. What caused me a problem was trying to prop myself up with a stack of regular pillows. The wedge pillow I'm using (almost a mini-mattress) is completely comfortable. It's perfectly flat and extends to my waist. Yes, I figure my own particular architecture gave me a problem any time the stack-it-yourself didn't create an even incline. Giving my neck and upper back a C-curve causes problems for me.

[Janknitz]

jskinner wrote:
...I have wondered about a number of possibilities:

1. The sleep apnea causes the GERD. Could the repeated apneas somehow cause the sphincter to stop working correctly?

2. The CPAP treatment causes the GERD. ...

3. Maybe GERD and Apnea have an underlying root cause? ...

This is a bit of a chicken and egg situation, but I vote for #3.

I have had GERD for years, not sure how long I've had OSA--perhaps just as long.

The genetic syndrome that I have has low muscle tone as an issue, so I've always blamed that for my GERD. Lots of people with Noonan's syndrome have GERD--beginning in infancy for some. Low tone in the soft structures could cause OSA as well.

BUT, we also have structural and soft tissue abnormalities including micrognathia (small lower jaw), narrow, arched palate, and enlarged tonsils and adenoids. So, OSA is probably more common in Noonan's than is currently recognized (many adults with Noonan's have never been diagnosed--because it's a relatively newly identified syndrome, but it is becoming more commonly recognized in young children).

I've read Dr. Park's theory that a narrowed airway causes OSA that causes a suction effect that pulls stomach contents up to the pharynx, thereby causing GERD, and it sounds pretty plausible.

I don't know the answer, but perhaps what should come out of such a discussion is the suggestion that individuals diagnosed with GERD (and there are MILLIONS because of the relatively easy treatment of proton pump inhibition medicaitons) should be tested for OSA.

Personally, CPAP has been wonderful for me--no reflux a all when I use my CPAP. The few times I've fallen asleep without it, I have reflux, so I'm very convinced that it helps me. Not sure what the mechanical explantion is for that, but I'll take it!

[Jane1966]

I have never been diagnosed with Gerd, but I have had acid reflux on occasion. Since I have started cpap therapy it does seem to have lessened. In fact, I guess I was having it almost daily for a while lately (just in the last year). Within the last month, I have only gotten once it when I ate some particularly spicy curry (yes, it was worth it!). On another note, I was getting up to go to the restroom throughout the night the last few months until I got on cpap. This was very odd for me so I went to a Urologist who said that it was typical for a 44 year old woman because basically your body starts falling apart (of course he didn't say that exactly). Since I have started cpap all those symptoms have gone away. My appetite has also decreased significantly since I started cpap therapy a month ago. I am hoping if I lose enough weight that I may not need the machine anymore. But, I don't find the machine uncomfortable and am fine with wearing it. So, we will see what happens. It is truly amazing how many problems the apnea can cause though and how clueless I would have been if my husband had not noticed my sleep issues. I may have never been diagnosed.

[elena88]

I was diagnosed with a nasty case of LPR (larynx reflux nine months ago.. NEVER had a single symptom of heartburn, just the
raw throat, lost voice, larangospasm stuff..

Ear nose and throat doc said it would take a year to heal (on kapidex every other day now )

Now right on target, its getting better, and actually I think much improved SINCE I started my apap two months ago.. so Im hoping my poor
little larynx will be completely healed in a few more months.. so I can sing the high notes again on karaoke night!

I had a singing lesson today and I did not know that the nasal sprays dripping down my throat would burn it to pieces, so I couldnt sing
very well..

No more nasal sprays before bedtime..

The Ear nose and throat doc said I probably had the LPR FOR many, many years, and I know i have had the apnea for over fifteen years,
I dont know which came first?