acid in my mouth but no GERD

[christinepi]

After struggling with aerophagia for 7 weeks or so after I first started using the machine I decided to drop my pressure down form 8 to 5 and incrementally go up to see whether the burping would go away. It did, until I reached 8 again, and now it's not so much burping that's plaguing me, but acid in my mouth (all the while, my AHI's stayed consistently at 0.2, even at 5cm). I did a barium swallow only 3 weeks ago for GERD and everything was negative.

1. So if I don't have GERD, what's the deal with the acid coming up? Would a pillow wedge be a good idea as a next step?

I did a sleep study without titration 3 months ago. The doc set my pressure at 8cm then. Clearly that is too high to not cause these side effects, at least under the circumstances (no wedge pillow). I'll do an actual titration study this week to get the correct pressure.

2. What so utterly confuses me is how my AHI's can be so low (down from 18.8 at first study), whether the pressure is 5 or 8, but my sleep's been worse than ever. I'm definitely getting no benefits whatsoever.

[Janknitz]

The fact that you had no GERD on a barium swallow does not rule out laryngeal esophageal reflux during apnic events. What happens is that when your airway is obstructed, your body is working hard to pull in air, and that creates a suction effect that will pull esophageal contents into the phyarnx. That might not have been seen on the barium swallow, because you weren't having an obstructed airway event at the time of the test. Not all doctors make the connection between obstructive sleep apnea and this lanryngeal reflux. For some CPAP treatment really helps, but for others, especially if you have aerophagia, it can be worse.

Try to control the aerophagia. The pressure change was a good idea, also try keeping your tongue on the roof of your mouth during CPAP--that will close off the nasalpharynx and reduce the air that goes down into your stomach. If you search for aerophagia here, you will also see a sleeping position that may help.

Try not to eat within a few hours of going to bed, and elevate the head of your bed if possible. The BEST way to do this is actually raise the bed itself--places like Bed, Bath, and Beyond make things you can put under the legs of the bedframe at the head of the bed. A wedge pillow, or "pillow mountain" doesn't work as well because it bends you at the waist.

Talk to your doctor about larnyngeal reflux and ask if a trial of a proton pump inhibitor might decrease the acid a little bit to minimize the damage.

[karl9000]

I had a problem come up after starting APAP where I had terrible pains on my shoulders and neck. After seeing the doctor (took a month of pain before I broke down) he diagnosed probably GERD and had me go in for a three letter test whose name I can't remember. The test involved sticking a tube/scope down my throat where they took some pictures. It was done at a hospital where they knock you out pretty good for it. It was like my colonoscopy, only I didn't wake up in the middle of it. Don't ask...

I was diagnosed with Barrett's Esophagus (not from the colonoscopy! ). The doctor that did the throat/stomach test also had me do a followup Barium swallow test which showed I had a serious reflux problem. The GERD I have, that led to the Barrett's, has caused some noticible damage to my thoat and larynx to the point where it has affected my voice. It almost always feels acidy back there. Don't just let this go, pursue it with diligence and determination.

As the other responder mentioned, the Barium swallow test won't identify other potential problems with your throat, espohagus, stomach, etc. It might be worthwhile going back to your doctor and discussing other potential issues that might lead to the acid taste and get some testing done. I'm trying to control my probelms with Prilosec OTC, diet (LOTS of fruits and vegetables, but only certain ones, and no meat), and some natural remedies like licorice (DGL), Marshmellow and Slippery Elm. Artichokes are good for controlling stomach bile if you can stand them. I couldn't until my neighbor gave me a recipe with artichoke hearts which I LOVE! It's all helping, but the damage has already been done.

BTW, in my case, the APAP didn't "cause" either the refluxing or the Barrett's. I had problems swallowing all my life but never knew it. I never realized I had trouble swallowing becasue I ALWAYS had trouble swallowing; it was "normal" for me. When doctors asked me if I ever had trouble swallowing I never realized what they were asking. The same for the acid stomach: it was something I always had and never realized it was abnormal.

But I'd just about KILL for a hamburger or a rare steak right now...

[miketech]

I, too, have been diagnosed with LPR (laryngopharngeal reflux). This condition makes my voice hoarse, feeling of a lump in my throat, constant throat clearing. It starts from having stomach acid go up the esophagus at night. My ENT Dr did scope my throat. And he said that the area around my voicebox is red and swollen. He put me on a double dose of PPIs. (but that's pretty much the extent of his help) The PPI drugs decrease the stomach acid, but that is not enough to heal the voicebox. We also need to stop eating anything acidic. I also jacked up the head of my bed by 4 1/2 inches. But I still think that the cpap opens the lower esophagal spincter.

I've been scouring the internet for information and support on this problem. It would be great to find a website as helpful as cpaptalk, but for LPR sufferers, but I have not found any. Heartburnhelp doesn't seem to have anybody on it, except a few people who wrote in questions- but don't get much help (and they want $15 to join).

But the best thing I have found is a website touting a book by a Dr Jamie Koufman. You don't get any help or support, but her book (which I bought) is like the bible of LPR.
Check out the website http://www.refluxcookbook.com/ The website's got beautiful photos, but it's not very easy to navigate around.

OK naysayers, I'm not trying to push the book... I'm just saying that I bought it and I think it is very informative (the ONLY information out there) for helping me understand LPR, which seems to be a not-very-well understood or publicized ailment. The book is the only support I have found, and is helping me take charge of my LPR.

Also, be sure to follow up on the Barrett's, I believe it is a pre-cursor to cancer.

[LSAT]

Great Heartburn discussion board.....no costs involved.

http://forums.heartburn-help.com/