OSA and acid reflux, looking for advice

[Truffles]

Hello,

When I began with cpap <a year ago I began sleeping on my right side so the air would not blow on my husband. By September I was experiencing such significant reflux that I thought I was having a heart problem. Also, starting midsummer I began to be less and less successful with wearing my cpap (from regular 6 hours a night to 1 hour a night). I felt like I couldn't breathe and the aerophagia was terrible. I was always pulling it off and gasping. I had difficulty managing my allergies so I was taking zyrtec every night which helped reduce sinus congestion. The season has since changed and I have added an air purifier to my bedroom, so I'm no longer taking the zyrtec at night.

Apparently with acid reflux the worst thing you can do is sleep on your right side or your back, and it is best to have the head of your bed elevated. I have been looking at a MedCline Acid Reflux relief pillow system and wondering if it is worth it. I've tried sleeping in a bed with riser under the front feet, but it's not very comfortable. In terms of medication I am finishing a two week course of protonix, and will be beginning regular pepcid.

Please share your insight with me. I think the acid reflux is interfering with my cpap therapy, but my sleep is feeling very complicated and miserable. I am having trouble figuring it out!

Some questions:
* Can this be solved with pillows or do I need to look at mechanical bed frames (essentially a $2-3k option with split twins)
* Which option would be kindest to my lower back? I intermittently have low back pain.
* Which option allows my bed partner to do what he needs to do to fall/stay asleep? He also has terrible insomnia.
* I have a queen bed in a smallish room. Is it worth it to consider a king size to accommodate pillows, cpap hoses, the dog...lol

I hope someone out there finds my "message in a bottle" sent from Terrible Sleep Island.

[Julie]

Gastric reflux (GERD) is common with apnea, but we need more info from you to help. What model of which machine do you have? Mask? Pressure settings (important)? Do you drink alcohol close to bedtime? Take any meds? Etc. etc. Position is not unimportant, but is certainly not the whole story. I personally take half a Tums before bed, but am not suggesting you do the same.

[Truffles]

I have a ResMed air curve vauto 10 with AirFit N20 nasal mask. My max is 8 and min is 6. I do not drink alcohol close to bedtime, I have a glass of wine on average a couple times a month. I am not currently taking any meds at bedtime, I take vitamins in the morning.

I've attempted to update my signature to reflect my machine. I recently changed my upper limit from 9 to 8 because I was struggling to breath properly without my stomach filling up with air. This seems to have brought about a modest improvement. I was able to sleep with cpap on for 6 hours last night for the first time in weeks.

[Julie]

Hi - a common way to deal with it is by lowering the min. pressure, not necessarily the max that needs to be high(er) enough so it doesn't block the min. if that needs to go up on occasion. Have you tried that - raising the max (it can go to 20, but your min. will only go up as needed, not randomly), but lowering the min. by even just 1 cm - accepting that you might not have as good an AHI as you want, but also won't have the problem?

[Truffles]

Thank you. I will try that tonight. I have high hopes of another six hours

[boxofrain]

I can identify! I used to suffer from GERD really badly. Always had a jar of Tums on my night table. I was also very nervous traveling, fearing that if I forgot my Tums and I had an attack on a plane, I would probably panic. About five years ago I eliminated gluten from my diet and lo and behold it TOTALLY went away. I mean 100%! It also cleared up my psoriasis! Now I know everyone is different and I am not suggesting it would work for you, but I do not think there would be any harm in testing this if you like. It basically changed my life!

[Miss Emerita]

Here, from a trusted web site, are some additional ideas about food to avoid and to include:

https://www.hopkinsmedicine.org/health/ ... -heartburn

[Miss Emerita]

Also -- just remembered this -- forum member Zonker had some suggestions here and there in this thread:

viewtopic/t178649/Remember-me-Im-back-o ... ch-up.html

[Pugsy]

Actually sometimes the maximum pressure does have to be limited when dealing with bad aerophagia when going above a certain point is a trigger. Sometimes just because a machine might want to go higher doesn't mean we have to let it go higher if the going higher causes more problems than the reason it wants to go higher is causing a problem.

Sometimes we do make compromises. If I got bad aerophagia at max of 10 and none at max of 9....I would set the max to 9 and let it hit the max.

Both EPAP and IPAP can be triggers. Most often the constant baseline minimum EPAP which is why we try lowering it first but sometimes the IPAP also plays a part depending on how long it stays up at the higher IPAP.

[Janknitz]

Whether GERD causes apnea (irritation of the airway causes narrowing that contributes to apnea) or apnea causes GERD (the struggle to breathe causes a pressure gradient that pulls stomach contents into the airway, and some people have more trouble with CPAP because of aerophagia), they often go hand in hand.

I have pretty bad reflux induced by apnea. If I fall asleep without my CPAP, I could be sitting straight up and will still reflux. So elevating the head of my bed does nothing--I do sleep on "Pillow mountain" already, and when I've tried a wedge pillow (can't really elevate my type of mattress with anything) I just slide toward the foot of the bed.

GERD is not caused by too much acid. We NEED stomach acid to digest our food. It's acid that gets in the wrong place, and too little acid can trigger GERD because the pH of acid in your stomach is what triggers the sphincters to close. Therefore chronic use of PPI's and acid reducers cuts off that important feedback and causes more trouble in the long term.

What Boxofrain said! On a low carb diet (therefore grain free) my symptoms of GERD went AWAY and stayed away as long as I stayed away from grains (until I stopped staying away from grains for too long and caused some major damage that refraining from grains won't help). Also dairy really does a number on me. I can have some in the morning, but not any later or I know I will deal with reflux.

Yes, sleeping on the left side really does help. My husband sleeps on that side of me, but we have a California King so he's not much bothered by it.

Two very helpful books:
Fast Track Digestion: GERD by Norm Robillard
Why Stomach Acid is Good for You by Jonathan V. Wright

BTW, the third "arm" of this triangle is usually asthma. Do you have that as well?

[Truffles]

Thank you for all of the great advice. I have lowered my min pressure to 6. I'm reading over the other information. Looks like not eating 3 hours before bed may help matters as well. It's very convenient that I don't have to call it dieting, I can call it "managing my acid reflux." Maybe I'll be more successful with staying away from the cookies.

[Jerseyguy]

Thanks Truffles for bringing this topic up. I have acid reflux that suddenly got bad a couple of years ago, I think it has to do with my switch of sleep aids from Ambien to Trazodone after being diagnosed with OSA. I had it so bad I stopped eating anything that could give me GERD at all and saw a gastro doc because I was still having acid doing it, Im now on Protonix 40mg and Im doing better but I have an issue keeping my mask on at night. Thanks to your post Im beginning to connect the dots and thinking that acid reflux could be the culprit. I eat horribly...I know its bad for me but with lack of energy from my undertreated OSA, I feel the need to eat o get thru the day and keep my mood up. I noticed when I was on vacation and didnt eat as much late at night, I kept my mask on no problem. I also do well if I wake up in the middle of the night and put my mask back on. So now Im going to focus on the GERD and try to force myself to stop myself from eating as much.

I'm hoping by talking this out, it may help others, sleep apnea (and to some extent my choices in dealing with it) has ruined my life and I hope to get it back as soon as I can.

[WWu777]

I have recurring acid reflux and GERD too. Is there a connection between sleep apnea and acid reflux? Does one cause the other or worsen the other? If so, how?

I find that it helps if you drink some apple cider vinegar at night before you go to sleep, or in the morning. Just a teaspoon with water. That does help a lot of people.

Another way is to drink one or two teaspoons of baking soda mixed in water at night or in the morning when you wake up. Do this on an empty stomach and make sure the baking soda is new, because if it's old it doesn't work as well. The alkaline from baking soda seems to balance out the acid so your stomach doesn't overproduce it. If you drink it for a few days it seems to solve the problem for a few weeks. You can get a box of baking soda at the grocery store cheap. But it doesn't taste good and some cannot tolerate it.

A more pleasant remedy is to drink two tablets of Alka Seltzer in the morning before breakfast. It tastes a lot better than baking soda, almost like 7 Up. Alka Seltzer also contains some antacids and helps with heartburn too.

[WakingKnowledge]

The way I solved a similar issue for myself was:

1) Stop eating after 5pm
2) Before bed drink: 1 TBSP Apple Cider Vinegar (ACV) mixed in an 8 ounce glass of water. This will neutralize any left over acid in your stomach. Basic chemistry: Acid + Acid = Base

With no food in your stomach no acid is created and the ACV turns the acid in your gut to a base. So there is no acid to reflux.

[mper!?]

Is there a connection between sleep apnea and acid reflux? Does one cause the other or worsen the other? If so, how?

Hi,
_ in accordance with the ENT, Dr. Steven Park (his book Sleep Interrupted and blogs, etc), definitively there would be connections between UARS and reflux, actually, it would be quite typical as well explained by Dr. Steven in the book.

all the best and good luck