Poll: GERD and Sleep Apnea

[biggziff]

FWIW I had no GERD-like sympoms until about a year after starting CPAP therapy. Doc told me it's common to have it start after therapy as the therapy can aggravate or cause it in some folks.

[jskinner]

The home page, http://sleepinterrupted.com/ , for Dr. Park's book has lots of interesting information.

Thanks Rooster, I have just ordered the book. If you buy if from hi site you get a free PDF version of it was well which is nice.

Here is a very interesting quote from the first chapter:

"there are numerous studies that show an association between the following pairs of conditions: LPRD and OSA, 2 GERD and asthma, 3 LPRD and chronic sinusitis. ... As I began to research hundreds of articles, I began to see a pattern. In the linked examples given above, LPRD has been shown to be associated with OSA, and LPRD has been shown to be associated with chronic sinusitis"

Very interesting given my nasal problems...

Everyone with GERD / LPRD should read that first sample chapter that you posted.

[roster]

.......

Everyone with GERD / LPRD should read that first sample chapter that you posted.

More stuff we need to educate our doctors about!

[socknitster]

I'll answer this question by copying and pasting what I wrote under the topic of breastfeeding and OSA a few minutes ago:

My son was breastfed for one year. However, he developed sleep apnea at the age of four and had to have surgery to have his tonsils and adenoids removed.

I think you are looking in the wrong place. I think the problem may start in infancy, but not about feeding. I think this is a GERD issue for many (not all) folks. My son had fairly severe infant reflux. We are just now realizing that he may still have it at night. At age 5 he is able to describe how he feels a little better and he is now describing waking with a "lump in his throat" and a "bad taste in his mouth." I take this to mean reflux. We learned long ago with Harry that if he doesn't eat supper by 5pm, he will probably be up with bad dreams or other nocturnal problems. He goes to bed at 7pm and needs those full two hours to digest his food. I have encouraged him countless times to sleep on his left side which should help. Also, he has had nose/sinus problems since age one. Coming down with every bug possible and having nasal symptoms and coughs lingering for extended periods of time. He was tested for allergies but they found nothing--the allergist called it non-allergic rhinitis and gave him a steroid nasal inhaler. I'm now wondering if acid wasn't getting up there during sleep and irritating these delicate membranes. After the holidays I'm going to take him to his pediatrician to see what he thinks we can do about this. I'm desperate to prevent him from getting full blown sleep apnea as an adult.

I, too, have nighttime GERD. Just last night, for example, I forgot to take a zantac 150 before bed and woke with mild heartburn and terrible aerophagia (which I normally don't have anymore). I hadn't eaten anything for hours before bed. My mother says I was a colicky baby which I take to mean I had infant reflux. I have severe sleep apnea. I was bottle fed.

Our second child, Charlie (6 months), is also breastfed and also has reflux. He also has terrible sleep habits despite all my efforts to help him sleep better.

Anyway, that is what I think. Maybe that will help someone else.

I am convinced that GERD causes sleep apnea. CONVINCED. All that acid where it isn't supposed to be, causing inflammation and permanent damage to the airway. It may not be the only cause, but I firmly believe it to be one of the largest contributing factors.

jen

[jskinner]

Thanks Rooster, I have just ordered the book. If you buy if from hi site you get a free PDF version of it was well which is nice.

I was interested to find that Dr. Parker mentions cpaptalk.com in Chapter 25 of his book.

[lvehko]

I got the GERD diagnosis first, then the OSA diagnosis about a year later.

Unlike some other posters, I find that the CPAP helps my GERD symptoms. If I'm having an attack, I can put on the mask and take a nap, and wake up 'all better.' I think the air pressure pushes the acid back down into my stomach, or something.

Also, I know this is insane, but for those of you with heartburn symptoms, I suggest trying the old folk remedy of a teaspoon of apple cider vinegar in a glass of water. I thought it was nuts when I first read about it, but I tried it, and it works. I don't need my prescription meds anymore.

Min

[buttonbir]

I had gerd and underwent successful surgery to cure it but I stillhave apnea

[curmudgeon]

GERD is caused by sleep apnea. Before my diagnosis of sleep apnea a glass of red wine used to be consumed for sleep purposes and my GERD developed and didn't get better until BIpap (CPap) etc. therapy. Most people with sleep apnea will develop a hernia of the linea alba from pressures that are exerted from inspiration (or lack thereof) This shows us that increases in intra abdominal pressure which can play havoc with the cardiac sphincter as well as more visible aspects of our body. The vicious cycle is simple and reversible.

[roster]

I had gerd and underwent successful surgery to cure it but I stillhave apnea

Which surgery cured your GERD?

[Guest]

When I started on CPAP after being diagnosed with sleep apnea, I developed GERD. However, I noticed that I was swallowing lot more when wear the mask and worked on reducing swallowing. This seem to have reduced GERD significantly.

GERD and Sleep Apnea often seem to be comorbidities of each other. I know lots has been posted about GERD in the past but since I didn't know I had it I never paid any attention to it.

I've been thinking about GERD and wondering what the relationship is to SDB. 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. Since CPAP splints open the airway it would seem possible that it could also splint open the esophagus allowing stomach acid to come up and injure the throat? I personally wonder if this is what happened to me. I had no problem with GERD until I started using the Oracle mask. Maybe the drying effect of the Oracle mask on the throat could also be a factor?

3. Maybe GERD and Apnea have an underlying root cause? They both seem to be failures of muscle systems in the airway.

[ycartf]

For any of you out there with GERD, I don't know if your doctor has discussed this with you, but there is a surgical intervention that helps TREMENDOUSLY with bad cases of GERD.

My wife used to wake me all through the night with her jumbo bottle of Tums rattling when she would have to take them (made us even for my snoring I guess). She couldn't lie down with even a cup of water in her stomach because she would get heartburn/reflux so bad. She went to see the GI group here and they would not even consider anything but medication and it got very frustrating. At one point, she was on two different medications for both reducing the acid production in her stomach and for speeding up the food's travel through the stomach. This led to her having to take two OTHER medications in addition to those - for the irritable bowel syndrome and digestive problems she developed (because the gut is not designed to handle food that has been rushed/inadequately broken-down). Throw in various hospitalizations for an endoscopy and other tests where she had to drink the awful "slurry" they prepare you, along with the still-prevalent problems she was having, and you can imagine how frustrated she was (and myself).

I suggested that since the GI group would not even consider surgery, she should go see an internalist, and recommended one I heard people speak highly of around the hospital. She saw him, he listened to her, agreed with her, and recommended a surgeon that he would use if he were having surgery. This surgeon saw her, performed one more test on her (so he could ensure she would benefit from the surgery) and told her she would see immense improvement from the surgery. He then performed what they called a Nissen fundoplication (maybe that is spelled right). It is a surgery in which they take a small portion of the top of the stomach and wrap it around the espohagus (where her valve was essentially non-existant) to create a valve. She couldn't swallow anything but liquids for a couple of days, then nothing bigger than a pea, then larger and larger things until after a couple weeks she could swallow regular stuff. She said that even with the pain of the surgery/recovery and the inability to swallow regularly for a first couple of weeks, she would do it again in a heartbeat. She has not had any further problems and that was about 10 years ago.

Just food for thought if your Dr. has not shared this with you, and not everyone would benefit from it (like minor cases of GERD).

[Arizona-Willie]

No, you still have GERD ... it is just under control. GERD is the result of weakening of the sphicter between the stomach and the esophagus. Medication can alleviate the symptoms but it doesn't fix the underlying muscle weakness in the sphincter.

The ONLY cure for GERd is surgical intervention.

Eventually you will experience the symptoms again, unfortunately.

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

..........

That was my vote. There is little doubt that in all the years of struggling to breathe at night violent muscle contractions forced acid into my esophagus. After I started cpap the doc looked with an endoscope and saw damage to the sphincters. Three months of Prevacid and elevation of the head of my bed and I no longer have GERD.

I would not rule out that cases of 2 & 3 exist in some people.

[One Tired Puppy]

ycartf,

I'm glad I read your post. I have been taking Prevacid once a day before cpap. Since cpap I have developed an inflamed esophagus and have been taking Prevacid twice a day. The GERD (only feel the heartburn through my chest and upperback) has been progressively been getting worse. My doctor put me on those pills for emptying your stomach faster along with the protein pump inhibitor plus I take Gaviscon liquid in between. It still has not helped and the GERD is coming on a more regular basis and is much worse than before. I thought it was pretty bad when I had to sit up straight for 6-8 hours to get any sleep. Now it starts in the early evening, goes all night and all the next day plus half of the next night without relief. It comes and goes every few minutes.

My doctor was on holidays and I saw another doctor who looked at my records and told me I had an inflamed esphogus a year ago. He raised my Prevacid to 3 times a day. I wonder why my doctor didn't tell me that I had an inflamed esophugus a year ago. That was when it wasn't bothering me very much. The fill in doctor told me to come back to see my doctor next week when he is back from holiday and have him refer me back to the GI doctor. In the meantime, I am not going to eat or drink anything for at least 3 hours before I go to bed. I have been noticeing the past couple months that part way through a meal when I swallow food I feel it get stuck halfway between my throat and my chest. It doesn't stay stuck but I can feel it stuck there for a second or two.

I am going to bring up with my doctor and the GI that surgery procedure your wife had. If this Nissen Fundoplication surgery will stop this painful condition I will be one happy and relieved person.

Thank you for the information.

Anne

[Arizona-Willie]

I can heartily recommend Dr. Heigh at Mayo Clinic in Scottdale AZ.

He did my first endo and promptly got me in surgery with Dr. Schlinkert for the life saving nissan fundoplication.

I got in for checkup endos every couple of years to keep an eye on my esophagagus to make sure cancer does not appear. Years of GERD causes cancer much like years of smoking. It can show up years after the cause has been removed.

What tests should be performed to access the extent of GERD damage. My ENT did an endoscopy when I complained of feeling like I had a lump in my throat. He discovered a sore spot on my Epiglottis, said the cause was GERD, and sent me home with some Nexium samples.

Esophagogastroduodenoscopy (EGD) by a good GI doctor.

[alpha]

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...