Gerd - heartburn - acid reflux and OSA

[Gerryk]

I know this has been discussed before but mostly in passing conversation in threads.

A few days ago I was thinking about this, since I have had problems with acid reflux for about 20 years. I changed my diet at first because my doc said it was the food I was eating, or that I was drinking too much coffee. Well I changed my diet and cut down on the coffee and it didn't help. I managed via tums or maylox or what ever else was handy when it hit me, which was several times a week if not every night. Finally I was put on Nexium and that worked great with only occasional problems.

I was thinking over this the other day and it hit me that I haven't had a flair up in about a year now. That's when it hit me that is after I began being treated on cpap where it was actually helping me. Well, I brought this up to my ENT the other day when I went in to see her. I am now being weened off of Nexium. I used to take it every day, now I take it every other day for a month then every third day until I am off it completely.

This is just another one of the signs that was missed by everyone that I had OSA for so long. I knew nothing about OSA until I was told I should go see a sleep doctor because I was ghasping for breath in my sleep.



What is everyone elses experiences? Did you have problems with heartburn? If so did you take meds for it? Since you have been successfully treating the OSA what has happened with your heartburn?


Gerry

[Mac33]

I was diagnosed with erosive Esophagitis about 5 years ago with bad ulcerations used previcid for years stopped afternstarting cpap 4-5 months ago.

[dsm]

GerryK
I also believe that there is a very strong link between GERD & developing OSA symptoms. In 1990, went in for a sleep study wondering if OSA was a problem. The sleep clinic said *no* you don't have OSA you are ok.

In the mid to late 1990s began getting indigestion pains & started taking gaviscon as a liquid, on nights where it was troublesome. Also found I could not drink beer or eat fatty foods without a flare up.

By early 2000s the heartburn was becoming chronic & snoring began to become an issues *as well as* wife complaining I would slowly stop breathing & not hearing me trying to breathe was greatly disturbing her sleep.

In 2005 did another sleep study & was told "you don't look like a candidate for OSA" but when seeing the RT again, he said, "I got it wrong, you
have severe OSA (AHI=40)".

At about this same time was having lots of sinus problems as well as the 'heartburn'. Med doc requested a colonoscopy & later said 'heartburn' was caused by GERD & initated treatment with GERD med called Pariet.

After 18 months on cpap-apap-bilevel lost a lot of excess weight (about 12 KG) then went in for another sleep study - was expecting RT to say, you are now cured of OSA but that didn't happen. Results showed it was only marginally better than the 2nd study 18 months prior.

8 months ago went to a Dr who specializes in repairing LES problems but after an endoscopy he said saty with the Pariet - it is doing equal to anything he could achive & that it would work better long term.

My conclusion (which I think is on target) from all this has been ...
- in 1990 OSA was not a factor
- in 1990-1995 slowly putting on weight and diet that included lots of coffee and continuous stressful work etc: began a cycle that led to GERD which began to affect LES which in turn allowed acid into esophagus which began to affect respiration
- Once GERD had a firm hold, I think the OSA & some CA developed and is now a permanent factor in my life that I have to live with
- With xPAP therapy and GERD meds, life has largely improved to the extent that exercise & weight management are very good but the OSA remains

This experience leads me to think it is a not uncommon path many of us males travel as we shift from our 40s to our 50s (can't be confident I can say same for women as well).

I hate to admit that am stuck with xPAP for the rest of my life but I am sure I am.

DSM

[Mac33]

why would a weak LES cause OSA?

[roster]

There is no doubt in my mind that untreated OSA often leads to the development of GERD. My ignorant sleep doctors did not know this (or did not care since it was not within their specialty), but the people at cpaptalk did and with their help and CPAP, I was cured of GERD.

Dr. Park has an interesting article on the OSA-GERD connection and one quote is:

During this process (apnea), a vacuum effect is created, actively suctioning up small amounts of your stomach juices into your lower esophagus or your throat.

Read the full article at http://doctorstevenpark.com/index.php?s=gerd

[Muse-Inc]

...haven't had a flair up in about a year now....

Don't forget you've been low carbing too. Many with GERD might see a dramatic drop in symptoms by switching to a low carb diet (Eades mentions this, a lot) -- this is in no way meant to suggest that your diet change was completely responsible; at this time, there appear to be multiple approaches and CPAP therapy might be the most effective.

[wlk]

I had severe bouts of reflux before CPAP that Prevacid and Nexium treated marginally.
When I began the CPAP therapy it was as if the reflux was turned off like a light switch. I have not had a single incident of nighttime reflux in the two years since I started CPAP therapy. I have even consumed some of the worst trigger foods close to bedtime with no adverse effect.

[Mac33]

There is no doubt in my mind that untreated OSA often leads to the development of GERD. My ignorant sleep doctors did not know this (or did not care since it was not within their specialty), but the people at cpaptalk did and with their help and CPAP, I was cured of GERD.

Dr. Park has an interesting article on the OSA-GERD connection and one quote is:

During this process (apnea), a vacuum effect is created, actively suctioning up small amounts of your stomach juices into your lower esophagus or your throat.

Read the full article at http://doctorstevenpark.com/index.php?s=gerd

Rooster this correlation makes sense apnea then Gerd not the other way around. Cure apnea and Gerd goes away for the most.........

[SleepingUgly]

Rooster, how did you get cured of GERD?

There is no doubt in my mind that untreated OSA often leads to the development of GERD. My ignorant sleep doctors did not know this (or did not care since it was not within their specialty), but the people at cpaptalk did and with their help and CPAP, I was cured of GERD.

Dr. Park has an interesting article on the OSA-GERD connection and one quote is:

During this process (apnea), a vacuum effect is created, actively suctioning up small amounts of your stomach juices into your lower esophagus or your throat.

Read the full article at http://doctorstevenpark.com/index.php?s=gerd

[SleepingUgly]

I have wondered about this concept of "silent GERD" and sleep disordered breathing. I don't have any symptoms of GERD, so I don't know if it's worthwhile to have an invasive study looking for it (e.g., Bravo study), or a trial of protein pump inhibitors, or forget it until I have symptoms.

[dsm]

why would a weak LES cause OSA?

Mac33,

What I understand happens is that (based on an assumption that GERD can often be a prelude to OSA), the pressure or other factors that allow stomach acid to squeeze out and attack the LES and the lining of the esophagus, leads to worse breeches until heartburn becomes so painful it requires medical treatment and often a serious modification of diet.

The acid coming up the esophagus also causes the body to go into defense mode and begin producing a very thick mucus in the throat area. The acid and mucus also finds its way into the sinuses and can contribute to repeated sinus infections. The acid can also affect the vocal cords.

Thus the overall effect of GERD can be to damage respiration.

Others may be able to add more info.

DSM

PS I realize this sequence can vary from person to person & what I am describing is what I believe happened in my own case.

PPS. This link may explain it better than I have -
http://ezinearticles.com/?The-Connectio ... &id=562550

[Mac33]

why would a weak LES cause OSA?

Mac33,

What I understand happens is that (based on an assumption that GERD can often be a prelude to OSA), the pressure or other factors that allow stomach acid to squeeze out and attack the LES and the lining of the esophagus, leads to worse breeches until heartburn becomes so painful it requires medical treatment and often a serious modification of diet.

Yep that's what happened to me....nights drinking heavy then stuffing my face with a dozen white castle murder burgers, crispy cream doughnuts etc... then aspirin in the morning........

The acid coming up the esophagus also causes the body to go into defense mode and begin producing a very thick mucus in the throat area. The acid and mucus also finds its way into the sinuses and can contribute to repeated sinus infections. The acid can also affect the vocal cords.

Yep I have bad sinus issues actually allergies and sinusuitis

Thus the overall effect of GERD can be to damage respiration.

Others may be able to add more info.

DSM

PS I realize this sequence can vary from person to person & what I am describing is what I believe happened in my own case.

I'm been fucked for a while.....can I say this???

[dsm]

Mac33 "can I say this"

The forum is open but it would be good if the choice of verb preceeding the above quote was ameliorated

Good luck with getting that GERD under control. It is evil.

DSM

[roster]

Rooster, how did you get cured of GERD?

Once the CPAP therapy was working properly for me, the lengthy apneic events stopped and digestive acids were no longer being vacuumed into my esophagus and throat. Then the inflammation of both LES and my vocal cords went away.

I also followed the recommended lifestyle and home remedies ( http://www.mayoclinic.com/health/gerd/D ... e-remedies ).

The gastroenterologist did have me take Prevacid, but I am not a fan of this and discontinued it quickly. Prevacid and other acid inhibitors only reduced stomach acid and do not prevent stomach juices from entering the esophagus. They are like a bandaid and do not get to the source of the problem. I was also concerned about side effects. Our bodies produce stomach acids for a reason and reducing their production could have some bad consequences.

Regarding DSM's comments, it has also been shown that GERD can cause inflammation of the vocal cords which can worsen or cause apneic events.

Read the Mayo Clinc article; you will find some help there.

[Gerryk]

...haven't had a flair up in about a year now....

Don't forget you've been low carbing too. Many with GERD might see a dramatic drop in symptoms by switching to a low carb diet (Eades mentions this, a lot) -- this is in no way meant to suggest that your diet change was completely responsible; at this time, there appear to be multiple approaches and CPAP therapy might be the most effective.

Muse, I didn't begin the low carb until Sept and thinking back a little more, I haven't had any problems with gerd since I probably January. I have let up on the diet some, having some bread for a sandwich a couple times a month and a taste of things I shouldn't. I am still losing just much slower with is better. I lost about 45 poounds since last summer and only about 5 since the Christmas. Still working out and eating better but Some wheat bread tasted better than any candy, steak or piece of fish I ever had in a long time.

I got my schedule mixed up and didn't take the nexium yesterday so I will take it today. That makes three days no nexium stupid me, but no problems.


Gerry