New with lots of questions -- silent reflux, sleep apnea

[beth0277]

I'm new here and I'll try to not be too long-winded.

18 months ago I was given an Upper GI (for something that ended up being nothing) but it did show a "small amount" of reflux. I was perplexed because I have never felt heart burn in my life, even with my pregnancy that I had just had 2 months prior. My doctor brushed it off and I went on my merry way. A few Dr Google searches later, I started worrying about silent reflux and the damage it could do to my esophagus. This was last Spring. My doctor agreed to send me to a GI doctor just to get their opinion. Over the summer, I started snoring very heavily and waking up fairly often in panic attacks (happened most often as soon as I would fall asleep). I have an anxiety disorder so I didn't think much of the attacks, until I mentioned them to my therapist and she asked if I had ever had a sleep study because her "non-medical" opinion was that it could have to do with sleep apnea. I mentioned this to my GP and she said we could do a sleep study if I wanted to. During this time, my snoring was getting so bad that my husband resigned himself to the couch a few nights a week.

Shortly after, the GI doctor agreed to do an endoscopy to check for reflux, or damage from it. I ended up having esophagitis (damage to my esophagus usually caused by reflux) and have been on a PPI (acid reflux medicine) ever since. My husband said he has not heard me snore in at least a few months, I also do not remember the last time I had one of my "falling asleep" panic attacks.

So...I know that silent reflux and sleep apnea can be related but it is more of a "what came first" argument.

Do any of you have any experience or knowledge of this? I am curious if anyone else has had a similar experience.

[teknomom]

I had silent reflux and was diagnosed in a similar situation to yours. I too, had damage to the esophagus. That was many years ago and it has been treated successfully. Now I've been diagnosed with sleep apnea. I think either one can "come first" as far as diagnosis, but they do often go together and a sleep study is the only way to find out if you have apnea. Good Luck!

[beth0277]

Thanks for the quick reply! I am hesitating on getting the sleep study as I am not having the issues now...we'll see how things go.

The silent reflux is the weirdest thing. I have never had any heartburn, no real sore throat (other than the occasional sinus infection or virus), no weird drainage, basically none of the symptoms. Even with the esophagitis, no pain at all.

I was on an SSRI (Prozac) when I was diagnosed, so I guess it could have been caused by that because as my GI doctor mentioned, those meds can sometimes relax your muscles and allow acid to reflux.

I have been on my PPI for 2 months now and I go next week for a barium swallow test. So long as everything looks okay, I will get off the PPI and have another endoscopy in 3 months to see if there is any damage. If so, it will be long term PPI treatment for me (which I am hesitant to do since I am only 27). If not, I guess we will go from there. I worry that there won't be damage in 3 months, so I will be brushed off but then in a year or so it will flair back up. I did not have 1 single symptom so how am I to know if it does flair up, you know? I feel like I just got lucky catching it because of the Upper GI that I had...maybe if it had gone for longer then I would have started having symptoms...or maybe my excessive snoring was a symptom...who knows?!

[beth0277]

Teknomom: Are you on continuing PPI therapy for your silent reflux?

[Janknitz]

I had pretty severe reflux and I'm sure there's a good deal of esophageal damage too (they will have to shoot me dead before they ever put anything down my throat, so no endoscopy to check!).

Here's what I know. When I'm wearing my CPAP, NO reflux. If I fell asleep for even 10 minutes without it, reflux. So first rule is wear your CPAP. Dr. Steven Park speculates that the struggle to breathe causes a vacuum effect in the airway, pulling stomach contents up into the esophagus and airway. This may very likely be the first step in the cycle.

Second thing is that since following a low carb diet, I have NO heartburn and the only time I have any reflux at all any more, awake or asleep, is when I have dairy--guess I'm lactose intolerant, but I love dairy (even the limited dairy I can have on my low carb diet). When I was younger and followed a low carb diet, I was completely off my PPI's and feeling fine. Now I can't get off them completely, probably because too much damage was done.

Obesity contributes to reflux, so losing weight helps too (if that's your issue). But even without losing any weight, getting the carbs under control has helped myreflux enormously.

[Mary Z]

Since you are having the panic attacks and snoring so badly that your husband has to sleep on the couch some nights I would go ahead with the sleep study. The worst case scenario is that it wll cost you a little money and may be negative. However, if you do have OSA it would be good to get treated and get the husband back in the bed.

I have reflux under control with meds, but I don't know if it's connected to my apnea.

[VVV]

beth0277

Beth,

A long time ago I had my experience with silent reflux - my only symptom was a constantly raspy voice. Endoscopy showed my vocal cords were somewhat irritated.

I used a PPI for six months but I also raised the head of my bed with riser blocks.

I haven't had reflux in years. My guess is that the PPI would have been unnecessary if I had first raised the head of my bed. My reflux may also never have started had I used CPAP 15 years earlier. I am convinced the major cause of mine was apnea causing the vacuuming effect. (See links below.)

PPIs do not prevent reflux. They only lower the acid content of the stomach. I encourage you to raise the bed head, eat well and at the right times, and in the near future discontinue the use of the PPI. Nature creates the stomach acid for good reasons. Stopping the production of stomach acid for long periods of time intuitively seems unhealthy to me.

You are right that reflux can cause apnea. Reflux may inflame and enlarge the airway and the vocal cords. This narrowing of the airway could lead to apnea.

But apnea also can vacuum stomach contents into the throat and mouth.

Here are some good articles - http://doctorstevenpark.com/how-reflux- ... leep-apnea
and http://doctorstevenpark.com/the-single- ... o-patients

Good luck,

[teknomom]

Teknomom: Are you on continuing PPI therapy for your silent reflux?

I couldn't tolerate anything but OTC Zantac which has worked for me. I watch what I eat (I eat low carb, too) and elevate the head of my bead about 25-30 degrees (electric bed). My Barrett's damage has disappeared. I also had "silent" sleep apnea - no snoring, gasping, etc. Even though you have stopped the symptoms you could still have apnea. My husband doesn't snore either but has OSA.

(they will have to shoot me dead before they ever put anything down my throat, so no endoscopy to check!).

Janknitz, I actually look forward to my endoscopy - no prep like a colonoscopy and such wonderful drugs for sedation! Plus I like the security of a clean bill of health - cancer of the esophagus is deadly!

[beth0277]

This is all very interesting. I am so glad I found this forum because my searches on "silent reflux" had previously been pretty unsuccesful. I do not want to stay on PPI's long term, but I am scared of Barrett's esophagus, added to the fact that I have had pretty much no symptoms from my reflux...I guess we will have to see what happens when I am off the PPI for a few months.

I think I will go ahead and plan the sleep study. It's interesting to think that my dad had heart issues at a fairly young age (in his late 40's, early 50's) despite being very physically fit. He also snored like no one that I had ever heard before. I am curious now to whether he could have suffered from sleep apnea for all of those years. We share so many characteristics that make me think it is all the more reason to go ahead with the sleep study.

[archangle]

CPAP may improve or worsen reflux. Sometimes changing the pressure will make it better or worse. Pay attention to how your CPAP and your reflux ineract.

[Janknitz]

I have reflux sitting straight up if I fall asleep without my CPAP after ingesting dairy. So raising the head of the bed didn't work for me.

[retrodave15]

As for reflux and respiratory issues, http://my.clevelandclinic.org/disorders ... sthma.aspx, there is a connection between reflux and asthma. I have noticed since I started on CPAP, my reflux issues have not bothered me. I am still taking Prilosec 20mg twice a day, but I am considering trying to cut that back to once a day. I had the asthma symptoms before I got the reflux under control.

It is not a stretch to see how this all interconnects: reflux causes acid to back up into the esophagus, if it is bad enough; it comes all the way up into your throat, you aspirate (inhale) the acid which causes inflammation, which causes OSA or worsens the symptoms of OSA. It's a chicken and the egg syndrome, what was the initiator of the problem. Stress can cause acid reflux by causing the stomach to pump out more acid. Lack of sleep can cause worsening stress or depression issues. I am lucky to have a doctor that has a whole body approach to disease management. Instead of just masking the symptoms of a problem, lets get to the root cause of the problem and take care of that and things should start to correct. For me it has been getting my sleep apnea under control, which is starting to help my depression and stress level, which is getting my reflux under control.

My last doctor was a pill pusher, don't feel well; there is a pill for that. You get turned into a recurring source of income, as you need to make an office visit every 3 months to get your script refilled. My current doc has the attitude of lets find out what the problem is, fix the problem, and move on, there are plenty of sick people to fill his appointment schedule.

[VVV]

I have reflux sitting straight up if I fall asleep without my CPAP after ingesting dairy. So raising the head of the bed didn't work for me.

Janknitz,

I am curious to know if you left your bed head elevated as precaution. I haven't had problems in a very long time and my wife and I are discussing whether to normalize the elevation of the bed head.

We also had a discussion about the possibility of the elevation negatively affecting circulation of blood in the legs and maybe even having a negative effect on RLS.

For now the head remains elevated but I wonder if this is the best thing to do?

[VVV]

Very good post retrodave15 and don't we wish all doctors were like your current doc!

The one thing that I would quibble with is that excess acid production causes reflux. I agree that stress has a bad effect on reflux. But the acid in the stomach which is quite normal and desirable is not the problem. I would say that stress causes problems with digestion of food and emptying of the stomach and that is the source of some reflux.

PPIs have some positive effect because by reducing acid production the stomach contents are less corrosive to the passages above the stomach. But still the reflux may continue and food and normal stomach bacteria are reaching the passages above the stomach and causing problems.

That is just my opinion and I will cede my position to clear arguments to the contrary.

[retrodave15]

I agree it is not the only issue; how long did we go before we realized the H Pylori was the main cause of stomach ulcers? Acid production play a role in reflux and the PPI and H2 antagonists reduce acid production which can help reflux symptoms. There is also non acid caused reflux, weak sphincter, low motility, which can only be determined my an esophageal manometery and 24 HR pH testing. Which are both pretty brutal tests. My Ex wife went through both of these tests. At the conclusion she was given the options of http://www.surgeryencyclopedia.com/St-Wr/Vagotomy.html or http://www.surgeryencyclopedia.com/Fi-L ... rgery.html. She elected to have the Nissen procedure, which did control her reflux and her reflux induced asthma. Looking back she also had all the symptoms of OSA as well. She to my knowledge never treated her OSA, even though she lost her dad to pulmonary fibrosis, and xpap therapy kept him around for several extra years.

Dave