Variable Breathing always 60%+ - Concerned

I'd like to re-insert some of Browser's original information here, should anyone care to focus on his original question about high Variable Breathing rates:

Browser wrote:I have severe osa and purchased an auto m-series and with J. Skinners program my variable breathing is 98% of the time over 55% up to 75%. I have tried auto and cpap mode and cflex 1,2,3 and off and still high. I noticed if I take 1/4 mg of Klonopin a couple hours before bed the VB drops to 25%. I have no known breathing disorders other than OSA with an AHI at the PSG over 100. I went to a cheesy sleep lab last time and was titrated at 15 but I wonder if they missed something and if I should go to a better lab instead of the cheesy one? Could I need a special machine? My AHI remains 5-10 if I set the machine 10-15 11-15 12-15 13-15 straight 14 or straight 15 and if I go over 15 I really fill with air in the tummy. I don't fall asleep during the day anymore but I don't feel right. I wonder if it could be related to antidepressant use or BP meds? Should I just ignore the VB or go to a better clinic.

Browser wrote:I take an antidepressant(SSRI) and BP med and nose spray(Steroid). I feel anxious often during the day and I read a post here about breath holding and I have noticed since I was a kid that I do that often when changing positions watching tv or after I wake up in bed - don't know why but I have always done it. I have my study results.

quoting his NPSG Browser wrote:I have my study results.
73 minutes to fall asleep (Noisey lab where they kept a cold fan running in my room to try and drown out all the noise they made-their words)
Slept just over 4 hours
Sleep efficiency 61% (Due to lab conditions-my opinion)
Some slow wave delta sleep was seen in later part of the night once cpap was applied
Onset to initial REM sleep was normal but a decreased proportion of overall rem sleep was seen
No PLM
During initial 3.5 hours of the night he slept for 2.2 hours for a sleep efficiency of 64%
During this time there was considerable disordered breathing seen with 185 OA and 52 HA
Repetitive arteial O2 desaturation as low as 78% in REM sleep with frequent episodes of desat below 90% from baseline of 94%
As a result of the frequency of apnea events there was prolonged sleep time below 90% SpO2.
Loud snoring was heard
Sleep ECG appeared normal
Cpap was applied and took just over an hour toresume sleep
Slept just over 109 minutes for a sleep effeciency of 58% of the remaining 3.1 hours in bed
During Cpap there was some consolidation of slow wave (delta) sleep seen and a reasonable amount of of REM sleep was evident
Minimal disordered breathing was seen with only 1 HA for an RDI of 0.6 per hour with treatment
O2 remained between 93 and 96%
Cpap was initiated at 7cm and he was unable to tolerate and it was raised to 10cm eventually this was raised to 15cm to overcome reidual snoring
He slept for 1.8 hours with no evidence of disordered breathing
Sleep stages - no treatment
Rem=13.5%
1=1.1%
2=85%
3=.4%
4=0%
Sleep stages with cpap
Rem=16.5%
1=4.6%
2=61%
3=17.9%
4=0%
Sa02 no treatment
Awake average = 94% With treatment = 96%
Lowest = 78% With treatment = 93%
Average desat = 8% With treatment = 4%
Lowest Sa02% = REM non-back 78% Non-rem Non-back 83% With treatment = Rem Back 94% Non-rem Non-Back 93%
Respiratory events=
OA = 184 Mixed = 1 Central = 0 Ha = 52 With treatment = OA 0 Mixed 0 Central 0 Ha 1
RDI = OA 83.0 Mixed 0.5 Central 0 Ha 23.5 With treatment = OA 0 Mixed 0 Central 0 Ha 0.6
Average duration OA 18.6 sec Mixed 13.5 sec Central 0 sec Hi 19.5 sec With treatment OA 0 Mixed 0 Central 0 Ha 29.4
Longest duration Total apnea = 36.6 sec Ha = 50.9 sec With treatment Ha 29.4
Number in NREM Oa = 169 Mixed = 1 Ha = 44 With treatment OA 0 Ha 1
Number in REM Oa = 15 Ha = 8 With treatment Oa 0 Ha 0
NON TREATMENT Respiratory arousal index = REM = 0 NON_REM = 45.7
Average HR = 71
Average HR assoc with AHI = 71
ARO RES - Rem = 0 Non-rem = 45.7
ARO Spont - REM = 8.2 Non-rem = 6.3
ARO Limb - O across the board
RERA - 0 Across the board
Snore 0.3 in Non-rem
Cpap - 10 12minutes - No events
Cpap - 12 20minutes - 1 Ha
Cpap - 15 79minutes - No events
Epworth score = 16
Note- Gained 10 pounds since study approx 2 years ago

While citing a recent Encore report Browser wrote:Here is my report from last night following snoredogs recommendation. I awakened and turned the machine off and back on so that is why in the morning the sudden pressure drop. I have a nice skin tear under my nose now. I feel about like usual today. Not tired but trying to perfect because I feel strange. Kind of like anxious. Eyes watering. Sinuses sore. Been at this for a couple years. I use the Activa mask. Humid was set at 3. Usually at 1. Cflex set at 1. Have tried all settings.



Thanks for your help...

So are there any more helpful thoughts/ideas to get Browser's discussion back on track? Thanks.

And yet a couple more charts that Browser recently posted to demonstrate the issue/problem he is hoping to solve:

There are two earlier comments in this thread that kind of resonated with my thinking. One was that 16cmH2O might be a good fixed pressure to try.

The other earlier comment was that dllfo is perhaps the only other poster on this message board who consistently presents Variable Breathing rates this high. I would comment that dllfo has a variety of health problems. One of dllfo's health issues that may contribute to his excessive Variable Breathing is his disorder known as "vocal chord dysfunction". Another possible Variable Breathing culprit might be the fact that dllfo has some heart issues. I think either or perhaps both of those problems just might be contributing to dllfo's consistently high Variable Breathing rates.



p.s. ...admiring those nice, low Variable Breathing rates on November 15th!

-SWS wrote: There are two earlier comments in this thread that kind of resonated with my thinking. One was that 16cmH2O might be a good fixed pressure to try.

The other earlier comment was that dllfo is perhaps the only other poster on this message board who consistently presents Variable Breathing rates this high. I would comment that dllfo has a variety of health problems. One of dllfo's health issues that may contribute to his excessive Variable Breathing is his disorder known as "vocal chord dysfunction". Another possible Variable Breathing culprit might be the fact that dllfo has some heart issues. I think either or perhaps both of those problems just might be contributing to dllfo's consistently high Variable Breathing rates.



p.s. ...admiring those nice, low Variable Breathing rates on November 15th!

I think before you can make an issue out of Variable Breathing you first have identify what it means.

I just searched the AASM Diagnostic and Coding Manual ICD copy I have and it does NOT even recognize Variable Breathing as a notable mention. Think it only covers up to 2001, So good or bad as far as the AASM is concerned VB is meaningless or does not exist. Search it for yourself, I didn't find anything on it. Google similar results. I found plenty of "variable" and "breathing" used but never "variable breathing" together. Maybe they are calling it something other than VB. But I looked at disturbances during REM and didn't see anything there either but I didn't look that hard.

I think using dllfo's case as an example of what VB might be good/bad is a bad example, when he came here he was on morphine for chronic pain, then I think he said he was put on methadone and/or a half dozen other drugs to get off that. Then you don't know if he had VCD from a UES dysfunction.

If VB is so important Respironics would have put it in their reports. If you say a low VB score is good you would only be guessing, you have no idea that the data you are looking at is even in the right context. In my search I couldn't find a single respective medical journal mention VB much less describe it. You have to know what it is first before you can determine what you are looking at is good or bad.

You want to know what his best pressure is? Do what I said in the beginning when I asked for the Encore Daily report, he's got James Pro Analyizer put up a trend report of Apnea/Hyopnea Index vs Pressure report for at least 7 days worth, longer the better.

SWS - this comment may be way off base, since this subject is over my head, but I noted that Browser uses a steroid nasal spray. I wonder how long he has been using it.

I used one briefly a few years ago and I was very "anxious" and completely restless all the time I was using it. My sleep was certainly disrupted as well although I had no idea what was going on. The anxiety forced me off the steroid spray within about 3 days and I was well aware of the relief my whole system seemed to feel when it was out of my system.

At the time, I had been diagnosed with sleep apnea and was using cpap but it was not a data capable machine so I could not make any connections, but the use of that steroid nasal spray along with an anti-depressant seems like a combination that could cause real trouble with sleep patterns.

Again, this may not be relevant since, as I said, I am in "over my head" on this subject but I did not want to leave the thoughts I had when I read the meds Browser was taking and he mentioned periods of anxiety during the day (possibly also during the night), unexpressed in this thread, now that we may be back to Browser's situation.

Snoredog - Sorry. I was typing while you were typing.

Snoredog, I agree that Variable Breathing is not at all a clinical definifition. Rather it's an admittedly ambiguous Respironics PAP machine statistic. And I think the crux of what Browser has come to inquire about is whether his highly atypical VB rates have health or sleep implications. The fact that they are atypically high---very high---warrants investigation IMHO.

However, somewhere along the way in this discussion it also became apparent that Browser's residual AHI is a bit higher than clinically acceptable on certain nights. Unlike Browser's issue relating to that very high VB statistic, a higher than acceptable AHI is a problem that gets fixed on this message board again and again. So that was the basis of my thinking 16cmH2O just might be a good thing to try next per ozij's observation of the Encore pressure tables. If fixed 16cmH2O pressure does happen to represent a significant improvement, then there may also be an impact on that high VB rate.

Hawthorne, I'm pretty much in the same boat as you regarding the steroid nasal spray. Without researching the topic I also suspect there just may be a possible CNS side effect---kind of like what you described. If so, maybe that nasal steroid does impact Browswer's breathing and heart rate during sleep. I thought it was interesting that klonopin at least partially mitigated Browsers high VB rates. Recall that klonopin inhibits the CNS. So let's put those two together: klonopin inhibits CNS activity and also decreased Browser's VB rates; nasal steroids just might increase Browser's VB rates if they happen to increase his CNS activity as a side effect----as might have been Hawthorne's case. I'm hoping SAG or others may help us with the nasal steroid question. Any other thoughts and ideas too.

Regarding the AHI variability---those AHI spikes during certain nights. Browser, is there any chance you ate, drank, or otherwise exacerbated GERD on those nights?

Any other ideas or thoughts are much appreciated...

Anyways, I will post the AHI versus Pressure graph here later. I think it is kind of useless unless you know how much time was spent at each pressure. The two blank days I didn't use the machine - bad me. I fell asleep in the chair watching TV and paid for it the next day.

I understand where both Snoredog and SAG are coming from and use a mixture of their advice. Not that I don't appreciate others advice also. It seems to me Snoredog makes a lot of sense and has given me the most in this thread and Sag has also given good advice about not "jumpin' the gun" on needing a different machine based on such little information.

I posted because I was curious why I had such a high VB, I noticed other people with these issues seem to be wearing the Activa so now I wonder if the Activa doesn't cause false high VB due to the bellows effect? I noticed in the past if I run in CFLEX of 3 my VB drops to the 20's but I also got major gas pains and awakened early. I tried the CFLEX of 3 at a set pressure of 15 in the past and had low VB but high gas pain and AHI... I will continue the 12-16 for now because of that one really good night of sleep and see what happens with different variables of CFLEX and post it here. I will try to get other masks and see what happens.

I can't breathe without the nasal sprays... I have serious allergies to most everything grass,weed,tree and dust related...

So last night I had leaking problems all night. This is a problem I have with the Activa. Some nights a beautiful seal and others are a train wreck like last night where I wake up all night to leaks.

Snoredog wrote:

-SWS wrote: There are two earlier comments in this thread that kind of resonated with my thinking. One was that 16cmH2O might be a good fixed pressure to try.

The other earlier comment was that dllfo is perhaps the only other poster on this message board who consistently presents Variable Breathing rates this high. I would comment that dllfo has a variety of health problems. One of dllfo's health issues that may contribute to his excessive Variable Breathing is his disorder known as "vocal chord dysfunction". Another possible Variable Breathing culprit might be the fact that dllfo has some heart issues. I think either or perhaps both of those problems just might be contributing to dllfo's consistently high Variable Breathing rates.



p.s. ...admiring those nice, low Variable Breathing rates on November 15th!

I think before you can make an issue out of Variable Breathing you first have identify what it means.

I just searched the AASM Diagnostic and Coding Manual ICD copy I have and it does NOT even recognize Variable Breathing as a notable mention. Think it only covers up to 2001, So good or bad as far as the AASM is concerned VB is meaningless or does not exist. Search it for yourself, I didn't find anything on it. Google similar results. I found plenty of "variable" and "breathing" used but never "variable breathing" together. Maybe they are calling it something other than VB. But I looked at disturbances during REM and didn't see anything there either but I didn't look that hard.

I think using dllfo's case as an example of what VB might be good/bad is a bad example, when he came here he was on morphine for chronic pain, then I think he said he was put on methadone and/or a half dozen other drugs to get off that. Then you don't know if he had VCD from a UES dysfunction.

If VB is so important Respironics would have put it in their reports. If you say a low VB score is good you would only be guessing, you have no idea that the data you are looking at is even in the right context. In my search I couldn't find a single respective medical journal mention VB much less describe it. You have to know what it is first before you can determine what you are looking at is good or bad.

You want to know what his best pressure is? Do what I said in the beginning when I asked for the Encore Daily report, he's got James Pro Analyizer put up a trend report of Apnea/Hyopnea Index vs Pressure report for at least 7 days worth, longer the better.

Must admit that what Snoredog has said here is my reaction. Where did this definition of VB come from such that it accurately describes dllfo's situation. Dllfo appeared to have Periodic Breathing - periods of breathing with centrals in between.

I did find documents (plus the M series patent) refering to VB so am satisfied there is a meaning for it. But I don'rt believe we ever resolved that here although the topic came up recently.

DSM

Browser, what you mentioned sounds like a perfectly viable plan to me. Methodical trial and error has been essential to CPAP success for so many of us.

Doug, I only contend that those VB rates are way up there. As I mentioned above I view those as an ambiguous manufacturer statistic---they are not scored clinical events by any stretch of the imagination. And you also very correctly point out that dllfo scored PB and central apneas on his autoSV (generally attributable to CHF---but perhaps exacerbated by his vocal chord dysfunction as well). But didn't he also occasionally turn in very high VB rates using his prior APAP machine: here are a few of dllfo's episodic variable breathing rates

I'm still of the opinion that PB's typical flow-amplitude standard deviations will allow PB to score as VB: PB may be cyclic or patterned, but PB is none the less highly amplitude variable on the vertical flow axis. That's not to imply that I think Browser is experiencing periodic breathing. Nor would I rule the possibility out.

Also, has anyone here ever turned in inordinately high VB rates and reported having awakened feeling refreshed? I honestly don't know the answer to that question. But I strongly suspect inordinately high VB rates may very well correlate to highly deteriorated sleep. I also suspect inordinately high VB rates just may correlate to an entire variety of possible health/sleep conditions such as PB, REM rebound, vocal chord dysfunction, CSDB tendencies, excessive wakefulness, REM sleep disorders, GERD, etc. Then again, maybe they don't.

snoredog wrote:No, no, no don't feel like you are in any way honored with any shrine at my house

Whoops! Sorry! My mistake! I guess the only other reason you'd be running around with pictures of me in my Argyle socks would be... would be...

EEEWWWW!!!!

I believe the high variable breathing (VB) offers important clues here. Given its position in the APAP hierarchy, an active VB mode would suggest the absence of abnormal respiratory events, specifically, snoring, hypopneas and/or apneas, otherwise those layers would have been active. The 4 minute analysis window would therefore be reflective of "normal" breathing. While the VB layer has upper and lower limits, I believe that the initial violation would be that of the upper limit (a prolonged violation of the lower limit would be interpreted as a hypopnea or an apnea). This scenario would be limited to either wake, spontaneous arousal, wake/sleep transition or phasic REM (not tonic REM). I don't think phasic REM is a strong consideration here because not everybody has significant respiratory variation, that percentage is quite small, and besides Browser's REM is probably suppressed by the Lexapro anyway.

So what this means is, severely increased VB may be an indication of poor sleep architecture, an inability to maintain consolidated sleep. This is further supported by the dramatic improvement in VB by the addition of Klonopin, which could simply improve sleep quality.

If the severe sleep fragmentation were to generate isolated central apneas (sleep onset or post-arousal), the software would label them obstructive. The only way Encore can suggest that apneas are central would be to to see failure to respond after challenge. Isolated events would appear to be successfully treated.

A review of the sleep architecture in all the studies will help to clarify this.

SAG

SAG wrote:I believe the high variable breathing (VB) offers important clues here. Given its position in the APAP hierarchy, an active VB mode would suggest the absence of abnormal respiratory events, specifically, snoring, hypopneas and/or apneas, otherwise those layers would have been active.

At one point you had raised the rhetorical question about whether VB rates corresponded to how much time was actually spent in the VB controller. I think the point was a good one.

No one really knows what or how Respironics is using that entirely secret and ambiguous VB statistic. The two possibilities raised so far are:

1) The Respironics VB statistic corresponds to percent of time that patient spent in the VB control layer (seems to be the favored theiry on this board), or
2) The Respironics VB statistic corresponds to percent if time patient experienced variable breathing (despite having spent time in higher-priority algorithmic layers)

So what this means is, severely increased VB may be an indication of poor sleep architecture, an inability to maintain consolidated sleep. This is further supported by the dramatic improvement in VB by the addition of Klonopin, which could simply improve sleep quality.

...A review of the sleep architecture in all the studies will help to clarify this.

I'd jump on that invitation for a review if I were Browser.

Well -SWS, I guess if he has chronic nasal resistance issues (as indicated by use of nasal steroids, allergies etc.) this could manifest itself by increasing the low pressure seen in the internal esophageal airway when he goes to inhale as compared to the ambient pressure seen at the nares. Should this occur, it could make it easier for the airway to collapse, same thought process as behind UARS but instead of it generating the arousal its actual airway collapse. He may also have the arousal, we don't know.

PAP would have to overcome any said resistance in order to splint the airway patent. While the PAP pressure would be able to make its way past the resistance of the nose, flow might be impaired to the point where it lacks the volume flow needed to offer up the splint, possibly seen as a delay.

Pressure is pressure but if you think of this as a column of air moving back and forth as the person breathes in and out it resembles that of a solid in hydraulics, like holding a column of air in a clear tube between your left and right hand and moving it back and forth and in the middle is the resistance seen from nasal obstructions like a spur, polyp, or enlarged turbinates.

On one side of that resistance (outside the nares) high pressure will be seen because of the compressor machine, on the other side (internal airway) there is low pressure. High pressure will always be rushing towards low pressure but the volume needed may be restricted enough to allow the airway to collapse. If he was that restricted I could only imagine what that would look like on the way of RERA's.

Similar principal as behind UARS theory, extra effort it takes to overcome that nasal resistance leads to an EEG arousal. But we are not looking at EEG arousals here, we are looking at plain old obstructions and wondering if VB is a concern.

CPAP is going to add XX volume only to maintain feedback pressure and that is measured back at the 5ft. away at the machine. As the person inhales, the machine has to rapidly increase motor RPM to increase the volume flow of air to make up for the volume of the inhale and expanding lungs. That resistance is still in the way, if it cannot keep up, airway collapses.

Now CPAP is one pressure. Bilevel would be different, not only would it maintain that base CPAP pressure, extra pressure would be added on inhale to help overcome that nasal resistance. This extra effort by the machine should keep the airway patent through out inhale and exhale preventing airway collapse. If Bilevel can also overcome that nasal resistance it may be able to eliminate the associated arousal with from the respiratory effort. Of course we wouldn't know that outside the lab.

While you might be able to reduce what is seen on the report using a single high CPAP pressure, it won't resolve the underlying problem especially if those happen to be arousals seen only on the EEG. I would still recommend a Bipap Auto and possibly seeing an ENT about the nasal issues. Relieving nasal restrictions would not only help greatly during sleep it would help him 24/7. Struggling to breathe is no fun. If he has excessive EDS, I would go for the Bipap and getting the nose fixed.

Put him on a Resmed machine at 16 cm pressure, I bet that VB drops to zero.

snoredog wrote:Well -SWS, I guess if he has chronic nasal resistance issues (as indicated by use of nasal steroids, allergies etc.) this could manifest itself by increasing the low pressure seen in the internal esophageal airway when he goes to inhale as compared to the ambient pressure seen at the nares.

I absolutely agree. We've discussed that exact nasal-impedance etiology in the past: nasal impedance contributing to transluminal airway collapse

Those suction type apneas are very similar to a collapsing paper straw trying but failing to draw a thick milk shake.

And since Browser has a high untreated AHI and requires high pressure to stent his airway.... that nasal impedance problem of his could very well explain his current AHI spikes. Variable breathing is a possible candidate as well. Very good call IMO, Snoredog.

-SWS wrote:

snoredog wrote:Well -SWS, I guess if he has chronic nasal resistance issues (as indicated by use of nasal steroids, allergies etc.) this could manifest itself by increasing the low pressure seen in the internal esophageal airway when he goes to inhale as compared to the ambient pressure seen at the nares.

I absolutely agree. We've discussed that exact nasal-impedance etiology in the past: nasal impedance contributing to transluminal airway collapse

Those suction type apneas are very similar to a collapsing paper straw trying but failing to draw a thick milk shake.

And since Browser has a high untreated AHI and requires high pressure to stent his airway.... that nasal impedance problem of his could very well explain his current AHI spikes. Variable breathing is a possible candidate as well. Very good call IMO, Snoredog.

You MUST have bought the book!!! LOL

Snoredog wrote:Well -SWS, I guess if he has chronic nasal resistance issues (as indicated by use of nasal steroids, allergies etc.) this could manifest itself by increasing the low pressure seen in the internal esophageal airway when he goes to inhale as compared to the ambient pressure seen at the nares. Should this occur, it could make it easier for the airway to collapse, same thought process as behind UARS but instead of it generating the arousal its actual airway collapse. He may also have the arousal, we don't know.

PAP would have to overcome any said resistance in order to splint the airway patent. While the PAP pressure would be able to make its way past the resistance of the nose, flow might be impaired to the point where it lacks the volume flow needed to offer up the splint, possibly seen as a delay.

Pressure is pressure but if you think of this as a column of air moving back and forth as the person breathes in and out it resembles that of a solid in hydraulics, like holding a column of air in a clear tube between your left and right hand and moving it back and forth and in the middle is the resistance seen from nasal obstructions like a spur, polyp, or enlarged turbinates.

On one side of that resistance (outside the nares) high pressure will be seen because of the compressor machine, on the other side (internal airway) there is low pressure. High pressure will always be rushing towards low pressure but the volume needed may be restricted enough to allow the airway to collapse. If he was that restricted I could only imagine what that would look like on the way of RERA's.

Similar principal as behind UARS theory, extra effort it takes to overcome that nasal resistance leads to an EEG arousal. But we are not looking at EEG arousals here, we are looking at plain old obstructions and wondering if VB is a concern.

CPAP is going to add XX volume only to maintain feedback pressure and that is measured back at the 5ft. away at the machine. As the person inhales, the machine has to rapidly increase motor RPM to increase the volume flow of air to make up for the volume of the inhale and expanding lungs. That resistance is still in the way, if it cannot keep up, airway collapses.

Now CPAP is one pressure. Bilevel would be different, not only would it maintain that base CPAP pressure, extra pressure would be added on inhale to help overcome that nasal resistance. This extra effort by the machine should keep the airway patent through out inhale and exhale preventing airway collapse. If Bilevel can also overcome that nasal resistance it may be able to eliminate the associated arousal with from the respiratory effort. Of course we wouldn't know that outside the lab.

While you might be able to reduce what is seen on the report using a single high CPAP pressure, it won't resolve the underlying problem especially if those happen to be arousals seen only on the EEG. I would still recommend a Bipap Auto and possibly seeing an ENT about the nasal issues. Relieving nasal restrictions would not only help greatly during sleep it would help him 24/7. Struggling to breathe is no fun. If he has excessive EDS, I would go for the Bipap and getting the nose fixed.

Put him on a Resmed machine at 16 cm pressure, I bet that VB drops to zero.

Snoredog,

Am reminded of the old rhyme "when she was good she was very very good ...'

The argument in the quoted post of yours is a striking example to me of being very very very good

DSM

Great Information ! Since my last study was in a makeshift lab with the worst technicians I have ever dealt with do you guys think at this point I might benefit from a new study in a certified lab before my good insurance runs out? I hate to feed the ripoff system more money but I think my case since the last study has gotten more severe and may require a different type of treatment.

VB last night was 40%.

Last night(With leaking problems and restarting the machine in the morning) - Now I must say I have been going to bed around 2am and my wifes alarm goes off around 5am(I don't recall it waking me up) then a couple hours later the kids running around wakes me up about 7am and I roll over and try to go back to sleep... Bad sleep architecture ??

SAG - I lost track in all the posts of bickering but I think you asked about gerd on certain nights or anything and I say no,not that I recall. I take Nexium prescription for GERD. I do drink a few cans of Mountain Dew a day and sometimes not far from bedtime... Nothing unusual on any particular night that I recall.