,,, and reflux, to boot

Doubtful Tom · Post by **Doubtful Tom** » Thu Nov 04, 2010 2:32 pm

The gastro probs I described below have linked arms with worst heartburn / reflux I've ever had for stroll along the boulevard of my rib cage. I'm trying to figure out who's kicking whom here, although strict division of symptoms is probably irrelevant.

Though it appears the cpap cures gerd for many, some posts in various forums suggest it can also aggravate it. I've had a minor sliding hiatal hernia that comes and goes and which I think got tweaked shortly before my cpap test (or perhaps provoked by OSA, as some research suggests?). The symptoms were minor compared to what I've had in past, but since starting cpap, they are off the chart, both at night and during day, horizontal or vertical. The following post, which I offer purely for informational purposes, from another forum offers this explanation: "We've seen several patients who developed reflux after starting CPAP, or had CPAP greatly worsen their reflux. In some people the pressure gradiant between the 2 sphincters at the top and bottom of the esophagus is less than the pressure supplied by the PAP. In these cases the PAP pressure can cause the sphincters to open, releasing acid into the esophagus."

Some older posts here -- 3-4 yrds old -- offer some technical suggestions, but the nomenclature appears outdated. So I was wondering if others with similar problem could recommend updated machinery that might help? Thanks! Tom

Janknitz · Post by **Janknitz** » Thu Nov 04, 2010 2:54 pm

You may need to go on GERD medication to help control this, and since your pressures are fairly high, you might do much better with:
1. An APAP that will allow you to have a lower pressure most of the time, increasing only when needed.
2. A BiPAP with more expiratory pressure relief.

Adjusting your EPR settings on your current machine up or down may also help. Try to elevate the head of your bed in the meantime so that gravity can help, and avoid eating or drinking for at least 3 hours before bed.

You really need to talk to your sleep doc ASAP. With GERD there is always the danger of severe reflux which can be aspirated into the lungs.

Junebug999 · Post by **Junebug999** » Thu Nov 04, 2010 11:28 pm

You have to be really careful with GERD -- It gave me pneumonia once, almost twice.

Aspiration of stomach contents into your lungs can cause your lungs to go into shock. And that goes south pretty fast, so it's imperative your doc starts looking into this right away. You really don't want to mess around with anything about your lungs. Remember Jim Henson!!!! If you suspect a hiatal hernia, that needs to be taken care of also. Get that checked out!

NEW YORKER · Post by **NEW YORKER** » Fri Nov 05, 2010 10:27 am

I agree. You have to get some GERD medication or take some tums to keep your acids down. I have had episodes of GERD for the last week after I ran out of meds and have been chewing on tums to aleviate it until I can see my doctor to get another script. Even though I avoid spicey foods and eat way before bedtime, my GERD continues to aggravate me. It is serious condition that can lead to all kinds of problems. Get yours checked out.

Janknitz · Post by **Janknitz** » Fri Nov 05, 2010 11:02 am

I used to live on Tums, but in general they are NOT a good idea if you have GERD. Studies have shown there's actually rebound acid about 1 hour after taking Tums.

Furthermore, they are not a good choice to treat GERD for apnea patients in particular because our reflux has little to do with acid and more to do with pressure gradients along the stomach, esophagus, and airway. Tums does nothing for those.

Please see your doctor ASAP.

roster · Post by **roster** » Fri Nov 05, 2010 11:43 am

Doubtful Tom wrote:The gastro probs I described below have linked arms with worst heartburn / reflux I've ever had for stroll along the boulevard of my rib cage. I'm trying to figure out who's kicking whom here, although strict division of symptoms is probably irrelevant.

Though it appears the cpap cures gerd for many, some posts in various forums suggest it can also aggravate it. I've had a minor sliding hiatal hernia that comes and goes and which I think got tweaked shortly before my cpap test (or perhaps provoked by OSA, as some research suggests?). The symptoms were minor compared to what I've had in past, but since starting cpap, they are off the chart, both at night and during day, horizontal or vertical. The following post, which I offer purely for informational purposes, from another forum offers this explanation: "We've seen several patients who developed reflux after starting CPAP, or had CPAP greatly worsen their reflux. In some people the pressure gradiant between the 2 sphincters at the top and bottom of the esophagus is less than the pressure supplied by the PAP. In these cases the PAP pressure can cause the sphincters to open, releasing acid into the esophagus."

Some older posts here -- 3-4 yrds old -- offer some technical suggestions, but the nomenclature appears outdated. So I was wondering if others with similar problem could recommend updated machinery that might help? Thanks! Tom

A visit with the doc should be considered.

However, there are three things which should absolutely be done for nighttime reflux. Raise the head of the bed at least four inches with bed risers (http://www.bedbathandbeyond.com/search/ ... im=1&nty=1&) and do not eat within three to four hours of bed or lying down. By experience, try to identify the foods that trigger reflux in you - it is different foods for different people.

Here is a good short article about acid reflux medications http://doctorstevenpark.com/the-truth-a ... edications.

I can't find it just now, but this week a doc published an article suggesting CPAP should be the first line of treatment for acid reflux.

SleepingUgly · Post by **SleepingUgly** » Fri Nov 05, 2010 12:02 pm

I just read that you should lie on your left side for reflux.

Obviously if it continues, you would want to consult a doctor.

roster · Post by **roster** » Fri Nov 05, 2010 12:08 pm

SleepingUgly wrote:I just read that you should lie on your left side for reflux.

Obviously if it continues, you would want to consult a doctor.

Makes some sense and this illustration helps explain it.

You can imagine how gravity will have a different effect on stomach contents entering the esophagus depending on which side you are lying on.

jonquiljo · Post by **jonquiljo** » Fri Nov 05, 2010 2:12 pm

I would bet you've had GERD for along time. Often it is not obvious. For you, it must be a manifestation with high pressures though - as I am a 35+ year GERD sufferer and find that CPAP has decreased it (for me). GERD can be present form many and they do not notice it for years.

I had it so long that I developed Barretts esophagus and low grade dysplasia. So this is not trivial stuff. I had to have the bad tissue removed. You may need to see a Dr. With the right meds, etc. - lifestyle, you can be symptom free and GERD free. But it seems to me that the CPAP just has made you aware of a problem, not created it. Stomach acid is mean stuff, and when it goes elsewhere - it really can burn things.

Short of going to a Dr. you can ...

1.) Take OTC Prilosec once or twice a day.
2.) Take some Pepcid AC about an hour before bed.
3.) don't eat anything at least 4 (preferably 5) hours before bed - you can learn to like that.
4.) avoid "trigger" foods such as tomato, chocolate, coffee - it varies for many.

... But I would still stress seeing a GI specialist if this continues. Self medicating is not the best thing when it comes to GERD. There are better medicines such as Prilosec out there that only a Dr. can give you.

Doubtful Tom · Post by **Doubtful Tom** » Sat Nov 06, 2010 9:57 am

Thanks all for the detailed advice.
The level of anatomical, as well as mechanical, literacy on this site is most impressive.
Like a long slow yo-yo, my HH has slid out of and back into place twice over recent years, so I'm hoping for a trifecta in that race between air and acid.
Now to choose who I'll be sleeping atop for next few weeks -- books that is, books beneath bed posts, something thick with gravitas, literary as well as pulpy: Churchill bio? Pope's Iliad? Brothers Karamazov? Rather turbulent sleeping partners, I fear, but perhaps they'll intimdate encroaching reflux.

sister · Post by **sister** » Sat Nov 06, 2010 11:59 am

Hi,
I realize the not eating 3 hours before bedtime applies if you have GERD, but if you have no problems with that is it okay to eat a bedtime snack?
Or is there some other reason you should'nt eat?
I just love my popcorn and caffeine free coke just before going to bed, I was just wondering if this affects the amount of apneas you have at night.
Thanks so very much!

Janknitz · Post by **Janknitz** » Sat Nov 06, 2010 12:27 pm

Bed Bath & Beyond sells these "bed elevators" which are designed to raise the end of the bed up 6 inches or so. They are kind of cone shaped with an indent in the top to hold the bed leg. Seems to me the safest way to elevate the head of the bed.

But I have to tell you that when my reflux was at its worst, NONE of the home remedies worked, even with lots of prescription meds. I still had reflux.

Get thee to a doctor!

Doubtful Tom · Post by **Doubtful Tom** » Mon Nov 08, 2010 4:05 pm

Thanks for the BB&B tip. (ain't reflux the mother of invention!)

So what did you do for such recalcitrant reflux? That sounds awful.
I'm loath to hop the PPI train again; that stuff seemed to do as much harm as good.
I've had some luck with self administered "energy medicine" -- accupressure, tracing meridians, etc -- basic idea being redirecting body's natural energy flows to subltly realign parts. Sounds hinky, I know, but my sweet-pea partner swears she's drastically reduced her chronic migraines and lowered her BP enough that her GP rescinded a Rx for stronger med. Go figure. if you're so inclined towards the alternative healing arts, look up Donna Eden and "EM."

I've read some interesting things re "mechanical links," a form of osteopathic manipulation (much subtler and gentler than chiro). Practitioners are few and far between, though.

Trust me, I'm not one to chase miracle cures (I come by my user name honestly) or proselytize, but after encountering so much rote and knee-jerk advice from mainstream "specialists," I started loosening my own rigid views re healing. Some has helped, some not.

The end.

Janknitz wrote:Bed Bath & Beyond sells these "bed elevators" which are designed to raise the end of the bed up 6 inches or so. They are kind of cone shaped with an indent in the top to hold the bed leg. Seems to me the safest way to elevate the head of the bed.

But I have to tell you that when my reflux was at its worst, NONE of the home remedies worked, even with lots of prescription meds. I still had reflux.

Get thee to a doctor!

Gerald? · Post by **Gerald?** » Wed Nov 10, 2010 4:48 pm

Doubtful Tom wrote: I'm loath to hop the PPI train again; that stuff seemed to do as much harm as good.

Have you tried Pantoprazole (Somac) as an alternative? It's still a PPI but I found it worked much better for me than Prilosec. Its designed to be more slow release.

Having said that I have not had to use it once I got my apnea sorted (with CPAP). GERD disappeared once I was actually breathing at night.

Doubtful Tom · Post by **Doubtful Tom** » Thu Nov 11, 2010 8:10 am

I'll give it a look, Gerald. Thanks.

Gerald? wrote:
Doubtful Tom wrote: I'm loath to hop the PPI train again; that stuff seemed to do as much harm as good.

Have you tried Pantoprazole (Somac) as an alternative? It's still a PPI but I found it worked much better for me than Prilosec. Its designed to be more slow release.

Having said that I have not had to use it once I got my apnea sorted (with CPAP). GERD disappeared once I was actually breathing at night.

,,, and reflux, to boot

,,, and reflux, to boot

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Mask	Humidifier

Additional Comments: my cpap is set at 12