Sleep Apnea, acid reflux, and CPAP

[cyborg4fun]

Since getting on CPAP for sleep apnea, all acid reflux symptoms have disappeared. With sleep apnea, when you try to suck air in -- the restriction to breathing is so great that a partial vacumm is created in the throat. This low pressure area literally sucks stomach acid past a leaking Spincter valve, up the esophagus, and into your lung. The positive pressure of CPAP keeps the airway open and the throat under positive pressure at all times... so no stomach fluids are sucked up into the throat and lung area. I wonder how many folks being treated for acid reflux are really suffering from sleep apnea?

[Debi]

My acid reflux disappeared the first night of cpap. After 15 weeks, it hasn't reappeared.

[okie-girl]

I never had much of an issue whith reflux (except while pregnant oh so many years ago) however, my husband would never go to bed without antiacids positioned on the nightstand for years and years....now he seldom takes them at all, but never during the night.

[-SWS]

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This low pressure area literally sucks stomach acid past a leaking Spincter valve, up the esophagus, and into your lung.

Indeed, untreated obstructive sleep apnea is statistically linked to acid reflux or GERD. That esophageal negative-pressure scenario you just described is the most widely-accepted theory as to why the presence of GERD is so statistically prevalent among those with untreated apnea.

When/if stomach acid repeatedly enters the lungs during night-time GERD episodes, an entire multitude of adverse respiratory and ENT side-effects are at risk as cited below by the University of Maryland Medical's web site:

"Current studies indicate an association between GERD and various problems that occur in the sinuses, ears, nasal passages, and airways of the lung. People with GERD also appear to have an above-average risk for chronic bronchitis, chronic sinusitis, emphysema, pulmonary fibrosis (lung scarring), and recurrent pneumonia. If a person inhales fluid from the esophagus (aspirates) into the lungs, serious pneumonia can occur. GERD may contribute to these conditions by triggering inflammation in these upper passages. It is not yet known whether treatment of GERD would also reduce the risk for these respiratory conditions."


UMM reference link for above text: http://www.umm.edu/patiented/articles/who_gets_pneumonia_000064_5.htm

[garym053]

I used to suffer from acid reflux so badly that I'd wake up almost vomiting! Been on CPAP for a year now and have never had acid reflux since!
Mentioned it to a DME once and they said that Acid Reflux could cause Sleep Apnea. I disagreed and said I would think it was the other way around! The explanation given here makes sense!

[-SWS]

Garym053, your DME cited yet another accepted medical theory. My understanding of this particular school of thought, is that swelling or inflammation brought on by repeated airway exposure to stomach acid may exacerbate or even cause apnea. If it were to cause apnea (versus simply exacerbate) then those airway clearances would have necessarily been marginal in the first place.

My entirely unqualified take is that these two theories are not necessarily mutually exclusive. I personally don't see why both scenarios couldn't happen accross the general population.

[ March 22, 2004: Message edited by: -SWS ]

[Biker]

The simple physics already discussed cause a vaccuum in the esophogus causing the stomach acid to be drawn up into the esophogus.

A friend of mine runs a large medical clinic in the Elmira are of New York state. All of his patients with diagnosed sleep apnea are sent for esophogeal biopsies to check for cancer precursors in the esophogus...........might not be a bad idea to do it for all apneaics.

Biker

My sphincter valve was so badly damaged by untreated OSA that I am on Prilosec for the rest of my life.

[-SWS]

quote:

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Originally posted by Biker:
My sphincter valve was so badly damaged by untreated OSA that I am on Prilosec for the rest of my life.

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Same here, only Protonix instead of Prilosec.

Hey Biker, we can't wait until your free time once again avails plenty more "Bikerisms" here---knowledge, humor, and wisdom all rolled into one!

Needless to say you have been missed by many here, myself included!

Only problem is once your work schedule, AWAKE volunteer schedule, and family obligations free up a bit.... warm motorcycle weather is here. Bummer.

[<jparris1>]

Just to add to the anecdotal evidence. I had terrible nighttime reflux until I began CPAP therapy. I too have yet to have another episode since starting CPAP. Quite a relief. Though I do wonder if I should have my esophagus checked as noted in Biker's post.

J-

[<dizzy>]

Yo Biker, there may be hope for you yet

quote:

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What is Endoluminal Gastroplication?
Endoluminal Gastroplication is a medical therapy developed for the treatment of symptomatic Gastroesophageal Reflux Disease (GERD). The procedure works by creating plications, or pleats, at the lower esophageal sphincter (LES). Performing the procedure has been shown to significantly improve symptoms and regurgitation while reducing or eliminating patients' dependence on acid-controlling medications.

How is the procedure performed?
The EndoCinch System, like a tiny sewing machine, is attached to the end of a standard, flexible endoscope or tube, which allows the physician to place suture (stitch) near the LES. Two stitches can be placed and tied together to create a pleat near the LES and treat symptomatic reflux or acid reflux.

Where is the procedure performed?
The procedure is typically performed in the hospital or surgical center, on an outpatient basis, so that patients can return home the same day. Typically, only mild sedation is required (no general anesthesia) and patients can return to normal activities the next day.

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Them GI docs are pretty good with that endoscopy, I read one study where the valve was nearly eaten away and they were able to restore partial function using the EndoCinch, in that one it was a staple procedure.

I had 3 hernia's repaired with endoscopy, was off work only 3 days. My left groin was ripped so bad they had to reinforce with stainless screen. Be careful refinishing them 36" solid industrial fire doors, they are heavier than one thinks, I had 27 of them to finish, thought I can flip these babies over all by myself.

[cyborg4fun]

What a great bunch of people out there! It is amazing the ways we all have suffered from sleep apenea. CPAP treatment has certainly changed my life for the better.

[-SWS]

quote:

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Originally posted by -SWS:
My understanding of this particular school of thought, is that swelling or inflammation brought on by repeated airway exposure to stomach acid may exacerbate or even cause apnea.

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Specifically it's vocal chord spasms that medical researcher's, who subscribe to this particular theory, believe cause sleep apnea.

I just posted these same three article links for Writerman in a different thread:


1- Digestive Health & Wellness: Are you losing sleep over GERD?

2- Sleep Apnea and Gastroesophageal Reflux Treatments Serve Dual Purpose

3- Are GERD and Sleep Apnea Related?

[<dizzy>]

this brings up the ole chicken or the egg question thingee

The first study I read indicated that OSA caused GERD, theory was when you had an obstructive event your already laying flat, when your awaken to breathe again a "vacuum" is created on the inhale gasp in the esophogaus which is enough to cause/suck stomach acid up past the LES.

In another study I read this refluxing of stomach acid was thought to also be the cause of periodontal disease, premature tooth enamel decay, etc., etc. etc.

In some people, this same "gasp" vacuum action is thought to cause partial airway collapse (i.e. hypoapnea and flow limitations).

What is unclear or unknown, IS the etilogy of this disorder caused by "relaxation of muscles" what the sleep medicine industry wants you to believe OR is it this "vacuum" action in the esophogaus which leads to GERD, OSA etc.

When you think about it (applying a bit of common sense of course) it nearly takes on some logic.

You would think that after 20+ years of study on these disorders (even longer in the GI field) they would have better answers for us patients.

So again one is lead to draw the conclusion that they have yet to make enough money off these disorders to be in a position to come up with a cure. Come to think of it, short of polio, measles, mumps and rubella their hasn't been a whole lot of diseases/disorders the medical community has actually cured

OSA: Holding your breath, just don't hold out for a cure

[-SWS]

Dizzy, you know that atypical flutter that your RemStar Auto categorizes as snore, but your ResMed Spirit refuses to categorize as snore?

Wonder if that's really low-level audio flutter that's generated from vocal chord spasms???

[-SWS]

I subscribe to the theory that in some cases the chicken comes first, in other cases the egg comes first.

A viscious cycle of sorts with two points of entry perhaps.