Gastroesophageal reflux disease (GERD) and sleep apnea (obstructive sleep apnea or OSA) are two health conditions that seem completely unrelated. From how they manifest their symptoms and their effects on the body, these two conditions seem very different. However, studies show that there is actually a strong link between the two. How are sleep apnea and acid reflux related to each other? Does the former cause the latter, or is it the other way around?
A quick overview of sleep apnea
Characterized by loud chronic snoring, sleep apnea (more commonly known as obstructive sleep apnea, as it is the most prevalent type of sleep apnea), is a common sleep disorder where one’s breathing is interrupted during the night. The breathing suddenly stops and starts, this causes someone to jolt and wake up from the feeling of breathlessness or choking.
Obstructive sleep apnea happens when the muscles around the throat and upper airway relax too much and collapse, causing a partial or complete blockage in the airway. As soon as the brain realizes that the body isn’t breathing normally, it will send panic signals to the body to cause the muscles to tighten and jolt, forcing the person to awaken from their sleep and try to breathe. This cycle happens multiple times at night.
A quick overview of acid reflux
Better known as Gastroesophageal Reflux Disease, acid reflux is an extremely uncomfortable, even painful condition where the stomach acid moves back all the way up to the esophagus. People who regularly experience acid reflux can develop GERD. Over time, the stomach acid can cause damage to the esophagus, which can lead to cancer.
In a normal condition, the muscles located under the esophagus will block and stop stomach acid from moving all the way up. However, when these muscles relax too much or weaken, the stomach acid can leak all the way up to the esophagus. For most people, infrequent acid reflux is not a big deal. However, for those who experience it regularly, it can cause some serious health problems, including:
- Sore throat, difficulty swallowing
- Chest pain
- Back pain, pain in the neck or jaw
- Difficulty sleeping
- Stomach acid or small food bits coming back up to the throat and/or mouth
- Hoarse voice
- Waking up feeling like choking or the need to cough
Understanding the relationship between sleep apnea and acid reflux
When you think of it, the association actually makes sense, since when you are awake, especially when you are sitting, standing, or walking, gravity helps keep your stomach acid down where it should be – in your stomach. When you are lying down on your bed, however, stomach acid can flow back and leak all the way into your esophagus, causing damage to the lining, increasing your risk of esophageal cancer.
Moreover, during the day, you swallow a lot. Swallowing often keeps stomach acid down. Plus, saliva can help neutralize stomach acid. During the night, however, the stomach acid can move up and backflow to the esophagus, since no swallowing motion keeps it down.
Sleep apnea and acid reflux, which one comes first?
If you think chronic snoring caused by obstructive sleep apnea is bad already, having acid reflux along with it is a completely different monster. But which one comes first? Does sleep apnea cause acid reflux, or is it the other way around?
The one theory that links the two together involves the contraction of the vocal cords, which restricts a pattern and leads to sleep apnea. Though people who suffer from GERD can experience the symptoms any time of the day, acid reflux tends to worsen in the evening. Most of the time, the symptoms wake them up.
Some research suggests the change in airway pressure during sleep triggers reflux. They theorize that when one stops breathing due to sleep apnea, the air pressure in the lungs changes. This change in temperature allows stomach acid to climb up to the esophagus.
Another factor that could have contributed to sleep apnea and acid reflux is that chronic snorers breathe harder when they gasp for air. The forceful breathing could draw acid all the way up from the stomach.
Moreover, when one has acid reflux, the throat muscles, and vocal cords spasm. This leads to a blockage in the airway, which then leads to sleep apnea.
So far, it is largely a chicken-and-egg question. However, the link between the two is undeniable.
Sleep apnea and acid reflux: remedies and treatment
Sleep apnea, especially obstructive sleep apnea, requires a diagnosis and medical intervention for effective treatment. While changing sleeping positions can help (sleeping on your side instead of lying on your back), there aren’t many in the way of home remedies when it comes to this sleep disorder. Your doctor may require you to change your lifestyle, lose weight, exercise, have a balanced diet, etc. Staying away from smoking and alcohol is also important.
For chronic and loud snoring, doctors can prescribe positive airway pressure therapy, such as CPAP and BiPAP therapy, to promote better breathing during sleep. Some mild to moderate cases can benefit from a dental appliance like a mandibular advancement device. This mouth device keeps the jaw from titling too far forward and the tongue from moving all the way back to make sure there is enough space for normal and easy breathing.
For acid reflux, there are short-term relief and long-term treatments. Reducing coffee, staying away from alcohol and carbonated drinks, and avoiding citrus and spicy food can help reduce acid reflux symptoms. Moreover, elevating the head during sleep can help keep stomach acid down.
To treat GERD, you need to undergo a series of tests to confirm the diagnosis and avoid complications. These include an upper endoscopy, ambulatory acid (pH) probe test, esophageal manometry, and/or X-ray of your upper digestive system.
Treatments for acid reflux caused by GERD range from the use of antacids (to neutralize stomach acid), medications (to reduce stomach acid production and/or help the esophagus heal), to prescription medications such as H-2-receptor blockers, proton pump inhibitors, or lower esophageal sphincter. For more serious cases, doctors may recommend surgery or other procedures.