The Biggest Throat Problem for Sleep Apnea Sufferers

If you wake up every morning needing to hack up lots of thick mucous, or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into the full-blown viral symptoms.

Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.

Beware of the “Vacuum Effect”

People with obstructive sleep apnea are more prone to breathing problems at night due to partial or total collapse of one or more areas of the entire upper airway, from the nose to the tongue. It’s usually worse when on your back, since the tongue can fall back more in this position. During deep sleep, your muscles naturally relax and you’ll be more susceptible to breathing stoppages.

Pressure sensors placed inside sleep apnea patients reveal that every time an apnea occurs, a tremendous vacuum effect is created inside the chest and throat, which literally suctions up your normal stomach juices into your esophagus and throat. This can happen occasionally, even for normal people, but if you happen to have a late meal or a snack just before bedtime, there will be even more stomach juices lingering in your stomach to come up into the throat. If you happened to drink a nightcap, the situation is even worse since alcohol is a strong muscle relaxant.

What comes up into your throat is not only acid, but also bile, digestive enzymes, and even bacteria. Washings of lung, sinus and ear contents have shown H. pylori, a common stomach bacteria, and pepsin, a major stomach digestive enzyme. So what comes up can cause severe irritation in your throat, provoking the mucous secreting glands of your throat to try to dilute these substances.

Although people generally attribute throat mucous to post-nasal drip, in most cases there’s nothing dripping down the back of the throat. It’s actually coming from your stomach. However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle.

Chronic acid and other irritating substances lingering in your throat can have other detrimental effects. One recent study showed that chronic acid exposure can numb or deaden the protective chemoreceptors in your throat. These are sensors that detect any acid in the throat to prevent aspiration of your stomach contents into your lungs. If these chemoreceptors sense any acid in your throat, a feedback signal is sent to the brain, causing you to wake up so that you can swallow. This is what’s called a reflux arousal.

Treating Reflux For Good

So besides not eating late and avoiding alcohol close to bedtime, what else can you do?

I’m assuming that many of you that are reading this article are already being treated for obstructive sleep apnea, via either CPAP, oral appliances, or even with surgery. The problem is that no matter which option you choose, there will always be some degree of reflux. Taking acid reflux medications can help sometimes, but for the most part, these reflux medications don’t really do anything for reflux. All they do is to lower the acid content content before it comes up into your throat.

Other options include stimulating your stomach via natural remedies or prescription medications to empty your stomach much faster. One fascinating study showed that using a combination of pseudoephedrine (Sudafed) and a pro-motility agent (domperidone) eliminated snoring in most people. Unfortunately, we don’t have the equivalent of domperidone here in the US. Other similar medications are available, but have more serious side effects.

This is why eating early at least 3-4 hours of bedtime is so important whether or not you have obstructive sleep apnea. The same also applies to alcohol. If your nose is stuffy, talk with your doctor to find a way to breathe better through your nose. Make sure you’re sleeping in your preferred or optimal sleep position. Lastly, work with your sleep physician to fully optimize your sleep apnea treatment, no matter which option you choose.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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17 thoughts on “The Biggest Throat Problem for Sleep Apnea Sufferers

  1. Hi Dr. Park,

    This is a real serious problem OSA suffers due to UARS with combination and with periodic serious tonsil inflammation as well. Especially during winter and spring seasonal allergy which caused missed treated from my GP doctors. Antibiotic doses after doses remains temporarily treatment to the tonsil and throat without treating the real root cause remain a mist in my GP doctors as common practices. This is a real concern generally in the medical industry.

    You may email me directly for more discussion.

    Best Regards,
    Malvin

  2. Dr. Park,
    This is scary; Does being on CPAP therapy help or prevent this from happening, or does this still occur when using a CPAP?

  3. Hello Dr. Park.

    I am currently suffering from the mucus in the back of the throat. I am learning to deal with waking up choking because the stomach contents has already entered my lungs… Learning not to eat late or drink a lot of fluids before chair time (I sleep in a recliner to deal with my sleep paralysis). I just got a new bipap machine of which is very difficult for me to use. I find myself being sleepy as can be (eyes going crossed)… yet when I put on my mask… I become wide awake. I have found myself sitting 2 hours after I put my mask on just sucking in air. Yet if I removed the mask… I can fall asleep with in 10 minutes (not good sleep, sever sleep apnea sleep).

    To your article… My other current problem… when I can use my bipap machine (maybe once, twice a week)… the problem isn’t the intake of air… the problem is breathing out. The mucus is causing something in my throat to close and lock up breathing out via my nose. The same thing happens during the day when I try to blow my nose… blowing will be locked until I clear my throat by horking (making that snoring sound) down the mucus. Even then when sleeping it only last for a very short period of time. I find if I turn my head extremely to the left or right… I don’t have the problem… however as soon as I drift off, my head doesn’t stay turned.

    The ironic thing about this… when I don’t use my bipap machine (of which is a lot)… I don’t have the breathing out problem due to the snoring constantly clearing my throat. But then there is the breathing in problem due to the sever sleep apena… I am currently at a total lost as what to do… not looking medical advise… just wanted to sound off…

    Thanks

    Aaron

  4. I have had 4 nasal surgeries for sinus. I have obstructive sleep apnea. I have been using Cpap which has not helped. I have tried the nasal mask and the full face mask.
    I have tried the mandular advancement which also has not helped. I also have a herniated disc C5/6. Consulting a neurologist I was told to have disc replacement.
    I still have blocked nose and have lots mucous blocking my nose at night causing the sleep problem. Should i pursue opening up nasal passage which has been affected by sinusittus or have a tongue reduction. The more i meet Ent doctors, the more confused i get about my situation. I am desparate for healing solution. I want my sleep back and my life back. Please help.

    Peter Lewis
    Mumbai, india.

  5. I am suffering from thick mucus coming out of my mouth when i go to sleep at night which disturbs my sleep and I have to get it out everynow and then. Please suggest a good remedy for this situation.

  6. I realise this is an old post, but I simply must ask a few important questions if I can?

    – I have post nasal drip all the time, but it is only when I swallow or relax it truly affects me and causes difficulty breathing. Why is this the case? It affects me in my sleep too.

    – This must sound utterly bizarre, but sometimes I feel like it’s my tongue pressing against my airways, not mucus. How can you tell the difference between post nasal drip that has gotten stuck above the vocal chords and the tongue?

    – We have proven I have mild LPR reflux in my sleep, and at normal rates in the daytime. I take all the measures to prevent it, from medications to lifestyle changes, but the symptoms persist all the same. Is it possible the LPR is a side-effect of say Upper Airway Resistance? How would I know this is the case?

    The only clue I have is that my parents both suffer from disturbed sleep – one snores, the other sleepwalks and has frequent night terror arousals. I had a home sleep study, but it was inconclusive as I didn’t sleep well with it on, and an XRay of my jaw is equally indecisive, showing a slightly thinner (but not exceptionally so) airway. A slight change of posture making me relax is sometimes all it takes to trigger symptoms.

  7. sinositis blocking of nose snoring disturbed sleep dreaming through out night . very much health hazardous. any way get rid from these ?

  8. I have been trying to called you by telephone Doctor Park but no called for 2 months so maybe you you answer this email can if you have PTSD can t effect your sleep apnea? PLEASE reply back.

  9. I have a lot of mucus that it in my throat it feels like it is so much unwanted gunk that in the the morning that I have to spit up it and I don’t want to get up from my bed because I feel horrible in the morning

  10. Last 2years i feel something block my throat and when i pressure it(throat) something coming out like liquid,and i am totaly go strong body weak body,and doctor treatment also going to zero result.what is this problem?
    Plz help me and solve my problem plz.

  11. Hi, I live in the UK and I’m confident this is my issues. Who can I see in the U.K regarding this. I am desperate to get it sorted.

  12. Hello Dr. Park, I use a bi-pap machine, have for many years and I have lots of congestion in my throat and nose. I also have large growths in my mouth at the back of my teeth and a sm. bump in the middle of my upper back mouth. If these were removed, if they can be, would that take care of the apnea during the night? Have had these lumps all of my life.
    Thanks

  13. Dr. My father is also suffering from similar symptoms. We have consulted ENT as well as general medicine but nothing has helped us.

    I request you to kindly suggest some remedies to get my father’s health issue rectified.

    Awaiting your response.

    Kethan
    Bengaluru
    India

  14. This was a great article. I was wondering why I’ve been waking up with a dry throat and so much phlegm in the mornings since switching to sleeping on my back. Is it at all dangerous to have those acids and enzymes refluxing into the throat? Or if I just decide to put up with having to expectorate every morning will I be OK?

  15. I am having this problem for about 15 yrs. I get tickle in my throat during day time and I make some wierd noises by deep breathing in and out to stop the tickly feeling. But at night during my deep sleep when I this tickly feeling I make the same wierd noise, but without my consent. And no one could wake me when I do it.
    I only come to know it the next day. I am sad of disturbing other’s sleep. I consulted many doctors, but they gave me similar medicines which I used for years ,and they couldn’t understand my condition. So I am helpless. Pleas help me get rid of this problem, it means a lot to me.

  16. I got more from reading this then I got from my own Doctor.i have a new Doctor now.i will have a talk with him. Thank you.