Can Sleep Apnea Cause Hiatal Hernias?

February 23, 2011

Someone emailed me in response to my comment that hiatal hernias may be related to sleep apnea. He basically said that my ideas were nonsense. Here’s what I wrote back:

“Thanks for taking time to comment. I did mention that it’s a hypothesis, and yet to be proven. In my opinion, a hiatal hernia is similar to having a deviated nasal septum. Everyone has some degree of it (due to jaw narrowing and dental crowding), but only some people have symptoms. One thing I’m learning as I study the effects of sleep apnea is that it can cause or aggravate almost every chronic medical condition that we know of, from a metabolic, hormonal, neurologic and immunologic standpoint. I know about the classic medical explanations of hiatal hernia as well as many of the alternative/complementary explanations. But I don’t find any of these explanations satisfying. If you look at all the various studies on the effects of sleep apnea (which is due to a craniofacial underdevelopment of the jaws that most modern humans have, that leads to crowding of the upper airway), it was only logical that sleep apnea (which is so common and undiagnosed) may lead to a hiatal hernia.

For example, pressure readings using catheters in the esophagus during apneic episodes show tremendous negative pressures in the chest cavity, with loosening of the phreno-esophageal ligament, which opens up the lower esophageal sphincter temporarily. These pressures are also strong enough to prevent blood flow to the heart during these episodes. The junction of the stomach and the lower esophagus (the lower esophageal sphincter) sits in an opening in the diaphragm, like a sleeve. If you’re pulling down on the diaphragm with excessive positive abdominal pressure, while creating tremendous negative pressure in the chest cavity, along with loosening of the phreno-esophageal sphincter, it’s plausible that the lower part of the stomach can slide up into the chest cavity. Continued vacuum effects in the throat, along with upper and lower esophageal sphincter dysmotility, can lead to pharyngeal reflux, which has been shown to reach the lungs, sinuses and ears. This also includes digestive enzymes, bile, and H. pylori.

Lack or oxygen to the brain and the body, as well as a massive physiologic stress response, can alter your involuntary nervous system, creating a relative overactivation of your sympathetic nervous system (increased adrenaline), and an underfunctioning parasympathetic nervous system (vagus nerve).

Sleep apnea is only a small aspect of my sleep-breathing paradigm, which states that all modern humans stop breathing occasionally, due to various factors. Even healthy people can stop breathing during a simple cold. Thin, young people can stop breathing 20 to 30 times per hour and not have official sleep apnea on a sleep study. It’s taken for granted that most people breathe properly at night, but this is absolutely not true—due to our ability to talk/communicate, as well as a shrinking of our facial skeletons. Looking at health and disease from this perspective, it goes against most traditional dogma, whether within allopathic medicine or alternative/complementary fields.

When I was a medical student, my mentors at Columbia University were laughing at the hypothesis that a simple bacteria could cause stomach ulcers. The person that proposed this hypothesis went on to receive the Nobel Prize in medicine. I’m not saying that my research is of that magnitude, but we have to be willing to think outside the box if we’re going to make any significant progress.”

What do you think about my hypothesis?

20 Responses to “Can Sleep Apnea Cause Hiatal Hernias?”

  1. Jane on February 24th, 2011 12:32 pm

    My dad had severe untreated sleep apnea. He had congestive heart failure, stroke, hiatal hernia, frequent trips to the bathroom at night. He had all of the classic symptoms that Dr. Park has described. It is no coincidence that his sleep apnea caused these illnesses.

    Sleep apnea runs rampant in my family. Our family has small jaws and/or recessed chins. Most of my family members have high blood pressure, heart disease; some have diabetes; some have had kidney stones; most have been treated for depression and anxiety. It’s all that Dr. Park has written. Thank you, Dr. Park for your dedication. It’s a relief to know what the cause of my family’s illnesses are.

  2. Jose on July 14th, 2011 12:23 pm

    Thank you for your suggestions.

    I think that you are 100% right.

    I have quite a large hiatus hernia and severe sleep apnoea. I have 54 apnoeas an hour.
    If I sleep with the CPAP machine my stomach is pumped with air until I wake up on pain. So much that I started been concern that might hurt me badly. I think that because I have the stomach hernia all air go straight to the stomach…

    But but if I do not use the CPAP machine I am a living ZOMBIE.

    So not mater what I do I am screw… I am only 33 and I cant believe that I have to live like this all my life.

    Doctors say that surgery for sleep apnoea doesn’t work. Therefore there isnt nothing they can do… I am in the waiting list to have the hernia put back in place… but ho knows when..

    Any suggestions? Please help

  3. Shar smith on December 3rd, 2011 5:31 am

    I think you’re on to something. I’ve been complaining of abdominal pain for 6 years and been diagnosed with everything from IBS to fibromyalgia. I’ve even told doctors I’ve felt a bulge in my stomach and been ignored. Now after years of having my complaints swept under the rug and treated like I was seeking drugs for pains that are “in my head” my inguinal hernia has been discovered. My sleep apnea started mild and in the 1 year became severe.

    I fully believe all my medical issues are from this untreated hernia. I believe there is a connection to fibromyalgia and hernias in women. I understand hernias are hard to diagnose in women, but doctors who don’t care to think outside the box shouldn’t put people in them.

  4. Alan Holman on December 18th, 2011 10:54 am

    I could not agree more and wonder why more people don’t come to the same conclusion. I was a very healthy 37 year old male. 190 lbs and 6ft 2 in. slim and athletic. very healthy throughout my life. I was diagnosed with severe obstructive sleep apnea due to recessed jaw, wide tongue at base and relaxed palate. I suffered near 60 episodes per hour. I also began suffering from GERD (badly) and at the same time was diagnosed with a hiatal hernia (sliding) that seems to create some major issues for me. Chest pain, trouble swallowing, vagal nerve issues (mayo diagnosed me with minor vasal vagal insufficiency). These all started near the same time and in the same areas of the body. I now have been diagnosed with graves disease (hyper-thyroid) which is an auto-immune disease. I often read about people who have these types of ailments together. I doubt it is coincidental and even common sense would tell you that they would affect one another. THE MILLION DOLLAR QUESTION…if your hypothesis is true, what do you do about to get your life back?

  5. Steven Park on December 18th, 2011 4:18 pm

    Alan, my first question for you is: Are you being effectively treated for your sleep apnea?

  6. Martin on April 14th, 2012 5:07 pm

    Hi all,
    great article, thanks for it. I suffered with hiatus hernia for 12 years and along this time sleep apnea was diagnosed as well. Like Jose, without CPAP I am living zombie.
    Now it’s 4th day after my operational treatmet of hernia (fundoplication) and I have to say that heartburn disapperaed as expected but extreme fatigue disappeared as well. I stopped using CPAP about a year ago and suddenly I feel much better. Does it mean that there can be any coherency between hernia and apnea?

    Many thanks for reply.

    Martin

  7. Steven Park on April 14th, 2012 5:29 pm

    Martin,

    OSA and GERD can aggravate each other. It’s a vicious cycle. Once your GERD and hiatal hernia was treated, it lessened inflammation in your throat, lessening your sleep apnea. Even if you do feel better, it’s important to undergo a sleep study again to make sure your OSA is significantly improved. If it’s still there, your chances of GERD and hiatal hernia recurrence may be higher.

  8. Doug W. on April 21st, 2012 3:37 am

    Dr Park, Its 3:00 in the morning, and after awakening in bed several minutes ago with a gasp for breath, it ocurred to me to ask this very same question. I’m a 64 year old white male who has a very large hiatal hernia for several years now, and have even been hospitalized for observation for a couple of days because this hiatal hernia caused symptoms that mimiced a heart attack, ie, pressure on my chest, shortness of breath, etc. I sleep with the upper 1/3rd of my matress blocked up at about a 30 degree angle similar fashion to a hospital bed to help deal with GERD that I’ve had in the past. For the last couple of weeks I’ve awakened several times gasping because I have seemed to stop breathing in my sleep. I’ve also noted from these incidents that they seem to ocurr at times when I’ve foolishly eaten 3 to 4 hours prior to bedtime, and wondered if pressure caused from aggravating this hiatal hernia condition could be causing me to cease breathing while asleep. I’ve also had a non stop nasal drip that you’ve described, but have had that all my life and assume it’s from allergies. I am somewhat of a shallow breather, however I was recently briefly hospitalized for an atrail fib episode, and my oxygen levels were running 94% to 96% even at night when they checked me. I think it’s entirely feasable that my hiatal problem could be triggering these aphnea episodes, whats your opinion?

  9. Steven Park on April 21st, 2012 8:08 am

    Doug,

    You’re describing classic obstructive sleep apnea. Even a-fib has been linked to obstructive sleep apnea. You should consider seeing your doctor about getting tested for obstructive sleep apnea.

  10. kendra on May 11th, 2012 1:18 am

    Hello Dr. Park,
    I am a 44 year old whit female. I have sleep apnea and yesterday was diagnosed with a slidding hiatal hernia. I have had acid reflux for years. I also suffer from poor digestion, my bones hurting, memory loss even mid sentence, recently I see light and dark shaded diamond shapes in my full vision for which I saw 3 specialsits and they say may eyes are fine. I have many more symtoms along that I wont list at this time. I also had a blood calcium level come back at 11.2 but when I stopped taking supplements it came back in the 9.9 so they dismissed hyperparathyroid disease. I am convinced that all my symptoms are related in some way. Somthing is causing these things to happen and they cant find it. I definetly believe that you cannot have this many different things happen to you and they arent related. Now they are trying to convince me that these things are happening because Im depressed. Ive never been depressed in my life, although I do take Lexapro for anxiety. Only because I get a fluttering in my stomach that they say must be anxiety. Why dont they put all this together and how can I convince them Im not depressed? Im at my breaking point after 15 years of un diagnosed sleep apnea, I feel like an 85 year old lady. Any suggestions? Help!
    Kendra

  11. Shane on June 9th, 2012 6:56 am

    Hi Dr.Park

    This is certainly an interesting topic. I tend to agree with your views. I’m 39 and unfortunately am morbidly obese 8-(. I know my mistake. Am currently awaiting barriatric surgery but sm having similar issues with breathing and sleep apnea. I am current just commenced cpap therapy but am yet to see results. It is only 5wks since I commenced therapy so it is still early. I am also awaiting a scope for my stomach as I too suspect a hernia or ulcer. I have Many bad days where I struggle to breath. Heart tests ECG’s, X-rays, lung function tests have all come back good. I’m lucky so far to dodge so many bullets that I suspect may have my name on it. Unfortunately the hospital where I live dismiss slot of my symptoms as anxiety. I acknowledge many of our symptoms can be linked to anxiety but I have never considered myself an anxious person like I’m sure many others claim not to be as well. It seems to be the way with 21st century medicine to think only in black n white. They do not think laterally. Where are all the Dr. Doogey Howsers (prob spelt wrong)?

    There a days I feel like I’m going to die. I only hope the upcoming tests reveal some results. But I agree with you Dr.Park. I’m sur there is a link, and if not, bravo to you for Atleast being open minded to investigate possible links and causes to conditions that are currently not considered possible. Good luck to everyone on here with your health. Will keep you updated on my progress. Cheers from Australia.

    Shane

  12. Doug on September 21st, 2012 1:49 pm

    Dr. Park,

    What treatments do you recommend for people who have OSA and hiatal hernia and find CPAP aggravates the hiatal hernia too much to continue using it?

    Thanks,
    Doug

  13. Carol Young on February 25th, 2013 7:05 pm

    Is it possible that a hiatal hernia causes impingement of the vagus nerve which in turn leads to sleep apnea? I have tried CPAP. nasal surgery, and mandibular advancement device with no success. Rather that thinking the the apnea is the driver what if its really the impairment of the vagus nerve by the hernia.
    Any thoughts??

  14. Doug C. on February 25th, 2013 10:39 pm

    Hello Dr. Park, I’m following up on my previous question and was hoping you can answer it?

    What treatments do you recommend for people who have OSA and hiatal hernia and find CPAP aggravates the hiatal hernia too much to continue using it?

    Thank You,
    Doug

  15. Steven Park on February 25th, 2013 10:47 pm

    Doug,

    There’s no specific research that can answer your specific question, but the same algorithms apply: BIPAP, dental appliances and surgery. Some people end up undergoing reflux surgery. There are so many other options that can’t be listed here. Ultimately, it’s a customized approach, based on your unique situation.

  16. Doug C. on February 25th, 2013 11:44 pm

    Thank you for responding.

    My hiatal hernia is under control with a good diet and only intermittent use of OTC medication and my sleep apnea does not occur when I sleep on my side. Both conditions worsen when my asthma is not well controlled. I ask because I tried the CPAP during my visit to the sleep lab and it immediately aggravated my hernia.

    I will look into the dental appliances.

    Doug

  17. Sue E. on April 9th, 2013 7:10 pm

    This all sounds too familiar. About 7 years ago I was diagnosed with Barrett’s syndrome which is precancerous cells on your esophagus. I did not want to take Prevacid as I had read about the side effects so I changed my diet. But then I started to develop sleep apnea. Recently I felt a sharp pain under my left breast and thought I was having a heart attack. Today I had a heart untrasound and my heart is fine.
    The next thing I am having done is to have a sleep study. I feel that pressure is a hiadal hernia but I think it was brought on from not getting a cpap sooner although many of these blogs are saying the cpap aggravates the hernia.
    We sure need God’s kingdom now but until then…… suffering is tough!!!

  18. Bedbugged on July 1st, 2013 11:10 am

    I like your hypothesis and I hope it’s true.
    Because then I can stop blaming myself for having
    a hiatal hernia and sleep apnea. Eg. “If only I wasn’t so
    anxious then I wouldn’t have given myself this
    hernia which has caused me to have sleep apnea. Maybe
    if I was smart enough I could overcome this anxiety
    disorder and stop making myself sick.”
    If your hypothesis is true then my underdeveloped lower jaw
    caused sleep apnea and anxiety and then came the hernia.
    Ahhhh…yes I like that much better. :)

  19. kathryn lee on October 15th, 2013 11:11 pm

    Hi, I am older female, with long undiagnosed sleep apnea. I noted that when i started with cpap machine, i developed a bump in my stomach and thought maybe it was from air being pushed into my stomach, by the machine.

    I was told it was just weak muscles, even though it kept getting bigger. Turns out the sleep doctor did do a hernia test back then and i had a small sliding hiatal hernia, but what size it is now is anyone’s guess.

    I now have a HUGE ventral hernia, that includes my stomach and part of intestine but no evidence of obstruction but terribly pronounced, to deformity i cannot even hide with clothes. as well as feeling like my stomach will fly across the room if i sneeze.

    no one seems to want to help me, they tell me i need to lose weight, but concurrently i developed terrible problems with low thyroid and digestive issues, with nature thyroid.

    i read it floats around and is never really metabolized, but am not on new drug calld tyrosinct, i hope will work, It is impossible to lose weight with low thyroid and i also had low ferritin.

    stuff just goes on and on. Now with my stomach hanging out of hernia, a gastroenterologist now says, i should look into bariatric surgery, to lose weight so i can repair the ventral hernia.

    i am 260 about and 5’5, but had no problems losing weight until sleep apnea and cpap machine. One month i put on 30 pounds, and did not even come close to consuming that many calories.

    What type of specialist should i go to now? I am in RHode island, but it seems that no one will give any answers or want to treat me, as afraid of the apnea and the hernia.

    Also, i find that the sleep doctors here, have huges incentives to not divulge problems with sleep apnea therapies, because they have rushed to invest in sleep labs ,et.al.

    I need a new sleep apnea doctor and someone to figure out things going on with my hernias, and so forth. Sometimes my stomach is so hard like a basketball, and i think it is entirely filled with air. and pushing it self out through weak abdominal hernia of originally tiny proportion. have an umbilical hernia also, as well as a hiatal hernia.

  20. kathryn lee on December 4th, 2013 8:43 pm

    saw sleep doctor recently and he acted surprised by size of my ventral hernia although i pointed it out often on visits, to quite a few doctors, as to what and why was it happening. He also acted entirely in the dark about any hernia/cpap connections, and when i inquired of bi pap his only remark was he liked cpap. This hernia ia now huge, and i am looking into fixing it, but am afraid same forces from cpap will conspire to ruin surgery. needing a re-do Any studies on this stuff anywhere to read?

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