How Sleep Apnea Causes Pepsin Reflux

Sleep apnea and acid reflux go hand in hand. An obstruction causes a vacuum effect in the throat, which suctions up your normal stomach juices into your throat, causing more inflammation and swelling, causing more obstruction. If you have large tonsils, it becomes even more enlarged, causing severe breathing problems at night. Not only do the mucous membranes of the throat become swollen, the tongue swells up as well, leaving impressions on the sides of your tongue due to pressing on the teeth.


Most people are aware of acid reflux, but what’s virtually ignored is the fact that your stomach juices contain many other irritating substances, including bile, digestive enzymes, and bacteria. In fact, pepsin, one of the main digestive enzymes, and H. pylori, a common stomach bacteria, are both found in ear, sinus and lungs washings. These are major sources of inflammation and swelling in your upper airway.


A recent study published in Otolaryngology – Head & Neck Surgery showed that deposits of pepsin can linger in the throat, and every time acid comes up, it gets activated in the more acidic, low-pH environment. They cultured throat cells with and without pepsin and measured 84 different inflammatory markers, of which 9 were found to be significantly increased, even in a non-acidic environment. This can potentially explain why people with laryngopharyngeal reflux disease have persistent symptoms despite maximal acid reflux medication therapy. 


Laryngopharyngeal reflux disease is a common condition where small amounts of stomach juices reach the throat. But it’s important to realize that giving acid suppressing medications like Nexium or Prilosec does nothing to prevent reflux. What these medications do is to lower acid production in the stomach so that whatever comes up doesn’t irritate the throat (or esophagus) as much. It’s not surprising that these medications don’t always help.


I think you’ll agree that constantly having small amounts of digestive enzymes in your throat can definitely cause problems. More commonly, people will complain of post-nasal drip, throat clearing, hoarseness, chronic cough, a lump sensation, tightness, burning, usually with no stomach problems whatsoever.


This is why eating early and not snacking before bedtime is so important for people with sleep apnea (and everyone else, too). 


Do you have to clear your throat constantly, or have post-nasal drip, chronic cough, or hoarseness? Please enter your experiences below in the comments box.

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

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51 thoughts on “How Sleep Apnea Causes Pepsin Reflux

  1. I also have LPR and probably UARS. I have been using xPAP regularly for about 15 months. It has helped the LPR . I wake up with less phlegm and sore throats. However, due to mask problems (my jaw is recessed and I have 2 missing lower molars), the xPAP is extremely disruptive to my sleep because I can’t stop the leaks that wake me up. The leaks are not bad enough to render the therapy unsuccessful, but they constantly wake me up. It has made my insomnia much worse and I have lost a lot of sleep because of it. Some nights I just have to take off the mask just to get some much needed sleep.

    I also use Sleepyhead, but I don’t find it very useful because my AHI is always low (around 1), but I feel lousy. Once in awhile, I get a good night’s sleep with it, but not often. I feel more tired and irritable than before I started xPAP. Something I have noticed is that the Sleepyhead pressure graph always looks like the auto PAP pressure wants to go higher than the max pressure I have set it for. I can’t go over 7 on max pressure because the mask leaks will be intolerable. Another thing is that I have quite a bit of activity on my Flow Limitation chart, which maybe why the machine pressure wants to go higher. When I use my PR Dreamstation (I like the Resmed much better), there are a lot of RERA’s on the pie chart. I had a really good attitude before starting xPAP, but I have to consider my case a failure.