How Sleep Apnea Causes Pepsin Reflux
November 9, 2009
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.
15 Responses to “How Sleep Apnea Causes Pepsin Reflux”
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Great article! But, does the sleep apnea cause the acid reflux, or amplify it? I have sinus congestion, acid reflux, and recently diagnosed with sleep apnea. My tonsils have “grown back” after 40 years. I can’t get off the Prilosec, but have gotten off one of my high blood pressure medications. Will my acid reflux eventually stop because I’m on a cpap? It’s like hot knives cutting through my throat.
Thank you,
Paula
It doesn’t matter which comes first. Once it starts, it’s a vicious cycle. Treating sleep apnea should help with your laryngopharyngeal reflux disease, but don’t count on curing it completely. You may need to stay on Prilosec for a while until things settle down and then consider tapering off once you feel better. Thanks for commenting.
I was diagnosed with pharyngeal reflux disease almost 4 years ago. I had been to my GP, and allergist when I was sent to an ENT. I had laryngitis for 6 months (no kidding) and it was really tough. I sing, and I am an educator, so I use my voice a lot. The protonix worked really well for about a month, but then symptoms started to return. It is so frustrating…my singing voice and range have been affected most of all. I have real difficulty with the transitions that are right aroune my lift-point (where I change from my “chest voice” to my “head voice”) I don’t know what else to do. I have gone to a new ENT, and he has ordered a video strobe test(?) So, here we go again. Do you have any suggestions?
Robin,
Your experience is not too surprising. Protonix and other acid relfux medications don’t prevent your stomach juices from reaching your throat. Are you absolutely avoiding eating or drinking alcohol within 3-4 hours of bedtime?
Do you have any other symptoms of an underlying sleep-breathing disorder such as unrefreshing sleep, not being able to sleep on your back, and maybe even snoring?
If some of the above problems resonate with you, I recommend that you read my book, Sleep, Interrupted. It describes my sleep-breathing paradigm, and steps you can take from conservative to more aggressive steps.
I have sleep apnea and acid reflux and it can be difficult to use machine sometimes I thin k I could use the cpap if i had the reflux under control but as it stands it hit and miss every night whether I get sleep or not its wearing me down I have started to use Kangen Water to see if it can help whats u opinion I would try anything
i recently in nov or so started thinking i had to clear my throat because of allergies which i treated to dry up..then in jan it got worse more stuff in throat to clear and my anxiety started up so i dont know if one fuels the other..i know if im more relaxed the throat wont flare but something is their even with anxiety..ive tried so many natural treatments one by one dont know if there working or not..but ill try anything..i feel a little burning in my stomach here and there but just the throat..how do u really treat this..ive checked my ph which was 6 but then 7.5 so is that a true test of acid..im really concerned it wont go away..what do i do to fix this? i dont eat wrong foods.drink alcohol or smoke..
[...] Tip #1: Avoid Acid Reflux [...]
I have been dealing with reflux for several years. Constant pain in my throat right side at the top of my collar bone – when I breathe outside in the cold or inhale after chewing a halls I can feel the pain sensation down there. I switched from prilosec to nexium and zantac about a month ago. I have a follow-up visit with my gastroentorologist next week. My wife says I snore very loudly. I also have pain where my left nostril connects to my throat but this has improved greatly.
[...] Tip #1: Avoid Acid Reflux [...]
Paula,
It doesn’t matter which comes first. Ultimately, it’s a vicious cycle. Reflux from sleep apnea can cause your tonsils to get larger, which causes more sleep apnea. Assuming your CPAP is being used effectively, your throat problems should improve. Good luck.
[...] Tip #1: Avoid Acid Reflux [...]
[...] Tip #1: Avoid Acid Reflux [...]
[...] Tip #1: Avoid Acid Reflux [...]
[...] Tip #1: Avoid Acid Reflux [...]
I am in the same boat as many. I have had reflux for over 4 years, and have now been told I have sleep apnea. I definately feel the 2 conditions make the other worse. I have tried the reflux medications-they dont work for me. I was told my tonsils are large and my tongue sits too high. I have propped up with pillows at night to sleep but think my next step is elevating the head of the bed itself. If that doesnt work I may consider having some of my soft tissue removed. I go home each day at lunch and power nap for 15 minutes just to work an 8 hour shift. yuck . I don’t go out anymore on the weekends because that is my sleep time. My friends make fun of me for “being old and tired. ” Its not funny.