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.

Leave a Reply

Your email address will not be published. Required fields are marked *

54 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.

  2. I have been on my CPAP for five years. Over the last 6-8 months, I wake up with very thick mucos in my throat. This causes lots of gagging. It take about 30 minutes to get my throat clear. I am clearing my throat constantly. I also have asthma.

  3. I began using CPAP about a year and a half ago, not because I had a sleep test and was diagnosed wit sleep apnea, but because I thought I might have some type of sleep disordered breathing. For years, I would wake up with sore throats and stuffed up nose and lots of mucous in my nose and throat. After reading Dr. Park’s book, I decided to try CPAP. I have not had any serious sore throats or asthma attacks at night and in the morning since. I had to train myself NOT to mouth breathe while I slept and spent many months with my mouth taped shut at night. I needed to learn to keep my tongue at the top of my mouth behind my teeth at all times so that I could not mouth breathe. It was a long slog, but it paid off. I still have some mucous and dry mouth at times, but I am doing so much better.

    Trish – do you know about the online help forum for CPAP called They may be able to help you optimize your therapy if you tell them about your problem. CPAP therapy is not perfect for me either, but it is much better for me than without it.

  4. I was diagnosed with sleep apnea by a sleep doctor in 2012. I was having numerous episodes where I would stop breathing. My problem with the mucos just started a few months. If I go a night without my cpap I have terrible headaches. I have not heard of the site you mentioned but I will check it out.