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.

Written by Steven Park · Filed Under Blog, obstructive sleep apnea
Tagged: ,pepsin, post-nasal drip, relfux, sleep apnea

5 Responses to “How Sleep Apnea Causes Pepsin Reflux”

Paula Brannon on November 10th, 2009 9:45 pm

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
Steven Park on November 11th, 2009 3:57 am

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.
Robin on November 24th, 2009 6:53 am

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?
Steven Park on November 24th, 2009 7:58 am

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.
kevin Mailey on March 11th, 2010 6:09 pm

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