Here’s one great example: One of the most common problems that I see in my practice is when patients complain of a lump in the throat or difficulty swallowing. In most cases, after seeing inflammation in the voice box, I diagnose silent reflux. I usually go one step further and treat the actual cause of the reflux (obstructed breathing), rather than just cover it up with medications. Oftentimes, however, the voice box looks completely normal, but they still have the symptoms. Usually, I’ll blame it on microscopic amounts of stomach juices that you can’t see.

Just this week I saw a young woman who complained of a lump sensation and a tightness in her throat, with difficulty swallowing. She had classic laryngopharyngeal reflux disease. I recommended the usual conservative measures, such as not eating late, avoiding alcohol close to bedtime, proper nasal breathing, and sleep position..

However, in passing, she commented that whenever she swims, the lump sensation goes away temporarily. I didn’t even think about the significance of this statement until a few hours later when I was seeing another patient with similar complaints. Of course! Not only is swimming a good form of exercise, it’s also a type of rhythmic, controlled breathing exercises. By taking regular, deep breaths, she’s doing the same thing that you’d normally do in yoga as you perform the relaxing breath.

Deep breathing has a calming effect on your involuntary nervous system, especially activities that promote prolonged exhalation. This also includes singing, whistling, humming, wind instruments, and even talking. The longer time you spend breathing out, the longer time you stimulate the parasympathetic nervous system. Since the vagus nerve is your main parasympathetic nerve that innervates the voice box as well as your digestive system, this makes absolute sense. Maybe this is why good conversation with friends or family during a slow-paced meal helps you to digest better.

One possible explanation for a lump in your throat is excessive tension and stress in your cricipharyngeal muscle, which is a sphincter-type muscle that closes off the top of your esophagus just behind your voice box. If you’re not sleeping well, then your body will have more physiologic stress, causing tension and spasms in various parts of your body, including the cricopharyngeus muscle. Plus, if there’s direct irritation by stomach juices in the immediate area, then it’s even more likely to go into spasm. (If this tension happens to occur in your muscles of mastication, then you’re likely to have TMJ.)

As a result of the above patient’s passing comment, I reaffirmed that complementary ways of stress reduction and relaxation are just as important as any medical recommendation that I recommend for better sleep. I experience numerous other similar “eureka” moments almost every day, mainly by listening for my patients’ pearls of wisdom.

What’s your opinion on this subject?

I recently had a woman who told me she gets sore throats when it rains or if she gets wet. How many you have this particular condition?

Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.

Beware of the “Vacuum Effect”

People with obstructive sleep apnea are more prone to breathing problems at night due to partial or total collapse of one or more areas of the entire upper airway, from the nose to the tongue. It’s usually worse when on your back, since the tongue can fall back more in this position. During deep sleep, your muscles naturally relax and you’ll be more susceptible to breathing stoppages.

Pressure sensors placed inside sleep apnea patients reveal that every time an apnea occurs, a tremendous vacuum effect is created inside the chest and throat, which literally suctions up your normal stomach juices into your esophagus and throat. This can happen occasionally, even for normal people, but if you happen to have a late meal or a snack just before bedtime, there will be even more stomach juices lingering in your stomach to come up into the throat. If you happened to drink a nightcap, the situation is even worse since alcohol is a strong muscle relaxant.

What comes up into your throat is not only acid, but also bile, digestive enzymes, and even bacteria. Washings of lung, sinus and ear contents have shown H. pylori, a common stomach bacteria, and pepsin, a major stomach digestive enzyme. So what comes up can cause severe irritation in your throat, provoking the mucous secreting glands of your throat to try to dilute these substances.

Although people generally attribute throat mucous to post-nasal drip, in most cases there’s nothing dripping down the back of the throat. It’s actually coming from your stomach. However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle.

Chronic acid and other irritating substances lingering in your throat can have other detrimental effects. One recent study showed that chronic acid exposure can numb or deaden the protective chemoreceptors in your throat. These are sensors that detect any acid in the throat to prevent aspiration of your stomach contents into your lungs. If these chemoreceptors sense any acid in your throat, a feedback signal is sent to the brain, causing you to wake up so that you can swallow. This is what’s called a reflux arousal.

Treating Reflux For Good

So besides not eating late and avoiding alcohol close to bedtime, what else can you do?

I’m assuming that many of you that are reading this article are already being treated for obstructive sleep apnea, via either CPAP, oral appliances, or even with surgery. The problem is that no matter which option you choose, there will always be some degree of reflux. Taking acid reflux medications can help sometimes, but for the most part, these reflux medications don’t really do anything for reflux. All they do is to lower the acid content content before it comes up into your throat.

Other options include stimulating your stomach via natural remedies or prescription medications to empty your stomach much faster. One fascinating study showed that using a combination of pseudoephedrine (Sudafed) and a pro-motility agent (domperidone) eliminated snoring in most people. Unfortunately, we don’t have the equivalent of domperidone here in the US. Other similar medications are available, but have more serious side effects.

This is why eating early at least 3-4 hours of bedtime is so important whether or not you have obstructive sleep apnea. The same also applies to alcohol. If your nose is stuffy, talk with your doctor to find a way to breathe better through your nose. Make sure you’re sleeping in your preferred or optimal sleep position. Lastly, work with your sleep physician to fully optimize your sleep apnea treatment, no matter which option you choose.

Upon further questioning, she remembers that she did have a late dinner with alcohol the night before she woke up with her throat pain. This confirms her laryngopharyngeal reflux disease diagnosis. But why does eating late cause throat pain the next morning, accompanied by cold symptoms? As I describe with my sleep-breathing paradigm, most modern humans stop breathing to various degrees at night while sleeping. If you're susceptible to this condition (due to having smaller jaw structures), having any additional stomach juices when you go to sleep will allow it to be suctioned up into the throat every time you stop breathing. 

Not only does this cause throat pain and additional swelling and inflammation, it also aggravates more frequent obstructions and arousals, which suctions up more stomach juices.

Well, that explains throat pain, but why would you have fever, chills, and sweats? Isn't this classic for cold symptoms?

Whether inflammation begins with a cold or from reflux, they both cause additional swelling in the throat, aggravating more tongue collapse. When the tongue falls back more and more frequently, this process upsets the balance with your involuntary nervous system. This causes vasomotor symptoms such as fever, night sweats, flashes, and chills. So what may seem like a cold can actually be a nervous system overreaction, with no sign of infection whatsoever.

In this example patients, I just had her stop eating close to bedtime (along with alcohol), as well as to optimize her nasal breathing, by using nasal saline and nasal dilator strips. Usually, most of these problems  go away within a few days.

What can you do if it doesn't go away? Find out my answer in a future blog.