Who Taught Me Most About Sleep Apnea?

Whenever I get asked by patients who are my best teachers, my answer usually surprises them. I tell them my best teachers are my patients. Over the years, I’ve learned more from listening to patients than from anything I’ll ever learn in medical journals or textbooks.

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?

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

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6 thoughts on “Who Taught Me Most About Sleep Apnea?

  1. Dr. Park I am quite thankful to find a physician dedicated to the mission of medicine (help us live better) and much less distracted by the business of medicine ($$$). I think it has quieted your soul enough that you can really hear our problems and see potential solutions to them. I do so hope that many or your piers follow your good example.

    I think that any patient you see coming to you with a specific problem presents the tip of the iceberg. Underneath is a body, mind, and spirit ravaged by a food supply system gone crazy with chemicals and genetic manipulation, an entertainment industry bent on stimulating our adrenal systems without mercy, and a society very much lacking in basic consideration and compassion. We really come to you with very little understanding of the basics of care of our bodies, souls, and spirits.

    Thank you for teaching us – may many others come alongside.

    Also, happy Thanksgiving!

    Tod

  2. I also wonder if the cool water in the swimming pool acted as an anti-inflammatory on your patient’s neck and that also helped reduce the sensation of a lump in her throat.

    I love your website!

    Thanks,
    Terri

  3. I found your article very comforting. I have the feeling of having lump in my throat and causing me sleep-apnea. I have done an endoscopy, seen two ent doctors, all of the could not see the lump. I just started sleep with APAP machine and in middle of the night it wakes me up cause the air pressure is very strong. I don’t snore I just stop breathing. I know there is a lump I feel it when I eat, drink the worst is when I drink ice cold beer ( i consume alcohol rarely) I get hick up right a away. I am not looking for diagnosis but guidance in how to steer the doctor into right direction.

  4. Nope doc that might be one theory but for me it was the fact that I think I had just woken up with a lump in my throat that I could not swallow and at the reason why she felt better when she was swimming was because she had her head tilted backward as it’s in the CPR position which means open airway and I when I did this after a big long night of snoring realize that Maybe I agitated something or inflamed something while I was snoring and when I looked up immediately and swallowed by looking up the symptom when away when I look straight back down and I swallow Ganic came back so it could be linked to snoring and it could be going to an open airway on some type of skin Lum felt like you were swallowing in coming back up but I slept upright in a chair for a couple of hours and solve the problem Sort off

  5. Late to the comment party, but this observation is very interesting. I have been diagnosed with LPR, my symptoms have lessened incredibly due to lifestyle changes, but the lump in throat and belching remain. Chewing gum and ice seem to help me not feel the lump all day long. Also, lying down on my back (sleep) and taking a shower usually lessen the sensation. I do not have the sensation when eating and shortly after eating.
    My symptoms began after an episode of food poisoning which caused vomiting which threw me into a-fib from the vagus nerve. A few months after this I began with the nasal run, mucous, cough, hoarseness, lump in throat, bad taste in my mouth, choking, bloating, etc.
    A lot of things began to happen, but my top concern was to get rid of this globus sensation. It truly is a confining type feeling. I can remember a couple of times waking us with a gasping type sensation for air, not sure if that was apnea or not. This hasn’t happened in quite some time.
    This was in 2011 through 2013.

    Fast Forward to yesterday — I had a Restech done and the ph was 6.4 -7.0 all day long. The average would have been 6.7. It seems my ph would go to 6.4 when ready to eat, on an empty stomach. During the night it went down to 5.5 when lying on my back. When I turned to my side, it went back up to 6.6-7 and stayed there until I awoke in the morning.

    I do not want to do acid blockers or ppi. I’m concerned this is what my ENT will strongly suggest. (I am hesitant about side effects due to possible vomiting and the risk of going into a-fib again.) I’m sensitive to many medications, plus they mask symptoms rather than get to the root cause. Some procedures that would stimulate the vagus nerve are not an option for me. I’m not sure my ENT will work with me if I decline the ppi’s. I will probably return to my own research and doctor myself via herbs or supplements or what have you. I’d rather not do this on my own.

    I’m wondering if drinking some sodium bicarbonate at night and/or raising my bed even more would be beneficial and/or sleeping on my side would be helpful in the night-time acid ph levels.
    I still hope to get rid of this sensation some time in my life. It has been over two years.

    Any thoughts are very appreciated.

    Thanks.

  6. That’s exactly how I feel. I have a twrrible tightness in my throat and chronic untreated sleep apnea. I took extreme measures to get it corrected
    I had the UPPP, MMA, GA, septoplasty, and reduction of turbinates. My body never tolerated the CPAP machine. I still wake up so tired and I never seem to get enough sleep. It’s impacting my whole entire life at both the personal and professional levels. A lady that I met about a year ago in NE told me that my cognitive skills are similar to those of a 4 year child. I am beginning to see her point. Excessive sleep deprivation is a killer!