One of the central tenets of my sleep-breathing paradigm is the connection between breathing obstruction and reflux: One can cause the other, and vice versa. I happened to be reading an article on gastrointestinal function while sleeping, and found some interesting facts about your stomach and how it behaves when you’re sleeping:
1. Gastric acid secretion is significantly increased just after bedtime, around 12 AM.
2. Stomach emptying is delayed.
3. Esophageal clearance is delayed.
4. Upper esophageal pressure is decreased.
5. Nighttime reflux is more difficult to control using medications.
Any kind of breathing obstruction can create tremendous vacuum effects in the throat, which can actively suction up your stomach juices. However, this is also actively being promoted by steps 1 through 4 above. Once acid reaches your throat, it can cause swelling in your throat. If you still have your tonsils, they can get very large, which obstructs your breathing even more. Acid also is known to desensitize your protective chemo-receptors that help to wake you up from deep to light sleep when it senses acid in your throat, so that you can swallow your stomach juices and prevent aspiration into your lungs.
We also know that it’s not only acid that’s coming up into the throat, but also bile, digestive enzymes, and even bacteria, which can all travel up into your nose, ears and sinuses, or down into your lungs, causing major inflammation. Inflammation causes more swelling, and even further obstruction to breathing.
One major reason why the standard reflux medications don’t work all the time is because they’re not designed to prevent reflux. Instead, these medicines help to lower your stomach juice pH or production, so that it’s less irritating to your throat. This is also why not eating within 3-4 hours of bedtime is so critical if you have sleep apnea.
How many of you with sleep apnea also have reflux issues. Your symptoms don’t have to be heartburn or indigestion. It can be throat clearing, post-nasal drip, coughing, hoarseness, a lump sensation, throat pain, and even tightening.