Living with Acid Reflux : How to Treat Nighttime Acid Reflux
Sleep Apnea and GERD
Some people with gastroesophageal reflux disease (GERD) also have irregular breathing patterns during sleep or even sleep apnea.
By Madeline R. Vann, MPH
Medically Reviewed by Lindsey Marcellin, MD, MPH
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While physicians and researchers are still working to understand exactly how gastroesophageal reflux disease (GERD) and sleep apnea are related, it's clear that there is a connection.
Between 50 and 75 percent of people with sleep apnea (a condition in which breathing frequently stops for a brief period during sleep, so the person wakes up) or sleep-disordered breathing (irregular breathing during sleep) also have GERD.
Physicians and researchers are working to understand the relationship between GERD symptoms like heartburn and reflux and sleep apnea and whether treating one disorder can ease the other.
What Research Shows About GERD and Sleep Apnea
A small study of 48 adults who had GERD symptoms three or more times a week showed that those who had the worst GERD symptoms also reported the worst quality of sleep.
Yet the nature of this relationship is not fully understood. Researchers suggest the following possible explanations for a link between heartburn and sleep apnea:
- Interrupted sleep.Nighttime reflux is often painful enough to disturb sleep or wake up the person. Close to 80 percent of people with GERD report nighttime reflux or heartburn. But that percentage may be underestimated, because a brief reflux event may only briefly rouse the person from sleep — something they may not remember in the morning. If you have trouble sleeping or don't get restful sleep, talk to your doctor about whether you may be experiencing reflux during the night.
- Relaxation triggers.People with GERD are more likely to experience reflux symptoms during periods of wakefulness at night because their lower esophageal sphincter relaxes during those times, so being awakened by an apnea event could then trigger reflux.
- Continuous positive airway pressure (CPAP) side effects.Many people with sleep apnea are treated at night with CPAP, provided by a machine that constantly feeds air into their system to prevent the interrupted breathing common in sleep apnea. However, for a small number of patients, this treatment may expand the stomach slightly, leading to more reflux in some sleep apnea patients.
Treatment Options for Sleep Apnea and GERD
Treatment of either condition appears to help the other for most patients. Doctors have noticed that if you improve reflux, you also improve sleep apnea and vice versa. But it is not yet known whether one condition causes the other or if either condition makes the other one worse.
The key is to let the specialist you are working with know that you may have both conditions. If you do have both, you will work with two specialists — a gastroenterologist to treat your GERD and a sleep medicine specialist or pulmonologist for your sleep apnea.
Treatments that may help include:
- Weight loss.Excess weight is a common risk factor for both GERD and sleep apnea, and losing weight may help either condition or both. Losing as little as 10 percent of your body weight, if you are overweight, can reduce sleep apnea.
- GERD treatment.Treating your heartburn with medication can help control reflux symptoms day and night, and may prevent some of the interruptions of your sleep.
- CPAP.For most patients with both GERD and sleep apnea, CPAP treatment eases both problems. But for a small number of patients with both conditions, there may be an increase in aerophagia, a side effect of CPAP treatment in which air enters the stomach. This can also cause some reflux.
GERD has also been linked to some forms of asthma, chronic coughing, and bronchitis, so the idea that GERD and sleep apnea are also related is not far-fetched. However, the exact nature of the relationship — whether one causes the other — is not yet understood.
Patients may take comfort in knowing that they do not necessarily have to live with either condition. Discuss your options with your physician.
Video: Sleep Apnea and Acid Reflux
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