# New Findings on GERD & Sleep Apnea



## em.london (Dec 11, 2001)

I came across this and thought you all might find it interesting reliminary Results Link GERD to Sleep ApneaCharlene LainoOct. 20, 2003 (Baltimore) ï¿½ Sleep disorders and gastroesophageal reflux disease (GERD) often go hand in hand; at least four fifths of the 60 million Americans who have been diagnosed with GERD say their symptoms worsen in the evening, often preventing them from sleeping peacefully through the night.But the exact relationship between the two ailments, if any, has been the subject of much debate. Some researchers speculate that sleep apnea results in changes in intrathoracic pressure that cause acid reflux, while others say that esophageal acid exposure may cause reflexes connecting the esophagus and airways to interrupt breathing, inducing apneas.Preliminary evidence that GERD may be the culprit, at least in nonapnea arousals, was presented here Wednesday by Brian P. Mulhall, MD, MPH, from the Gastroenterology Service at Walter Reed Army Medical Center in Washington, D.C., at the 68th annual scientific meeting of the American College of Gastroenterology.But it's not just the acid, he said. Other liquids such as bile reflux may interrupt breathing and sleep."I must stress the preliminary nature of these findings," Dr. Mulhall told Medscape.Eamonn Quigley, MD, from the Department of Medicine at Cork University Hospital in Ireland, agreed.Also emphasizing the preliminary nature of the findings, Dr. Quigley said, "What they are suggesting is that GERD, in some way, and we don't know how yet, is affecting the control of respiration, leading to a drop in oxygen levels, which can lead to sleep apnea."To date, Dr. Mulhall has studied 50 adults, 30 of whom had been diagnosed with sleep apnea, 10 of whom also suffered from nocturnal GERD. The patients were monitored using either a traditional pH probe to measure acid reflux or with a multichannel intraluminal impedence (MII) catheter, which can detect and measure reflux of any type, not just acid reflux.The MII catheter is better able to capture the nonacid reflux that might play a role in sleep apneas and arousals, Dr. Mulhall told Medscape.The researchers monitored all the patients as they slept, tracking reflux incidents with both measures. "Many patients with obstructive sleep apnea have no symptoms of heartburn," he said. "In the next phase of this study, we will be evaluating whether these patients are having more esophageal injuries than other people with reflux." GERD events were measured and related temporally to apneas, hypopneas, and arousals. In addition, the researchers used questionnaires to measure baseline GERD symptoms and daytime somnolence. Using a chi-squared test and intraclass correlation coefficients, the researchers found that a third of the patients with sleep apnea experienced "substantial" nighttime reflux.If the preliminary results in the new report are borne out, MII may allow a better capture of nonacid GERD events that could play a role in respiratory events during polysomnography, Dr. Mulhall said."It may be the case that if you have obstructive sleep apnea, you need to be examined for reflux ï¿½ even if you have no symptoms of GERD," he said. "MII may allow us to better capture both acid and nonacid GERD events that may play a role in the respiratory events that occur in these sleep disorders," he added. Also, treating GERD may be an effective way to improve apnea-related sleep woes, Dr. Mulhall said. The next phase of his research will involve another 280 patients, who will also be evaluated with traditional pH probes or MII to measure all contents that flow into the esophagus, including nonacidic liquids that may produce fewer symptoms. Those patients with GERD will eventually be randomized to receive either antireflux medication such as a proton pump inhibitor or placebo, as well as continuous positive airway pressure, to see if symptoms improve, he said.The bottom line, Dr. Quigley said, "is these are very interesting findings, but further study is needed."The study authors have disclosed having a financial relationship with AstraZeneca and Sandhill Scientific.ACG 68th Annual Scientific Meeting: Abstract 594. Presented Oct. 15, 2003.Reviewed by Gary D. Vogin, MD


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## overitnow (Nov 25, 2001)

Interesting, because I have suffered from both conditions, although reflux was a late development. I can well understand how it can disturb your sleep, and it would be interesting to know if there are minor events that cause the same apneas without a complete awakening. In my case, I solved the GERD/indigestion problem some years ago without a change in my sleeping/breathing patterns. Weight loss this year seems to be stopping the snoring and subsequent stoppage of breath that leads to the apnea. (Now if the cessation of snoring becomes complete and I can hold my weight, there really will be nothing wrong with me any more...other than the personality.)







Mark


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## em.london (Dec 11, 2001)

LOL MarkMine is worse at night. I am trying to research all this so if I get anymore I will post it for you.Emx


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## starfishgina (Nov 16, 2003)

hi!i can't get a full night's sleep ever! i take acifex and ambien, but i don't think either is completley solving the probleems. i am an anxious person and i assume that is not helping with either one.


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## em.london (Dec 11, 2001)

StarfishI also take Omeprazole that stops my stomach producing too much acid and therefore helping the relux. It hasnt taken it away completly but it has helped a little.Ask you doc about it.Emx


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## em.london (Dec 11, 2001)

Mark,I did try and PM you but your box is full.Thank you for your message. I do have sleep apnea but have never considered a sleep clinic. To be honest with my IBS, Knee dislocation(I am on crutches waiting for op) and Migraines (await scans) sleep seems to be the less of my worries ! As I am at home I tend to try and take a nap during the day before my daughter comes home from school. My mother has Crohns and Migraines.Any idea's though would be helpful, Thank you.Em


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## lauriejohnson (Jan 21, 2001)

Hi there!Can I jump in here on this sleep apnea thing? I have GERD and will be having an endoscopy in two days to see what's going on there. Anyway, more on that later. My Dad has done the sleep study thing and has been diagnosed with sleep apnea. Hooks up to a crazy, loud machine every night, and it helps some. Anyway, I wonder if it could be hereditary and if I have it, as for several years I wake up in a panic, at the refrigerator, which I don't remember even getting to, heart pounding and gulping water, as I feel like I can't breathe or something. This happened once every month or two until recently, when the last few months when the Prilosec stopped working, gave it up and have gone 4 weeks with no medication other than supplements, changing my diet, etc. This regime has actually helped with the heartburn a great deal, however now I have terrible pressure in my throat, like someone's strangling me. Not all the time, but too much! I have been put on Xanax for when this occurs, because it is intolerable. Consequently, these night-time "attacks" have increased to 2 or 3 nights a week. Do I just sound like a nut-case (okay, don't answer that!), or does this sound like sleep apnea? I'll run it by my doc when I see him, I guess.Thanks!~LaurieP.S. Scared witless over this endoscopy thing, too! Anybody able to offer some calming advice?!? I am going to be put "nearly out", as I have the worst gag reflex in the world, but I am still afraid....will I be aware of what's going on at all, what will they find, what's going to happen to me (doc wants to do surgery). HELP!


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## overitnow (Nov 25, 2001)

Feelinyucky:My Father had it, my Brother has it, and I have it, too. Aside from the genetic thing, all of us were overweight. I have recently lost a bunch and often am not snoring, anymore.The funny machine is a CPAP. They have really made a difference for my brother and myself. (I really would like to know how you would introduce them if you were dating; but that's just me...) As far as sleepwalking and strangulation, neither have been a part of my experience; but your doc would be the one to ask. Out of curiosity, and because I use only supplements for my digestive and bowel problems, what are you taking?Em--I will clear my box today and send another note across the water.Mark


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## em.london (Dec 11, 2001)

Thanx Mark







FeelinyuckyFor the Endoscopy they give you a sedative that calms you and then place a tube in your mouth and ask you to swollow. To be honest I dont remember much about it as I was out of it ! I dont remember it hurting just feeling alittle funny. I hope it goes well.Emx


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## lauriejohnson (Jan 21, 2001)

Thanks for the advice on the endoscopy, Em! It helps to know that others have done it and survived!







Mark: The supplements I am taking are DGL, probiotics, anti-yeast medication, and then following a strict no yeast, sugar, wheat, etc. diet. These things I have been doing for 4 weeks now, and it has dramatically helped my heartburn. The only problem is the lump-in-the-throat feeling. I read a book called "No More Heartburn" by Dr. Sherry Rodgers, and this is where I ran across this alternative treatment. The wierd sleep-deal I've been experiencing happened again last night. I don't know what is going on, but I will ask my doctor about sleep apnea. My Dad, who has it, is overweight, however, I am only 115 lbs., so that's not the problem. Thanks for your help!~Laurie


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## em.london (Dec 11, 2001)

Mark and Feelingyucky I have PM you.Emx


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## DavidLA (Nov 28, 2000)

FeelingYucky-Great name for this condition! Two suggestions. I also had the endoscope test done..& remember being very uptight before the procedure but believe me its one of the easiest tests I've ever had. The only discomfort was a sore throat for about one week after. Knowing that everything looked O.K. is a great relief!. Regarding the throat sensation, I had that for about one year straight!.It's not only a very very un-comfortable feeling but I had alot of problems swallowing(dysphagia) & also it constantly felt like I had a rock in my throat or huge lump(globus)The only way I can describe it is simply PURE MISERY!! I think this would make a great type of torture to get confessions out of people!!! Anyway.. For me I found it completely related to my acid reflux problem..When my acid reflux problem started going away..the sensation completely dis-appeared. I achieved this strickly through supplements & diet. I also was on Prilosec & you could't pay me enough MONEY to ever take that DRUG from HELL again!!Let me know if you want any acid reflux tips! Good Luck!!!!!


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## lauriejohnson (Jan 21, 2001)

David:Thanks for your thoughts on the endoscopy. I actually had it 10 days ago. It went well, and I was all worried about nothing! I was pretty much out, so don't remember anything, and I didn't even feel any pain or sore throat at all. Best of all, everything looked fine, so that was a relief! Next I go for a 24 hour pH test and manometry to see what that shows. Kinda worried about that, since I won't be out this time! Anyway, the heartburn is MUCH better, thanks to you and Dr. Sherry Rogers' book! The lump-in-the-throat feeling is even getting better...don't feel it at all some days! I'll agree that diet plays a big part, as well as the supplements. What a relief, since the Prilosec stopped working, and after reading the book, I was scared to death of the pills anyway! I am so glad that I am not on them for life now! I sure do miss chocolate, oranges, and tomatoes, though! Any thoughts on the possibility that I can EVER try those again!?!?!?


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## em.london (Dec 11, 2001)

FeelingyuckyI am so pleased that the Endoscopy went well and you had no problems. There are alot of foods we can't have due to the reflux etc. I keep a diary of what I have eaten and what the reactions are then over time you know what you can and cant have. Occasionally that does change and you can have the odd bit of good things







Hope it continues to get better.EmxP.S Here is a great article and site that might also help: http://www.gerd.com


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## overitnow (Nov 25, 2001)

Feelinyucky--I have not had a reflux attack in over 5 years. With the exception of couple of dietary indiscretions, I have also not had any heartburn over the last four years. And I don't have to watch what I eat. It has been possible for me to supplement this whole thing away. Don't know why it shouldn't work for you. Mark


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