Sleep Apnea & Acid Reflux: A Painful Connection

Sleep apnea and acid reflux are two common conditions, and many patients find that they frequently occur together. Each can disrupt your sleep, leading to an impact on your daily quality of life. Some research suggests that they may actually worsen one another when left untreated.

This page will explain what sleep apnea and acid reflux are, what may cause them, how they’re connected, and what you can do to manage them – whether you are dealing with one or both.

Sleep apnea: what is it?

Sleep apnea is a common condition in which breathing repeatedly stops completely (called an apnea) or becomes significantly reduced (called a hypopnea) during sleep. These pauses last at least 10 seconds and can occur many times per hour. This can result in drops in blood oxygen levels, brief awakenings from sleep, and poor sleep quality.

Does your partner tell you that you snore loudly? Have you ever woken up gasping or choking, or been told that you do? Do you feel excessively sleepy during the day despite getting enough hours of sleep? These could be signs of sleep apnea.

There are two main types of sleep apnea, and both can range from mild to severe:

Obstructive sleep apnea (OSA): The most common type of sleep apnea. It occurs when the muscles and soft tissues of the upper airway relax and collapse during sleep, blocking airflow even as the body continues to try to breathe.

Central sleep apnea (CSA): A less common type of sleep apnea. It occurs when the brain temporarily reduces or stops sending signals to the breathing muscles during sleep. The two most common associated risk factors in adults are heart failure and opioid medication use.

What are the risk factors for sleep apnea?

Several factors can increase the risk of developing sleep apnea:

• Tissue around the neck and throat – more, larger, or thicker tissue around the tongue and throat puts physical pressure on the airway, restricting airflow at night. This is often associated with obesity or being overweight. 
• Enlarged tonsils or adenoids
• Face and jaw structure – such as a small or recessed jaw
• Male sex – men are 2 to 3 times more likely to have sleep apnea than premenopausal women
• Older age
• Postmenopausal status – the protective effect of certain hormones like progesterone decreases after menopause
• Family history of sleep apnea
• Pregnancy
• Smoking and nasal congestion – less well-established risk factors

How is sleep apnea diagnosed?

Sleep apnea is diagnosed through a sleep study. This can be done in two ways:

In-laboratory polysomnography: You sleep overnight in a sleep lab, while your breathing, oxygen levels, brain waves, and other measurements are monitored. This is considered the standard diagnostic test for providing a sleep apnea diagnosis.

Home sleep apnea testing: For patients without significant other medical conditions who are suspected of having moderate to severe OSA, a portable device can be used at home. It monitors breathing and oxygen levels while you sleep in your own bed.

Many factors go into figuring out which type of testing is best for you. If you think you may have sleep apnea, talk to your healthcare practitioner. They can help determine which type of testing is right for you and discuss treatment options.

Acid reflux: what is it?

Gastroesophageal reflux (commonly called acid reflux or heartburn) occurs when stomach contents flow back up into the esophagus. Some degree of reflux is actually normal and happens in healthy people, especially during and after meals. However, when reflux becomes frequent or severe enough to cause troublesome symptoms or damage to the esophagus, it’s called gastroesophageal reflux disease (GERD).

Acid reflux can happen during the day or at night. Nighttime reflux tends to be particularly problematic because the body’s natural defenses against reflux (i.e., swallowing and saliva production) are reduced during sleep, which may allow acid to stay in contact with the esophagus longer.

Common symptoms of GERD include heartburn (a burning sensation in the chest), regurgitation (a sour or bitter taste in the mouth), chronic cough, a sensation of a lump in the throat (globus sensation), and/or hoarseness.

Without treatment, chronic GERD can lead to complications including inflammation of the esophagus (esophagitis), narrowing of the esophagus (strictures), and Barrett’s esophagus (a change in the lining of the esophagus that can increase your risks of esophageal cancer).

What are the risk factors for acid reflux?

Several factors can increase the risk of developing GERD or trigger reflux episodes:

• Pressure on the stomach – Extra weight or tissue around the midsection can sometimes push the stomach and esophagus, which can force stomach acid upward and increase the risk of a hiatal hernia. This is frequently associated with overweight and obesity.
• Smoking – This can reduce the pressure of the lower esophageal sphincter and prolong acid clearance.
• Certain medications – (i.e., calcium channel blockers, anticholinergics, nitrates, and benzodiazepines).
• Pregnancy – Weight gain and hormonal changes (especially progesterone) can contribute to reflux.
• Eating within 2–3 hours of bedtime.
• Certain foods – (i.e., spicy, fatty, or fried foods). These may trigger symptoms in some individuals. Identifying trigger foods rather than general avoidance is an effective method for reducing the opportunity for reflux to occur.

How are sleep apnea and acid reflux connected?

Sleep apnea and acid reflux are known to frequently occur together. The relationship between these two conditions appears to be bidirectional, meaning each may influence the other, though the exact nature of this relationship is still being studied:

• When the airway gets blocked during sleep, suction-like pressure is often created in the chest. This suction can pull stomach acid upward into the throat; though researchers believe this is only one of several reasons reflux happens during sleep apnea. 
• At the same time, acid travelling up into the throat at night can wake you up briefly and disturb your sleep.
• Treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) has been shown to significantly improve GERD symptoms in most patients, and treatment of GERD may also improve sleep quality for those with sleep apnea.

Beyond any direct interaction, these conditions share important risk factors (most notably smoking and increased weight), which partly explains why they so often occur together. However, research suggests the association between OSA and GERD exists even after accounting for these shared risk factors.

How to manage both conditions effectively

If you are experiencing symptoms of both sleep apnea and acid reflux, several approaches may be beneficial, depending on the individual patient and their unique condition:

• Support for a healthy body size: Small, manageable shifts in body size can often reduce the physical crowding in your airway and stomach, which may help to ease symptoms of sleep apnea and acid reflux in those with increased body size. 
• Smoking cessation: Quitting smoking may help reduce the severity of both conditions and has broad benefits for overall health. Your healthcare practitioner can help with smoking cessation strategies and support.
• CPAP therapy: If you are diagnosed with OSA, CPAP therapy will most likely be the most effective treatment. Studies suggest that CPAP use often significantly reduces nighttime reflux symptoms.
• Medications for GERD: Proton pump inhibitors (PPIs) are the mainstay of GERD treatment and can reduce acid exposure in the esophagus. Some evidence suggests that treating GERD may also improve sleep quality.
• Lifestyle modifications: Avoiding eating close to bedtime, elevating the head of your bed, and sleeping on your left side may help reduce nighttime reflux.
• Pregnancy: If you are pregnant and experiencing symptoms of either condition, talk to your healthcare practitioner about safe management options. Symptoms often resolve or improve after delivery, as pregnancy-related physiological changes reverse.

When should you seek medical assistance for sleep apnea and/or acid reflux?

As soon as either of these conditions begins to impact your daily comfort or quality of life, it’s time to think about contacting your healthcare practitioner and talking to them about what sleep apnea or acid reflux treatment options could be available to you.

Whether it’s for sleep apnea or acid reflux, Felix’s healthcare practitioners are always eager to assist our patients in finding an actionable solution that they can use to improve their quality of life and happiness.

This way, you can get support for your acid reflux and sleep apnea symptoms, helping you to feel better and get back to living life on your terms – the way it should be.