Can CPAP use make GERD worse?

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Can CPAP use make GERD worse?

Postby Luvsoccer » Wed Dec 28, 2011 5:02 am

Greetings. I was diagnosed with moderate sleep apnea about 6 months ago and have been using a CPAP device for most of the past 6 months. On the positive side, the quality of my sleep is noticeably better when using the machine. On the negative side, my GERD (acid reflux) has gotten significantly worse during the same time period and I now suspect that the CPAP use is one of the principal causes. Over the past week I slept a couple of nights without the CPAP and noticed that my reflux started to improve. I then started in again on the CPAP and the reflux is much worse again.

After doing some online research I saw reference to a small study done a few years ago that indicated CPAP use actually improved GERD so I am scratching my head. Other than acid reducers, about the only other medication I have been on during this time period has been Flomax. I stopped taking Flomax a week ago, thinking that might be the contributing factor, but now it appears that it is the machine. I go back to see the sleep specialist in a week and my ENT in a few days.

My question: have others experienced similar results, where GERD gets worse with machine use? I was scheduled for turbinate reduction surgery in two weeks but will likely now put it off so I can first find root cause for the increased GERD. If I can no longer use the machine I will have to try something else. My ENT has indicated he can do some throat work while performing the turbinate reduction. I had previously ruled that option out but now that I am having this CPAP/GERD issue I wonder if I should reconsider. The GERD gets pretty bad after using CPAP, including esophageal spasms, pain in sternum, acid throat, acid in sinuses, etc. It is not a pretty picture.

Thanks in advance for any info on similar experiences, or suggestions on how to find root cause so I can determine the appropriate remedy.
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Re: Can CPAP use make GERD worse?

Postby Todzo » Wed Dec 28, 2011 10:39 am

Luvsoccer wrote:Greetings. I was diagnosed with moderate sleep apnea about 6 months ago and have been using a CPAP device for most of the past 6 months. On the positive side, the quality of my sleep is noticeably better when using the machine. On the negative side, my GERD (acid reflux) has gotten significantly worse during the same time period and I now suspect that the CPAP use is one of the principal causes. Over the past week I slept a couple of nights without the CPAP and noticed that my reflux started to improve. I then started in again on the CPAP and the reflux is much worse again.

After doing some online research I saw reference to a small study done a few years ago that indicated CPAP use actually improved GERD so I am scratching my head. Other than acid reducers, about the only other medication I have been on during this time period has been Flomax. I stopped taking Flomax a week ago, thinking that might be the contributing factor, but now it appears that it is the machine. I go back to see the sleep specialist in a week and my ENT in a few days.

My question: have others experienced similar results, where GERD gets worse with machine use? I was scheduled for turbinate reduction surgery in two weeks but will likely now put it off so I can first find root cause for the increased GERD. If I can no longer use the machine I will have to try something else. My ENT has indicated he can do some throat work while performing the turbinate reduction. I had previously ruled that option out but now that I am having this CPAP/GERD issue I wonder if I should reconsider. The GERD gets pretty bad after using CPAP, including esophageal spasms, pain in sternum, acid throat, acid in sinuses, etc. It is not a pretty picture.

Thanks in advance for any info on similar experiences, or suggestions on how to find root cause so I can determine the appropriate remedy.


Hi Luvsoccer!

The research does show a strong relationship between GERD and Obstructive Sleep Apnea (OSA). And yes, if your OSA is well treated then the tendency toward GERD may reduce.

So you have been treated for six months. It took me about seven years to figure out that every autumn I would see a greater Apnea Hypopnea Index (AHI) and that (noticed by pictures of the back of my throat) the increased AHI was related to GERD. I try to stay away from pharmaceutical use so chose to raise the head of my bed a few inches to solve the GERD.

That seems to work except near the anniversary of a severe physical attack (I was stabbed, robbed, and beaten) which has left me with what I now know is a tendency to hyperventilate. CPAP tends to make Hyperventilation worse (this probably has to do with the increased ease of inhalation making it even easier to over breath). The doctors call this ventilatory instability brought on by a lack of CO2 reserve.

Also whatever makes the AHI go up, once it is up it tends to get worse. Also, if you have GERD your AHI will likely go up. Since the OSA increases stress hormones and since the breathing that occurs when the ventilatory instability results in the use of much more air means much less room for stomach contents and greater vacuum to bring it into the airway passage the GERD and OSA tend to help each other become worse.

To help manage this I:

Monitor my CPAP data with it's software regularly

Make time to get more sleep

Walk regularly with a eventual goal of 10,000 steps a day, often walking at a constant pace while consciously breathing less or more to achieve lowest heart rate at the constant output.

Eat a bit of fibrous veggies near bedtime (this seems to make my tummy happier).

Try to watch my weight.

Have learned to note such things as a stuffy nose as an indication I am breathing too much and use some techniques I learned to reduce my air use and stabilize my breathing at a lower healthier level (note the reference to my heart rate monitor above).

Keep my machine clean using my vibratory snoring levels (indicated by my CPAP software) as a guide for when to change filters and possibly use some O3 (ozone) to freshen the inside of the machine (of course I let it run for a couple of hours in the open air after that).

I do hope you and your doctors find good answers. You may need a better machine.

Todzo
AHI=52 SpO2 Nadir=55% (!!!) Focus & Vigilance problems w/PTSD from Trauma
CPAP since 2003 Respironics REMstar Auto A-flex with EncoreViewer and SleepyHead SW
Pulse oximeter CMS-50-F, night audio recorded via Audacity or Linux “sox”. Zeo.
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Re: Can CPAP use make GERD worse?

Postby Luvsoccer » Wed Dec 28, 2011 1:15 pm

Todzo,

Thanks for the information. What I find particularly troubling is that while I have had GERD in the past, I had cured myself of it about 18 months ago when I learned that it was caused by lactose intolerance. I used to use PPI meds for years but once I figured out it was lactose intolerance, the GERD was completely eliminated by avoiding dairy products. I also was able to completely stop taking PPI meds.

Having it come back by using CPAP (and be much worse than it ever was due to diet) is disheartening to say the least. I fear that I will no longer be able to use the breathing machine and must now look for other remedies such as oral appliance or even surgery.
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Re: Can CPAP use make GERD worse?

Postby Todzo » Thu Dec 29, 2011 11:23 am

Luvsoccer wrote:Todzo,

Thanks for the information. What I find particularly troubling is that while I have had GERD in the past, I had cured myself of it about 18 months ago when I learned that it was caused by lactose intolerance. I used to use PPI meds for years but once I figured out it was lactose intolerance, the GERD was completely eliminated by avoiding dairy products. I also was able to completely stop taking PPI meds.

Having it come back by using CPAP (and be much worse than it ever was due to diet) is disheartening to say the least. I fear that I will no longer be able to use the breathing machine and must now look for other remedies such as oral appliance or even surgery.


Hi Luvsoccer!

One thing my constant monitoring of my CPAP data has told me is that every night and every season is different. The problem with the CPAP is probably related to another problem. In my case allergy would make the CPAP therapy go bad which, along with some personal stress would make for acid reflux. Solve the allergy, reduce the personal stress, back to happy.

Please do try raising the head of your bed. It is cheap and I found it quite effective.

If your CPAP therapy does not work (is not working) then the rest of your life will go down hill. I think the answer is to get the therapy working which, when it is, it is likely the acid reflux will go away. The reflux is more likely related to stress or a dietary change. CPAP not working is due to the extra load and it causing some ventilatory instability is related to the fact it is not working well. Make the changes I mentioned and then call your doctor if no joy.

May we find good health!

Todzo
AHI=52 SpO2 Nadir=55% (!!!) Focus & Vigilance problems w/PTSD from Trauma
CPAP since 2003 Respironics REMstar Auto A-flex with EncoreViewer and SleepyHead SW
Pulse oximeter CMS-50-F, night audio recorded via Audacity or Linux “sox”. Zeo.
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Re: Can CPAP use make GERD worse?

Postby Vicki » Thu Dec 29, 2011 7:04 pm

It is possible that your GERD is worse when you use your PAP because you are subconsciously swallowing air (aerophagia). That is not an uncommon reason for increasing GERD with CPAP use. Besides raising the head of your bed as Todzo suggested, do you have EPR on your PAP and is it enabled? EPR decrease exhalatory effort and thereby decreases the amount of air that can end up going into your stomach. Or a BiPAP may be helpful if your prescribed pressure is high. Also, talk to your doctor to make sure your pressure is optimized. If it is too high, that will also cause aerophagia and if it is too low, then you might gulp air causing the same condition. It sounds like your CPAP therapy is working otherwise correct?

Vicki
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Re: Can CPAP use make GERD worse?

Postby redrumxtina » Sat Jun 09, 2012 4:14 am

yep it can cause gerd to get worse. I have sleep apnea and gerd just like you. Prop up on some pillows and have your chin sort of tilted down .This should help reduce it.
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Re: Can CPAP use make GERD worse?

Postby blueh2o » Tue Jun 12, 2012 4:17 pm

Two things that make your GERD worse with apnea. 1. Stomach pumping, the use of your stomach to breathe against the pressure of the machine forces the fluid up from your stomach. 2. The vacuum pressure created by the narrowing of your upper airway during apneas "sucks up" the fluids from your stomach.
Check out the book "Sleep Interuppted" by Dr. Steven Park which explains the GERD/Apnea relationship in detail. Also, I suggest getting back on the PPI. I can't do without it (Dexilant, in my case).
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Re: Can CPAP use make GERD worse?

Postby feberam » Sat Jun 14, 2014 7:39 am

I'm so happy to see this post!

I recently changed to the nasal pillow mask after 2 failed attempts at other masks. I suffer from GERD before I was diagnosed with sleep apnea. And I've been on PPI meds for a while now. These meds have helped get my reflux under control. I experience little to no symptoms.

The first night of the nasal pillow, I woke up with horrible relflux and severe coughing. The 2nd night even worse coughing. I slept w/o the mask last night and my no reflux symptoms. I already use a wedge pillow. I talked to my doctor and she suggested the pillow and PPI. Which is crazy because she JUST refilled my PPI meds for the year lol. And she said there's no connection whatsoever between increased GERD symptoms and cpap. WHAT?!

I'm so frustrated.
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