Ronnie47 wrote:So, I just came up from the ENT surgeon's office and he looked through my nose, soft palate, tongue etc and found everything to be normal. No deviated septum, no large soft palate, no large tongue base. He saw acid in my voice box and little redness due to the reflux. So he thinks the real problem is that the acid at back of my thorat could be causing throat spasms at night making it harder to breathe. Also, he mentioned that acid might be seeping into the airway causing the blockage while sleeping. When asked about the repeating cycle of waking up with a jolt right at the moment of falling asleep, and the need to consciously keep breathing during the day/night, he is attributing that to anxiety + acid in the back of the throat
I am really confused. My sleep study said that I have servere Obstructive Sleep Apnea where in there was a complete or partial blockage of breathing for a total of 31 times in an hour. My ENT says, that my OSD is not the problem, but it is LPR. He asked me to get a second sleep study done.
Can OSD be confused with LPR? Has anyone here faced a similar situation?
I have had LPR since 3 years, but it was always under control with PPIs.
The symptom of "waking up with a jolt right at the moment of falling asleep" is common enough to have the name "hypnic jerk". One thing they say about it may be familiar to you, it is common amongst those whose sleep schedules are irregular.
My severe Obstructive Sleep Apnea (OSA) was diagnosed in 2003. It greatly contributed to the end of a carrier I loved for over 20 years. Crawling up out of that hole with some retraining I was slammed down again by being attacked with a knife coming home from getting a treat at my local AM-PM two little blocks from my house. Now I am still treating the OSA while also dealing with panic attacks (for me long times when my body is hypervigilant - six to 48 hours of it!). Seeing a return of symptoms (sleepiness, high blood pressure, high blood sugar in the morning (8+ hours fasting), cognitive decline and emotional liability) I started looking for possible causes. One doctor mentioned that gastroesophageal reflux disease (GERD) is, in his experience, common amongst those with OSA (GERD has heartburn as one of it's main symptoms, in Laryngopharyngeal reflux (LPR) only 50% experience heartburn - both are caused by acid moving up from the stomach and into the airway). He theorizes that the GERD is due to the low pressures created by the increased respiratory effort due to the airway obstructions of the apnic events causing low pressure in the airway which tends to draw juices out of the stomach due to the vacuum.
I used a small camera to photograph the back of my throat each morning and did indeed find that I had redness and swelling back there after nights that showed bad sleep quality (measured by a Zeo), apneas (measured by my CPAP) and blood oxygen desaturations (measured by my recording pulse oximeter). In my case the reflux is probably contributed to by my use of Selective Serotonin Reuptake Inhibitors (SSRIs) along with the fact that the hypervigilance upsets my tummy and tends to make me want to gag a bit sometimes.
Then I remembered that a doctor many years ago told me I should raise the head of my bed (I think he noticed my LPR). The experiment was cheap, less than five dollars spent to purchase a couple of 6"x6"x8" concrete blocks. The results I am still finding out. My 30 day and 7day Apnea-Hypopnea Indexes (AHIs) are less than two per hour. Sleep quality is good, regulation of blood pressure and blood sugar and blood oxygen are good. I have more energy more of the time and my hearing seems to be improving. The back of my throat looks a lot better. For me this little thing helped a lot!
All of my research, which included that mentioned above and audio recordings of my sleep times, has led me to believe that my often hyperviligant state makes me more sensitive to my breathing obstructions and that I consequently have many more Respiratory Effort Related Arousals (RERAs). Even these have become less after raising the head of the bed. I hope that as summer approaches I can get back a bit more to living a life.
In regard to your question "Can OSD be confused with LPR?" did you mean to write OSA instead of OSD? If so, I think that your doctor is having trouble believing that you have OSA since he can find none of the "usual (physical) suspects". Just as many doctors have trouble believing that skinny people have OSA (about 20% of those with OSA are of normal body mass index) yours has not yet made the connection between GERD and OSA that other doctors have. Me, well, I am not a doctor but I do read, think a lot, and have experience with OSA so I wonder if GERD would tend to cause OSA by desensitizing the nerves in the airway such that the air flow monitoring does not make it to the brain and the muscles have more trouble receiving the signals that do make it back from the brain. Along with the swelling of the airway tissues I think that if I were an ENT I would tend to suspect OSA if I saw LPR or GERD. But, that is just me.
May God Help Us!