Gastroesophageal reflux disease (GERD) is a common problem caused by the retrograde flow of stomach contents into the esophagus. The condition, which is characterized by symptoms such as acid regurgitation and heartburn, is a particular problem for patients with OSA, especially those with comorbid obesity.
When compared with individuals without OSA, those with the sleep disorder exhibit a greater number of nocturnal GERD symptoms and events.
GERD is often easily identified in the dental chair through the presence of enamel erosion.
What is Acid reflux
Acid reflux, more commonly referred to as heartburn, occurs when stomach contents repeatedly flow backward into the esophagus. This can happen at any time of day.
A muscle known as the lower esophageal sphincter (LES) attaches at the lower end of the esophagus where it drains into the stomach.
The chief role of the LES is to provide a one-way valve between the throat and the stomach; it opens up as you swallow food to allow it to enter the stomach for digestion.
In healthy individuals, this valve remains shut except for the purposes of driving digestion during mealtime.
However, when the LES doesn’t close properly or tightly enough, a reflux (or regurgitation) of digestive juices and stomach contents can rise back into the esophagus. This leads to the usual acidic sensation and taste that characterizes heartburn.
When does acid reflux become GERD?
Those with an ongoing condition (symptoms occur at least twice weekly) are typically diagnosed with Gastroesophageal Reflux Disease (GERD).
GERD is considered a chronic form of acid reflux. It may require a more proactive treatment strategy than those who experience heartburn less frequently.
GERD can have a dramatic impact on sleep, leading to risks of:
- aspirating (breathing in) stomach acid while asleep
- aggravating or contributing to obstructive sleep apnea (OSA), and
- experiencing sleep fragmentation caused by the discomfort of heartburn symptoms
These chronic symptoms may signal something more serious than occasional distress caused by overeating.
Signs of acid reflux
Acid reflux is one of those medical concerns that may not be apparent for some. For them, acid reflux may not result in the usual burning sensations it causes in the stomach, chest, or throat, or the sour or acidic taste in the mouth after a meal. For them, the only indication they have acid reflux may be a problem with swallowing, a dry nagging cough, the development of asthma, or the repeated loss of one’s voice (laryngitis).
Like many sleep disorders, acid reflux may be a hidden problem. What makes it even more complicated is its overall prevalence. People of all ages, from infancy to the golden years, may experience and suffer from acid reflux, and many don’t know it.
How reflux influences sleep quality
During sleep, a case of reflux may actually allow stomach contents to rise as far as the back of the mouth. This is due to the (usually) horizontal position of sleeping.
While upright and awake during the day, gravity can help limit the impact of reflux to the stomach and mid-chest. However, in a reclining position, gravity can no longer “push down” stomach acid. If the LES is faulty, it may easily fail at its task.
For those who experience reflux during sleep, this means rude awakenings with a sour, burning sensation in the back of the throat. Falling back asleep may require reintroducing gravity at night, either by:
- sitting partially upright in a reclining chair
- using a wedge pillow to elevate the upper body, or
- raising the head of the bed by 3 inches (usually by adding risers to the legs beneath the headboard).
Other tactics include:
- use of over-the-counter acid neutralizing medications
- sleeping on the left side, as a right-, back-, or stomach sleeping position typically encourages more reflux
GERD and sleep apnea
Research shows that a relationship exists between obstructive sleep apnea (OSA) and GERD. Reports suggests that around 60 percent of patients with OSA also experience GERD. Sometimes, obesity plays a third role in this relationship.
When OSA occurs, changes in pressures within the diaphragm and the chest cavity make conditions favorable for acid reflux. It is also thought that an episode of apnea could alter digestive processes in a way that disrupts the function of the LES. Apneas also cause more “respiratory effort” during sleep. This might force a change in pressure in the esophagus that leads to an increased chance for reflux.
It’s beneficial to know that treatment of OSA by positive airway pressure (PAP) therapy has been consistently shown to result in an improvement to the symptoms of GERD.