CPAP CAUSING ACID REFLUX

I have been on CPAP for two months. I have no problems tolerating the mask and the machine. It has been wonderful, I get more rest than I had the last 10 years. I only need 7 hours on the machine and stay awake all day. I must be weird though, instead of getting rid of Acid Reflux it is creating it. Before starting CPAP I had a perfectly happy esophagus no pains to complain about. Within two days of starting CPAP Acid Reflux started in. It has gradually been getting worse and now has gotten to the point where my pipe burns off and on all day long causing nausea, burping up acid, even some burning in the stomach. I can knock it down temporarly with food, green tea, Braeburn apples, reflux drugs. CPAP keeps it knocked down at night, but somehow it has irritated my pipe to the point where it is totally sensitive to acid. I am using a S8 ResMed I started it out at 3 on the humidifier, cranked it up to 4 still no help my pressure number is 10 Dr. said we couldn't go lower. Please any help, ideas, experience. I am 48 and have Severe Sleep Apnea I need this machine to stay alive. My mother has been on CPAP for years without reflux her setting is only 7. Her father had it with no treatment and suffered from heart attacks and failing organs. So now I have a perfect opportunity for treatment and am suffering a reverse side effect.

Don't assume it's the Cpap - you may just be unlucky enough to have had the reflux kick in after you started it. It may well have been simmering prior to your being diagnosed (OSA) and you just weren't aware of it. It goes along with OSA in many of us (mine showed up a few years before my OSA diag). My best bet is to NOT take more and more antacids, prescribed or not, but just to be really vigilant about what you eat - and the hidden amts of irritants in processed or prepared food - and then just take a small Tums before bed, otherwise you end up in a vicious circle of having antacids suppressing TOO much acid all day long (when just a little protein - pinch of tuna, little bit of meat, etc) would take care of acid build-up and not set up a backlash of your system producing more acid in retaliation - the Tums alone may still leave you with a bit of reflux in the a.m., but eat a little something quickly and watch it go away. Better to give the acid something to work on, rather than trying to keep it from ever 'producing'. But stay away from caffeine in ANY form at all, even in the a.m. if you can stand it, and watch out for things like ginger, cinammon, garlic, etc. as well as more obvious things like tomato sauce, vinegar, etc.

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j_dow,

You have my sympathy with the double whammy. I do sincerely doubt that a cpap machine is going to *cause* acid reflux. I can believe it may expose what was already there.

The air pressure forcing its way down to your stomach is an added dimension you apear to have luckily avoided until going on cpap. I am on GERD treatment & still need to keep it up.

Good luck - not a nice thing to have to grapple with on top of OSA.

DSM

I dont know about it causing acid reflux, but for sure if you are getting air in your stomache, it could lead to things coming back up.

I, on the other hand, don't think that it is all that unusual for CPAP to contribute to reflux.

As we get older our muscles do tend to weaken a bit. If and when the LES (lower esophageal spincter is the term I believe) weakens, reflux can be the result. Silent reflux is not at all unheard of. Its not so much an overproduction of stomach acid as it is the weakened LES allowing some to flush thru. CPAP pressure, not so much as to cause obvious aerophagia, can definitely adversely affect a weakened LES.

Personally, as conservative as I am regarding medical treatments, I'd be inclined to back my pressure down by 1 cm for one week, check my data to see what that does to my AHI and see if that helps at all w/the reflux w/o changing in any way my reflux meds. I'm not sure that one week will tell you much about the reflux but it will tell you if it adversely affects your AHI and/or how rested you feel.

Of course, if you don't have a fully data capable Resmed S8 you have no way of knowing how it affects your AHI. I didn't check to see which S8 you use. Just my thoughts and I sure am no medical professional! Keep in mind that your titration was based on just one night of testing and usually the selected pressure is the pressure at which it stops ALL apnea events which can be higher than the pressure we really need.

This much I can tell you based only on my own experience. I have a slight sliding hiatal hernia (as do most people once they hit their 50s or so). Its never been a problem as far as reflux except about 5-6 years ago when I was experiencing some bacterial overgrowth in the intestines from Crohn's disease. Antibiotics treated that and no more problems. Now, at just under a year on CPAP (when it started), I occasionally run into the "lip flutters" (minor air escapes thru my lips on occasion) and it coincides w/some "aerophagia" type symptoms and some minor reflux. More frequent burping is the one obvious sign of the aerophagia and a tender area when pressed in the area of the LES an indication of the reflux. (This info via my gastro and my sleep pulmo).

J-Dow. Click on Profile at the top of the page which takes you to the info you provided on registering. Scroll down towards the bottom of the page and fill in the information about which CPAP machine you are using, which mask and humidifier. (We know w/the Resmed S8 that it will be a Humidaire 3i if it is an integrated humidifier). Look on the top of your S8 and it will say which model it is: Compact, Escape or Elite (It doesn't sound like you have the AutoSet Vantage which is an AutoPAP). That will help us when trying to offer any advice or suggestions. While the avatars for each machine are "cute", the text identity is easier and quicker for us to know which CPAP you are using. All Resmed S8s look alike in their avatar as do all Respironics M Series look alike in their avatar so we would have to click on the avatar to find out what type of machine you have.

Also, even tho it has only been two weeks for you on CPAP I would contact my sleep doctor and explain about the reflux and point blank tell him/her that I want to drop my pressure a bit to see if that helps. If he/she is against that then I would push for a 2 week loan of an autoPAP to more closely titrate my needed pressure.

In addition, I'd ask for a copy of my summary data report for both my sleep evaluation study and my titration study (about 5-6 pages, w/graphs) and my dictated results report (about 1-2 pages) if you don't already have them. That titration summary data will be the most revealing regarding pressure. They are part of your medical records so if you are in the US you have a legal right to copies. Refer them to HIPAA if they are reluctant or drag their feet giving them to you.

Thank you, all.

best thing you can do is elevate the head of your bed, even if you only raise it 3" it will help.

Don't eat anything 2-3 hrs before bed, take a PecidComplete right before bed (nothing else works as good in my opinion, berry flavor is great).

Straight CPAP can be pretty aggressive with that condition.

Snoredog wrote:best thing you can do is elevate the head of your bed, even if you only raise it 3" it will help.

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I agree here with 'Snoredog.' I had the same problem and took care of it by purchasing the "Mattress Genie." Now every nite I raise the head of my bed up approximately 12" and have not had any of those problems since. If your mate doesn't want that then you may need to purchase a 'pillow wedge.' If you do a search on those terms you will find lots of them.

Thank goodness I happened upon this post! The same thing has happened to me. No tummy trouble until I started using my CPAP machine. Then aerophagia and all kinds of pain throughout my whole upper and lower abdoen. I had to lower my pressure, but the doctor won't let me lower it any more. I wake up with gas and abdominal iscomfort. But now I also have a constant burning my esophagus.

In fact, I went to an ENT because my voice is hoarse and won't get better. He looked at my vocal chords and said that I had severe acid reflux. He immediately put me on prescription strength treatment.

Questions: Has anyone else had CPAP make acid reflux come on or get worse? And does raising the head of the bed really help?

ONe more question: does the type of mask make a difference. I use resMed nasal pillows

J

I know that cpap can cause severe aerophagia and this might contribute, IMHO to acid reflux. It's also possible that you have had silent GERD for quite some time and it just reared it's ugly head. That's what I had. I have raised the head of my bed 11 inches, per my GI doc. I had it lower, but higher does seem to work better.

However, this is one case where you need to continue with cpap and take care of the GERD. Sleep Apnea is an extremely serious condition. If there are higher pressures involved, I wonder if a bipap is in order, to offer some relief. I wonder if anyone knows if bipap is known to help with a problem like this? I'm not a bipap user, so have little info on it, but maybe some who knows more can chime in.

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No doubt in my mind that if you have any stomach issues at all Cpap will make them worse for a lot of people.

Snoredog wrote: Straight CPAP can be pretty aggressive with that condition.

It sure can be.... I was on straight cpap on a REMstar plus with c-flex set 10 and it was horrible. Then went to an REMstar Auto with C-flex.... which greatly improved on that problem. About about 3 weeks ago I went to the new M-series Auto with A-flex range 7-14 a=3 and have not had ANY problem with air in the stomach thus far


So, you might want to talk to your doc about either an Auto CPAP or a Bi-pap device.

Another treatment for serious GERD when the PPI's (proton pump inhibitors like prilosec) don't work sufficiently: your gastro doc can, if trained in the procedure, do an endoscopic plication in which they put in one or more stitches to strengthen the LES and prevent regurgitation. Think of it like a little sewing machine on the end of the endoscope

m