The Biggest Throat Problem for Sleep Apnea Sufferers

http://doctorstevenpark.com/biggestthro ... ment-37075

The Biggest Throat Problem for Sleep Apnea Sufferers
August 21, 2010
If you wake up every morning needing to hack up lots of thick mucous, or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into the full-blown viral symptoms.
Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.
Beware of the “Vacuum Effect”
People with obstructive sleep apnea are more prone to breathing problems at night due to partial or total collapse of one or more areas of the entire upper airway, from the nose to the tongue. It’s usually worse when on your back, since the tongue can fall back more in this position. During deep sleep, your muscles naturally relax and you’ll be more susceptible to breathing stoppages.
Pressure sensors placed inside sleep apnea patients reveal that every time an apnea occurs, a tremendous vacuum effect is created inside the chest and throat, which literally suctions up your normal stomach juices into your esophagus and throat. This can happen occasionally, even for normal people, but if you happen to have a late meal or a snack just before bedtime, there will be even more stomach juices lingering in your stomach to come up into the throat. If you happened to drink a nightcap, the situation is even worse since alcohol is a strong muscle relaxant.
What comes up into your throat is not only acid, but also bile, digestive enzymes, and even bacteria. Washings of lung, sinus and ear contents have shown H. pylori, a common stomach bacteria, and pepsin, a major stomach digestive enzyme. So what comes up can cause severe irritation in your throat, provoking the mucous secreting glands of your throat to try to dilute these substances.
Although people generally attribute throat mucous to post-nasal drip, in most cases there’s nothing dripping down the back of the throat. It’s actually coming from your stomach. However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle.
Chronic acid and other irritating substances lingering in your throat can have other detrimental effects. One recent study showed that chronic acid exposure can numb or deaden the protective chemoreceptors in your throat. These are sensors that detect any acid in the throat to prevent aspiration of your stomach contents into your lungs. If these chemoreceptors sense any acid in your throat, a feedback signal is sent to the brain, causing you to wake up so that you can swallow. This is what’s called a reflux arousal.
Treating Reflux For Good
So besides not eating late and avoiding alcohol close to bedtime, what else can you do?
I’m assuming that many of you that are reading this article are already being treated for obstructive sleep apnea, via either CPAP, oral appliances, or even with surgery. The problem is that no matter which option you choose, there will always be some degree of reflux. Taking acid reflux medications can help sometimes, but for the most part, these reflux medications don’t really do anything for reflux. All they do is to lower the acid content content before it comes up into your throat.
Other options include stimulating your stomach via natural remedies or prescription medications to empty your stomach much faster. One fascinating study showed that using a combination of pseudoephedrine (Sudafed) and a pro-motility agent (domperidone) eliminated snoring in most people. Unfortunately, we don’t have the equivalent of domperidone here in the US. Other similar medications are available, but have more serious side effects.
This is why eating early at least 3-4 hours of bedtime is so important whether or not you have obstructive sleep apnea. The same also applies to alcohol. If your nose is stuffy, talk with your doctor to find a way to breathe better through your nose. Make sure you’re sleeping in your preferred or optimal sleep position. Lastly, work with your sleep physician to fully optimize your sleep apnea treatment, no matter which option you choose.

Thank you for this amazing information! Very helpful...

Great article.... I've added Dr. Park's blog to my Google Reader feed. He has some great posts.

Very interesting...any GERD sufferer should read this.

OMG, every light bulb went off when I read this..

IT EXPLAINS EVERYTHING!!!

I always suspected this stupid osa caused my LPR !
(Laryngopharyngeal reflux)

I also have high hopes that apap therapy would cure the LPR, because I LOVE to sing..

This is a fantastic article, thanks so much for sharing it, and I signed up for
the newsletter and the pdf file, etc..

wow!

Not many Sleep Docs or GPs are welling to explains well as Dr.Park and his partners.
Good that he show the problems and SOLUTIONS!
Unlike many Sleep Docs just lips serving.
Highly Valuable.
God Bless.


Watch Dr.Park Web sites.
Come to this forum for Q&A.
Customize to Suit yourself,

Thank you for posting this! It explains a lot.

Ditto the lightbulb moment! I was recently diagnosed with LPR and have had no relief despite Protonix 40mg twice/day and following a restrictive diet as well as not eating close to bedtime. I never was informed how OSA and LPR were related physiologically. This makes so much sense. I wish I could figure out how long it's going to take before I feel better. My throat burns most of the time with a constant lump, hoarseness, and choking at times. I even wondered if the CPAP was causing it because my symptoms are so much worse since I had surgery in May.

Thanks for the information. If anyone has experience with LPR, please let me know what worked best for you and how long it took to feel better.