Acid in throat while sleeping

by Acid

I wake up sometimes from sleep gasping and with a large amount of acid build up in my throat.

I usually sleep on my side.

Is this sleep apnea?

Answer

Acid in throat while sleeping is a pretty classic description for a stomach problem which is often accompanied by indigestion. This problem is called Gastroesophageal Reflux Disease (GERD), also known as acid reflux or heartburn.

In a patient with acid reflux, the partially digested stomach contents are regurgitated up into the esophagus. Acid reflux occurs when esophageal sphincter does not work properly and allows acidic stomach contents back up into the esophagus.

Too much food in the stomach or increased pressure in the stomach can cause the sphincter to relax. Long-standing acid reflux or GERD can result in pain and bleeding.

There is always acid, mucus, enzymes, bile in the stomach - empty or full. Granted, there may be some more in the stomach after a meal, but the primary problem with food in the stomach is that it increases intragastric pressure which in turn increases the pressure gradient across the esophageal sphincter.

If that pressure gradient is greater than the contraction pressure of the esophageal sphincter at any given moment, reflux happens, and that can be exacerbated if you're laying flat where gravity isn't assisting at keeping stomach contents in the stomach.

The main reason not to eat after 8 pm or so is to keep the intragastric pressure as low as possible when you lay flat and increase that gradient. I concede that it may also be helpful to keep acid content down, but that's not the big problem. It's the reflux, not the acid.

Reflux is all about that pressure gradient across the esophageal sphincter because there is negative pressure in the chest (where the esophagus is) and positive pressure in the abdominal cavity where the stomach is.

If you have about -5 mmHG average pressure in the chest cavity and +5 mmHg pressure in the abdominal cavity (those are typical averages for non-obese people standing up with an empty stomach), then the esophageal sphincter has to have a mean pressure of at least 10 mmHg to keep gastric contents out of the esophagus.

Things that increase intragastric pressure include full stomach, obesity, bending over, and lying flat. In addition, increasing the pressure gradient across the esophageal sphincter, you can have transient inappropriate esophageal sphincter relaxation, wherein the esophageal sphincter has lower contraction pressure and allows reflux.

Things that contribute to inappropriate esophageal sphincter relaxation include full stomach, nicotine, caffeine, alcohol, and a wide variety of foods and spices (such as garlic, tomatoes, other stuff).

Bottom line, to stop reflux it's most important to address the pressure gradient across the esophageal sphincter, not the amount of acid in the stomach.

You should also know that gastroesophageal reflux disease (GERD) rates are increased in individuals with obstructive sleep apnea. Studies show that the severity of GERD also increases with an increase in the AHI.

In patients with obstructive sleep apnea, treatment of GERD has been shown to decrease the number of arousals during sleep.

Peptic ulcer disease, ischemic heart disease, sleep apnea, abnormal swallowing, and sleep choking syndromes may be mistaken for gastroesophageal reflux. So I think you should speak with your doctor about your problem to prevent wrong diagnosis.

I hope it helps. Don't be afraid to comment back.

Remy Thierry
Founder of Sleep Apnea Guide

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