At-A-Glance
- Acid reflux (especially nighttime respiratory reflux) and sleep apnea are closely connected: Silent reflux can lead to airway inflammation and, over time, cause obstructive sleep apnea.
- Lifestyle changes can help manage both conditions: Avoid eating close to bedtime, eliminate carbonated beverages, and follow a low-fat, low-acid diet for improved sleep and reduced reflux symptoms.
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The rise of sleep apnea in recent decades has paralleled increases in obesity, asthma, and acid reflux. While much attention has been given to sleep apnea as a standalone condition, the connection between acid reflux and sleep apnea has been overlooked. Exploring this connection can explain why so many individuals struggle with both conditions simultaneously. Understanding Sleep Apnea
Sleep apnea is a condition characterized by repeated interruptions in breathing during sleep. There are three types of sleep apnea:
- Obstructive Sleep Apnea (OSA): The most common form, OSA occurs when the airway becomes physically blocked, often due to inflammation, excess tissue in the throat, or narrowing of the airway.
- Central Sleep Apnea (CSA): A neurological condition in which the brain fails to signal the muscles to breathe properly.
- Complex Sleep Apnea Syndrome (Mixed): A combination of OSA and CSA, this is less common but presents challenges for diagnosis and treatment.
While CSA is frequently mentioned in medical literature, I’ve observed that fewer than 10% of patients with sleep apnea have CSA. Most cases involve OSA, which may have a notable link to acid reflux … reflux testing and examinations both point to chronic SNoRR (Silent Nocturnal Respiratory Reflux) as the primary cause of sleep apnea.
The Role of Acid Reflux in Sleep Apnea
A decade ago, I began noticing a distinct pattern among my patients. Many individuals diagnosed with sleep apnea also exhibited signs of swollen and inflamed upper throat tissue—a hallmark of acid reflux. Silent reflux, which lacks typical symptoms like heartburn or regurgitation, is often the culprit.
What is Silent Reflux?
Silent reflux, also called laryngopharyngeal reflux (LPR) or Respiratory Reflux, primarily affects the respiratory system. Unlike GERD (gastroesophageal reflux disease), which impacts the esophagus, silent reflux involves acidic and non-acidic gastric contents reaching the throat, voice box, and even the airway.
One specific form, silent nocturnal respiratory reflux (SNoRR), occurs during sleep. At night, stomach contents can flow into the airway, causing inflammation and narrowing the airway over time. This process may lead to snoring, gasping, and eventually obstructive sleep apnea.
How Acid Reflux Worsens Sleep Apnea
Chronic nighttime reflux damages tissues in the upper airway, contributing to swelling and narrowing; see photo above. Over the years, this inflammation increases the likelihood of airway obstruction during sleep. Based on my experience treating over 100,000 reflux patients over the past 50 years, it often takes a decade or more of untreated nighttime acid reflux to develop sleep apnea. This gradual progression highlights the importance of early intervention.
After years of observing these cases, I became adept at identifying sleep apnea based on physical examination alone. Time and again, I would ask patients, “You didn’t tell me, but do you have sleep apnea?” Almost always my suspicions were confirmed.

The photo above shows the swollen throat of a person with sleep apnea caused by acid reflux. All the tissue that looks like rolls of fat screams, “Reflux Sleep Apnea!” FYI: That’s not a normal throat in any way; it should be smooth, wider, and much much more open.
Why Conventional Testing Falls Short
Unfortunately, standard acid reflux and sleep apnea tests often fail to capture their connection. Gastroenterological tests like pH monitoring or endoscopy detect acid in the esophagus but may not identify respiratory reflux affecting the airway. Similarly, sleep studies focus on breathing disruptions without investigating the underlying reflux issue. Comprehensive testing that examines both reflux and sleep apnea together would provide deeper insights and improve treatment strategies.
Unique Challenges for Women
In my practice, I’ve observed a surprising trend: women are less likely to snore than men but still suffer from severe reflux-related sleep apnea. Testing reveals that 100% of women under 60 who snore have significant respiratory reflux. Left untreated–in addition to sleep apnea–this combination can lead to serious complications, including aspiration, pneumonia, and even airway cancer. Women with snoring and reflux symptoms should seek lifelong treatment to prevent these outcomes.
Effective Treatments for Acid Reflux and Sleep Apnea
Addressing acid reflux can significantly improve sleep apnea and overall sleep quality. Here are evidence-based strategies:
- Avoid eating and drinking within five hours of bedtime. Eating late increases the likelihood of nighttime reflux as lying down allows stomach contents to flow into the airway.
- Eliminate alcohol and carbonated beverages. Alcohol weakens the lower esophageal sphincter (LES), while carbonated drinks increase stomach pressure and activate pepsin, exacerbating tissue damage.
- Sleep on an incline. The higher the better; if you can, go for about a 45-degree incline. You can use a recliner, or if you can afford to do so, consider getting a bed that inclines mechanically.
- Follow a low-fat, low-acid diet. Low-acid foods prevent pepsin activation, while low-fat meals reduce stomach pressure and maintain LES integrity, minimizing reflux episodes.
- Minimize processed food, fast food, and red meat. These foods delay stomach emptying, weaken the LES, and stimulate excess acid production, worsening reflux symptoms.
- Drink alkaline water. Alkaline water neutralizes acid and deactivates pepsin, protecting tissues in the airway from inflammation.
- Use an alginate supplement before bed. Alginate creates a gel-like barrier in the stomach, preventing acid and pepsin from reaching the esophagus and airway, which can reduce nighttime reflux and improve sleep apnea symptoms.
Conclusion
The link between acid reflux and sleep apnea is more significant than many realize. Silent reflux, particularly during sleep, plays a critical role in the development of obstructive sleep apnea by causing chronic inflammation and narrowing of the airway. Recognizing the signs early and implementing lifestyle changes can help manage both conditions, improving sleep and overall health. By addressing acid reflux proactively, individuals can reduce the risk of long-term complications and enjoy more restful nights.
For more information about diagnosis and treatment of acid reflux, see two companion books on Amazon: Dr. Koufman’s Acid Reflux Diet and Dropping Acid: The Reflux Diet Cookbook & Cure. If you would like to receive personalized guidance and strategies for lasting relief, consider scheduling an online consultation.