Curious how to cure sleep apnea? For starters, it's important to understand the connection to GERD, and to acid reflux in general, even silent reflux.
Over the course of my career, I’ve continued to make observations and perform studies that link respiratory reflux to many respiratory diseases, now including sleep apnea.
In my practice, most patients with sleep apnea also had severe acid reflux in their throat, and the correlation appears to be a reliable diagnostic.
It is possible to reverse sleep apnea with anti-reflux treatment, but you need to follow the rules in my bestselling book Dropping Acid strictly enough to consistently prevent silent nighttime respiratory reflux.
How Reflux Ties to Sleep Apnea (Technical Section)
A 38-year-old came to see me with complaints of excess mucus, chronic throat clearing, and a sensation of a lump in the throat. On examination, he had findings of long-standing silent nighttime reflux. In particular, the caliber of the barrel of his throat was narrow and the lining membranes were thick, granular and inflamed (see below).
While I do not usually put medical photographs on my blog, in this case, two pictures are worth a thousand words. On the left is a normal throat looking from the top down (from the back of the nose all the way down to the vocal cords). This is normal!
This examination and photographs like this are taken by ear, nose, and throat physicians using an ultra-thin tube with a lighting fiber and camera on the end. It then is placed through the nose without pain. Your family physician or others do not usually perform this specific examination. It is an ENT exam. (I took the above photos.)
The photograph on the right is taken from the same spot high in the nose and looking down the patient’s throat. The findings are severe granularity, inflammation and narrowing from the back of the nose all away down to the voice box.
I asked the patient if he has sleep apnea and he confessed that he did. I also asked if he snored loudly, and he told me his wife made him sleep in another room.
I want to show you why this patient (and maybe you) snore, but before I show you those photos, let me talk about the palate and uvula.
The uvula is the little thing hanging down from the front of the palate seen here in its normal configuration and size. This is a view from the front. A normal small uvula is not seen with the examination that I use with my little examination tube that I place through the nose (these photos are seen from this angle, from the back).
Here are two examples of patients with silent nighttime reflux and large uvulas. The one on the right is gargantuan and resting on the epiglottis, which is part of the larynx. These people snore. (The photograph on the right is actually taken from the patient described above.)
For years, ENT surgeons have been removing parts of the palate and uvula as a surgical treatment for snoring. This is called an UPPP. While this procedure can stop snoring for most undergoing the surgery, it does not address the underlying cause.
In my practice, the uvula can return to normal size with anti-reflux treatment within weeks to months. The reason I show these photographs here in this blog is because to my knowledge these findings have never been reported in the medical literature.
For doctors, especially ENTs: The findings of silent long-standing silent nighttime reflux that cause both sleep apnea and snoring are: (1) cobble-stoning, erythyema and obliteration of the fossa of Rosenmuller (photo not shown), (2) a narrow granular pharynx, (3) an enlarged uvula, (4) thick mucus in the nose and throat, and (5) swelling of the back part of the larynx, the medical term of which is post-cricoid edema (shown below). Theoretically, swelling in this area helps keep reflux out of the lungs by creating a biologic barrier, like a levy.
For the average reader of this blog, these photographs may be meaningless or confusing. However, when your ENT doctor examines you – if you have snoring and/or sleep apnea — ask him whether these findings are present, because if they are, your snoring and sleep apnea are probably caused by reflux.
One final word about reflux and sleep. Even if you don’t have snoring sleep apnea, reflux can wake you up in the middle of the night coughing and gasping for air like a fish out of water. This is called a laryngospasm and it is a frightening symptom. Even if you don’t have laryngospasm, reflux can disrupt sleep. I cannot tell you how many of my patients tell me how much better they sleep once their reflux is controlled.
First, See If You Likely Have Reflux
The Koufman Reflux Symptom Index (RSI) is a proven tool to determine if you likely have acid reflux. Note that heartburn / indigestion is just one symptom in the index (which only 20% of refluxers experience).
If you have an RSI score of 15 or greater, you have a 90% chance of having reflux, even if you have never had heartburn or indigestion. This is called silent reflux, and it's very common.
Please understand that it’s important to take steps if you have reflux to manage it through lifestyle changes (explained later). If you let reflux run rampant, you’re setting yourself up for sleep apnea, COPD, chronic respiratory conditions, and a far higher risk of esophageal cancer.
Where to Get More Information
My best-selling book Dropping Acid with the companion book Dr. Koufman's Acid Reflux Diet provide a comprehensive plan to start. If you’d like an initial primer on reflux, this article is also wonderful.
If you've read at least one of my books and you're following my guidance and you still need help, you can book a consultation with me.