Gastroesophageal reflux disease (GERD) has become a very common condition. In this disorder, stomach acids leak out from the stomach and accumulate in the throat and/or mouth. The result can be painful mouth and throat sores as well as damage to the teeth.
We know that there’s a connection between sleep apnea and GERD, but we’re not sure exactly what the relationship is. Research gives us tantalizing clues, but so far there is no convincing evidence of a single definitive scenario.
Does Sleep Apnea Cause GERD?
One possible explanation for the relationship between these conditions is that sleep apnea causes GERD. This wouldn’t be too far-fetched. We know that sleep apnea causes or worsens many dangerous health conditions.
There is some evidence that sleep apnea causes GERD. One of the studies suggesting this relationship is based on the fact that GERD attacks are 2-4 times more common after an arousal or awakening caused by sleep apnea.
Another study found that although the attacks didn’t seem to be related in time, people with sleep apnea had five times as many GERD attacks and spent nearly six times as much time with an acidic pH in their throat as people without sleep apnea.
One possible explanation of a causal effect is that apneic events reduce the pressure in the esophagus and body as a whole. This reverse pressure makes it easier for the contents of the stomach to bubble out.
Does GERD Cause Sleep Apnea?
This seems like the least likely scenario. There is an uncommon theory that GERD irritates the vocal cords, triggering a spasm that leads to airway collapse. This has not been confirmed with quality research at this point.
However, there are many who point out that GERD is strongly associated with sleep disturbance. When people with GERD experience irritation of their throat, they are likely to report disturbed sleep.
Does Obesity Trigger GERD and Sleep Apnea?
Another possibility is that neither GERD nor sleep apnea causes the other, but both are effects of a third condition: obesity. Obesity is associated with both conditions. We have even established that obesity is a likely cause of both conditions.
One small study set out to prove whether obesity was the cause of both conditions, or whether GERD might be more common in people with sleep apnea, even if they weren’t obese. This study had three groups: obese individuals without sleep apnea, non-obese individuals with sleep apnea, and individuals who were obese and had had sleep apnea.
Researchers found that obese individuals had more GERD attacks than non-obese individuals. Obese individuals with sleep apnea had more GERD attacks than obese individuals without sleep apnea. However, the difference was not very large from a statistical standpoint. Therefore they concluded that obesity is the cause of both conditions, although they acknowledge that their data is limited.
The Most Likely Scenario
Based on the research, the most likely scenario is that obesity causes both GERD and sleep apnea. However, once the conditions have been triggered, sleep apnea likely worsens GERD. It is extremely unlikely that GERD triggers sleep apnea.
Sleep Apnea Treatment Improves GERD
No matter what the true causal relationship between these conditions, numerous studies show that sleep apnea treatment improves GERD symptoms. In one study from 2016, 79 patients with GERD and sleep apnea were prescribed CPAP. Patients who complied with CPAP saw a 62% decrease in their nightly GERD symptoms.
In a 2003 study, patients who had nighttime GERD and used CPAP saw a 48% improvement in their symptoms. Those who didn’t use CPAP saw no improvement in their symptoms. This study also noted that the higher the pressure setting on their CPAP, the better their GERD improvement.
One study also showed that people without sleep apnea who used CPAP also saw their GERD symptoms improve, suggesting that CPAP might be responsible for the reduction, independently of sleep apnea treatment.
Will Oral Appliance Therapy Help GERD?
As with many studies of sleep apnea treatment, it seems that most studies about the impact of treatment on GERD focus on the use of CPAP. This makes it hard to say whether oral appliance therapy will help with GERD symptoms.
There is some evidence that it’s the pressure of CPAP that makes it effective against GERD. Essentially, the air forced into the esophagus reduces the pressure drop that contributes to stomach acid bubbling out of the stomach. This would explain how CPAP can help people even if they don’t have sleep apnea.
However, there are two other factors to consider here. First, it’s important to note that sleep apnea incidents can trigger pressure drops in the esophagus. Reducing the number of apneas a person experiences should reduce the amount of reflux they experience, whether the reduction comes from CPAP or from an oral appliance.
Second, CPAP still has a huge compliance problem. In some of these studies, compliance rates were less than 50% even over six months. This means that most of the people prescribed CPAP aren’t seeing benefit for GERD anyway. It’s worth it for these people to try oral appliance therapy. They will benefit from treating their sleep apnea and might also see improvement in GERD symptoms.
Oral Appliance Therapy for Sleep Apnea in Columbus, OH
If you have sleep apnea, and CPAP isn’t working for you, it’s time to try another way. Sleep dentist Dr. Mike Firouzian can help you try oral appliance therapy. This is a highly effective treatment for controlling sleep apnea symptoms and effects. To learn whether this treatment is right for you and can help improve your sleep apnea symptoms, please call (614) 683-4640 today or use our online form to request an appointment at Firouzian Dentistry in Columbus, OH.
