GERD and Sleep Apnea: What is the Link? 

 Key takeaways

• Sleep apnea and GERD are both common disorders that are not life-threatening but can lead to serious health consequences if left untreated. 
• There is a connection between sleep apnea and GERD—sleep apnea can worsen GERD symptoms, and on the other hand, GERD can also trigger sleep apnea. Both conditions also share similar risk factors.
• Treating either condition can improve the symptoms of the other. 

If you’re one of the millions of people suffering from gastroesophageal reflux disease (GERD) or sleep apnea, it may surprise you to know the presence of either condition puts you at an increased risk of developing the other.   

On the surface, sleep apnea and GERD appear unrelated. However, a closer look reveals a strong link between them. Sleep apnea is a common comorbidity (having more than one medical condition at a time) of GERD. 

This article explores the relationship between sleep apnea and GERD with research-based evidence. But before getting into that, it’s important to first understand what both conditions are and why they occur. 

 What is GERD?

GERD is a chronic disorder that causes the acidic content of the stomach to flow backward into the esophagus. This happens because the lower esophageal sphincter (LES), a muscular ring that separates the stomach and esophagus, doesn’t close as it should. 

Symptoms associated with GERD include heartburn (irritation of the esophagus by stomach acid), chest pain, bad breath, nausea, and difficulty swallowing. On rare occasions, GERD can also cause back pain.

GERD affects roughly 20% of the United States population. Although it is not a life-threatening condition, if left untreated for a long time, it can lead to serious health complications like Barrett’s esophagus and cancer of the esophagus.     

 What is sleep apnea?

Sleep apnea is a serious sleep disorder characterized by frequent breathing pauses during sleep. 

There are three types of sleep apnea: 

• Obstructive sleep apnea (OSA) 
• Central sleep apnea (CSA) 
• Complex sleep apnea

OSA is the most common type and affects about 26% of people aged 30 to 70 in the U.S.

In OSA, the pause in breathing is usually due to a blockage in the airways as a result of the relaxation of the muscles in the back of the throat that helps keep them open.  

A blockage doesn’t cause CSA. Instead, it occurs because the brain fails to send proper signals to the muscles that control breathing. It is usually caused by an underlying medical condition. 

Complex sleep apnea is a combination of OSA and CSA. It is also known as treatment-emergent sleep apnea because it is diagnosed when apnea doesn’t resolve after treatment for OSA. 

Sleep apnea symptoms can vary depending on the type. However, some symptoms that persist in all types include insomnia, daytime tiredness, inability to concentrate, and frequent morning headaches. 

 The Connection Between GERD and Sleep Apnea: What Research Says

Sleep disorders can induce or worsen the symptoms of GERD, and GERD can equally trigger sleep disorders. 

Here is a summary of the link between GERD and sleep apnea: 

When there is an obstruction in the airways, like in OSA, negative pressure builds up in the chest. This creates a positive pressure in the stomach, increasing the likelihood of acid flowing into the esophagus.  

Additionally, insomnia induced by sleep apnea can cause increased pain sensitivity and symptom severity in patients with GERD.

On the other hand, people with acid reflux may experience vocal cord spasms that make breathing difficult, leading to episodes of OSA.  

The results of several studies show that treating GERD improves the symptoms of OSA and vice versa.  

 Prevalence of sleep apnea among people with GERD

According to research, sleep apnea has a relatively high occurrence rate in people with GERD. 

A nationwide study in the U.S. showed that 12.21% of patients diagnosed with GERD had a concurrent diagnosis of OSA. In contrast, only 4.79% of patients without GERD had OSA.

GERD is more symptomatic and likely to be reported by patients than OSA. Therefore, OSA screening for patients diagnosed with GERD can be useful in preventing potentially dangerous complications.    

 Does GERD and sleep apnea share similar risk factors?

GERD and sleep apnea share several common risk factors. Some of them can’t be helped, while others are lifestyle choices that can be modified. 

One common risk denominator in GERD and sleep apnea is age. Over time, the muscles in the body get weak, including the lower esophageal sphincter (LES). LES malfunction becomes more likely, increasing the risk for GERD. 

In the case of OSA, aging leads to loss of muscle tone in the upper airway, which can cause frequent relaxation of the muscles during sleep. 

Older people are also at increased risk of CSA. This is because elderly people often have comorbidities associated with the development of CSA, like stroke, heart failure, and kidney disease.  

Obesity is another risk factor shared by people with GERD and sleep apnea. OSA is the type of sleep apnea generally caused or worsened by obesity.   

Fat deposits in the upper respiratory tract of obese people narrow the airway and increase the possibility of muscle failure, which can lead to OSA and hypoxia (low oxygen levels in the body). 

People with obesity are also more likely to develop hiatal hernia, a condition in which a part of the stomach protrudes above the diaphragm, increasing the risk of acid reflux. Hiatial hernia makes it difficult for the LES to function properly and delays acid clearance from the esophagus. 

Other risk factors associated with GERD and sleep apnea include:

• Alcohol use 
• Family history 
• Smoking 

 Why are GERD symptoms worse at night?

GERD symptoms are often more pronounced at night because, when people are active and upright during the day, gravity helps keep stomach acid down. However, when they lie down at night, it's easier for the acid to enter the esophagus. 

Another reason GERD symptoms can worsen at night is due to the physiologic change that occurs during sleep. While awake, high acid levels in the esophagus cause an increase in saliva production and swallowing frequency. During sleep, the secretion of saliva stops and swallowing rarely occurs.        

 How to get a good night’s sleep

If you have received a diagnosis of sleep apnea, GERD or both, there are a number of ways you can relieve your symptoms to get the quality sleep you need to function optimally. 

 1. Lifestyle changes

Making major lifestyle changes like quitting smoking and cutting back on alcohol consumption if you smoke or drink will help you sleep better at night. Drinking alcohol and smoking cigarettes can induce or worsen GERD and sleep apnea symptoms.  

Quitting alcohol or smoking can be difficult. If you need help, do not hesitate to seek out rehabilitation and cessation programs. Your doctor may also prescribe drugs to help reduce your cravings. 

Obese people or people with a higher BMI can reduce or eliminate OSA symptoms by embracing positive changes like lowering calorie intake and exercising more. Weight loss reduces the fat deposits in the tongue and upper airway that cause breathing difficulties.  

GERD patients also benefit from losing weight because it reduces abdominal pressure and the risk of acid flowing back into the esophagus.  

In addition, research has shown that elevating the head of your bed with bed risers or using wedge pillows can relieve symptoms of GERD and OSA. Gravity keeps stomach acid down when your upper body is elevated, and your airways stay open. 

Sleeping on your left side is another way to leverage gravity and reduce GERD symptoms. The esophagus is positioned centrally, while the stomach is on the left side of the upper abdomen. Lying on your right side pulls the acid toward the center of your body, increasing the likelihood of it entering the esophagus.  

Other lifestyle changes that can help people with GERD include:

• Not eating close to bedtime
• Eating small meals throughout the day instead of large ones
• Eating slowly 
• Avoiding known triggers like spicy food
• Wearing loose-fitting clothes to bed

 2. Healthy sleep habits

Proper sleep hygiene is about making your sleeping environment and habits conducive to quality rest. Practicing good sleep hygiene may not make your GERD and sleep apnea symptoms go away. However, it ensures that you get the best results from any efforts you put into getting interruption-free sleep. 

Here are some actionable tips for improving your sleep hygiene. 

 Follow a sleep schedule

Try to go to bed and wake up at the same time every day —including on weekends. This can reinforce your body’s circadian rhythm (internal clock) and make your sleep more restful. Ensure that your schedule allows you to get at least seven hours of sleep every night. 

 Do something that helps you unwind

Take the time to engage in a relaxing activity 30 to 60 minutes before bed. You can try reading a book, meditating, listening to soothing music, or doing light stretching, anything that helps ease the transition from wakefulness to sleep.  

 Create a sleep-friendly environment

A comfortable, quiet, dark room is ideal for falling and staying asleep. The best temperature for sleep is between 60°F and 67°F. 

It’s also important to turn off electronic devices like phones, tablets and laptops at least 30 minutes before turning in every night. The blue light these devices emit reduces your body’s melatonin levels and can make it difficult to fall asleep. 

 Avoid caffeine at night

Consuming coffee or other caffeinated beverages late in the afternoon can keep you awake and shorten your sleep duration. It is recommended to abstain from substantial caffeine use for at least six hours before bedtime.  

 Get physically active

Asides from aiding weight loss, regular exercise can also improve sleep quality. Simple aerobic exercises like walking for 30 minutes daily can make a difference.  

You can exercise any time of the day, as long as it is not too close to your bedtime. Vigorous exercise within an hour of bedtime can raise your body’s core temperature and make it harder to fall asleep.   

 Avoid or limit daytime naps

Napping during the day is a great way to reboot and reduce fatigue. However, it can cause sleep difficulties, especially in older people. If you need to nap during the day, do so in the early afternoon and ensure it’s not more than 30 minutes long.         

 3. Treatment

Sleep apnea and GERD are both treatable. But because symptoms and cases vary, what works for one person may not work for another.

Continuous positive airway pressure (CPAP) therapy remains the most effective treatment option for sleep apnea. It involves the use of a machine that continuously delivers pressurized air into your airways to keep them open while you sleep.  

Dental appliances may be prescribed for managing mild to moderate OSA. These custom-made devices push your lower jaw and tongue forward while you sleep to prevent obstruction of your airways.      

GERD is treated with antacids or stronger medications like H2 receptor blockers and proton pump inhibitors (PPIs), depending on the severity of the symptoms. 

Unlike antacids that contain bases that neutralize stomach acid, H2 receptor blockers and PPIs lower the amount of acid that the stomach makes. All three classes of drugs are available over the counter, and your doctor can prescribe a higher dose if necessary.  

A surgical procedure known as fundoplication can also be used to treat GERD. The surgeon wraps the top part of the stomach around the lower part of the esophagus and holds it in place with stitches to reinforce the lower esophageal sphincter. Some people may also find some supplements helpful for GERD symptoms.

 Wrap up

The global prevalence of sleep apnea and GERD is on the rise and highlights the need for awareness, early detection and treatment, especially in people with sleep apnea who usually don’t notice the constant pauses in their breathing while asleep. 

If you suspect you have sleep apnea or GERD, modifying your lifestyle and practicing good sleep hygiene may help alleviate your symptoms. If there are no improvements after a while, you should talk to your doctor. They are in a better position to carry out a diagnosis and advise you on treatment options.