WED, Heartburn, and GERD

[debbluebird]

My stomach has been very upset since I started the thyroid med. I was living on antacids. I don't like that. So that is the main reason. Since eliminating wheat(all gluten), sugar, dairy (mainly milk), tomatoes, and processed foods I feel much better. I knew that it was tearing up my stomach and esophagus.

[ViewsAskew]

I never has issues with reflux or acid indigestion until I did two things. First, I decided to take cinnamon capsules. There is a history of diabetes in my family and I am always doing things to keep my blood sugar low. I have never had a high test, but it's one of those slightly irrational things a person does. The cinnamon created INSTANT and severe heartburn. I stopped the cinnamon, but it seemed that opened the gate and it happened more frequently in situations it wouldn't have before. Shortly thereafter, I was prescribed opioids. I've heard other people say that opioids increase heartburn and the Mayo Clinic lists them on their website. Each time I've stopped taking them, my stomach is immediately better.

I take an acid blocker daily - I'd be in constant pain without it.

[debbluebird]

White bread and soda crackers would give me acid.

[ViewsAskew]

let me rephrase - white rice would give me acid - pick anything without a high acid or fat content that isn't on one of the "deadly" food watchlists, and I'd still have acid. It wasn't gluten or grains or wheat for me, sounds like it may be for you.

[Frunobulax]

I never has issues with reflux or acid indigestion until I did two things. First, I decided to take cinnamon capsules. There is a history of diabetes in my family and I am always doing things to keep my blood sugar low. I have never had a high test, but it's one of those slightly irrational things a person does. The cinnamon created INSTANT and severe heartburn. I stopped the cinnamon, but it seemed that opened the gate and it happened more frequently in situations it wouldn't have before. Shortly thereafter, I was prescribed opioids. I've heard other people say that opioids increase heartburn and the Mayo Clinic lists them on their website. Each time I've stopped taking them, my stomach is immediately better.

I take an acid blocker daily - I'd be in constant pain without it.

Interesting. Have you read http://chriskresser.com/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd?

I mentioned before that I suspect a connection between my GERD (gastroesophageal reflux disease) and WED...

[ViewsAskew]

I have read something similar. Loooooong ago when it first started. I used something (can't remember what) that was supposed to test this theory. Unfortunately, I failed the test. I wonder if I still have the substance....

I just looked, but I seem to recall it was HCL of some kind and I also had licorice of some kind.

I did some searching and found the two tests I did - http://scdlifestyle.com/2012/03/3-tests ... mach-acid/ . One was the betaine HCL and the other was the baking soda one. Neither showed I had low acid.

My WED was horrible long before I had stomach acid issues, unfortunately. It's very likely there is a correlation for some. Research has shown people with IBS are more likely to have WED, for example, and it sounds like this is possibly related.

I've removed these posts into their own thread as I don't want to hijack the OPs thread.

[Frunobulax]

I'm not sure if low stomach acid causes severe problems - a LOT of people seem to live fine with it. But then, it should be safe to experiment with Betaine HCl for some time.
Since I take antiacids the test would surely report low stomach acid. I did order Betaine HCl pills and intend to live gluten-free for a few weeks. Let's see if I can take the HCl pills without severe heartburn, and if this combination influences my WED, or the amount of antiacid pills I have to take.

[ViewsAskew]

Would be great if it works!

[Rustsmith]

One of the theories about the type of sleep disordered breathing that I have is that it is a cause of GERD. The idea is that during a breathing event, a vacuum is created in the esophagus as the throat closes off. This vacuum then opens the valve between the base of the esophagus and the stomach and then draws stomach acid back up above the valve. This results in the reflux part of GERD and eventually weakens the valve to allow GERD at other times. The pressure in my esophagus was measured during my sleep study and I was told that it reached reached levels of 27cm of vacuum (meaning 27cm less than atm pressure).

[ViewsAskew]

One of the theories about the type of sleep disordered breathing that I have is that it is a cause of GERD. The idea is that during a breathing event, a vacuum is created in the esophagus as the throat closes off. This vacuum then opens the valve between the base of the esophagus and the stomach and then draws stomach acid back up above the valve. This results in the reflux part of GERD and eventually weakens the valve to allow GERD at other times. The pressure in my esophagus was measured during my sleep study and I was told that it reached reached levels of 27cm of vacuum (meaning 27cm less than atm pressure).

Is it possible that people diagnosed with OSA might have this instead? My husband and his brother both have terrible GERD and OSA. My husband has few of the OSA risk factors - including that he's not heavy. Might be no relation, but your description definitely made me wonder.

[Rustsmith]

It is definitely possible. Very few sleep labs are set up to perform the tests that are required to properly diagnose UARS. It requires additional equipment and training. UARS also cannot be diagnosed with the home sleep studies that the insurance companies prefer. My doctor had to get pre-clearance for me start out in the lab. Add to that the fact that the insurance companies will not cover CPAP for UARS and it tends to push even the labs that can get the diagnosis to say that it is OSA so that the patient can get their machine paid for. Finally, there is some controversy that UARS is low end of a the OSA spectrum, which once again pushes the doctors to say that it is OSA.

For the UARS purists, the theory is that UARS is due to a collapse in the upper throat or nose that limits air flow. This results in a vacuum. There is evidence of nerve damage in the throats of OSA patients that is not present with UARS (presumably the nerve damage is due to years of snoring). Therefore, when the airway is blocked with OSA, the person only reacts when the CO2 levels in the blood get too high. With UARS, the nerves still work, so the throat sends a signal to wake up - thus creating a micro-arousal and the person wakes up before a true apnea event has time to occur. UARS patients generally do not show O2 desaturation during their sleep studies (O2 levels stay above 90) while OSA patients will frequently show O2 levels below 80.

UARS patients typically have thin builds with narrow jaws. The narrow jaw means a small opening at the back of the mouth, hence less to block off and a tongue that sits further back in the mouth ready to block the throat during REM sleep. Deviated septums and enlarged nasal tissues due to chronic allergies or infections are also typical. There is even one theory that it is associated with some asthma due to suction of stomach contents into the lungs.

[ViewsAskew]

He's definitely that thinner build, has had nasal surgery, and has both asthma and chronic allergies. Hmmmm. But, sounds like it doesn't really matter in that you still need the CPAP?

[Rustsmith]

I still need it, but I use a slightly higher pressure than the normal OSA testing would have recommended. I have also altered the treatment parameters on my APAP machine to be more sensitive to hypopneas.

However, CPAP is not reported to be effective for some UARS patients (the basis for no insurance coverage). Part of this is due to our (UARS patients) increased sensitivity as compared to OSA, which makes it more difficult to adjust to sleeping with a mask and more likely to discontinue treatment. The other part may well be that they do not have enough pressure due to inadequate testing, which makes the treatment pretty much a waste of time because it is not going to keep the airway open.

A partially telling question that I got during my initial exam was whether I had trouble swallowing large pills. The question was asked in a tone where she knew that I was going to say an emphatic Yes.

[ViewsAskew]

Interesting. Thanks for the info.

[Frunobulax]

I still need it, but I use a slightly higher pressure than the normal OSA testing would have recommended. I have also altered the treatment parameters on my APAP machine to be more sensitive to hypopneas.

Well, I guess I may have UARS too. During the last checkup with the CPAP I had no apneas, but arousals that were assumed to come from PLMS.
How much higher do you set the pressure? I do feel that the pressure could be a bit higher for me (currently set to 7-13).
I guess I'll have to discuss this with my sleep doctor, since I can't alter treatment parameters myself. (I have a Weinmann machine that reads the parameters from the SD card, and the configuration comes with a CRC check.)

Still, I'm not sure about the connection with GERD in my case. My GERD did not seem to improve when I started APAP treatment - and the snoring (and apneas) seem to be more connected with the amount of WED medication I take. My wife reported breathing pauses first when I took large doses of pramipexole, and snoring/apneas got a lot worse when I switched to opioids.