GERD and Sleep Apnea: The Dangers of Having Both and How to Find Relief

If you’re dealing with both gastroesophageal reflux disease (GERD) symptoms at night and sleep apnea, it’s important to understand the serious health risks their combination can pose. These two conditions often coexist, worsening your overall well-being. This can lead to severe reflux sleeping issues, breathing difficulties, and even complications like acid reflux choking in sleep.

Research indicates that up to 60% of patients with obstructive sleep apnea (OSA) also experience GERD. This overlap creates a cycle of worsening symptoms and disrupted sleep. The pressure changes during sleep apnea episodes can intensify reflux, increasing acid exposure in the esophagus and making heartburn and nocturnal coughs more severe. At the same time, untreated GERD can increase the risk of developing or worsening sleep apnea, leading to respiratory and cardiac issues.

Recognizing the dangers of having GERD and sleep apnea together is essential to improving your quality of life, especially if you suffer from sleep apnea reflux or sleeping with GERD.

The Interplay Between Sleep Apnea and GERD

Obstructive sleep apnea (OSA) is a serious sleep disorder which is characterized by pauses or interruptions in breathing during sleep. It is caused by an obstruction of the upper airway and can have significant health complications. It impacts various physiological systems including the digestive system. 

The chronic stress response from OSA can redirect blood flow and nutrient supply away from the gastrointestinal system, disrupting normal digestive functions such as acid secretion, peristalsis, and nutrient absorption. This can affect nutrient breakdown and cause irregular bowel movements, worsening conditions like acid reflux during sleep.

How Sleep Apnea Could Trigger GERD

Sleep apnea can contribute to gastroesophageal reflux disease (GERD) due to the pressure changes caused by airway obstructions. When the airways are blocked, the pressure in the chest cavity reduces, which can cause stomach contents—such as acid, bile, and digestive enzymes—to flow back into the esophagus. This causes acid reflux symptoms, for example heartburn and regurgitation during sleep.

The stress associated with sleep disruptions worsen GERD symptoms, increasing the frequency of reflux episodes and prolonging esophageal acid exposure. This can cause intense heartburn during the night.

Common Symptoms of GERD

Many patients with GERD experience classic symptoms such as intense heartburn at night, chest discomfort, and acid regurgitation, which often worsen when lying down. You might notice acid reflux sleep apnea, characterized by a burning sensation that disrupts your rest and sometimes causes coughing or choking sensations. Other common signs include a sour or bitter taste in the mouth, difficulty swallowing, and a feeling of food sticking in your throat. These symptoms, particularly when they occur at night, can lead to significant sleep disturbance and in turn worsen the symptoms of sleep apnea.

Identifying Silent Reflux

Unlike typical GERD, silent reflux (also called laryngopharyngeal reflux or LPR) often lacks the hallmark symptom of heartburn, making it harder to recognize. Instead, you may experience symptoms like chronic hoarseness, persistent throat clearing, a sensation of a lump in the throat, or a frequent bitter taste. These symptoms can be easily mistaken for allergies or respiratory infections, but if left untreated can cause inflammation in the throat and voice box. Diagnosis typically requires examination by an ear, nose, and throat specialist to detect acid exposure beyond the esophagus and into the throat and larynx.

Lifestyle Modifications

Managing the combination of GERD and sleep apnea begins with meaningful lifestyle changes that reduce the impact of both conditions on your sleep and overall health. One of the most recommended strategies is to sleep on your left side, as this position has been shown to decrease reflux episodes and protect your esophagus from acid exposure. Elevating the head of your bed by at least six inches can also significantly reduce reflux during sleep, preventing stomach acid from traveling upward.

Your diet plays a significant role as well. Avoiding heavy, spicy, or acidic foods—especially within 2 to 3 hours before bedtime—helps minimize causes of nighttime heartburn and reduces the risk of acid reflux causing sleep apnea or making sleep apnea worse.

Limiting carbonated beverages, caffeine, and alcohol intake can also alleviate symptoms. Maintaining a healthy weight is particularly important, as excess weight increases pressure on your stomach and airway, exacerbating both GERD and OSA symptoms. Staying hydrated throughout the day (while reducing fluid intake close to bedtime) and engaging in regular physical activity can further improve your condition.

Medical Treatments: CPAP and Beyond

The most effective therapy for OSA is Continuous Positive Airway Pressure (CPAP) therapy. CPAP keeps the airway open during sleep, reducing apnea episodes and indirectly lowering reflux events by stabilizing breathing patterns. Effectively addressing sleep apnea with CPAP can reduce GERD symptoms in individuals who experience both conditions.

For GERD, medications such as antacids, proton pump inhibitors, and H2 blockers are commonly prescribed to reduce stomach acid production and protect the esophagus. In more severe cases, surgical options like fundoplication can strengthen the lower esophageal sphincter, preventing acid reflux altogether.

Dentists may also provide oral appliances to reposition the jaw, which can improve airway patency and reduce symptoms of both sleep apnea and reflux.

A combined approach that includes lifestyle adjustments, medical therapies, and sometimes surgical interventions offers the best chance of improving sleep quality and reducing GERD symptoms. A healthcare provider experienced in both sleep disorders and gastroesophageal reflux will be able to put together an individually tailored treatment plan for you.

Talk to your healthcare provider

Understanding the complex relationship between GERD and sleep apnea is essential for those experiencing persistent heartburn and breathing problems at night. These conditions often cause worsening of the other, leading to disrupted sleep and increased health risks. This includes the possibility of sleep apnea secondary to GERD.

Targeted lifestyle changes, such as sleeping with your head elevated, and medical treatments like CPAP therapy or acid-reducing medications, can help reduce and alleviate symptoms. If you frequently experience nighttime reflux, sleep apnea vomiting, choking sensations, or unexplained fatigue, speak to your healthcare professional so that you can address both conditions and restore your sleep and overall quality of life.