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Thursday, July 31, 2014
Throat Closing Up
Why does GERD (one of the causes of laryngospasm) become worse at night and is often silent in the day????
Gastroesphogeal reflux disease (also know as GERD or heartburn) is due to stomach (gastric) contents coming up into the esophagus and irritating the esophagus and/or the upper airway. GERD can be worse during sleep due to a number of issues:
1. We lie down when we sleep. Lying supine as opposed to being upright can increase the likelihood of gastric contents refluxing into the upper airway. Of interest, lying on your right side is more likely to promote GERD than lying on your back (lying on your left side is least likely to lead to GERD).
2. There are a number of physiologic changes that happen during sleep with the gastrointestinal system that can promote GERD. This includes increases in the amount of gastric acid produced by the stomach during sleep, decreases in the amount of swallowing and saliva secreted during sleep so refluxed acid is not neutralized as quickly as it is when awake, greater ease of gastric contents migrating up the esophagus during the sleep due to changes in esophageal sphincter pressures, and delay of emptying of stomach contents into the small intestine during sleep. These all can lead to increased GERD during sleep.
3. If you eat a large meal at night, you go to bed with a full stomach and are producing more acid, two factors that may predispose to night-time GERD.
4. Certain night-time behaviors, such as using alcohol close to bedtime, can also promote GERD at night.
If GERD is a problem for you, there are a number of things you can try to control this problem:
1. Try avoiding big meals at night as well as food that you find cause problems with reflux.
2. Avoid alcohol and caffeine containing drinks in the 4-6 hours before bedtime.
3. Elevate the head of the bed by about 30 degrees. This can be done with pillows or placing blocks under the legs of the bed.
4. Avoid sleeping on your right side.
5. Use an over-the-counter H2 blocker (i.e. cimetidine or famotidine) or proton pump inhibitor (i.e. omeprazole) 1-2 hours before bedtime.
In addition to the above measures, I recommend that you discuss this with your physician if you feel you are having issues with GERD, symptoms of stomach pain or burning or poor sleep related to this. It’s important to get a full history and exam performed in order to make sure appropriate testing, if needed, is completed as well as to ensure appropriate treatment is recommended.
Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University