Breathing problems while sleeping leaving me tired and miserable

[Sarahsmom46]

Dear Dr. Park,

You have been so helpful for us on the MS forum, thanks.  Since this isn't really an MS question, I thought I would post it to the sleep disorders forum.

I wanted to ask you a question about breathing problems people have during sleep making it hard to lay flat.  In my case the culprit is most likely acid reflux that is then getting in to my lungs that then is causing some lung issues.  I have tried everything the doctor suggested including lifestyle changes and medications, but the fact is I'm still waking up several time a night with breathing issues and lately that includes hiccups. No kidding, painful hiccups in the middle of the night.  ;-(

A friend suggested that since I'm having problems sleeping while lying flat that I should try using one of those wedge foam pillows to see if that would help with the reflux and the breathing problems.  What do you think of patients using these types of pillows?  Is there anything I need to keep in mind about using it long-term other than the fact that its not a natural way to sleep?  Are there any other options?  

Thanks so much for your help.  Much appreciated!

Julie

[Steven Y Park, MD]

Thanks for your great question. The traditional recommendation for what you describe (GERD) is to sleep inclined, either using pillows, or better yet, elevate the head of your bed by placing 2-4 inch blocks under the feet only at the head. Other recommendations include not eating close to bedtime (3-4 hours), avoiding alcohol for the same timeframe, avoiding spicy or citrus containing foods, and avoiding tight-fitting clothes.

However, what I propose in my book with my sleep-breathing paradigm is that all modern humans (to various degrees), due to certain anatomic reasons, are susceptible to breathing pauses at night. Most people with these issues naturally prefer not to sleep on their backs. But even sleeping on their sides or stomachs is not good enough, leading to intermittent obstructions and arousals. This process also creates a vacuum effect in your throat, actively suctioning up normal stomach juices into your throat. This is why all the traditional recommendations for GERD doesn't work all the time.

Also, what comes up is not only acid, but bile, digestive enzymes, food, and bacteria. Even microscopic amounts of normal stomach juices can irritate the throat. Furthermore, it's been shown that these juices can then reach the lungs, ears, nose and sinuses!

Is there a reason why you have to sleep on your back? Did you use to sleep on your side or stomach in the past? If you now must sleep on your back then using a contour-type pillow that bends your head back slightly may help, as this opens your airway somewhat.

I don't know your full medical history, but if these problems persist, you should consider a formal sleep study sooner or later. It's been shown that you don't have to snore or be overweight to have sleep-breathing problem. Take a look at my articles on sleep position, upper airway resistance syndrome and obstructive sleep apnea.

[Sarahsmom46]

Thank you for the very informative response.  I will definitely take a look at the articles.  

I should have mentioned that I did have a sleep study about 5 months ago.  I didn't understand most of the report from the copy the doctor gave me, but was told that I have only mild sleep apnea and it wasn't anything to worry about or need to be treated.  I guess I did well that particular night.  

By the way, I am definitely a side sleeper and have been for many, many years.  I notice that when I do awaken at night that I just happen to be laying flat on my back for some reason.  Also, when I use the wedge pillow, I still sleep on my side.  Its uncomfortable, but its better than nothing.

I'll look into a contour pillow and see if that helps.  Thanks again for your response and I hope the suggestions you gave will help.  

Take care.

Julie