Waking up choking
June 12, 2011 1:22 AM   Subscribe

About once a month, I wake up severely coughing and choking on my own vomit. What's the best course of action when this happens, and how I can stop it happening? (icky details within)

As you can imagine, this is really gross and unpleasant. It's also scary because I'm worried about what might happen the next time I start aspirating on vomit. What if I don't wake up? Am I going to die in my sleep??

Typically the way this goes down is that I just happen to wake up coughing and I taste acidy vomit. I get up and continue coughing really hard until I can breathe normally. I usually drink quite a lot of water at this point (two or three 16-ounce glasses) trying to soothe things. When I'm confident the coughing has stopped, I usually try to go back to bed, and things are ok by the morning. So my first question is: Is this the correct procedure for dealing with this problem??

As for cause... I am not sure, really. I rarely drink alcohol, and I haven't noticed any correlation with any particular food. I do have some generalized GI issues, including heartburn. I take Prevacid pretty regularly, but I still have problems. I also get frequent digestive distress, loose bowels, diarrhea & constipation, etc. I sleep with three pillows to elevate my head because of the heartburn. So my second question is: Why the hell is this happening, and is there any way I can stop it??

Unfortunately, I do not have health insurance (nor do I have a regular GP). So if I need to see a doctor, please be as specific as possible as to what kind of doctor, where to find such a doctor, and what questions I need to ask to try to get this cleared up with as few appointments and the minimal expense possible.

I'm a 31-year-old woman... not sure what other info might be relevant, but please ask if there's some other detail that might help. I'm not sure how long this has been going on, but I'd say about a year or a bit longer. Oh, and I know YANMD, but I would still like your input.
posted by pupstocks to Health & Fitness (29 answers total) 5 users marked this as a favorite
IANAD, but you really need to see a gastroenterologist ASAP. Even with significant acid reflux, waking up and choking on vomit is seriously abnormal. My only other suggestion would be to supplement your Prevacid with a more short-term acid reducer with a different mechanism, such as Zantac. Even if that helps, though, you should really see a doctor for this.
posted by tau_ceti at 1:27 AM on June 12, 2011 [3 favorites]

You need to see a gastroenterologist, a specialist who does nothing but work on disorders of the GI tract.
posted by Blazecock Pileon at 1:28 AM on June 12, 2011 [2 favorites]

Gastroenterologist, stat. Here's a physician finder that can help you get started. I would literally start going down the list to find someone who will see you ASAP; if you can't see someone in the next week or so, consider at least going to an urgent care office, as even a GP might want to give you a prescription for an acid reducer or proton pump inhibitor.

I know that cost is an issue (and a worry), but try to place that on the back burner for now. Some doctor's offices will try to work with you to set up a payment plan when you don't have insurance.
posted by scody at 1:37 AM on June 12, 2011

Alas, I was afraid you guys would say that. :) Ok, message received and I will start my search in earnest on Monday. I'm in a rural area and on webmd, the closests gastroenterologists are 90 miles away, and of course it's TBD whether any of those people can see me asap... so if anyone has any suggestions for anything I can do while I'm waiting to see someone, I would very much appreciate them. Thanks guys.
posted by pupstocks at 1:50 AM on June 12, 2011

I work with people with voice problem where acid reflux is often a large contributing factor. What you are describing sounds like a typical symptom of reflux coming up high enough to enter your larynx.

It might be different for you, but in the UK this can be treated by your GP. They typically prescribe proton pump inhibitors like omeprazole or lansoprazole.

You may already be taking all reflux-prevention advice, but this might include:
* avoiding fatty foods
* avoiding spicy foods
* avoiding acidic foods (tomato, citrus)
* avoiding caffeine
* limiting alcohol
* some people recommend avoiding dairy products and chocolate
* not eating less than two hours before bed
* raising the head of your bed (bricks under the legs of the bed can work better than extra pillows because extra pillows can just put your neck at an awkward angle)
* lose weight
* eat smaller meals
* don't wear tight clothes (obviously this doesn't apply at night!)
posted by kadia_a at 3:07 AM on June 12, 2011 [3 favorites]

If getting to a specialist is tricky, this is totally something a family doctor will at least be able to take some remedial steps to alleviate while you're waiting. Prescription antacids are actually pretty effective. The no insurance thing is problematic, but a GP is likely to be cheaper and more convenient than going straight to a specialist, who may not even want to see you without a referral.
posted by valkyryn at 4:44 AM on June 12, 2011

In addition to all of the above, consider buying a bolster pillow for your bed.

You could also consider elevating the head of your bed by a variety of methods. My grandmother used wooden blocks under the head of the bed to achieve the proper elevation.

There are some new foam mattress toppers that elevate the head buy a couple of inches.

Dr. Leonard's and others carry them.

Get evaluated by a doctor asap.
posted by AuntieRuth at 6:20 AM on June 12, 2011

It sounds like GERD, which can be linked to sleep apnea. Please go see a gastroenterologist as soon as you can.
posted by elsietheeel at 6:22 AM on June 12, 2011

Until this issue is resolved: When you go to sleep, always always always put yourself in the safety position (safe for drunk people, also safe for you): sleep on your side with one leg rotated past the other (so that your lower body is sort of between "side" and "face down"). The weight of the leg will help prevent you from rolling onto your back in your sleep. Being on your side will help keep you from aspirating on your vomit.

This is also how drunk people should always be put to bed.
posted by telegraph at 7:10 AM on June 12, 2011 [3 favorites]

Get checked out, but I would venture that you are eating too close to bedtime. The stomach should be very nearly empty by the time you go to bed.
posted by gjc at 7:16 AM on June 12, 2011

Another possibility would be laryngospasm triggered by the acid reflux. I've had this happen - it can be terrifying to wake up gasping for breath with a throat burning from stomach acid. I've had good results managing it by being careful of what I eat and how close to bedtime I eat it (no spicy foods closer than four hours to bedtime, no fizzy drinks in the evenings). Also, recognizing that "it's just laryngospasm" to help calmly breathe through it, helps it go away faster.

That said, breathing problems are not something to mess around with - seconding everyone else who's recommending you get to a physician to diagnose what's really going on.
posted by penguinicity at 7:47 AM on June 12, 2011

I had that. I generally found that avoiding certain foods close to bedtime helped. It could just be over-stress coupled with the wrong foods at the wrong time. In my case, it turned out to be a symptom of a bigger (but luckily slow-moving) problem.

Things that could signal a bad problem particularly when coupled with bad night reflux: freaky menstrual behavior, unexplained fever, weird back pain that doesn't correlate with any actual injury, or actual abdominal pain. These could be signs of some kind of abdominal tumor. IANAD, but those were the symptoms that came with weird reflux over months when I had ovarian rumors.
posted by rmd1023 at 7:47 AM on June 12, 2011

Laryngospasm. You only make it worse if you cough and gasp - try taking calm breaths.
posted by yarly at 7:52 AM on June 12, 2011 [1 favorite]

Absolutely get treatment ASAP. I left my acid reflux untreated for two years (I would wake up with a acid tide rolling up my throat), and now I'm undergoing several thousand dollars worth of dental work, because all of that acid makes bad things happen with your teeth. I need fillings in pretty much all my teeth plus a special and painful deep cleaning treatment for the pits in my gums... it's fun.
The longer you let this go, the more it will cost you in the end.
posted by L'Estrange Fruit at 8:21 AM on June 12, 2011 [1 favorite]

I'd not heard of laryngospasm, but let me share another aspect of my history that might be relevant: when I was a teenager, I started having some difficulty singing (I'm a singer, or I was anyway), and I went to an ENT who discovered a cyst on one of my vocal folds. He theorized that the cause was acid reflux, although I wasn't really sure if I had any of the symptoms of reflux, but he sort of convinced me that I did. Anyway, the cyst had to be removed surgically, and I was on prescription Prevacid after that until I was in my mid/late 20s, when I decided I the Prevacid was messing with my digestion and worked with a naturopathic doctor to get off it. Also last night before I went to bed I was talking about something upsetting with my husband and I was crying, and my throat closed up and felt uncomfortable. I stayed awake for a while after I calmed down, but I'm wondering if my throat could have been tense or something and caused a laryngospasm last night? (This happened last night, precipitating my question.)

So, not sure if that puts marks in favor of this laryngospasm business, but I'll also say I have no idea how I could not cough when it happens -- even though coughing doesn't seem to help, I don't know how else to get the acid/vomit out of my throat?? And if I try to breathe deeply, I start coughing involuntarily. I basically just cough and drink water and try to swallow as much as I can until I can breathe normally when this happens.

Also, the abdominal tumor is a frightening possibility, though I did just have a pelvic exam in December and everything was doing ok. My period is irregular and problematic, though.

I had a high-stress life event/transition that happened about two years ago; for the first time in my life, while that stress was going I had really severe physical symptoms -- my body really expressed the stress physically, with very severe digestive problems, constant stomachache, abdominal pain, etc (and also sleep problems). The really bad problems went on for at least 6 months or so. Things are a lot better now, but still not what I'd call normal. My body has never been the same, really. :(

Thanks again everyone for your help and your ideas. Clearly there's a lot to sort out, and I appreciate your assistance helping me think through what's going on.
posted by pupstocks at 9:02 AM on June 12, 2011

This is terrible!

One thing you should be doing (that is free!) is keeping a record of what you eat, drink, take and otherwise consume/experience. And when, as well.

Please, please start a diary of consumption, stress and other habits. Eventually you may see an important correlation. You can look back after some time and you may realize, "Oh my God, every time I drink milk in the morning and do yoga that day this happens!" or "Every time I don't get enough sleep the night before and I talk to Bob and eat after 10 p.m. this happens!"
posted by RJ Reynolds at 9:05 AM on June 12, 2011

Have you tried Prilosec? It is available OTC now. (IANAD but a friend who has reflux problems controls it 100% with a daily Prilosec.)
posted by fritley at 9:12 AM on June 12, 2011

There are a lot of things it -could- be but one thing to try right now is taking Prilosec twice a day, every day, whether you feel like you need it or not, for a month. That's probably the first thing a gastroenterologist will do anyway before subjecting you to an endoscopy or other invasive test.

Also, track your symptoms. Keep a food/meds/mood/activity/symptom diary. Not every gurgle or twinge, just stuff that interrupts your day.

Having this information will help the doctor either come to a swifter diagnosis or rule things out more quickly.

My money's on reflux, though. It's been suspected in you in the past, and going off the antacids seems to correlate with a worsening of your symptoms. Reflux can cause the spasms and stress can worsen the reflux.

Next time it happens, try a warm compress to help relax the muscles. Try to drink some warm tea. Or go the other direction--try ice and some cold water. Both of these work for me--my completely unscientific theory is that a temperature extreme startles the muscles out of their spasm.
posted by thinkingwoman at 9:45 AM on June 12, 2011

Prilosec is OTC, right? How is it different from Prevacid?

Thanks so much, everyone.
posted by pupstocks at 10:19 AM on June 12, 2011

Sorry, fritley -- I missed that you clearly said it was OTC. Reading comprehension!

But I am still curious about Prilosec vs Prevacid, if anyone has info there.

Thank you guys again... I truly appreciate everyone's responses and concern.
posted by pupstocks at 10:31 AM on June 12, 2011

Prilosec (generic: omeprazole) and Prevacid (lansoprazole) are different types of proton pump inhibitors. Some comparisons are discussed here.
posted by scody at 10:45 AM on June 12, 2011

You probably know this, but it also matters what time of day you take the proton pump inhibitor. It should be taken ~45 min or an hour before your last meal of the day. This lets the acid inhibition take effect before you eat, so that eating that meal doesn't have the chance to trigger acid production. I switched to this schedule (I had been taking it right before bed, having eaten a couple hours before), and have had much better effectiveness.
posted by Corvid at 1:38 PM on June 12, 2011

Obviously, cough if you actually have something in your airway. But the next time it happens, try to tune into whether you have something you need to cough up, or if you have more of a urge to dry cough. And don't take deep breaths - the idea is to take calm, regular breaths instead of gasping, because (as I've read and experienced) gasping just makes the airway tighter.
posted by yarly at 2:08 PM on June 12, 2011

I have a foam wedge (from a pharmacy, but you can usually find them at medical supply shops) which helps and is more comfortable than a pile of pillows.

You probably need to see a gastroenterologist instead of a GP because your symptoms sound really severe plus you have other digestive problems. My partner takes prescription-only anti-reflux meds that most GPs have never heard of.

Good luck.
posted by the young rope-rider at 3:40 PM on June 12, 2011

I have mild apnea and had exactly what you are describing. I was swallowing air in my sleep as I tried to breath and would belch in my sleep once my stomach was full. If I was sleeping on my stomach I would "verp" if you will. If people have told you that you snore I suspect apnea is causing this.
posted by The Violet Cypher at 8:23 PM on June 12, 2011

I do snore. Loudly. Also babble in my sleep. (And the snoring at least really became an issue when I gained some weight a few years back -- and I'm still carrying the weight and snoring away.)

I'm totally nervous about going to bed tonight but I'm going to try the safety position and hope for the best!
posted by pupstocks at 9:06 PM on June 12, 2011

Sounds like the acid reflux I had during my first trimester. I would wake up coughing with a very strong acidy feeling in my throat. Usually chewing two Tums before bed and prevented it (though occasionally I'd wake up with it later -- a bottle of Tums by the bed was a must). Also I've been told by my doc that a couple of bricks under the two legs of the head of the bed will help. Of course you should also see a doc to find out the root cause, but maybe this will help with the symptoms until then.
posted by statolith at 7:31 PM on June 13, 2011

Tums can help, but be careful to avoid taking too many chewable antacids if you have bowel issues; the ones with calcium can aggravate constipation, and the ones with magnesium can aggravate diarrhea.
posted by scody at 9:22 PM on June 13, 2011

In addition to the gastroenterologist, I would get a sleep study. Snoring, "sleep babbling" and reflux can all be signs of sleep apnea - which is very serious business, as in possible stroke, heart attack, and falling asleep while driving. It's often the sleep partner of an apneic who pushes them in to get tested and treated because the person with apnea is such a noisy sleeper - they make ungodly noises (snorting, smacking their lips, grunting, etc.) because they are struggling to breathe; their own bodies are smothering them in their sleep.

Getting a sleep study can be an expensive pain in the rear - you may have to beg, plead, and pay out of pocket, but it is worth it for your health - not to mention your tooth enamel, which gets eroded by vomit. CPAPs (the usual treatment for apnea) are also a pain, but are do-able, are much more comfortable than in the past, and getting adequate sleep without choking on your own vomit will make you feel like a whole new person.

Apnea Support is a helpful website if you are trying to get diagnosed and/or treated. At the very least, a sleep study can rule out apnea and help focus your treatment.
posted by Rosie M. Banks at 6:50 AM on June 14, 2011 [1 favorite]

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