How dangerous are middle-of-the-night acid reflux attacks?
February 28, 2013 10:43 AM   Subscribe

My partner's middle-of-the-night acid reflux attacks are scary for both of us because he wakes up unable to breathe due to aspirating acid, and he's worried that one night he might not wake up. How concerned do we need to be?

These attacks are a lot less frequent than they used to be, as he's made a bunch of positive changes: he's on a daily medication, we've raised the head of the bed, he sleeps on his left side, and tries to eat earlier in the evening and avoid foods we know are triggers. But they still occasionally happen, and they're scary for both of us. He wakes up suddenly unable to breathe, and then coughs violently for awhile, and it takes him a long time to recover and go back to sleep. He's worried that one day he might have one of these attacks and not wake up. Is this a valid concern? Is there anything we should do when these attacks occur? Currently he takes a fast-acting heartburn medication, drinks some milk to soothe his throat, and goes back to sleep once he recovers.

He is under a doctor's care and will be seeing a specialist soon, so I'm not looking for advice on treatment, but specifically wondering if these late-night attacks are dangerous and how to better handle them.
posted by rhiannonstone to Health & Fitness (12 answers total) 2 users marked this as a favorite
I used to have this occasionally happen to me - the first time it happened, I thought I might be dying. I can't imagine that this would happen and someone would *not* wake up - it's the sort of thing that generates a full-on panic reaction on a very basic deep-brain and metabolic level.
posted by rmd1023 at 10:52 AM on February 28, 2013

I used to have pretty bad acid reflux and I would wake up in a panic with what felt like acid in my throat. I did everything you are doing (was prescribed the generic for Prilosec and Nexium after that). Has he had an endoscopy yet?

The thing that made the biggest difference was dropping some serious weight. Now I'm off my prescription (bad for the bones long term) and sleeping on a flat bed again.
posted by entropicamericana at 10:58 AM on February 28, 2013

I used to have this occasionally happen to me - the first time it happened, I thought I might be dying. I can't imagine that this would happen and someone would *not* wake up - it's the sort of thing that generates a full-on panic reaction on a very basic deep-brain and metabolic level.

I don't know anything about acid reflux, but I know that a lot of can't-breathe-wake-up-and-panic reactions get suppressed pretty easily by alcohol and medication, which is why people choke to death in their sleep on vomit.
posted by Jairus at 11:02 AM on February 28, 2013

Getting material from your stomach into your lungs (like what Jairus is referring to with alcohol) is called aspiration. Aspiration of stomach contents into the lungs can be dangerous if you get enough of your stomach contents in there, it can cause inflammation (aspiration pneumonitis) or infection (aspiration pneumonia) - these complications are dangerous but would not stop your partner from waking up from sleep, and also would not be expected with run of the mill reflux, they're typically associated with vomiting or having a full stomach and an impaired level of consciousness.

I've never seen a patient with aspiration who didn't have some other reason to have impaired consciousness - like sedating medication, alcohol, or neurologic issue - it's not at all common. People with an altered level of consciousness have an impaired gag reflex that makes aspiration more likely. I cannot speak to your partner's specific case but I hope that is useful.
posted by treehorn+bunny at 11:24 AM on February 28, 2013 [2 favorites]

Are you sure it is acid reflux and not sleep apnea?
posted by COD at 11:36 AM on February 28, 2013 [1 favorite]

You should look into it because that acid is etching your throat. I found 2 things helped: smaller meals, and daily Activia. I take an Omeprazole before dinner. I am not much of a drinker, but alcohol can be a factor for some.
posted by Cranberry at 11:43 AM on February 28, 2013

I had all the symptoms you describe.

My acid reflux completely went away without medication when I did three things: Lost 40lbs, stopped eating or drinking after dinner and going for after dinner 40 minute walks.
posted by srboisvert at 1:06 PM on February 28, 2013 [1 favorite]

This can be serious. RedBud was a sufferer for years before she got a handle on it. It can damage your esophagus permanently.

After years of medical treatment (mainly anti-acid type drugs), she came to grips with it by a diet change. I can't possibly go into all the details, but, for one thing, it meant lighter meals in the evening, and cutting out certain types of food. She suffers much less than before, but she still sleeps in a semi-upright posture.

Heavy and constant use of many anti-acid remedies can have damaging side effects. Bone density issues are only one. The endocrine system also takes a beating. Because we are all truly snowflakes I can't really project her condition to yours, but you are right to take it seriously.

I suggest that one of your areas of inquiry would be with an established dietician / nutritionist.
posted by mule98J at 4:36 PM on February 28, 2013

I'll go full-scary here. Given that he's already seeing a doctor, he should get scoped ASAP. Depending on his age, ethnic group, and luck, he could develop Barrett's esophagus. It usually precedes esophageal cancer. The fatality rate is staggering, because people generally realize something is wrong when they have trouble swallowing due to the damage.

He should probably stay on the Nexium, and follow developments on that front. It's going to be horrible if/when he travels to places with unsanitary food practices (Delhi belly is guaranteed), but he should be able to push off the worst of the effects with medication and triennial scopes.

My father went through the whole process and eventually had his esophagus removed. It's not a lovely operation, but he's been fortunate enough to keep his larynx and his ability to eat, albeit with more mindfulness. It was a very rough fight trying to avoid the surgery, counting millimeters of esophagus given over to Barrett's, biopsies every 3-6 months to look for cancer cells, and trying a number of light and laser therapies, which would have been cripplingly expensive or impossible without a combination of insurance and getting into a Barrett's study at the University of Washington.

I suspect as well that it prevented me from following the same path, or at least delaying it by 15-20 years. With the understanding of what frequent heartburn and GERD can do over time, I've been able to avoid some of the behaviors that led to his condition. No heavy meals late at night, the lovely purple pill, and getting up when aspirating (fortunately less acidic) stomach fluid until the problems subside will make a big difference. Getting scoped is just another fun benefit.

I'd also be careful about the medications his doctor may prescribe. A number of them are black-boxed here in the US. They were discovered to have a palliative GI effect that was secondary to the primary purpose of the drug. They can have very bad medium and long term side effects, such as hallucinations, tardive dyskinesia, memory loss, etc. (I'm looking at you, Reglan.)

Make sure he has a competent doctor who understands the genetic challenges, as other groups are also susceptible to interesting problems from frequent dousing with acid. (Who would have thought?) A weak doctor can miss a lot of things that can't be fixed.
posted by reeses at 5:12 PM on February 28, 2013 [1 favorite]

My husband had this -- waking up in the night to severe, severe coughing fits for at least 10 minutes, despite taking ranitidine (Zantac) every night before bed. He referred to them as simply "agita."

He's benefited ENORMOUSLY from getting evaluated by a sleep specialist and using a CPAP. He almost never has an attack. (I can't remember the last time.)
posted by Madamina at 9:20 PM on February 28, 2013

I used to have serious acid-reflux and on a couple of occasions I aspirated in my sleep and it was very, very scary. Like others here, I dropped a lot of weight and eat smaller meals and, to all intents and purposes, save for the odd weird onset that's cured by over-the-counter antacids, the reflux is gone. I do not imagine this to be the case for everyone, but, it worked for me and whilst losing weight requires commitment, whatever I had to do to do it was well worth the price.
posted by ob at 9:22 AM on March 1, 2013

You are already under medical care.

Aspirating large amounts of acidic stomach contents can certainly be very bad for you, but he's probably coughing most of it up - that's what your cough is for.

If it's coming up far enough for him to choke on it then it overlaps with Lanyngopharyngeal reflux (LPR), which might give you another useful search term. Here in the UK when people have voice disorders caused by that, we often advise them to use a remedy called 'Gaviscon Advance' (not the other gaviscons) which supposedly forms a physical barrier to reflux when taken after food and drink. If you do try it, you need to take it last thing at night and not swallow anything at all after it, not even water. They recommend you take it four times a day - after each meal (not eating or drinking between meals) and last thing at night, but the night one is most important. Just another thought. Lots of our patients like it because it's not a drug and allows them to get off or lower the dose of PPIs, and it doesn't change stomach acidity. Plus it's not only the acid that's damaging in acid reflux.
posted by kadia_a at 11:51 AM on March 1, 2013 [1 favorite]

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