Choking while Sleeping: Causes, Symptoms, Diagnosis, Complications, and Treatment

Nighttime choking can be a terrifying, painful, and disruptive experience that can seemingly arise out of nowhere. In certain cases, it can even be life threatening. However, there are warning signs that can indicate an impending episode of choking while sleeping, as well as symptoms to watch for that can help identify a source of the sudden interruption to breathing, that is causing you to wake up when choking while sleeping.

Waking up choking?

This article will explore many of the symptoms and causes of nighttime choking in adults, as well as provide you with some options for relieving the symptoms while exploring longer term treatment. If you or a loved one are experiencing nighttime choking, or recognize some of the warning signs presented in this detailed article, please speak with your doctor right away.

What are you experiencing?

Going to your doctor with a good understanding of what you may be experiencing is incredibly beneficial to the process of getting an accurate and speedy diagnosis. Therefore, it’s important to try to remember what other symptoms you were experiencing during the choking episode, and to keep as mindful of your body as you can if you experience further episodes.

While nighttime choking is in and of itself a warning sign of a more complicated issue, there are a number of other symptoms that can help narrow down exactly what you might be experiencing. After going through this short list of symptoms that commonly accompany a nighttime choking episode, you will have a good idea of what to bring up to your doctor on your next visit.

Common Symptoms:
1.   Are you experiencing any of the following physical symptoms?

1. Racing heart or severely increased heart rate
2. Difficulty breathing
3. Panic-style coughing or gasping
4. Burning sensation in the chest
5. Horrible taste in throat
6. Feeling of stomach contents “rising” into throat
7. Vomiting
8. Feeling of “volcanic-type” rising burning, acidic, and/or hot pain shooting up through throat
9. Sore throat
10. Phlegmy coughs
11. Severe sweating
12. Fever
13. Swollen areas in back of throat
14. Sharp pain in chest
15. Painful burning when breathing that likely diminishes in the following days
16. Pain in your teeth and gums
17. Burning or Pain in your sinuses

2. Are you experiencing any of the following psychological symptoms?

1. Feeling of terror, panic, or intense fear
2. Mental exhaustion or fatigue
3. Irritability or mood swings

Taking note of which, if any, of these symptoms you are experiencing can help narrow down the list of possible conditions that might be affecting your sleep. Later in this article, we will explore what common and uncommon illnesses can cause combinations of the symptoms above. While this is not a comprehensive list of symptoms that are often experienced alongside nighttime choking, possessing multiple symptoms from the list can point to a likely cause with some level of accuracy. This information can help guide your decisions and conversations with medical professionals.

Who experiences nighttime choking?

Nighttime choking can be experienced by anyone of any age or background, though, there are certain groups that are more frequently affected by it than others. The two most prominently affected groups are the elderly and those suffering from obesity. Nighttime choking is more prevalent as a whole in people over the age of 30, with nighttime choking being least common in people between the ages of 10 and 30. Infants have also been reported as having a notably high occurrence of nighttime choking, though still considerably lower of a percentage than people above the age of 30, and generally from very different causes.

From current data available, people belonging to one or more of the groups listed above (for example, an elderly patient who is also categorized as obese) are at heightened risk for experiencing nighttime choking and the illnesses that cause it. As a result, if you or a loved one fall into these risk groups, it’s doubly important to pay attention to the symptoms and possible causes presented here.

How and why is it happening?

The most common causes of severe and recurring nighttime choking in adults can be traced to two conditions: Gastroesophageal Reflux Disorder (GERD) and Sleep Apnea. Both conditions should be treated as serious because, while they are often manageable in their early stages, their complications can be very serious and potentially sudden. There are, of course, other causes of nighttime choking, and based on what symptoms you identified in the first section, a process of elimination can likely lead you to a good idea of what you might be suffering with. We will start with easily identifiable, common, and temporary conditions that may cause choking while sleeping and then continue to more serious conditions.

The most minor causes of nighttime choking are conditions like post-nasal drip from allergies or even common colds. While these are unlikely to cause particularly severe choking during the night, it is possible for enough buildup of phlegm to occur and cause a nighttime choking episode. It is also possible, especially with severe allergies, to experience choking while sleeping as a result of irritated respiratory paths. Sinusitis and pneumonia can both also be causes of nighttime choking. While more severe than the common cold or seasonal allergies, nighttime choking caused by sinusitis or pneumonia is likely to be quite temporary, and usually will not be a recurring issue unless the infection is particularly severe. Also, upper respiratory tract infections, much like pneumonia, can cause nighttime choking by restricting the respiratory tract triggering choking or by causing post-nasal drip similar to a cold.

The aforementioned group of respiratory conditions can certainly cause nighttime choking, however, they are likely to be accompanied by symptoms like fever, coughs, runny nose, sore throat, and body soreness. Additionally, they are likely to be temporary, with choking episodes being less common and usually following particularly bad symptoms of the sickness (for example, a common cold causing post-nasal drip intensifies before the sufferer goes to sleep and causes a choking episode.) Taking over-the counter medication (in the case of common colds or seasonal allergies) or prescribed antibiotics (in the case of bacterial pneumonia and sinusitis) is likely to reduce the occurrence of nighttime choking significantly.

A less common condition that can cause nighttime choking is tonsillitis. Tonsillitis, being a swelling of the tonsils near the back of the throat, can cause irritation in the throat which triggers a choking sensation. Swollen tonsils are the clearest sign of tonsillitis, so checking your throat for swollen tonsils after a choking episode can help rule out this condition right away. Tonsil swelling large enough to cause a choking episode should be visible to the eye in most cases.

The most severe, but also least common conditions that can cause nighttime choking are pulmonary embolisms and heart failure. Heart failure and embolisms both have very similar symptoms characterized by shortness of breath, pain in the chest, coughing, swelling of the legs or feet, and fatigue. Embolisms in particular, being a clot that travels to the lungs, will often most clearly cause pain upon breathing. Both of these conditions should prompt immediate emergency medical treatment as both are very dangerous. Immediate medical care reduces the chance of death or complication majorly. Nighttime choking from these conditions is likely to be restricted to the individual occurrence of heart failure or embolism and is unlikely to be recurring.

If you are experiencing recurring nighttime choking, but your symptoms do not match the conditions above, it is possible you are suffering from acid reflux, GERD, or sleep apnea. All of these conditions are characterized by repeat occurrences of nighttime choking as well as the presence of a number of other very characteristic symptoms. In the sections below, we will explore the key symptoms of acid reflux / GERD and sleep apnea.

GERD is a severe disorder of the stomach that causes excess acid to flow back up into the esophagus from the stomach instead of being neutralized as normal on a frequent basis.

“GERD is the chronic, more severe form of acid reflux”

While acid reflux and GERD are not the exact same disorder, they share many symptoms. Unlike acid reflux, which occurs less frequently and has less severe symptoms, GERD is a chronic issue that is a progression of acid reflux that has become regular. Acid reflux and heartburn more than twice a week may indicate GERD..

The backflow of acid and stomach content associated with Reflux and GERD can trigger a severe choking reflex that can awaken or disrupt the sleep of the sufferer.

While there are varying severities of both acid reflux and GERD, it is common for GERD sufferers to experience “heartburn”. It may feel like a burning, warmth, or pain just behind the breastbone or a feeling of acidic pain shooting up through the throat. In the most severe cases of GERD, sufferers may experience a bad, acrid taste in the back of the mouth, vomiting, or a rise of stomach content through the throat (that may or may not lead to vomiting.)

Additionally, it is common for GERD sufferers to experience coughing and even choking that can lead to a racing heartbeat, hyperventilation, and sometimes accompanied by a sense of terror, panic, or intense fear. This panic will continue while clearing the airway from stomach content and catching one’s breath.

Reflux and GERD sufferers often describe a burning feeling that comes with painful breathing during (and after) episodes of reflux, that likely diminishes in the following days. acid reflux (GERD) can cause pain in the teeth, gums, and even sinuses.

Reflux/GERD symptoms are likely to occur sometime after eating, and are worsened when lying down during a reflux episode.

Nighttime reflux of acid can lead to poor sleep which results in fatigue and sleep deprivation.

It should be noted that while the most common symptom of GERD is heartburn (a burning sensation that may feel like a burning, warmth, or pain just behind the breastbone, often at night or when lying down after eating,) pain behind the breastbone should be closely watched to ensure that it does not match that of heart issues. Heart issues are generally associated with feelings of tight, dull, heaviness, and aching pains or discomfort as opposed to burning pains, and they most commonly occur after you are active.

Resources:
Heartburn vs Acid Reflux (healthline)

Later in this article, we will explore the possible complications that can arise from untreated acid reflux. We will also, more extensively discuss prevention steps and techniques for immediate relief and long term treatment.

Meanwhile, let’s explore the second most common cause for waking up choking.

Sleep apnea is a disruption of reflexive breathing during sleep, which can lead to sufferers gasping for breath during the night or even briefly choking in sleep. It largely occurs as a result of blocked breathing passages, and even brief episodes of apnea that are not immediately noticeable can trigger fatigue and the need to sleep during the day.

There are actually three types of sleep apnea with different causes.

The first type is “obstructive” sleep apnea (OSA), which is caused by soft tissue of the throat relaxing in such a way that it blocks the airways in the throat, generally causing severe snoring, and occasionally triggering a choking episode.

The second type of sleep apnea is “central” sleep apnea, which is caused by a failure of the central nervous system to properly regulate the muscles that operate reflexive sleep. When this occurs, it generally results in a sudden disruption of sleep due to the body reacting to a lack of breath.

The third form of sleep apnea is known as “complex” sleep apnea, which represents a combination of both obstructive and central sleep apnea.

Symptoms of Sleep Apnea
It is very common for obstructive and complex sleep apnea sufferers to have issues with very loud snoring and short, repeating episodes of interrupted or loud breathing through the mouth. Central sleep apnea is generally characterized by recurring, potentially sudden moments in which the sufferer stops breathing for an extended period of time while sleeping, usually resulting in a panicked awakening. All three forms of sleep apnea are also often associated with dry mouth, irritability, headaches, and mood swings. It should be noted that the fatigue, Mental exhaustion, and tiredness experienced by sleep apnea sufferers (of all three types) is quite severe, and is generally characterized by its presence even after long nights of sleep and supplemental napping.

Obstructive sleep apnea (OSA) and psychiatric illness:
Psychiatric disorders often are comorbid with OSA. These include depression, anxiety, bipolar disorder, schizophrenia, posttraumatic stress disorder (PTSD), panic disorder, and substance use disorder.(source)

Sleep Apnea and Acid Reflux (GERD) Overlapping Causes and Symptoms
Sleep Apnea itself does not generally exhibit many of the symptoms associated with reflux by itself. For example, acid symptoms like burning, bad taste in mouth, and the sensation of stomach contents rising up towards the throat are not generally present with sleep apnea alone.

While sleep apnea and acid reflux have many different causes and symptoms, there is some research that indicates that acid reflux could contribute to the development of sleep apnea and that pre-existing sleep apnea could contribute to acid reflux.

Overlapping Causes:
The reflux of stomach acid could, for example, irritate the vocal cords in such a way that they spasm chronically. Over time, this could result in sleep apnea.

Likewise, coughing, choking, and snoring caused by sleep apnea can result in acid being sucked upward from the stomach. During these episodes the snoring causes the esophagus to act as a straw, sucking out the stomach content causing reflux.

Overlapping Symptoms
In this way, there are two overlapping symptoms of both sleep apnea and acid reflux/GERD, which are sleep deprivation and fatigue.

Resources:
Are GERD and Sleep Apnea Related? (WebMD)
Sleep Apnea and GERD (everydayhealth)
GERD AND SLEEP (Sleep Foundation)
Treating sleep apnea may help control acid reflux (Sleep Foundation)

As you can likely see, recurring choking while sleeping can be narrowed down to one of these two causes based on their exclusive accompanying symptoms. Going forward in this article, as we explore the dangers of leaving both of these disorders untreated, we will assume that you are exhibiting the symptom sets of either Acid Reflux/GERD or sleep apnea. The other conditions explored as possible different causes of temporary, non-recurring nighttime choking will be explored in another piece.

Do you think you have sleep apnea? Read from this point on!

In the following sections we will briefly explore the possible complications that can arise from untreated sleep apnea. We will also, more extensively, discuss prevention steps and techniques that can help bring immediate relief. If you think you might be experiencing GERD symptoms, please skip slightly further in this article, where we will explore GERD similarly.

Complications of Sleep Apnea That Can Arise From a Lack of Treatment

Long-term untreated sleep apnea can lead to a number of complications both severe and simply intrusive to the sufferer’s daily life. In addition to chronic fatigue, long term sleep interruptions can lead to depression and other mood disorders. Studies have shown that untreated sleep apnea can increase cancer risk by more than double over the course of two decades of suffering, and can quadruple the general mortality rate of sufferers. Risk of stroke, heart attack, high blood pressure, and diabetes have all been linked to sleep apnea. As mentioned above, some researchers also believe that sleep apnea can contribute to or even trigger the development of chronic acid reflux.

In addition to these more severe complications, untreated sleep apnea can cause soreness, consistent mood swings, and disruption of partner’s sleep cycles as a result of overly loud snoring and coughing.

How can sleep apnea be prevented?

• Losing weight
• Avoiding depressants and stimulants like alcohol and sleeping pills
• Quitting smoking
• Raising upper body while sleeping, which opens airways
• Avoiding sleeping on back

The clearest preventable contributor to sleep apnea is weight and lack of exercise. Obesity contributes strongly to the likelihood of sleep apnea as well as the severity both of symptoms and of possible complications. Because both obesity and sleep apnea are tied to conditions like high blood pressure, diabetes, and heart disease, it is important to be aware of the risks tied to obesity and seek treatment if you fall within this risk group.

Developing a strong exercise habit and a balanced diet plan both contribute to the prevention and treatment of complications from sleep apnea and obesity. Seeking the assistance of a nutritionist or wellness coach can be effective, as exercise habits and diet habits can be difficult to implement without knowing your personal needs. Your general practitioner or family doctor can likely make a referral to a specialist for you in this case.

Another preventable major contributor to sleep apnea is smoking. Smoking severely exacerbates the symptoms and complications of sleep apnea by taking a heavy toll on your airways, lungs, and cardiovascular system. Smoking increases the chances of nighttime choking episodes, increases the likelihood of complication from heart disease, and contributes heavily to an increased mortality. As smoking is incredibly addicting, quitting can be difficult to accomplish; however, it is one of the best decisions you can make for your health, especially if you are experiencing or at risk for sleep apnea.

Avoiding depressants and stimulants before sleep can help reduce and prevent sleep apnea symptoms. Depressants, like alcohol or sleep aids, can further relax muscles of the throat, complicating sleep apnea symptoms such as choking or snoring. Caffeine and other stimulants can contribute to further troubled sleep, which is likely to exacerbate fatigue and mood issues.

There are also a number of sleeping habits that you can undertake to reduce the symptoms and risk of sleep apnea. The first of these habits is to establish regular sleeping hours. A regular sleeping schedule helps your body fall into sleep easier, and therefore your overall sleep will be better. Additionally, side-sleeping and sleeping slightly upright both can help reduce symptoms significantly. Using a wedge, an adjustable bed, or pillows to raise your upper body to a higher angle can prevent relaxed throat muscles and the tongue from sliding backwards due to gravity. Additionally, some snoring aids, like nasal cleansing and breathing strips can help reduce the negative effects of sleep apnea.

The effectiveness of modifying position while sleeping varies depending on the severity of the symptoms. Wedges, both full-length and short, have shown to be more effective than pillows, with full length wedges being most comfortable and effective out of those three options. Under mattress wedges and adjustable beds are the most effective of all, though they both tend to be less affordable than basic wedges. When using wedges or adjustable beds, products that simply incline by bending at the waist should be avoided as they often cause sufferers to default to sleeping on their back, which complicates sleep apnea. Instead, the full sleeping surface should be inclined to allow for freedom of sleeping position.

It should be noted that most of the advice in this section applies primarily to obstructive sleep apnea and obstructive symptoms of complex sleep apnea. Prevention of central sleep apnea, while sharing some techniques with the prevention of obstructive sleep apnea, is more focused around maintaining cardiovascular health. Central sleep apnea often develops as a result of long term, untreated obstructive sleep apnea. The stress that obstructive sleep apnea places on the central nervous system has the potential to manifest as interruption to reflexive breathing that characterizes central sleep apnea.

Avoiding smoking, maintaining a healthy diet, and exercising regularly can help to prevent both obstructive sleep apnea as well as central sleep apnea. Studies have shown that central sleep apnea is tied very closely to cardiovascular health. Heart conditions, especially, can cause or complicate sleep apnea. If you currently suffer from cardiovascular conditions, or are at risk of them, make sure to pay close attention to the treatment of your cardiovascular conditions in order to prevent the possible development of central sleep apnea.

What can I do to help relieve sleep apnea if I am suffering right now?

There are a number of simple steps you can take to help reduce the suffering that can be caused by sleep apnea episodes, especially nighttime choking. Some of these steps were mentioned above, too. For example, if you should find yourself awakened by a sleep apnea-related choking episode, try shifting to side-sleeping or, if that is not possible, raise the angle you are laying at slightly, so that your back is coming up off the bed.

If changing your position is not helping, consider taking the time to use a neti pot or similar nasal cleansing remedy. These remedies pass a saline solution through the nasal passages, clearing out the sinuses of anything that might add additional, unneeded stress onto your airways while sleeping. Sometimes, this type of cleansing can allow for the rest of the night of sleep to go uninterrupted.

For severe sleep apnea, it is likely that your doctor will prescribe the use of a continuous positive airway pressure machine (CPAP.) These devices can grant immediate relief of symptoms of sleep apnea by producing pressurized air that is delivered to a mask which is usually worn over the nose or the nose and mouth simultaneously. The pressurized air produced by the CPAP machine prevents the airway from becoming blocked by slackened tissues of the airway. Additionally, this pressurization helps keep alveoli in the lungs more open so that more respiratory surface meets with inhaled air.

Many CPAP machines also have extra features beyond simple pressurization to increase their efficacy in relieving sleep apnea. One of the more common extra features of CPAP machines is humidification. Having a built-in humidifier helps alleviate and prevent dryness from continual inhalation of pressurized air. Some models include heat management measures so that the air being pumped into the mask maintains a consistent temperature level. Additionally, models incorporating newer, digital features can offer things like gradual pressurization, which allows the pressure to slowly increase for the user to adjust naturally; pressure relief, which automatically lowers pressure when sensing an exhalation to create a more natural breath feel; and data logging, which allows for the CPAP machine to record changes in pressure and breathing in order for a doctor to analyze and adjust the machine to fit your needs.

CPAP machines are often the best solution for both immediate and long-term relief of sleep apnea, which is why their use has become almost synonymous with the condition. While many sleep apnea sufferers may be apprehensive about the use of a CPAP machine, CPAP machines are usually much less intrusive than they seem and the relief of sleep apnea symptoms is usually quickly noticeable.

Resources:
Sleep Apnea Treatments (WebMD)
elevate the head-of- bed for Sleep Apnea relief

Buy your Under Mattress Wedge now!

In the following sections we will briefly explore the possible complications that can arise from untreated acid reflux and GERD. GERD should be understood as the chronic and severe form of acid reflux that can lead to the most harmful complications. Mild episodes of acid reflux are common, but frequent acid reflux episodes could indicate that someone is suffering from GERD. We will also, more extensively, discuss prevention steps and techniques that can help bring immediate relief. If you think you might be experiencing sleep apnea symptoms, please scroll up to the section before this one, where we explore sleep apnea similarly.

What are the complications and risks of foregoing treatment for Acid Reflux and GERD?

GERD is a serious and painful condition that, if left untreated, can lead to a number of even more serious complications. The most common complications arising from untreated GERD are chronic sore throats, coughing, asthma, and tooth decay. However, GERD can also contribute to severe esophageal damage, including causing bleeding, scarring and the formation of ulcers. Untreated GERD has been linked strongly with cancer of the esophagus and a condition known as Barrett’s esophagus, which manifests as severe damage to the lower end of the esophagus. Barrett’s esophagus can develop into esophageal cancer much easier than an undamaged esophagus.

Additionally, what many GERD sufferers do not realize is that GERD can actually contribute to the development of both obstructive and central sleep apnea. Sleep apnea comes with its own risks, which are explored in the section above this one.

Resources:
9 Reasons Not to Ignore GERD Symptoms (health.com)
The Risks of Untreated Heartburn and GERD (webmd)
What Are the Consequences of Untreated GERD? (mainlinegi.com)
What will happen if I don’t treat my acid reflux? (sharecare)

How can Acid Reflux (GERD) be prevented?

Much of the prevention of GERD rests on wise lifestyle choices, more so than some other conditions. While genetic factors can contribute to the initial likelihood of developing GERD, there are many lifestyle factors that greatly increase those chances.

Smoking:

Smoking is one of the most significant contributors to GERD and GERD complications, so quitting smoking is one of the best preventative steps you can take. Because smoking greatly increases the chance of cancer, quitting smoking also reduces the chance that GERD will complicate into a cancerous condition.

Eating Habits:

Eating habits are a significant part of preventing GERD and GERD flare ups.

Size of Meal:

Avoiding overly large meals is a great first step, as larger meals tend to stimulate acid production, but you can further reduce the risk of a GERD flare up by being active after eating.

Timing of Meals:

Wait before going to bed after eating meals. Additionally, avoid laying down for at least two hours after eating anything regardless of the size or amount of food eaten. Lying down puts gravity in the favor of GERD, making it more likely that acid will flow upwards into the esophagus.

Food choice:

The size of meals and timing aren’t the only things to watch, however. Certain foods contribute greatly to reflux conditions. Common culprits are acidic foods such as citrus based dishes and tomato based dishes. Additionally, certain herbs and spices can contribute to reflux. While tea is generally fine, coffee, carbonated sodas, and alcohol all increase the likelihood of a reflux episode. Spicy foods also frequently contribute to acid flare-ups. Two culprits that many people may not predict are certain forms of chocolate and garlic. Avoiding these foods, especially in the evening, will help prevent GERD flare ups, and may help prevent stomach acid issues from progressing into chronic GERD.

Sleeping Habits:

There are a number of sleeping habits that can be taken to help avoid nighttime acid reflux (GERD) symptoms.

Clothing:

Most simply, avoid sleeping in clothing that can restrict your waist or stomach. Clothing that applies pressure to these areas actually contributes to pushing acid upwards towards the esophagus while sleeping.:

Sleep on your left side:

Many doctors, including Dr. David A. Johnson, M.D., have identified that sleeping on the left side of the body can help reduce heartburn symptoms at night. Dr. Johnson’s personal memory trick is to remember the phrase, “Right is Wrong.” Read more about Dr. Johnson’s findings here.

While the efficacy of left side sleeping is not yet fully understood, some researchers believe that left side sleeping prevents the relaxing of the esophageal sphincter which would otherwise cause unwanted acid flow. Other researchers believe that sleeping on the left side of your body holds the meeting point of the stomach and the esophagus above the areas of the stomach where gastric acid naturally collects.

You can read more about What Side To Sleep On With Acid Reflux in the extended article

Raise the Head of Your Bed:

Another effective way to counteract nighttime acid flare ups is to purchase a wedge pillow. Wedge pillows lift your upper body significantly upwards from a horizontal position, putting gravity in your favor. If a wedge pillow does not work for you, consider purchasing an adjustable mattress or bed. These often electronic mattress types allow you to customize the angle that you sleep at, greatly aiding resistance to GERD episodes, albeit at a higher price point than mattress bed wedges.

Similarly to the notes on sleep apnea above, the effectiveness of modifying position while sleeping varies depending on the severity of the symptoms experienced. Wedges, both full-length and short, have shown to be more effective than pillows, with full length wedges being the most comfortable and effective out of those three options. Under mattress wedges and adjustable beds are the most effective of all, though they both tend to be less affordable than basic wedges. When using wedges or adjustable beds, products that simply incline by bending at the waist should be avoided as they often cause sufferers to default to sleeping on their back, which promotes acid reflux. Instead, the full sleeping surface should be inclined to allow for freedom of sleeping position.

Buy your Under Mattress Wedge now!

Medication:

Medication should also be considered in preventing GERD. If you do not currently have GERD, but are at risk for it, there are a number of medications to discuss avoidance of with your general practitioner or family doctor. Nitrates, alpha blockers, tricyclic antidepressants, and certain over the counter medications like aspirin can all contribute to increased risk of developing GERD, or of reflux episodes in patients already suffering from GERD.

Obesity:

Finally, one of the major factors contributing to GERD is obesity. If you are overweight, it’s worth considering building a weight loss plan as weight loss often greatly reduces the occurrence of GERD and can even prevent its development in the first place. Being overweight or obese also greatly increases the chances of developing a complication, so losing weight is beneficial on multiple levels for those at risk of or currently suffering from GERD.

How can I get immediate relief if I am suffering from acid reflux (GERD) now?

If you are currently experiencing acid reflux (GERD) symptoms, there are a number of ways that you can immediately alleviate symptoms. While not every tactic will be effective for every acid reflux (GERD) sufferer, the following actions tend to help reduce suffering from acid reflux (GERD) symptoms.

If you suffer from acid reflux (GERD,) consider keeping a pack of mild chewing gum on hand or nearby at all times. In case of a flare up, chewing a piece or two of gum can actually help dampen or prevent pain. Gum stimulates your mouth to produce extra saliva that, when swallowed, acts as an antagonist to the acids of the stomach. Stimulating saliva production is, therefore, a very natural way to take advantage of mechanisms your body already has in place. As a word of warning, however, this tactic is unlikely to provide significant relief for severe reflux episodes, even though it can sometimes stop smaller episodes.

Antacids can also be very effective at combating reflux episodes. Over-the-counter acid neutralizers (such as calcium antacids) function by adding a basic substance to your stomach which counteracts some of the acid present. These drugs will not stop the initial overproduction, but they can at the very least prevent further damage from a single flare up. Caution should be taken with over-the-counter acid neutralizers though; they cannot undo damage to the esophagus from acid, nor can they relieve swelling caused by acid. Additionally, many acid neutralizers are formulated with minerals that can build up in the body and cause issues of their own when used long term.

There are also two classes of over-the-counter acid reducers which function by lowering the initial production of acid by the stomach. While not as quick-acting as acid neutralizers, acid reducers deactivate or block receptors that prompt the stomach to produce acid, meaning they can provide relief for longer periods of time or be taken before meals as a preventative. There are two types of acid reducers: medications that act on H-2-receptors and medications that act on proton pumps. H-2-receptor blockers are more designed for preventative measures and relief of pain, while proton pump inhibitors are designed to greatly reduce acid for long periods of time so that esophageal tissues can heal.

In addition to over-the-counter medications, there are also prescription-only medications of similar drugs. H-2-receptor blockers and proton pump inhibitors both have prescription-only versions which can provide relief for severe cases of GERD. At the prescription-only level there are also drugs which do not act on acid receptors at all, but instead focus on another aspect of GERD, a weakened esophageal sphincter that leads to acid leaving the stomach when it should otherwise be retained. These drugs help prevent undue relaxation of the esophageal sphincter. While not ideal for immediate relief, in severe cases of GERD this type of drug can work in tandem with other medications to provide relief.

Related:
‘The Mechanics of Acid Reflux‘

As a final tactic for relieving pain associated with acid reflux (GERD,) try to move yourself to a relaxed environment during an episode of painful reflux. Stress and anxiety can contribute to worsening of symptoms, as well as make it more difficult to relieve symptoms. Studies have associated stress and anxiety with a number of muscle contractions and stomach problems, all of which will worsen the symptoms of a reflux episode. While the effects of relaxation on individual reflux flare ups is difficult to exactly quantify, removing undue stress and giving oneself time to recover and focus on relieving pain is a healthy step.

What are options for long term treatment of GERD?

The most common long term treatments for GERD are the aforementioned prescription drugs. In addition to often having an immediate effect of relief, prescription antacids can, in some cases, completely prevent reflux episodes from occurring, especially when used in combination with good lifestyle habits. Additionally, prescription medications are the only drugs designed to reduce acid to the point of allowing healing. If you have been living with an untreated, irritated esophagus, a regimen of prescription GERD medication can actually make future reflux episodes significantly less painful by allowing much needed healing to occur.

If prescription medication is not bringing you the relief and healing you need, there are some surgical options for long term and hopefully permanent GERD relief. The two common surgical procedures for treating medication-resistant GERD both involve working on the esophageal sphincter. The newest of these surgical options is known as LINX. The LINX device is a small, flexible ring of specially crafted titanium beads which is fitted around the bottom of the esophagus, on the esophageal sphincter. The LINX does not inhibit consumption of food, and aims to strengthen and assist the esophageal sphincter without requiring any modification of the sphincter itself. The surgery is minimally invasive and consists only of implanting the titanium ring.

Another form of surgery which is still quite common is known as a fundoplication, though more invasive than the LINX treatment, there is considerably more clinical information available on the fundoplication surgical procedure, as it has been used in practice considerably longer. It is a minimally invasive surgery that is generally completed laparoscopically (meaning it is performed through a minor incision into which a camera and surgical tools are inserted.) In the fundoplication procedure, a portion of the stomach is wrapped around the esophageal sphincter to reinforce it. The most common type of fundoplication by far is known as the Nissen fundoplication which involves a full 360-degree wrap of the top of the stomach around the esophageal sphincter, followed by a suturing of the stomach. Some patients and special cases call for partial fundoplications, though these are much less common. GERD sufferers who are considering a fundoplication procedure should be aware that, due to the nature of the surgery, belching and vomiting can become painful or impossible. While this is not a guaranteed outcome, lifestyle steps to prevent excessive gas buildup in the stomach should be taken. Additionally, avoiding alcohol, undercooked meats, and other substances that can cause vomiting should be avoided regardless.

If you have suffered from nighttime choking, do not ignore your symptoms. This guide should give you an idea of what to discuss with your doctor, but it is not a substitute for a visit to your family doctor or gastroenterologist. While there are many conditions that can cause individual episodes of choking while sleeping, repeated or chronic choking and nighttime waking can indicate a more serious condition that warrants investigation. Especially if you are experiencing any of the other symptoms of GERD and/or sleep apnea, pay attention to what you are feeling, document the conditions around the event as best as possible, and make an appointment with a doctor. The risks of untreated GERD and sleep apnea should be considered very serious, as they contribute to discomfort, pain, and even mortality in the long term. As with any condition, your experiences may vary from those presented here, but if you feel you are experiencing relevant symptoms, trust your intuition and seek the professional care that you deserve.

Remember that you are not alone! Cumulatively, GERD and sleep apnea affect almost 3.5 million Americans each year. One fourth of all Americans suffer from acid reflux regularly. There is a plethora of support, guidance, and knowledge on these two conditions you can access if you need it.

Resources:
Esophageal Cancer: The Fastest Growing Cancer in the U.S. (Dec 2012 Study)
Choking When Sleeping | Cause Of Choking (SleepDisordersGuide)

By: Jay Karpen Dec 2017