GERD Sleep

Until we started investigating why we were having a problem that was previously unknown to us: Acid Reflux or Gastroesophageal Reflux Disease. We started chalking it up to old age. We were just getting to the point where we just had to suffer through it. We thanks to our thirst for knowledge we discovered that in our case the problem was pronounced because we'd be eating "milk" chocolate and adding powdered "milk" to our coffee. You might remember we were promoting the eating of chocolate and the drinking of coffee to improve our health.

What we did not want to do before we knew that we were creating our own misery we didn't want to take any medicine over the counter or prescribed. We're not particularly keen on what are called PPI's (Proton pump inhibitors) even though:

"The PPI's have been shown to be very safe. Most of the information that we have on side effects come from studies where a PPI is compared to a placebo. The most common side effects are headache, abdominal pain, bloating, diarrhea and nausea. They occur in 1-2% of patients given PPI's. Interestingly, the incidence of these "side effects" is the same as when patients take the placebo. It is hard to compare side effect profiles between the medications, but there is no reason to believe that there are significant differences. - About GERD

Our problem is that the information may indeed be true and accurate but the website AboutGERD doesn't seem reputable enough for us. As always when we're in a quandary we head to GOOGLE and search for answers.  AboutGERD said:

"It is important to recognize that GERD is a disease that should not be ignored or self-treated. Heartburn, the most frequent symptom, is so common that its significance may be underestimated, casually dismissed, and not associated with a disease – like GERD. In studies that measure emotional well-being, people with unresolved GERD often report worse scores than those with other chronic diseases, like diabetes, high blood pressure, peptic ulcer, or angina. Yet, nearly half of acid reflux sufferers do not recognize it as a disease. - About GERD"

When we found the more technical information that we've grown accustom to read it was a bit to heady for us as well. We stumbled on the International Foundation for Functional Gastrointestinal Disorders (IFFGD) the umbrella organization for AboutGERD and immediately thought less of them. We finally stumbled on information we could use. The acid reflux was beginning to make it difficult to sleep and no it wasn't all the coffee. We stop drinking coffee after 2pm. So it couldn't have been the java!

"Sleep-Related Gastroesophageal Reflux: Evidence Is Mounting - Therefore, sleep-related GER disrupts sleep, causes insomnia, and is associated with daytime impairment. The relationship between sleep-related GER and sleep disturbances appears to be a bidirectional one. Furthermore, common medications used to manage insomnia depress the arousal response that is vital to esophageal refluxate clearance. The data are impressive." - Clinical Gastroenterology and Hepatology (CGH) September 2009.

We're not anti-medicine we just aren't comfortable with the current batch of PPIs. We did take a couple of antacids but they weren't TUMS they were discount fruit flavor versions from the dollar store. While the antacids did provide relief they didn't cure our problem. It was appropriate that we discovered the following:

"What Makes Individuals With Gastroesophageal Reflux Disease Dissatisfied With Their Treatment? - Patients who are given prescriptions for PPIs (proton pump inhibitors) tend to be more satisfied than those given H2-receptor antagonists. Partial responders are likely to be more dissatisfied than patients whose symptoms are fully resolved. A decrease in health-related quality of life is associated with greater dissatisfaction. Patients are more likely to be satisfied if they are taken seriously by their physician and if their symptoms are investigated. They are also more likely to be satisfied if the patient-physician consultation is interactive." - Clinical Gastroenterology and Hepatology (CGH) August 2009

We weren't patients and even without using the PPIs we were dissatisfied prior to their use. They should do a study to determine if patients were predisposed to being dissatisfied with acid reflux medications. Though the following study was presented months prior it wasn't published until this month and is probably the most comprehensive study of its kind.

"A population-based, cross-sectional, case-control study was based on 2 large health surveys performed in the Norwegian county Nord-Trondelag in 1984–1986 and 1995–1997. Gastroesophageal reflux disease was assessed in the second survey, which included 65,333 participants (70% of the county's adult population). The 3153 persons who reported severe reflux symptoms constituted the cases, and the 40,210 persons without reflux symptoms constituted the controls. Data on insomnia, sleep problems, and several potential confounders were collected in questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using unconditional logistic regression in crude and multivariable models. Results - In models adjusted for age, sex, tobacco smoking, obesity, and socioeconomic status, positive associations were observed between presence of insomnia (OR, 3.2; 95% CI, 2.7–3.7), sleeplessness (OR, 3.3; 95% CI, 2.9–3.8), problems falling asleep (OR, 3.1; 95% CI, 2.5–3.8), and risk of gastroesophageal reflux disease. These associations were attenuated after further adjustments for anxiety, depression, myocardial infarction, angina pectoris, stroke, and gastrointestinal symptoms, but they remained statistically significant. Conclusions - A large population-based study indicated a link between sleep problems and gastroesophageal reflux disease that might be bidirectional." - A Population-Based Study Showing an Association Between Gastroesophageal Reflux Disease and Sleep Problems (March 2009) - Clinical Gastroenterology and Hepatology (CGH)

It was because of this study and conversations with our physicians that we discovered the lactose GERD connection. We highly recommend keeping a food diary if you suffer from acid reflux and proton pump inhibitors (PPI) don't quite do it for you. Bring all your medications and your diary to your doctor and don't self treated. We self diagnosed that's different. But we're imaginary professionals so don't try this at home!