CorruptAlligator - CPAP Problems

[Geer1]

There is both LPR (laryngeal pharyngeal reflux, aka reflux into upper airway) and GERD (acid reflux into esophagus). The symptoms are different (GERD is heartburn, LPR often does not have heartburn like symptoms) and both can have multiple causes.

GERD can be caused by too much acid production, hiatus hernia, and digestive issues like bloating. LPR is largely thought to have a neurological aspect (both esophageal sphincters opening when they shouldn't) and can also be caused by too little acid production along with above causes of GERD.

With my situation regarding dairy it might be a food allergy (doctor hasn't tested as I don't have obvious IgE reaction such as trouble breathing) but more likely is an intolerance/sensitivity which they can't really test for (other than using elimination diets). In my case it is an allergy/sensitivity to the proteins (Casein most likely) not lactose. Everyone is different in this regard and the only way to know if a certain food is causing reflux issues is to try elimination diets (the main allergic foods such as dairy, wheat, soy, nuts are good places to start). Even if it is an allergy than the LPR (in my case) or say GERD in your case then it is still GERD. GERD being called a disease is kind of a misnomer and it should probably be considered a disorder as it can be caused by multiple issues and is more just a name for the symptoms caused by acid getting into your esophagus.

Reducing my LPR may have reduced my nasal congestion but I think the two are separate related symptoms. I have now noticed that eating dairy causes nasal congestion before I have noticeable LPR or lay down etc. I think it is similar to an allergic reaction and maybe is a minor IgE reaction (which would make it a real allergy) or perhaps acts via a different mechanism like IgG (which is controversially called an allergy by some people and not proven to cause allergy symptoms).

I have even noticed other physical symptoms like geographic tongue are related to ingestion of both dairy and gluten further supporting some sort of allergy/autoimmune type reaction going on with these foods. I think this stuff affects quite a few people but for the majority of these people it only affects them in minor ways that can be lived with. Looking back I am positive I have had digestive issues for years/decades and either this cumulative problem finally became a worse issue or something else happened and their effects became more pronounced. At one point I could barely breath out nose at night and was having to use nasal sprays daily and decongestants semi regularly, that all went away with diet/digestive treatments.

LPR is still present but in a much less invasive form (minor inflammation still present but no chronic cough like before).

[CorruptAlligator]

I thought GERD and LPR was the same. My mistake. I was diagnosed with LPR by an ENT. Some nights I notice heavy sinus congestion when I lay for a short duration that I can breath through my nose very well. Other nights, I don't have this. I'm wondering if the cause is particular foods?

My doc made LPR sound like mild form of acid reflux (I think I've heard it interchangeably with GERD), and LPR gets contolled the same like for any reflux, by controlling the acidity. Like reducing spicy foods, not chewing mint gum, eating at least 3 hr prior to bed, etc...

[Geer1]

GERD is chronic heartburn. It is the symptoms of acid reflux in your esophagus (only past your lower esophageal sphincter). LPR is reflux into your upper airway (but not necessarily acid), for this to occur it needs to pass through both your upper and lower esophageal sphincters.

Lots of doctors don't fully understand LPR and seem to think it is the same as GERD. Most even try to treat it the same way (PPIs) even though there is clinical proof that doing so is usually ineffective unless GERD is also present.

PPI's work for GERD because GERD is caused by acid damage in esophagus. LPR is often not caused by acid damage but rather pepsin (an enzyme) which reacts with water. Acid is only produced during digestion so LPR without GERD is probably occurring at times when digestion isn't currently happening whereas GERD and heartburn often occur directly after eating a meal or in patients with say hiatus hernia that get stomach flow into esophagus when laying down.

PPI's often don't work for LPR because acid isn't the problem. In fact there is clinical evidence that low acid production can cause LPR due to its effects on the microbiota in digestive system.

It actually surprises me how so many doctors (even ENT's) don't seem to understand this. My ENT and also an internist tried and failed to treat my LPR with PPI's. My mother also has LPR and her first ENT also tried and failed with PPI's before a second ENT told her that she shouldn't be using PPI for LPR. I think some doctors do understand this but still oversimplify it when explaining to patients because it is easier to say it is like acid reflux than to explain it is often caused by an enzyme reflux that occurs for unknown reasons.

[CorruptAlligator]

Yeah, my ENT told me I have LPR, and prescribed me PPI. It made no sense to me. I don't have heart burns or anything like that. There was a bit of a confusion.

So, this even makes me question how legit the diagnosis of LPR is. I came in and told him that I have issues with too much mucus build up that I spit extraordinary amount of time. And have morning nausea that makes me almost throw-up. He took a look at my passage way, and concluded I have LPR. He probably didn't find anything to have an idea what is of the issue and decided on LPR.

There is obvious link of sinus issues and heavy mucus build-up. Perhaps it's an allergic reaction to a specific trigger. It's a common occurrence so something I commonly interact with.

[Geer1]

Did your ENT do a scope? LPR causes inflammation of your larynx/voice box which they can see with scope. If you have hoarseness or a chronic cough that also supports LPR diagnosis.

[Ratchick]

Sometimes acid reflux can cause no real symptoms other than maybe a little bit of a cough. It's not always the most obvious central burning chest pain, digestive discomfort etc. But it would depend what the ENT used to diagnose you.

[CorruptAlligator]

@Geer1, he shoved a scope down my nose to take a look at the situation, and it sounded like he saw inflammation of the esophagus and called it LPR.

@ratchick, my symptoms are high mucus build up with morning nausia when brushing my teeth. Once I did what he told me to do, like eat 3 hrs before bed, the nausia went away, and I started to lose weight. So, I benefitted from the assessment. But, like Geer says, I don't have a good idea of what LPR means and the way the doc put it was mild form of acid reflux. But, I don't get cough symptoms, but like something is in my through all the time and I must spit it out. Lots of mucus build up, and which would mean inflammation. I think he said inflammation of the esophagus.

So, based on inflammation of the esophagus, he concluded it's acid coming up from the stomache issue. I guess that is reasonable, no? So, that would mean mild acid reflux due to not being to the point of causing heart burns.

[CorruptAlligator]

My AHI has been consistently around 1, and now it's dropped drastically, and I can safely conclude that cervical collar is working to reduce my apnea in general (including CA).  Thanks so much for all of yours help.  This tells me my ideal setting for my APAP is 7-12.

[Gideon]

But how do you feel?

Your flow Limits are a bit high,
Your max setting seems a bit low and you are at 12 (max) for a while. This says to consider raising your max.
Your EPR is maxed at 3 so I'd consider a higher min to help with RERA and Flow Limits, hypopnoea too. Maybe min= 8.

On a BiLevel I'd say to try a higher PS.

BUT..... All this depends on a critical analysis of how you feel and not the numbers.

[Geer1]

Yeah the scope findings support LPR. As mentioned mine was bad and I had more symptoms (chronic cough could even feel reflux in throat at times etc), now I barely have any obvious symptoms but still have minor inflammation present because of it that ENT spots each time I have a checkup.