How GERD Can Lead to Sleep Apnea

Many veterans with gastroesophageal reflux disease (GERD) also suffer from obstructive sleep apnea (OSA)—and research shows this is more than just a coincidence. In fact, up to 60% of people with sleep apnea also have GERD, compared to only about 20% of the general population.

What’s the Connection Between GERD and Sleep Apnea?

There’s growing evidence of a strong link between GERD and sleep apnea. Here’s why:

1. Sleep makes GERD worse – When we sleep, stomach acid can more easily travel upward into the esophagus and even the airways. This backflow is called reflux, and it can lead to:
   • Inflammation or swelling of the throat
   • Coughing or wheezing
   • Bronchospasms (tightening of the airways)
2. Acid can irritate the upper airway – At night, stomach acid can move high up the esophagus and sometimes even into the windpipe. This microaspiration of acid can inflame the airways and make them more likely to collapse during sleep—one of the main problems in obstructive sleep apnea.
3. Nerve reflexes can trigger breathing problems – Acid in the esophagus can activate the vagus nerve, which controls many automatic body functions. This reflex can cause airway narrowing and make breathing harder during sleep.
4. GERD-related inflammation contributes to airway collapse – Swelling caused by acid irritation can make the airway narrower and more prone to blockage while sleeping.

Treatment Evidence Supports the Link

• Treating OSA with CPAP (continuous positive airway pressure) not only improves breathing during sleep—it often reduces GERD symptoms too.
• Conversely, treating GERD with proton pump inhibitors (PPIs)—medications that reduce stomach acid—has been shown to improve sleep apnea in some patients by reducing airway irritation and improving breathing.

Nighttime GERD: A Bigger Problem

People who have GERD symptoms at night are at higher risk for developing sleep apnea. Studies show that people with nighttime acid reflux are more likely to:

• Snore loudly
• Wake up gasping
• Feel tired during the day
• Experience worsening sleep apnea symptoms

In fact, a recent study showed that people with ongoing nighttime GERD symptoms were more likely to develop new signs of sleep apnea.

Why This Matters for Veterans

If you have service-connected GERD and are also experiencing symptoms of sleep apnea, there may be a direct medical connection between the two. Acid reflux, especially at night, can damage the upper airway and lead to breathing disruptions while you sleep.

This makes sleep apnea a condition that can potentially be claimed as secondary to GERD for VA disability benefits—especially if supported by medical evidence.