It seems we have a national energy crisis...
...but this time, the problem is at the pillow, not the pump. More and more often, people are telling me that they have no energy and feel tired all the time.
Some of these people are simply burning the candle at both ends. And another small percentage has true insomnia. But more often than not, there's no obvious reason for their exhaustion - because they tell me they "sleep" six to eight hours a night.
There are all sorts of possible explanation for this phenomenon - anemia, chronic fatigue syndrome, depression, adrenal depletion. Now new research adds another possibility to this list: acid reflux.
No doubt you've heard of reflux - it's been one of the darlings of pharmaceutical advertising for the past several years. Basically, it's what your mother used to call "heartburn" - a burning sensation in your chest you get after eating too much, or eating certain irritating foods (usually spicy or acidic foods).
Acid reflux occurs when digestive acids leak out of the stomach and into the esophagus, the tube that carries food from the mouth to the digestive system. Ideally, a muscle valve called the esophageal sphincter keeps the opening between the two tightly sealed. But for a number of reasons, the esophageal sphincter can weaken, allowing acids to escape.
Occasional heartburn is part of life. But when heartburn is a daily occurrence, it's not just uncomfortable - it can be dangerous. Over time, digestive acids begin to eat away at the lining of the esophagus. This is now recognized as a precursor for esophageal cancer, a disease that kills about 13,000 people a year and is in fact on of the fastest growing cancers in our country today.
The tie in with sleep is logical simply because of gravity: when you lay down, it's easier for stomach acids to trickle through a leaky esophageal sphincter. That's why the first recommendation for chronic heartburn sufferers is to prop up the head of the bed and get gravity working in your favor.
But this new study takes that line of reasoning a step further, suggesting that people with reflux are unable to sink into the truly restorative REM sleep because they partially wake up several times a night to clear acid from their throats. They may think they're sleeping through the night, but they're really not - or at least, not getting the quality sleep they need.
Sleeping pills may seem like an obvious answer - but when poor sleep quality is caused by reflux, that's a really bad idea. Sleeping pills may keep you from impulsively clearing the acid from your throat throughout the night, leaving your esophagus to marinate for hours in tissue-damaging fluids.
Not surprisingly, the study's authors suggest proton-pump inhibitor drugs like Protonix, Nexium and their over-the-counter cousin Prilosec as the answer. They did find them to be effective: after just a month of therapy, PPIs helped about 40 percent of patients get a more restful night's sleep.
But at what cost? I feel like a broken record, but it bears repeating: drugs like these don't solve the underlying problem, they just mask the symptoms. Plus, PPIs were only intended to be taken for a few weeks - not as an everyday maintenance drug like they are used now. Many physicians believe that artificially suppressing acid in the stomach over time disrupts digestion and absorption of nutrients. And some studies have even suggested that long term use of PPIs can increase your risk of cancer of the stomach and pancreas.
So what can you do? If you are chronically tired, with no obvious explanation, consider reflux as a possible cause. Not everyone feels the burn - some patients have described it as a tight or full feeling in the center of the chest, under the breast bone, or a feeling like something is stuck in their throat.
If the shoe seems to fit, your first step should be to prop up the head of your bed, as I mentioned before. Propping yourself up with regular pillows isn't enough - you actually need to raise the front two feet of your bed about four to six inches off the floor or use a specially designed prop-up pillow. Also, eliminate foods from your diet that can cause reflux. I see some patients who are really savvy about figuring out food triggers. Common reflux triggers include coffee, alcohol, chocolate, tomato-based sauces and anything spicy. Also, losing weight usually helps - research has shown that losing just 10 pounds can help minimize symptoms.
If you don't think you have reflux, or if none of these things help, talk with your doctor about other issues that could be interfering with your sleep. And really implement all those good sleep guidelines you've heard so often: don't watch TV or do work in your bed, stick to a regular sleep-wake schedule, and keep your bedroom dark, quiet and cool. And remember, exercise is a simple (and healthful) one-size-fits-all therapy for improving sleep quality, no matter what the cause.
