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Can Sleep Apnea Cause Hiatal Hernias?

Posted Feb 23 2011 9:34pm

Someone emailed me in response to my comment that hiatal hernias may be related to sleep apnea. He basically said that my ideas were nonsense. Here’s what I wrote back:

“Thanks for taking time to comment. I did mention that it’s a hypothesis, and yet to be proven. In my opinion, a hiatal hernia is similar to having a deviated nasal septum. Everyone has some degree of it (due to jaw narrowing and dental crowding), but only some people have symptoms. One thing I’m learning as I study the effects of sleep apnea is that it can cause or aggravate almost every chronic medical condition that we know of, from a metabolic, hormonal, neurologic and immunologic standpoint. I know about the classic medical explanations of hiatal hernia as well as many of the alternative/complementary explanations. But I don’t find any of these explanations satisfying. If you look at all the various studies on the effects of sleep apnea (which is due to a craniofacial underdevelopment of the jaws that most modern humans have, that leads to crowding of the upper airway), it was only logical that sleep apnea (which is so common and undiagnosed) may lead to a hiatal hernia.

For example, pressure readings using catheters in the esophagus during apneic episodes show tremendous negative pressures in the chest cavity, with loosening of the phreno-esophageal ligament, which opens up the lower esophageal sphincter temporarily. These pressures are also strong enough to prevent blood flow to the heart during these episodes. The junction of the stomach and the lower esophagus (the lower esophageal sphincter) sits in an opening in the diaphragm, like a sleeve. If you’re pulling down on the diaphragm with excessive positive abdominal pressure, while creating tremendous negative pressure in the chest cavity, along with loosening of the phreno-esophageal sphincter, it’s plausible that the lower part of the stomach can slide up into the chest cavity. Continued vacuum effects in the throat, along with upper and lower esophageal sphincter dysmotility, can lead to pharyngeal reflux, which has been shown to reach the lungs, sinuses and ears. This also includes digestive enzymes, bile, and H. pylori.

Lack or oxygen to the brain and the body, as well as a massive physiologic stress response, can alter your involuntary nervous system, creating a relative overactivation of your sympathetic nervous system (increased adrenaline), and an underfunctioning parasympathetic nervous system (vagus nerve).

Sleep apnea is only a small aspect of my sleep-breathing paradigm, which states that all modern humans stop breathing occasionally, due to various factors. Even healthy people can stop breathing during a simple cold. Thin, young people can stop breathing 20 to 30 times per hour and not have official sleep apnea on a sleep study. It’s taken for granted that most people breathe properly at night, but this is absolutely not true—due to our ability to talk/communicate, as well as a shrinking of our facial skeletons. Looking at health and disease from this perspective, it goes against most traditional dogma, whether within allopathic medicine or alternative/complementary fields.

When I was a medical student, my mentors at Columbia University were laughing at the hypothesis that a simple bacteria could cause stomach ulcers. The person that proposed this hypothesis went on to receive the Nobel Prize in medicine. I’m not saying that my research is of that magnitude, but we have to be willing to think outside the box if we’re going to make any significant progress.”

What do you think about my hypothesis?

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