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Sat, Jan. 25

Antacids mask damage from nighttime heartburn

Dear Dr. Rosenberg,

My husband takes antacids almost every night because he wakes up complaining of heartburn. He also snores like a freight train. He is sleepy, irritable and fatigued all day. I have asked him to speak to his healthcare provider but he insists that antacids are all he needs. What do you think?

A: I think your husband is making a big mistake. First, recurrent heartburn during the night can destroy sleep. More importantly, nighttime heartburn poses a far greater risk of esophageal damage and even cancer than does daytime heartburn. Finally, if he has more than snoring and has sleep apnea, that can contribute to and may be causing his heartburn. Taking Tums is treating the symptom and not the cause. I would urge your husband to discuss this with his healthcare provider.

Dear Dr. Rosenberg,

My husband suffers from severe depression. He has not responded to any of a number of antidepressants. His psychiatrist wants to have a device called a vagal nerve stimulator (VSN) implanted. We were told it can be helpful in patients with depression who do not respond to medication. When the surgeon who was to implant the device heard that he snores, he insisted on a sleep study first. My question is why?

A: The FDA has approved VNS devices for the treatment of depression. Originally, they were used for refractory seizures by stimulating the vagus nerve. Unfortunately, this stimulation can lead to collapse of the upper airway during sleep. This may result in worsening of sleep apnea in susceptible individuals. That is why it is a good idea to be tested for sleep apnea before the device is implanted.

Dear Dr. Rosenberg,

I had a sleep test done several weeks ago. My primary care provider said I had "positional sleep apnea" and that if I could avoid sleeping on my back I might not have to wear a CPAP. What is positional sleep apnea and what might I do if this is true?

A: Positional sleep apnea means that you have twice as many obstructions when sleeping on your back as opposed to other positions. When you're not on your back, you should have few apneas if any at all. If this is the case, devices that prevent you from sleeping on your back may be the answer and could eliminate the problem.

Dear Dr. Rosenberg,

My 8-year-old snores loudly. This happens every night. Should I be concerned? Should I mention this to my pediatrician?

A: Yes, I would. The incidence of snoring in children is about 8 percent. Many of these children may have sleep apnea. This can affect their school performance, moods, growth and cardiovascular systems. The American Academy of Pediatrics now recommends that children who snore chronically be tested for sleep apnea. Removing the tonsils and adenoids is curative in the majority of these children.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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