Chronic Illness

GERD and the Midnight Gurgle

Many sufferers of gastroesophageal reflux disease spend their nights sleepless with fear that they'll choke to death before morning. Here's what that's like.

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I worry about choking in my sleep.

More specifically, I worry about suffocating on the contents of my own stomach as I’m asleep, quietly asphyxiating as bile fixed my mouth in a lethal drowning from the inside out.

If you’ve seen Breaking Bad, this imagery might seem familiar. I’ve never forgotten the scene at the end of the second season, in which the addict Jane–played by Kristen Ritter–choked to death in her sleep, drowning in everything she ate before her bender.

But when you suffer from practically unpredictable episodes of GERD, a more intense version of acid reflux, this scene is even more arresting, because you know exactly how it feels.

GERD’s The Word

For me, the worst part of GERD–an acronym for Gastroesophageal Reflux Disease–is the gurgle.

It keeps me on my toes. A wet effervescent rising, it can happen when I eat too little or eat too much. One day, it might be angered by raw onions, tomatoes, or too much caffeine; the next, it stays quiet, no matter what I eat. Others, it can be brought on by ingesting cream, artificial sweetener, garlic, or other triggers it’s yet decided on. On an empty stomach, it can even surprise me when I turn to check my blind spot while driving, reminding me that despite all seeming well, it really just may not be.

You see, GERD is caused by a weakening of the esophageal sphincter. It’s a muscle you don’t think much of until it stops working. What this circular band does is creates a seal between your lower esophagus and your stomach, which keeps the harmful acids and bile safely away from the delicate tissue in your throat. When it malfunctions … well, that’s when any matter of things can happen.

For some, it causes frequent heartburn. Serious cases of heartburn can feel like a heart attack; milder ones feel exactly like how it’s named, a slow burning that can be hard to quench no matter how much liquid you pour down your hoarse throat.

For others, the backwash of acid can create esophagitis, an inflammation of that pathway. This is uncomfortable as it swells and irritates the esophagus, but the danger is in the long-term effect of having your stomach contents burn through the esophageal lining. From that, you can experience complications that include bleeding and open ulcers that make it painful or challenging to swallow; scar tissue that thickens enough to make eating difficult; or cause the precancerous Barrett’s esophagus.

I’m lucky that none of these things are part of how GERD presents itself for me. My gurgle … well, that’s much more obscure, more vague. It’s hard to describe, hard to define, and hard to predict. Therefore, it’s also nearly impossible to treat.

As amorphous and ill-defined as the foam that bubbles up with it, the gurgle can take many forms and many sounds. It can emerge as a little burst that catches you unaware, like a hiccup. It came come out a slow, rippling growl, an embarrassingly drawn out sound that has to be coaxed out by manual pressure right above the dip between your collarbone and windpipe.

The Gurgle

Imagine this. You’re trying to drift off to sleep, at the end of a hard day. Then, the gurgle comes.

Like a soap bubble blown from a wand, you can feel it rising up, up, up … until it’s stopped by the width of your esophagus. There it floats, holding the passage open like an ironic gentleman. As it settles there, you feel it begin to expand and firm up, as if every second it sits shores up its walls.

It’s a deeply conscious feeling; you can’t stop thinking about the bubble that has started to solidify in your throat. It’s like choking on a fuzzy tennis ball, holding your throat open and your mind hostage. You start to panic, because you don’t know when it’s going to stop; it feels like it will never end, and the more you think about it, the worse it gets.

But you can’t stop thinking about it. Not when every breath you take brings you dread, knowing that the exhale will bring back that pressure in your throat. And even when a breath out results in the ‘pop’ of the bubble bursting, it’s dissatisfying. The relief in pressure is strictly momentary, for as soon as the air is release, another bubble floats up to take its place. And thus the cycle continues.

The feel of the excess air rushing up and hitting an invisible wall goes to your head in dizzying fashion. You don’t know if it’s the feeling of being lightheaded or that staleness of what’s at the back of your mouth that’s creating the nausea. This taste in your mouth t lingers, a warm and dirty, almost furry feeling that hovers around your epiglottis. Or could it simply be the slow simmer in your stomach of acid?

It’s like choking on a fuzzy tennis ball, holding your throat open and your mind hostage

But at this point, you don’t really care, do you? You just want it to stop. You have to work tomorrow. You need to sleep. You try to eat, and drink, reprogramming the esophageal sphincter to close after each gulp, or at least rinse out or soothe the stagnation in the back of your mouth.

You pray for a deep, satisfying belch, one that comes from the core of your belly, strong enough to push that tennis ball out. A normal one.

You massage your throat, pushing along the Adam’s apple to release a primitive growl. You rock back and forth, try left and right. You lean forward, put your head down and hope that only air, not liquid is pushed out by the pressure of it. You try the classic yoga wind-relieving pose, one leg straight out and the other pulled in.

You try crossing your legs, first one way, then the other. Squeezing different parts of your midsection, trying to physically push the excess air out of your swollen torso.

You learn that tightening your stomach muscles helps expedite the bubble’s exit. Pushing directly onto your abdomen helps to force the bubble out, too, with a slight dull burst. … but the supply of stale, slightly foul air is endless and this yields nothing more than a second’s relief.

From most of these attempts, a hic, pop. An exclamatory urp, sometimes accompanied by fizzing bile and remnants of partially digested bites from hours before. That rumbling growl that sounds and feels like tiny octopus tentacles slapping against each other as they fight against ejection. A glimmer of hope that you’ve run out of air in your throat.

You live to fight another day. But worn a little thinner.

But then it comes back again. Again. Again. Until you realize that it’s 4 in the morning, you have work the next day, and you have spent the past several hours panicking that, if you go to sleep like this, you might just choke to death.

Yet somehow, eventually, you sleep. Poorly and not for long, only because the body and mind can only take so much. You wake up hoping your stomach has nothing left to push up, that  the invisible beast tightening up your chest has gone for the day. You take a deep breath, hold the bottom of the exhale, and sigh with tremendous relief as you find it punctuated with … nothing.

You live to fight another day. But worn a little thinner.

The Invisible Costs Of Chronic Illness

The new morning doesn’t feel quite so new.

You’re typically a morning person, but is it really morning when you didn’t have a night? When you spent the wee hours visualizing your stomach eating away at itself, churning bile into your throat like a factory expelling noxious fumes?

This image, seared into your sleep-deprived consciousness, haunts you as you steel yourself for what’s sure to be a long day. The fear follows you through the day, hovering over you like the brain fog left by the night’s tossing. You’re exhausted, your adrenal stores depleted from choking down your anxiety all night… the same way you choked down your stomach acid.

As you roll out of bed, you dress loosely, partially because you’re worried about constricting your angry gut, and partially because your midsection is still bloated and distended from your restless night. You eat carefully, declining office treats for fear of reawakening the gurgling monster in public and midday, while coworkers scoff: “Who cares? You’re thin!” Rather than explain your disgusting condition, you smile wanly and cite your residual nausea as the culprit.

“Let this not be the night I choke in my sleep.”

You start to feel optimistic by dinnertime, heartened by the apparent dormancy of the beast in your stomach so far. You dare to eat something in sauce, something with flavor. It’s amazing you dare to eat at all.

The gurgle remains sleeping, and you start to think that maybe you will tonight, too.

You celebrate your victory over your GERD this day, indulging in that one more slice of pizza, the one bite of tiramisu or cheesecake, or that single extra scoop of tomato sauce, hoping against hope that you haven’t overstepped that fluid line of what the monster will tolerate … today.

You swallow and breathe, and as you lay you down to rest, pray a different sort of prayer to the powers that be.

“Let this not be the night I choke in my sleep.”


Creative Commons Image by Rocky Sun

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