Gastroesophageal Reflux Disease (GERD), commonly known as acid reflux, is a digestive condition where stomach acid flows backward into the esophagus. This backward flow occurs when the lower esophageal sphincter, a ring of muscle separating the two organs, relaxes inappropriately. For many, the reflux extends up into the throat, causing a terrifying sensation of suffocation or “choking.” This distressing feeling is one of the most common and frightening symptoms reported. Understanding the actual respiratory events caused by reflux helps manage this anxiety and find effective relief.
Reflux-Induced Respiratory Distress vs. True Choking
The sensation of choking caused by acid reflux often feels like the throat is closing up, mimicking a life-threatening obstruction. This differs from true choking, which occurs when a foreign object physically blocks the windpipe, requiring the Heimlich maneuver. Reflux-related breathing difficulty is an involuntary physiological response to acid irritation, not a physical blockage from food. While physical obstruction is rare, the feeling of suffocation is a real form of acute respiratory distress. This distress is caused by the body’s protective reaction to stomach contents reaching the upper airway, primarily categorized as laryngospasm or aspiration.
The Mechanisms: Laryngospasm and Aspiration
Laryngospasm
The most frequent cause of the choking feeling is laryngospasm, a sudden, involuntary tightening of the vocal cords. Even a minuscule amount of acidic fluid reaching the vocal cords can trigger this intense protective reflex. The larynx is far more sensitive to acid than the esophagus, leading to this powerful spasm. When the vocal cords seize up, they temporarily block the flow of air, creating a sudden inability to inhale. The spasm typically lasts for a few seconds up to a minute, serving as the body’s attempt to seal off the airway and prevent stomach acid from entering the lungs.
Aspiration
A less common but more serious mechanism is aspiration, which involves the inhalation of stomach contents, including acid and partially digested food, past the vocal cords and into the lungs. The chemical irritants cause an inflammatory reaction called aspiration pneumonitis. This event is more likely to happen silently, particularly during sleep. Repeated aspiration can lead to chronic inflammation or infections like aspiration pneumonia, which is a significant complication for lung health. Individuals with a weakened cough reflex or underlying respiratory conditions are at a higher risk. Long-term exposure to acidic material can cause scarring and changes in the lungs.
Immediate Steps During a Respiratory Episode
During a sudden respiratory episode, the primary goal is to remain calm, as panic can worsen the spasm and prolong the event. Laryngospasm is temporary, and the airway will eventually open on its own. Immediately moving to an upright position is helpful, allowing gravity to assist in moving the acid back down the esophagus. Specific breathing techniques can help override the spasm by forcing the vocal cords to open. Try breathing in slowly through the nose and exhaling through pursed lips to slow the breath. Alternatively, taking two short, quick sniffs in through the nose, followed by a slow exhale, can sometimes break the spasm. Sipping a small amount of water may also help wash residual irritant off the vocal cords, shortening the event. If breathing does not return quickly, or if the person loses consciousness, emergency medical services should be contacted immediately.
Reducing the Risk of Nocturnal Events
Since many severe reflux-induced respiratory events occur while sleeping, positional changes are highly effective preventive measures. Elevating the entire head of the bed by six to eight inches is recommended to use gravity to keep stomach contents down. This elevation should be achieved using blocks or a wedge under the bedposts or mattress, not by stacking pillows, which can flex the neck and worsen the situation. Avoiding food and beverages for at least two to three hours before lying down gives the stomach time to empty its contents. Sleeping on the left side is also beneficial, as this position helps the stomach sit below the esophagus, making it harder for acid to reflux upward. Minimizing trigger foods, such as alcohol, caffeine, and high-fat meals, particularly late in the evening, reduces the acidity and volume of stomach contents.