The sudden sensation of choking, often waking a person from sleep, is one of the most frightening symptoms associated with acid reflux. This acute event occurs when stomach contents backflow into the esophagus and reach the sensitive structures of the throat and airway. It is a distressing experience that can cause intense panic due to the momentary inability to breathe. This guide offers immediate steps for managing the crisis, understanding the underlying cause, and implementing long-term preventative measures.
Immediate Crisis Management and Airway Clearing
The first step during a choking episode from reflux is to immediately sit upright or stand up. Lying flat allows stomach acid to pool near the throat, so this positional change uses gravity to pull the liquid back down into the esophagus. Avoid the tendency to lean back or lie down, which prolongs the airway’s exposure to the irritant.
Once upright, focus on a series of forceful coughs to clear the throat and larynx of any acid or fluid. This mechanical action helps expel the irritant, which causes the choking sensation. While the initial reflex is to panic and gasp for air, this can actually worsen the spasm.
Managing panic is the next step, as it can intensify the feeling of a blocked airway. Laryngospasm, the reflex responsible for the choking, is often short-lived, typically lasting less than a minute. Remaining calm helps shorten the duration of the spasm.
To regain control of breathing, try slow, controlled techniques, such as the pursed-lip method. Breathe in slowly through the nose and exhale slowly through pursed lips. Alternatively, taking two rapid sniffs through the nose can briefly open the vocal cords, followed by a slow exhale on a “sh” sound. Small, frequent sips of water can also help wash the irritant away from the vocal cords and soothe the throat.
Understanding Why Reflux Causes Choking
The choking sensation is a protective reflex triggered by stomach contents reaching the throat. Gastroesophageal Reflux Disease (GERD) or Laryngopharyngeal Reflux (LPR) occurs when the muscular valve at the top of the stomach does not close properly, allowing acid to travel up the esophagus. When this acidic material reaches the sensitive tissue around the voice box, it triggers a defense mechanism.
This defense mechanism is known as laryngospasm, where the vocal cords slam shut involuntarily to protect the lungs from inhaling foreign material. It is a temporary, intense spasm that feels like true choking because the airway is momentarily blocked. The choking is usually the result of this spasm rather than the physical blockage of the airway by liquid.
True aspiration, the inhalation of acid into the lungs, is a serious event that can lead to complications such as aspiration pneumonia. However, the most common acute symptom is laryngospasm. Treating the underlying reflux condition is necessary to reduce the frequency of both the spasm and the risk of aspiration.
Post-Event Recovery and When to Seek Medical Attention
Once the choking episode subsides and normal breathing resumes, the throat and esophagus will likely feel irritated from the acid exposure. Rinsing the mouth and throat with water helps clear residual acid from the oral cavity and larynx. Swallowing small sips of water or a neutralizing liquid, such as milk, may help soothe the inflammation and wash the esophagus.
Following the event, monitor yourself for residual symptoms. Hoarseness, a persistent cough, or a feeling of a lump in the throat are common and may take several hours to resolve. These symptoms occur because the delicate tissue of the vocal cords and throat has been irritated by the acidic contents.
Certain “Red Flag” symptoms require immediate emergency medical attention. Call for help if you experience a persistent inability to breathe normally, suggesting severe or prolonged airway obstruction. Other urgent signs include:
- Coughing up blood.
- Developing a fever.
- Experiencing severe chest pain unrelated to heartburn.
- Having an inability to swallow even water.
These symptoms could indicate aspiration into the lungs or serious damage to the esophageal lining.
Long-Term Strategies for Preventing Aspiration
The most effective long-term strategy involves using gravity to prevent nocturnal reflux. Elevating the head of the bed by six to ten inches creates a downward slope, making it harder for stomach contents to travel up the esophagus. This elevation should be achieved using a wedge pillow or blocks under the bedposts, ensuring the entire torso is inclined, not just the head.
Changing your sleeping position is also beneficial for managing nocturnal reflux. Sleeping on the left side is recommended due to the stomach’s natural anatomy. When lying on the left, the junction between the stomach and the esophagus is positioned higher than the acid pool, reducing the chance of backflow. Conversely, sleeping on the right side or flat on the back can worsen reflux symptoms.
Timing and composition of meals play a large role in prevention. Avoid consuming large meals, snacks, or liquids for a minimum of two to three hours before lying down. This allows the stomach time to empty its contents and reduce the volume available for reflux. Limiting personal trigger foods, such as fatty foods, caffeine, chocolate, and acidic items, can also decrease the frequency of episodes.
Non-prescription medications can be used as part of a comprehensive strategy. Antacids provide rapid, short-term relief by neutralizing stomach acid. H2 blockers and proton pump inhibitors (PPIs) reduce the amount of acid the stomach produces, offering sustained control over acid levels. If lifestyle modifications and over-the-counter medications are insufficient to control nocturnal reflux and choking episodes, consult a healthcare provider to discuss prescription options or other treatments.