In a new study, researchers at Thomas Jefferson University Hospital, in Philadelphia, found that people taking the popular sleep aid zolpidem (Ambien) snoozed through nighttime reflux instead of arousing from slumber for the second or two it takes to swallow. Swallowing is the bodys natural defense against the backwash of stomach acids that can bathe the esophagus at night.
“[Swallowing] protects your esophagus because you neutralize the acid with saliva, which is rich in bicarbonate,” explains lead author Anthony J. DiMarino Jr., MD, the William Rorer Professor of Medicine at Jefferson Medical College and the chief of the hospitals Division of Gastroenterology and Hepatology.
Thats true for people diagnosed with gastroesophageal reflux disease (GERD), a condition characterized by persistent acid reflux, as well as people who experience only occasional bouts of heartburn.
The study, which was funded in part by AstraZeneca (which makes heartburn drugs), appears in the September issue of Clinical Gastroenterology and Hepatology. One of the coauthors of the study, Karl Doghramji, MD, the director of the Sleep Disorders Center at Thomas Jefferson University Hospital, serves as a consultant to Sanofi-Aventis, the maker of Ambien.
Over time, acid can damage the esophagus
Donald O. Castell, MD, a professor of medicine at the Medical University of South Carolina, says the study is “extremely important” for GERD patients. “It sends a definite warning that serious levels of acid reflux can occur without detection after a sleeping aid, and that the prolonged acid exposure has the potential to produce injury to the esophageal lining that might not otherwise occur,” he says.
If left untreated, long-term acid reflux can damage the cells lining the esophagus, leading to a precancerous condition known as Barretts esophagus, which, in turn, increases the risk of esophageal cancer. Although the study showed that sleeping pills might increase nighttime exposure to stomach acid, its not clear if they increase the risk of Barretts esophagus or other conditions. (Ambien is only recommended for short-term use.) The study was also relatively small, the researchers note, and it only looked at acid reflux for two nights.
However, it may be the first study to systematically examine the effect of taking a sleep aid on nocturnal acid exposure, says Dr. Castell, who was not involved in the study. “In this sense, a good nights sleep may be dangerous.”
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