I hate and love waking up in the middle of the night. The feeling of relief when you realise you have 4 more hours of sleep before the alarm goes off, versus the worry that you might not get back to sleep.
You can imagine my dismay when I awoke a few weeks ago at 3:55am with stabbing pains in my chest and stomach.
In my confused half asleep state, I assumed it was just the remnants of a dream and it would pass now I had woken up. But as the pain continued to worsen I began to have the panicked thought of “Am I having a heart attack”?
The pain by this point had jolted me wide awake and as I started to become more aware of the sensations in my body I realised the pain was spreading into my nose and in my ear.
At this point I realised that I was not having a heart attack, but was suffering from an acid reflux attack.
What is acid reflux?
“Gastroesophageal reflux disease (GERD) is a syndrome caused by structural or functional incompetence of the lower esophageal sphincter, such that it permits retrograde flow of acidic gastric juice into the esophagus, and up to the level of the larynx and pharynx (throat). GERD is made more likely by obesity, large, late meals before bed, alcohol, and acidic, salty, or spicy foods.”
This video shows how the esophagus works and how acid can splash into the esophagus and cause problems.
Acid reflux from the singer’s perspective is a big problem, acidic gas can often be burped up into the larynx and mouth causing damage to the vocal folds and surrounding areas.
Acid can strip the outer coating of the vocal folds causing them to rub together when they vibrate. Often the body will respond by producing phlegm to try and keep the cords lubricated. Usually during this you will find that the vocal folds will swell or “puff” up as a response to being attacked by the acid.
Puffy vocal folds are harder to vibrate and adjust for pitch making your voice feel tired and stiff. It can also cause “rasp” or a “huskiness” to your voice. Some people even report feeling hoarse or suffering from laryngitis as well (voice box inflammation) after an acid reflux attack.
The problem we find is that most people don’t realise that they suffer from acid reflux. They wake up with a sore throat, or a bad taste in their mouth and don’t make the connection.
Another common symptom is the sensation of something being stuck in the throat which can be felt all the time or during swallowing.
Not being aware of the reflux and carrying on as normal is where you will get into trouble as a singer.
Things to do when you suffer from reflux
- Firstly, watch for the warning signs of acid reflux (chest pains, bad breath, sore throat, huskiness, a stubborn voice that might feel tired or stiff to name a few)
- Understand that when you have had reflux your voice maybe be compromised due to puffy vocal folds which make it harder from them to vibrate. You need to adjust how you handle your voice during that day to avoid making the problem worse
- Gently vocalise your voice using gentle vocal exercises like an edgy “m” sliding up and down from comfortably low to comfortably high, or sliding up and down singing through a straw. What you want to do is avoid exercises that slam the vocal folds together (consonants like g, or k)
- Avoid prolonged periods of talking or singing without warming up your voice first. Also be aware that warm-ups might take longer to be effective
- Warm your voice down after a long period of use, just like warming it up, cooling it down will help the muscles to release any tension
- Avoiding coughing and clearing your throat, these slam your vocal folds together and cause the production of more phlegm to compensate for them. You often will get stuck in a vicious circle
- Be mindful of what you eat that day as you don’t want to trigger it again
- Sleep on your left side if you can, as this has been shown to keep the stomach acid in your stomach. Another helpful tip can be to raise the head of your bed to allow gravity to keep the acid down
- In the longer term, you might want to consult a doctor as you may have too much stomach acid, or not enough stomach acid
- Start a food journal to see if anything you eat triggers the reflux. Sometimes a food intolerance can cause it
- Steam your voice! Inhaling moist steam will encourage blood flow into your larynx which will help your cords to regenerate and repair the damage
By taking action, you can start to control the problem in your body allowing your vocal folds to heal and repair and return your voice to a healthy function again.
So how did I get on?
After sitting for 10 minutes and hoping it was going to go away I realised it wasn’t. I got up and took a small glass of water with a teaspoon of bicarbonate of soda in it (this is what heartburn remedies are made from) and went back to bed.
The next morning, I woke up with a pain running all up my chest, a lump in my throat, pain in my ear and nose and pretty much no voice to speak of.
Being very careful with my voice, I gently warmed it up and continued to keep it warm throughout the day whilst teaching and running a choir rehearsal, and absolutely no shouting or clearing my throat where possible.
The next day the pain subsided quite considerably, and I luckily haven’t suffered from reflux again. My trigger I think was eating almonds late at night when my body didn’t have time to digest them before I went to bed.
So please, singers, take a moment to learn about acid reflux and check your own voice and body for any signs or symptoms and take action as quickly as you can! Let’s keep those voices nice and healthy!
NB: Please note we are NOT medical doctors and do not prescribe any medical advice or solutions. Please seek medical advice if you believe you suffer from these problems.