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DEAR DR. ROACH: I am 74 and have sleep apnea. I’ve used a CPAP device for over 20 years. Over the past four to five years, I’ve been awakened several times each night with a seriously dry mouth. I will get a drink, use the bathroom, and get right back to sleep, only to have the same thing happen over and over again.
I’ve used several different types of face masks with a full face mask working the best, and I’ve tried using a chin strap without success. This impacts my quality of sleep. I am otherwise in pretty good health and have an active life. — G.I.
ANSWER: Dry mouth is a common problem with any kind of positive airway-pressure device. The first thing I try is adding an in-line humidifier to the CPAP device so that you get moisturized air. Well-done trials have confirmed that this solution can reduce dry mouth and dry throat, as well as related symptoms like nasal discharge (a reaction to being dry all the time), nasal congestion, nosebleeds, a decreased ability to smell, a hoarse voice, and a sore throat.
Dry mouth can be a real problem for people in their 70s even without the use of a CPAP device, and it’s worth looking at your medicines to see if any could be exacerbating your problem. (Diuretics, some antidepressants, bladder medicines and antihistamines can be a big problem in this area.)
DEAR DR. ROACH: In June, my physician ordered a barium esophagram, as I had occasional feelings of food being stuck in my mid-chest area. The results were: “The esophagus demonstrates normal primary and secondary peristalsis. The esophageal mucosa is smooth without evidence of focal stricture or ulceration. There’s a mall sliding hiatal hernia in the distal esophagus. No GERD disease was identified.”
An endoscopy this week was attempted but stopped due to fungating lower esophageal tumors causing a blockage. This was confirmed by a CT scan. How could the barium test miss this? I see the oncologist next week. -- C.C.
ANSWER: I’m very sorry. This is terrible news, and I’m at a loss to explain the benign result of the barium swallow test when you have an obstructing mass in the esophagus, which needs to be considered as esophageal cancer. The published “miss rate” for a barium esophagram is on the order of 2%, and this should be for very small and nearly flat lesions. The only thing I can think of is that they mistook the tumor for the lower esophageal sphincter.
It’s particularly bad that this miss caused you to have a delay in your diagnosis for months, when it’s critically important to get treated quickly. If there’s a lesson for my readers here, it’s that a barium swallow test isn’t perfect. When symptoms aren’t explained by this test, it’s prudent to reasses quickly and get another type of test if indicated.
Food getting stuck in the chest is a “red flag” symptom that should be evaluated. Although reflux disease often ends up being the diagnosis, this is a classic symptom for an esophageal mass. Older men with new onset symptoms are at the highest risk, particularly if there’s an associated weight loss.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
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