When you have to sleep with acid reflux, every night can be a challenge. The burning and discomfort not only makes falling asleep harder but nearly guarantees you’ll be waking up during the night making a good night of sleep difficult.
Acid reflux and GERD are common conditions among adults in the United States— in fact, an estimated 20 percent of American adults suffer from GERD. To make matters worse, most people with acid reflux or GERD experience those symptoms at night, either during sleep or while trying to fall asleep.
Thankfully, there are ways to get a good night’s sleep even if you’re experiencing nighttime symptoms of acid reflux or GERD. But first, let’s take a look at these two conditions, and how exactly they can ruin your sleep.
What are Acid Reflux and GERD?
Acid reflux, also known as heartburn, is when stomach acid flows out of the stomach and into the esophagus. It can be caused by a number of factors, including:
- Being overweight or obese
- Hiatal Hernias
- Certain medications, including NSAIDs or benzodiazepines
- Improper Diet
A muscle called the lower esophageal sphincter creates a portal between your stomach and your esophagus. When functioning properly this muscle only opens to allow food into the stomach to digest— however, reflux symptoms occur when this sphincter doesn’t function properly. This dysfunction allows stomach acid or stomach contents to flow upwards and back into the esophagus. When this occurs, you experience the symptoms of heartburn or acid indigestion, such as an acidic taste in your mouth, discomfort in your stomach and throat, and possibly some regurgitation of stomach contents.
It’s actually normal to experience acid reflux or heartburn every so often. However, if it happens too frequently, it’s an indicator that you may have gastroesophageal reflux disease. Left untreated, GERD can result in some very serious health issues including erosion of the esophageal lining, conditions like Barrett’s Esophagus, or even esophageal cancer.
How do Acid Reflux and GERD Affect Sleep?
As mentioned above, most people with acid reflux experience their symptoms at night. The uncomfortable symptoms of nighttime heartburn can make getting proper sleep difficult, but the way we sleep can also exacerbate those symptoms.
There are a few reasons acid reflux occurs at night:
- It’s much easier for reflux to occur while lying in bed, because gravity is no longer keeping everything in your stomach down.
- Saliva can neutralize stomach acid, but you produce less at night during deep sleep. This negates the potential benefits your saliva can have if you have reflux.
- Similarly, decreased swallowing during sleep does not provide adequate pressure to keep acid in the stomach, also contributing to reflux.
There is also a connection between GERD and sleep apnea. In fact, around 60 percent of obstructive sleep apnea (OSA) patients also have GERD. While one does not cause the other, they can actually be secondary conditions for each other; Obstructive sleep apnea symptoms can be exacerbated by GERD, and GERD symptoms can be exacerbated by OSA. People who have obstructive sleep apnea often experience more severe symptoms of GERD as well.
For example, a vacuum effect is created around the stomach and throat during an apneic episode, which draws stomach acid out of the stomach and into the esophagus and throat. The chest’s negative pressure brings air in through a constricted opening due to the apnea. This creates a positive pressure in the stomach, which results in reflux, with stomach acid or contents shooting upwards from the stomach and into your throat.
If you have obstructive sleep apnea and GERD, then treatment for one could actually be an effective treatment for the other. CPAP, or continuous positive airway pressure, has been shown to be effective in treating both nighttime heartburn and obstructive sleep apnea.
One study showed that OSA patients experiencing nighttime GERD symptoms had their heartburn scores drop by sixty-two percent when they used CPAP therapy consistently. The study also found that consistent CPAP therapy over time reduced heartburn scores further.
CPAP therapy is one of the most popular and effective treatments available for obstructive sleep apnea. Thankfully, there are other ways to treat your nighttime acid reflux symptoms if you aren’t experiencing sleep apnea.
Sleep Solutions for Acid Reflux and GERD
Positive lifestyle changes can make a huge difference in your nighttime acid reflux symptoms. If you’re looking for relief, these are a great place to start!
1. Change your Sleep Position
I mentioned above how nighttime GERD symptoms can be exacerbated by how we sleep. However, you can reduce or even potentially eliminate those symptoms by changing your sleep position.
Laying flat while you sleep can worsen your symptoms. Laying flat on your back makes it easier for reflux to occur, which can even cause you to wake up coughing or choking on your reflux.
Instead, I recommend sleeping on your left side. This position is most beneficial to alleviating GERD symptoms because gravity will position your stomach below your esophagus, making it harder for reflux to rise into your throat. Even if reflux occurs, gravity can return the reflux to your stomach faster than if you were sleeping on your back or right side.
Similarly, it’s also the most beneficial sleeping position for pregnant women, whether or not they are experiencing nocturnal symptoms of acid reflux.
Sleeping on your right side does not offer the same benefits though. Sleeping on your right side often produces liquid reflux, while sleeping on your left side may produce more gas if you’re still experiencing symptoms. While potentially annoying, however, the latter is much easier to tolerate than the former. So remember this if you’re planning on adjusting your sleep position: Right is wrong.
2. Sleep on an Incline
If you prefer to sleep on your back, elevating your upper body can also relieve or prevent nighttime reflux. Similar to sleeping on your left side, this makes it so your stomach is lower than your esophagus and gravity will make it more difficult for reflux to rise into your esophagus.
However, propping yourself up with pillows won’t be effective, as this only elevates your head and not your upper body. Instead, try using a wedge pillow that is thickest at the top. This will keep your upper body on an appropriate incline to prevent reflux and alleviate discomfort.
3. Watch your Diet
If there are foods that trigger your heartburn, be sure to avoid these before bed. Some of these may include:
- Spicy food
- Caffeine and alcohol
- Acidic foods, like tomatoes or citrus
- Greasy foods
- Onions or Garlic
Also, make sure to stop eating 2-3 hours before you lay down— this reduces stomach acid and allows your stomach to partially empty before bed. Similarly, avoiding large meals before bed can also help with acid reflux symptoms.
Weight loss can also help prevent reflux. Excess weight puts more pressure on the stomach and the diaphragm, which contributes to acid reflux and GERD. Losing that extra weight can remove that pressure and help relieve your symptoms.
When to Seek Additional Help
Often sleep disturbances can be alleviated or prevented with some simple changes. In cases where lifestyle changes don’t help your nighttime symptoms though, it’s important to consult your doctor about further treatment options. For severe cases of acid reflux, treatment options can range from taking medication to even receiving special surgery.
If you find that you’re struggling to sleep even beyond your acid reflux symptoms, it’s possible an undiagnosed sleep disorder is to blame. If you think disorders like obstructive sleep apnea or insomnia are contributing to your poor sleep quality, be sure to consult your doctor or a sleep expert. They can provide a diagnosis and help you find the treatment options that work best for you.
To find accredited sleep experts in your area, check out this tool provided by the American Academy of Sleep Medicine.
Acid reflux symptoms can really ruin your night and make it impossible to get a good night’s sleep. Thankfully though, there are easy and holistic lifestyle changes you can make to ensure reflux is a thing of the past. Give them a try and see how you feel!
Michael J. Breus, PhD, FAASM
The Sleep Doctor