Sleep and Heartburn

Heartburn or gastroesophageal reflux disease (GERD) is a common condition. For most individuals who suffer from GERD, symptoms occur during the day. However, nighttime GERD occurs in one out of four Americans according to a 2005 study published in the journal CHEST. GERD symptoms are caused by a reflux or back-up of stomach content causing acid exposure to the esophagus. The lower esophageal sphincter (LES) is a muscular ring that keeps the stomach content from traveling back up the esophagus. If it gets weak, stomach acid can travel back and cause reflux symptoms.

Physiological changes during sleep are also responsible for the predisposition of nighttime GERD. During sleep, there is a dramatic drop in saliva production and frequency of swallowing; there is slowing of gastric emptying and decreased perception of heartburn symptoms. As a result, you are less likely to clear your throat or swallow, leaving the acidic content to hang around the stomach longer.

Nighttime GERD can cause prolonged acid exposure to the esophagus and eventually leads to chronic inflammation, scarring and even cancerous changes within the esophagus. GERD patients can also experience hoarseness or respiratory complications including asthma.

Nighttime GERD affects the quality of sleep by causing frequent awakenings and reduced amount of deep sleep that we need to feel refreshed. Many patients will then suffer from daytime fatigue, low energy or sleepiness. One study showed that the more prolonged the acid exposure to the esophagus, the poorer is the sleep quality.

Tips on how to cut down on nighttime heartburn:

  • Elevate your head to about 20-30 degree angle or whatever feels comfortable with wedge pillows. You may also choose to elevate the bed with bricks or wooden blocks. Be aware of the placement of your pillows- avoid pressure or bend on your stomach.
  • Avoid eating close to bedtime. It is recommended to avoid heavy meals 3 hour before bedtime, but you may find that getting out of the kitchen even earlier will serve you well. Avoid snacking close to bedtime. Drinking warm milk to help you sleep might not be such a good ideas since the fat and protein can stimulate digestion and acid secretion.
  • Chew gum after dinner to increase saliva production, which neutralizes stomach acid.
  • Wear loose clothes at night and avoid tight clothes around the waist.
  • Sleep on your left side. Studies have shown that this position somehow helps digestion. The right side seems to aggravate symptoms.
  • Abstain or at least avoid food that can trigger heartburn: acohol, chocolate, peppermint, coffee, carbonated drinks, citrus fruits and juices, tomato-based foods, pepper, vinegar, catsup and mustard, garlic, onion and spicy or fatty or fried foods.
  • Stop smoking if you are a smoker.
  • Keep a body weight that is ideal for you.
  • Avoid medications that worsen heartburn: aspirin, certain sleeping pills or anti anxiety pills (benzodiazepines). Check with your doctor or ask the pharmacist first before making changes if you are embarking on new medications.
  • Screen yourself for sleep apnea: snoring, gasps, daytime tiredness and frequent awakenings at night. Ask your bed partner to listen. Sleep apnea might aggravate heartburn.
  • If the symptoms persist, you need to talk to your doctor to consider other treatment options and possibly a course of acid suppression medication.