If you've ever found yourself tossing and turning at night with a burning sensation in your chest, you are not alone. Gastroesophageal Reflux Disease (GERD) impacts nearly 20% of adults throughout the United States, with many complaints of worsening symptoms during bedtime. According to the American College of Gastroenterology, as many as three quarters of GERD sufferer's report sleep disruption due to nocturnal reflux.
GERD is a common digestive disorder, but it's underlying negative effect on sleep is rarely addressed—yet it is directly involved with adverse sleep, fatigue, and lessened quality of life. In this blog, let’s dive into the primary causes of GERD and the concrete suggestions to help you get more sleep through the night.
What is GERD?
Gastroesophageal Reflux Disease (GERD) is a chronic digestive condition that develops when stomach acid or bile flows back up into the esophagus, the tube that connects your mouth to your stomach. This backward movement of acid is called acid reflux disease and can irritate the lining of your esophagus. The symptoms of GERD can include:
- Heartburn (burning feeling in chest)
- Regurgitation of food or sour liquid
- Chest pain
- Difficulty swallowing
- Chronic cough or sore throat (especially at night)
GERD occurs when the lower esophageal sphincter (LES), the ring of muscle at the end of your esophagus, becomes weak or relaxes when it should not, allowing acid to escape upward. While it is common for people to have occasional acid reflux, we consider it GERD when the reflux occurs frequently (usually more than every two weeks), bringing inflammation, or causing other complications.
If untreated, GERD can cause additional health problems e.g., esophagitis, esophageal ulcers, Barrett's esophagus, increases a person's risk of developing esophageal cancer.
How Does GERD Impacts Your Sleep?
GERD can severely impact sleep, often making sleep elusive. Here’s how it can affect sleep:
1. Increased Nighttime Reflux
When in a horizontal position, stomach acid can move more easily back into the esophagus. Gravity is no longer a protective factor to reduce acid in the esophagus, and it is easier for reflux at night.
2. Disturbed Sleep
Symptoms such as heartburn, chest pain, cough, and the sour taste in the mouth may wake you multiple times. Those symptoms can make it difficult to fall asleep or even stay asleep during the night.
3. Sleep position
Sleeping flat on your back or on your right side can worsen reflux symptoms, as certain positions can allow acid to rise more readily and makes sleeping discomforting.
4. Poor quality of sleep
With disturbed sleep, you will often have poor sleep quality, which can lead to feeling fatigued, irritated, and decreased productivity during the day.
5. Risk of Sleep Disturbances
Commonly associated with sleep disturbances, which include insomnia and obstructive sleep apnea (OSA) - along with other health issues caused by chronic symptoms of GERD - this makes restful sleep even more challenging and puts your overall health at even greater risk.
6. Cycle of Deteriorating Symptoms
Poor sleep impacts the immune system, which could elevate pain perception, thereby causing GERD symptoms to feel worse and makes them more difficult to deal with the next day.
Approaches to helping manage your GERD symptoms through lifestyle changes, medications, and sleep changes (elevate your head while sleeping, don't eat late at night) can achieve improvement of both reflux symptoms and sleep quality.
Causes of GERD
GERD occurs when stomach acid frequently flows back into the esophagus, causing irritation of the esophagus. Acid reflux is the backward flow of stomach acid into the esophagus. There are several factors that can contribute to acid reflux:
Weak or Relaxed Lower Esophageal Sphincter (LES) The LES is a ring of muscle that works like a valve between the esophagus and the stomach. If the LES is weak or relaxes too much, then stomach acid can escape upward.
Hiatal Hernia
A hiatal hernia occurs when a part of the stomach pushes through the diaphragm into the chest cavity. A hiatal hernia could diminish the effectiveness of the LES and contribute to a person having reflux.
Obesity
Soft tissue mass in the abdomen (abdominal fat), puts extra pressure on the stomach, which pushes stomach acid into the esophagus. Research shows that individuals who are obese are almost three times more likely to develop GERD.
Pregnancy
During pregnancy, a woman will experience weight gain and pressure changes in the abdomen; as well as the physical changes in hormone levels. All of this can lead to reduced effectiveness of the LES and development of reflux.
Certain Foods and Drinks
Spicy food, high fat meals, chocolates, caffeine, alcoholic beverages, carbonated drinks, citrus fruits, and tomatoes may stimulate the LES to relax or worsen symptoms by relaxing the LES.
Smoking
Smoking weakens the LES sphincter and decreases the body's saliva production, which neutralizes stomach acid.
Large or Late Meals
Overeating or eating close to bedtime can cause high stomach pressure, leading to reflux; this is especially true if you lay down soon after eating.
Medications
Specific medications, including NSAIDs (non-steroidal anti-inflammatory drug) like ibuprofen, calcium channel blockers, some sedatives, and some medications for asthma may relax the LES or irritate the esophagus.
How to Sleep with Acid Reflux/GERD?
The best way to sleep with acid reflux is to modify your sleep position and bedtime habits so that stomach acid does not flow back into the esophagus. Symptoms of GERD will often intensify at night because lying flat eliminates the effect that gravity normally has on keeping acid in the stomach.
These nighttime symptoms: heartburn, coughing, throat irritation, and loss of sleep, can significantly diminish your overall health and well-being. Here are several proven strategies to help you sleep better with GERD:
1. Sleep on Your Left Side
Sleeping on your left side is the better position to alleviate acid reflux symptoms and is thought to be the safest position for nighttime reflux. It allows the opening from stomach to esophagus to remain above the level of stomach acid. Sleeping on forcibly relaxes the lower esophageal sphincter, which allows acid to escape when you sleep on your right side.
Why it Helps: The stomach sits on the left because it has a sac shaped that finds its resting position on the baffled porcupine shape of the left side of our body. When you rest on your left side, there is simply less exposure to acid and more rightness in digestion.
Fact: A study in The Journal of Clinical Gastroenterology found that sleeping on the left side led to a reduction of nearly 50% in reflux episodes compared to the right side.
2. Elevate the Head of Your Bed
Not surprisingly, sleeping with your upper body raised takes advantage of gravity to keep stomach acid from coming up into the esophagus. Raising the head of the bed by 6 to 8 inches will be more beneficial than simply propping yourself up with pillows (you can end up straining your neck and spine with pillows).
How to do it: Use a foam wedge pillow or put some kind of risers or blocks under the head posts of the bed.
Tip: Don't stack pillows—they can accidentally shift while you are sleeping, and they won't keep you at a consistent height.
3. Don't Eat Before Bed
One of the most common triggers for nighttime GERD is eating right as you lie down. When you lie down with a full stomach, it can lead to reflux. And if you recline too soon after eating, it can increase reflux risk.
Recommendation: Be sure to eat at least 2 to 3 hours before bed. This gives your body enough time to digest food and reduce acid reflux risk.
Bonus Tip: Try to keep it light for dinner. Try to avoid high-fat, spicy, or acidic foods in the evening.
4. Invest in a GERD-Friendly Pillow
GERD or acid reflux wedge pillows are designed to support the torso and keep an incline overnight – standard pillows only elevate the head and neck.
Why it helps: It keeps the esophagus above the stomach and minimizes the chance of reflux at night.
Tip: A wedge with a gentle slope (approx. 30 to 45 degrees) that will be the most comfortable and effective.
5. Wear Loose, Comfortable Clothes
Close-fitting waistbands, belts, or too narrow/tight pajamas can increase abdominal pressure and push stomach acid upwards, so stick to lose, soft, and stretchy sleepwear that will not constrict your stomach as you lay down.
6. Achieve a Healthy Weight
Excess weight, particularly around the belly, contributes pressure onto the stomach and can aggravate GERD symptoms during sleep. In fact, studies show that losing as little as 5-10% of your body weight can significantly decrease how often and how intense of acid reflux episodes you have.
Bonus Tip: Combine weight management with light walks in the evening to support digestion and reduce pressure on the digestive system.
7. Recognize Nighttime GERD Triggers
Some food and drink choices are more likely to relax or weaken the LES or cause the stomach to produce more acid. If you limit or eliminate these from your evening routine, you may be able to lessen the symptoms of nighttime GERD. The common food and drink that can trigger GERD symptoms includes:
- Spicy or fried foods
- Citrus fruits or juices
- Tomatoes or tomato-based sauces
- Chocolate
- Caffeine-coffee, tea, or soda
- Alcohol
- Carbonated beverages
8. Quit Smoking and Limit Alcohol
Smoking reduces the tone of the LES and increases the stomach's acid production. Alcohol is also an irritant to the stomach lining and will increase the chance of reflux, especially if you consume it in the few hours before you go to bed.
Smoking and GERD: Smokers are more likely to have severe GERD symptoms, and heal slower from esophageal irritation.
Helpful Tip: Stop drinking alcohol or limit the amount of alcohol intake within the three to four hours before going to bed so that you are giving your body's time to process alcohol out of your system.
When to See a Doctor?
Without treatment, GERD can result in significant complications such as, esophagitis, esophageal strictures, Barrett’s esophagus, and esophageal cancer. When diagnosed and treated quickly, unnecessary prolonged damage can be avoided, possibly affecting your quality of life. If you are on the fence about whether your symptoms are GERD, or something more serious, your safest bet is to check with a healthcare provider.
Final Thoughts
GERD can have a significant impact on your sleep, and comfort, primarily at night, and the simple fact is that by implementing small changes, you can lessen your symptoms. Changing sleeping position, avoiding food in the late evening, and avoiding food triggers, may reduce symptoms, for the better. If lifestyle changes do not resolve your GERD, then it may be time to talk to a doctor to reduce your chronic risk of esophageal complications, by being managed properly. Taking control of your GERD may allow you, to take control of your sleep, health, and quality of life.
