If you’ve ever experienced a slow burn moving up your chest, that’s acid reflux. Acid reflux is when stomach acid flows back up into the esophagus. It causes symptoms like heartburn, regurgitation, a feeling of having a lump in your throat, or difficulty swallowing. A more uncommon symptom is a radiating chest pain that lasts from minutes to hours and can wake people from their sleep.
Why Is Acid Reflux, or GERD, Worse at Night?
Acid reflux is pretty common: it affects nearly one-third of U.S. adults on a weekly basis — and wreaks havoc at night. One study found that out of adults who report heartburn twice a month or more, nearly 90% of them report nighttime reflux symptoms. Nearly half have difficulty falling asleep and 58% have trouble staying asleep.
As for why it happens at night? Primarily gravity (or lack thereof).
When you are upright, gravity’s force helps keep food moving through the esophagus and down into the stomach. When you lie down, it can become harder for your digestive tract to clear the food out and send it on its way. With more severe reflux — also known as gastroesophageal reflux disease (GERD) or “silent reflux” (laryngopharyngeal reflux) — episodes can happen more than twice a week and may cause sleep issues, both with falling asleep and staying asleep.
Additionally, your swallowing reflexes are relaxed when you’re asleep — meaning your esophagus is cleared less often and it is harder to neutralize your stomach acid.
Other conditions can also make acid reflux worse. If you snore, have sleep apnea, or have other sleep-breathing problems, you can also get caught in a cycle of deteriorating sleep. Snoring can make the reflux worse by causing more acid to irritate the throat.
Luckily, there are many things you can do to improve acid reflux so you can get a better night’s rest.
What to Do Before Bed to Ease Acid Reflux
Maintain a plant-based, Mediterranean-style diet
The key to avoiding bedtime acid reflux is managing what and when you eat. “The primary cause of reflux itself is diet, and unless dietary changes are made, you're still going to have symptoms despite whatever tricks you try to do,” says Dr. Craig Zalvan, chief of otolaryngology and medical director of The Institute for Voice and Swallowing Disorders at Phelps Hospital.
The diet can improve other elements of sleep, too. A recent study published in the Journal of Clinical Sleep Medicine showed that after just 8 weeks, participants who ate a Mediterranean diet of healthy whole foods (fruits, vegetables, beans, olive oil, seafood, poultry, eggs and herbs) and increased their step count by 15% had a 51% reduction in the number of obstructive sleep apnea episodes.
While ideally you’d be eating 90 to 95% plant-based meals all the time, Zalvan says, it’s especially important that your last meal before bed focus on fruits, vegetables, nuts, whole grains, and/or legumes.
Avoid the usual suspects, especially at the end of the day
Your last meal should be at least three to four hours before bedtime, and you’ll want to avoid: coffee, tea, chocolate, soda, greasy food, fried food, fatty food, spicy food, and alcohol.
“Those are all things that I don't believe actually cause reflux, but I believe are all triggers that set it off or make it worse,” says Zalvan. (Worth noting: Some people also find onions, citrus, and tomatoes or tomato-based foods to be acid reflux triggers. If you’re not sure what’s triggering your reflux, keep a food log to track when you have symptoms in order to more easily ID the culprits.)
Keep your nighttime meals small as well
“We tend to eat a large dinner in the U.S., but that's not really easy for us to digest and move around,” explains Zalvan. “[A large meal] can slow down the digestion, which could lead to more regurgitation and more acid reflux issues.” Instead, have a larger lunch or early supper, with a smaller plant-based snack later.
Drink alkaline water
What you drink matters, too — drinking water regularly between meals is a good idea, andZalvan says alkaline water may help, too. “This is water that has a higher pH. A high pH interacts with acid and neutralizes it,” explains Zalvan.
Zalvan’s research has found that drinking alkaline water in addition to the plant-based, Mediterranean-style diet is just as effective as leading medications in managing laryngopharyngeal reflux.
Exercise gently and at the right time
While exercise is almost always good for you — and indeed, being at a higher weight is a risk factor for acid reflux — you may want to avoid high-impact exercise at night, as bouncing and jostling can contribute to GERD symptoms. Intense core work can also trigger symptoms in some people, so experiment to find an exercise that doesn’t exacerbate symptoms, or consider working out earlier in the day.
Wear loose-fitting clothes
As you get ready for bed, avoid wearing skin-tight PJs. “Super-tight waistbands on clothing sometimes can promote reflux-related issues,” says Zalvan.
Use OTC medications
If you suspect you’ll be experiencing heartburn (maybe you had an extra-rich or late dinner and you’re dreading the after-effects), you can try popping an over-the-counter antacid before bed. These chewable tablets work to reduce the amount of stomach acid you have, which may relieve some of your symptoms.
Another type of OTC med, which Zalvan prefers, are alginate therapies like Gaviscon Advance. “Alginates coat the throat and the esophagus,” he explains. “It helps really nicely with symptoms.”
How to minimize acid reflux in bed
Keep your body elevated
If you have frequent or severe reflux, Zalvan recommends propping your actual bedframe, rather than using pillows to prop yourself. “I don’t recommend using extra pillows — most people just end up throwing them off the bed, and getting no help,” he says. Raising your head above your toes helps get gravity back on your side, even while lying down.
An adjustable bed, such as the Mattress Firm 600 Adjustable Base can raise your head in bed with the push of a button.
If you sleep with a partner who doesn’t want to elevate the whole bed, you can try a split-king bed with a split base, or start smaller using a wedge pillow, which will raise only your head.
Test sleeping on your left side
Some believe that sleeping on your left side may help alleviate acid reflux symptoms, but Zalvan says it’s hard to generalize — a sleeping position that works for one person may not work for another.
“Some people sleep extremely well on one side and on the other they'll sleep terribly, and that may not be due to reflux,” he says. “It's just due to their levels of comfort.”
If sleeping on your left side works for you, try also elevating your bed and body. In fact, a combination of all these lifestyle tips above will go a long way towards relief, rather than one solo change.
When to See a Doctor
“If you're having symptoms that are increasing, becoming more frequent, they're waking you up, you're having more abdominal pains, or changes in bowel movements, all of those are worrisome and certainly time to see a doctor,” says Zalvan. This is important to rule out other conditions that may mimic reflux, like Barrett’s Esophagus or even certain cancers.
You may also be experiencing acid reflux as a side effect of body size, substance use, or age. Risk factors for acid reflux and GERD go up if you are:
- Overweight: Larger bodies are more likely to experience acid reflux due to additional pressure on the abdomen.
- Pregnant: As the womb grows, it can cause pressure against your abdomen and cause stomach acid to flow back up.
- Tobacco or alcohol user: Nicotine in tobacco relaxes the valve between the stomach and the esophagus. Drinking alcohol may also cause damage to the esophagus that increases reflux symptoms.
- Over 40: The muscles between your stomach and esophagus weaken as you age.
Tweaking your habits to be conscious of how acid reflux affects your sleep may be the silver bullet to neutralizing acid reflux, but if relief is only temporary, your doctor can prescribe medication. These may be H2 blockers, which decrease acid production (drugs like Pepcid AC and Zantac) or proton pump inhibitors (PPIs, including Prevacid and Prilosec), which both decrease production and help heal damaged esophageal tissue.
While relatively rare, there are side effects. H2 blockers may cause headache, dizziness, diarrhea, and changes in sexual function. They can also paradoxically induce drowsiness or trouble sleeping. PPI side effects may increase risk of bone fractures, increased risk of pneumonia, and diarrhea.
If you are pregnant and worried about side effects, OTC antacids (like Tums or Rolaids) may be safe, but check with your doctor before adding anything new to your routine.
Bottom line: If you’re having trouble sleeping due to acid reflux symptoms, you don't have to feel the burn any longer.
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