Acid reflux is bad enough during the day, but when it affects your sleep, it can be a true nightmare. The condition occurs when acid from the stomach backs up into the esophagus, leading to symptoms like heartburn, regurgitation, chest pain, and nausea that make it difficult to fall asleep. The backflow of acid into your throat and larynx while you’re sleeping can also wake you up in the middle of the night with a coughing fit or terrifying choking sensation.
The good news is that there are ways to sleep better if you have acid reflux. Here’s a closer look at why acid reflux tends to get worse at night and what you can do to catch some Zzz’s if you’re living with this common condition.
Why acid reflux gets worse at night
It’s not your imagination: Heartburn and other acid reflux symptoms do tend to act up the moment your head hits the pillow. When you’re standing up during the day, gravity helps keep acid, bile, and other stuff in your stomach from rising into the esophagus. That all changes when you crawl into bed — symptoms can flare.
“As you’re lying flat at night, acid from your stomach can creep up into the esophagus and throat, causing symptoms like chest tightness, chest discomfort, and burning in your throat,” says Dr. Frank Coletta, co-director of the Center for Sleep Medicine at Mount Sinai South Nassau, where he also serves director of pulmonary medicine and critical care.
The prevalence of nighttime acid reflux (not to mention drool spots on your pillow) can also be blamed on a reduction in swallowing that occurs while we sleep. “Swallowing is an important force that pushes food down into the stomach,” says Dr. Raj Dasgupta, pulmonary and sleep medicine specialist and spokesperson at the American Academy of Sleep Medicine. But since the muscles in our mouths relax at night, swallowing occurs less frequently. This creates an opportunity for heartburn-inducing contents to slide up into the esophagus.
Saliva helps neutralize stomach acid, and the quantity in your mouth also plays a role in acid reflux at night, says Dasgupta. Research shows that saliva production peaks during the day but diminishes significantly during sleep. That, in turn, can make it more difficult for the pH in your esophagus to normalize after acid reflux occurs — leading to lingering symptoms that keep you up at night.
The best sleeping position for acid reflux
Getting better sleep with acid reflux often starts with choosing a sleeping position that helps the force of gravity keep your stomach acid where it belongs. In most people, the stomach pouch is on the left side of the body. The more that acid stays within the stomach pouch, the less likely you are to experience acid reflux.
“Therefore, the best sleeping position to reduce acid reflux is to sleep with the left side down,” says Dr. James Lee, gastroenterologist with Providence St. Joseph Hospital. He also recommends raising the head of the bed by 2 to 4 inches, which helps gravity work in your favor.
If you do not sleep on an adjustable base bed, sleeping on a wedge pillow can elevate your head and reduce acid reflux, says Coletta. Staying at least partially upright makes it more difficult for acid to flow into the esophagus.
Adjusting your dinnertime for better sleep with acid reflux
The timing of your meals — particularly your last meal of the day — can make a big difference in whether or not acid reflux affects your sleep.
Experts typically suggest that giving your body time to digest dinner and empty your stomach while you’re still upright can help reduce the likelihood of dealing with heartburn and other acid reflux symptoms when you’re ready to lie down.
“Sleeping with a stomach full of food is the worst thing one can do to prevent reflux,” says Lee. He recommends eating dinner at least three hours before bedtime, a buffer of timing which has been shown to significantly reduce symptoms associated with gastroesophageal reflux disease (GERD), a chronic acid reflux condition.
“After dinner, light activity such as walking can help to reduce nighttime acid reflux,” Lee adds.
Avoiding foods that can trigger acid reflux
In addition to when you eat, what you eat also matters when it comes to preventing acid reflux during sleep. Spicy foods are known to worsen acid reflux symptoms, so consider staying away from things like hot sauce, jalapeños, and cayenne late in the day. According to the National Institute of Diabetes and Digestive and Kidney Diseases, you should also avoid:
- citrus fruits, tomatoes, and other acidic foods
- caffeinated foods and drinks, such as coffee
- high-fat foods
With that said, trigger foods aren’t the same for everyone. If two people eat pizza right before bed, one might be up for hours dealing with heartburn while the other sleeps soundly. Consider tracking what you eat and any symptoms you experience to figure out which foods trigger your acid reflux. Then, tweak your diet accordingly.
Reducing stress to ease acid reflux and improve sleep
Stress can be an underlying contributor to acid reflux and sleep troubles, potentially worsening both issues. Research has shown that people with acid reflux report worse symptoms when they’re stressed out. The Centers for Disease Control and Prevention (CDC) also notes that stress can cause nightmares or problems sleeping. Worse yet, inadequate sleep has also been linked to increased stress levels, which can make your acid reflux symptoms feel worse — leading to even more lost sleep, and, well, you get the picture.
Finding ways to reduce your stress can help ease acid reflux symptoms and boost your chances of good sleep. Lee suggests trying yoga and meditation to relax. He also recommends diaphragmatic breathing, a breathwork technique used by opera singers. It can help you calm stress and provide the body with other benefits to help with acid reflux.
“This technique utilizes breathing using abdominal muscles only and can strengthen the diaphragm muscle, which will increase lower esophageal sphincter pressure and reduce the frequency of acid reflux,” he adds. The esophageal sphincter is the muscle that controls the opening between the esophagus and stomach.
You can practice diaphragmatic breathing techniques sitting up or lying down. Check out this helpful guide from the Cleveland Clinic for specific instructions.
Checking in with a doctor
Acid reflux happens to everyone from time to time. But if you’re experiencing acid reflux a few times a week or more and changes to your diet and lifestyle aren’t helping, you should check in with a doctor. They may recommend trying over-the-counter medications such as antacids, Pepcid AC tablets, Prilosec or Nexium, or prescription drugs, says Lee.
Unless your doctor says otherwise, avoid taking sleeping aids when you have acid reflux, says Lee. “Deeper sleep induced by sleep aids can worsen the damage done by reflux. Waking up due to reflux is almost a protective mechanism,” he says.
Acid reflux that regularly disrupts your sleep can also be a sign that you should get checked out for obstructive sleep apnea (OSA). Research shows that the risk of OSA is higher among people with GERD than those without the condition.
“A lot of people who have reflux also have sleep apnea, and they don’t recognize it because they think their sleep is being disrupted by reflux,” says Coletta.
Adds Lee, “If one is snoring loud, getting the sleep study to diagnose and treat sleep apnea can also lead to better sleep and less acid reflux.”