Other sleep problems
Nighttime Acid Reflux (Sleep-Related GERD)
Stomach acid flowing back into the oesophagus at night, causing heartburn, coughing or choking that disrupts sleep.
Overview
Gastro-oesophageal reflux disease (GERD) occurs when stomach contents flow back into the oesophagus. When it happens at night, lying flat makes reflux easier and swallowing and saliva, which normally clear acid, decrease during sleep.
Nighttime reflux can cause heartburn, a sour taste, coughing, choking or hoarseness and can wake you repeatedly. Some people have reflux at night without obvious heartburn and notice only poor sleep or a morning cough.
Simple changes such as raising the head of the bed, avoiding late meals and sleeping on your left side can help, and medicines are effective for many people. Persistent or severe symptoms need medical evaluation.
Common symptoms
- Heartburn or burning chest pain at night
- Sour or bitter taste in the mouth
- Waking with coughing, choking or wheezing
- Hoarseness or sore throat in the morning
- Regurgitation of food or liquid
- Frequent awakenings and poor sleep
Causes and risk factors
- Eating large or late meals
- Fatty or spicy foods, chocolate, caffeine and alcohol
- Excess weight
- Hiatal hernia
- Smoking
- Pregnancy
- Obstructive sleep apnea, which often coexists with nighttime reflux
How it is diagnosed
GERD is often diagnosed from symptoms and response to treatment. If symptoms are severe, persistent or include warning signs, a clinician may recommend an upper endoscopy or esophageal pH monitoring to measure acid exposure. Sleep apnea screening may be suggested if you snore or feel unrefreshed.
Treatment options
Raising the head of the bed
Lifting the head end with blocks or a wedge is recommended for nighttime symptoms by the American College of Gastroenterology.
Avoiding late meals
Not eating for 2 to 3 hours before lying down.
Weight loss
Reduces reflux in people with overweight or obesity.
Medicines
Antacids, H2 blockers and proton pump inhibitors reduce acid, and a clinician can advise on timing for nighttime symptoms.
Treating sleep apnea
May reduce nighttime reflux in people with OSA.
Surgery or procedures
For selected people who do not respond to medicines.
What you can do yourself
- Finish eating 2 to 3 hours before bed
- Raise the head of your bed, rather than just stacking pillows
- Try sleeping on your left side
- Limit alcohol, caffeine and foods that trigger your symptoms
- Stop smoking
- Wear loose clothing around the waist
When to see a doctor
- Heartburn more than twice a week or that persists despite treatment
- Difficulty or pain swallowing
- Unexplained weight loss, vomiting blood or black stools (seek urgent care)
- Chest pain, especially with exertion, shortness of breath or sweating (seek emergency care, as it may be your heart)
- Nighttime choking or coughing that wakes you often
Frequently asked questions
What is the best sleeping position for acid reflux?
Raising the head of your bed and sleeping on your left side tend to reduce nighttime reflux. Lying on your right side and flat on your back can make it worse for some people.
Do extra pillows help?
Stacking pillows bends your body at the waist, which can increase abdominal pressure. Raising the head of the bed frame or using a wedge is usually more effective.
Is there a link between reflux and sleep apnea?
Yes. GERD and obstructive sleep apnea often occur together and share risk factors such as obesity. Treating sleep apnea may improve nighttime reflux in some people.
How long before bed should I stop eating?
Guidelines suggest avoiding meals for 2 to 3 hours before lying down to reduce nighttime reflux.
Sources
This page is general information, not a diagnosis or medical advice. Read our medical disclaimer.