The Truth About Nighttime Acid Reflux (GERD): Don’t Let It Keep You Up

When you experience the uncomfortable and painful symptoms of acid reflux during the day, you’re naturally in a position to help relieve the problem. Simply by being upright and swallowing, gravity and saliva do their part to help put leaking stomach contents back where they belong. However, during the night, the body’s natural mechanisms are suspended, resulting in more harmful exposure to stomach acid and often, a poor night’s sleep.

With up to 25% of Americans dealing with nighttime heartburn, it’s a serious problem that deserves our attention. The potential adverse health problems and a substandard quality of life means there are both long-term and short-term consequences to consider. 

In the last few years, gastroenterologists have recognized that the occurrence of GERD at night is a more critical form of acid reflux. According to Lawrence J. Cheskin, MD, co-author of Healing Heartburn and associate professor of medicine at the Johns Hopkins School of Medicine:

“When you’re lying down, gravity isn’t pulling in the right direction. Instead, the stomach contents are pressing on the sphincter muscle that connects the esophagus to the stomach. And because you’re lying down, once acids get into the esophagus, they can sit there for much longer than during the day. That can increase the damage.”

With an irritated esophagus from prolonged exposure to stomach acid, you’re vulnerable to painful reflux during the day. In subjecting an open wound to additional injury, your body has a more intense reaction. 

Fortunately, when you alleviate reflux during the night, daytime symptoms are less severe and your risk of associated health problems is greatly reduced. Your esophagus has a chance to heal with several hours free of acid and you’re more likely to get the quality sleep that you need.

While it’s tempting to turn to medications for nighttime reflux relief – like Proton Pump Inhibitors (PPIs) and over-the-counter drugs – there are some notable limitations

  • Over-the-counter PPIs are not meant to be a long-term solution. The recommended treatment, per the FDA, is not more than 14 consecutive days of taking medication and not more than three, 14-day treatment courses in one year.
  • PPIs are most effective when taken before meals. Even delayed-release PPIs don’t prevent acid secretion at night. 
  • The majority of people taking medications for reflux relief still experience symptoms. Only 30% of people taking over-the-counter medications report satisfactory relief at night and only 40% found relief from PPIs.

So what’s the best way to put reflux to rest?

1. Don’t eat for at least 3 hours before going to bed 

With a bigger window of time between your last meal and going to bed, your stomach has a chance to empty its contents. When your stomach is empty, then there’s nothing to reflux. The average time it takes your stomach to pass along semi-digested food into the intestinal tract is between two and four hours. However, factors like illness and the type of food you’re eating can mean a shorter or longer time period.

2. Sleep on an incline system designed specifically for acid reflux/GERD (that is, one that keeps you on an incline and on your side)

When you sleep on an incline, there’s a drastic reduction in acid exposure and acid clearance time (the time that it takes your body to naturally clear acid from the esophagus). Some studies show a reduction in total number of reflux episodes in this position. Then, if you also sleep on your side, any contents that may be in your stomach, will empty more quickly.

Currently, the only sleep system that keeps you comfortably on an incline and on your side is MedCline. With its 2-part system, you’ll sleep comfortably in a position that helps alleviate acid reflux. Your esophagus will have some time to heal and you’ll have better rest without reflux disturbances.

Keep in mind that some incline products – like wedge pillows and bed risers – only prop you up at an angle without securing you on your side. If you roll onto your back, you’re not optimally positioned for reflux relief. Or, if you slide down the bed or off the pillow, you won’t have the benefit of gravity to help reduce acid exposure.

Given the damaging nature of acid reflux, both to your physical health and quality of life, you need to attack the problem on all fronts, and especially when it has the most impact – during the night. Allow yourself more time between eating and going to bed. And use a MedCline reflux relief system that will keep you on an incline and on your side while you sleep. Your body will thank you for it.

For more information on lifestyle changes that can help with relieving acid reflux/GERD, please see the previous post titled “Refluxology: Understanding Acid Reflux and Finding Relief”.

References:

1. William C. Orr, PhD. ”Management of Nighttime Gastroesophageal Reflux Disease”. Gastroenterol Hepatol (N Y). 3(8): 605–606. August 2007.

2. R. Morgan Griffin. “The Special Risks of Nighttime Heartburn.” http://www.webmd.com/heartburn-gerd/features/spec... nighttime-heartburn?page=3ities. April 13, 2009.

3. Philip O. Katz, M.D. “Nocturnal Reflux: Assessing and Addressing the Problem.” Gerd In The 21St Century, Series #16. Practical Gastroenterology, December 2005.

4. Khan BA, et al. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. J Gastroenterol Hepatol. 2012 Jun;27(6):1078-82. June 27, 2012.

5. Johnson LF, DeMeester TR. Evaluation of elevation of the head of the bed, bethanechol, and antacid foam tablets on gastroesophageal reflux. Dig Dis Sci 1981;26:673-80.

6. Hamilton JW, Boisen RJ, Yamamoto DT, Wagner JL, Reichelderfer M. Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Dig Dis Sci 1988; 33: 518-22.

7. Stanciu C, Bennett JR. Effects of posture on gastro-oesophageal reflux. Digestion 1977;15:104–9.

8. FDA US Food and Drug Administration, Possible Increased Risk of Bone Fractures With Certain Antacid Drugs, http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm213240.htm (May 25, 2010)