Sleeping with acid reflux can be downright impossible. Waking up in the middle of the night, choking on acid, and coughing violently are all symptoms of nighttime reflux.
At times it can feel like you’ll never get a good sleep. However, some research suggests that your sleeping position could in fact influence your nighttime reflux.
So, what is the best sleep position for acid reflux patients? Studies show that sleeping on your left side is better for acid reflux, whereas right-side sleeping is associated with longer esophageal acid exposure and high incidence of lower esophageal sphincter relaxation.
In this article, we discuss the science behind acid reflux and sleep, as well as the key tips to sleeping with your upper body elevated.
Can Sleeping Positions Affect Acid Reflux?
Sufferers of acid reflux know how difficult it can be to try and get a good night’s sleep. Eating a high-fat diet, engaging in exercise before falling asleep, and being exposed to high levels of stress can result in wakefulness throughout the night. But it’s not just these things that could exacerbate reflux symptoms during bedtime.
What position you sleep in at night can also affect your reflux symptoms, studies suggest. As a patient, have you ever noticed that some nights tend to be better than others? That’s because some sleeping positions worsen acid reflux symptoms.
Lying Down VS Sitting Up
When a person with acid reflux is lying down, the stomach contents don’t go down the stomach. In fact, it’s more likely for the stomach contents to travel back up the esophagus, leading to acid reflux symptoms.
Compare that to sitting or standing where gravity pulls the stomach acids and digested food contents away from your esophagus.
When in doubt, make sure your head is elevated to help your body keep stomach contents right where they belong.
Common Complaints From Acid Reflux Patients
The onslaught of reflux symptoms while sleeping vary from one patient to another. The bottomline stands: it’s difficult to get a good night’s sleep if you’re experiencing acid reflux at night.
Here are just some of the top complaints when it comes to sleeping with acid reflux:
1. Heartburn worse when lying on left side
Sleeping on your side tends to worsen your heartburn symptoms, but you also notice that sleeping on a specific side makes it even worse. It turns out what side you’re lying on can in fact affect how your symptoms flare-up.
A substantial amount of studies found that reflux patients tend to get worse heartburn when they’re lying on their right side. Although it’s unclear what mechanisms cause this, scientists believe that sleeping on the right side tends to trigger symptoms longer than lying on the left.
Another study showed that lying on your right side prolongs the esophagus’ exposure to the acid. Doctors believe that lying on your right side is more likely to induce relaxation of the LES (lower esophageal sphincter), which is the muscle responsible for keeping stomach contents in, and preventing acid reflux.
The general consensus among doctors and patients alike is that lying on your left side is more beneficial for heartburn patients. But if you’re one of the uncommon cases where reflux strikes worse when you’re lying on your left, consider experimenting with different sleeping positions to figure out which one will help soothe your symptoms.
If you realize that your symptoms don’t get better even with different sleeping positions, consider making dietary and lifestyle modifications to reap long-term benefits.
2. Waking up with heartburn in the middle of the night
Falling asleep soundly can be a feat for reflux patients. Nighttime heartburn is a common occurrence for reflux patients, so much so that 75% of reflux patients report experiencing heartburn at night at least once a week.
Patients often report waking up choking, coughing, or feeling a strong acid sensation at the back of their throat. This is also accompanied by a sharp chest pain that could easily be mistaken for a heart attack.
Although doctors have yet to understand what separates daytime and nighttime heartburn, a study revealed the possible indicators of nighttime heartburn, which include:
- High BMI
- Consumption of sodas and carbonated drinks
- Daytime sleepiness
- Use of benzodiazepines (anti-anxiety medicine)
Patients with nighttime heartburn tend to be treated differently than those who only experience symptoms in the daytime. This is because nighttime reflux sufferers often have more complex and aggressive symptoms compared to daytime patients.
At night, patients with heartburn symptoms aren’t just experiencing empty symptoms; they’re also experiencing acid reflux. Nighttime reflux tends to have a “longer clearance time”, which means the acid stays longer in the esophagus before receding again. Because of this, doctors suggest more intensive therapy methods in order to protect the esophagus from prolonged acid contact.
Chronic esophageal exposure to acid may eventually lead to esophagitis and respiratory complications. Part of the GERD diagnosis involves distinguishing between nighttime and daytime symptoms in order to provide the right treatment plan.
If you notice that your reflux is more inconvenient at night, let your doctor know. An upper endoscopy might be recommended to you in order to understand whether you’re experiencing sleep apnea (disruptive snoring and breathing) or gastroesophageal reflux disease (GERD).
3. Stomach acid coming out of nose while sleeping
When lying down, stomach acids can travel back up the esophagus and reach the sinuses. This can result in sinus infections, respiratory problems, and bad breath.
Some patients also report stomach content coming out of their nose or mouth while sleeping. This symptom is observed in more severe cases of GERD and requires immediate medical intervention. When left untreated, this could expose your sinuses to the acid and bacteria in the regurgitated contents, leading to sinusitis.
Taking antacids before falling asleep is a common remedy for GERD patients. If you don’t feel any relief after taking medication, your doctor might put you on PPIs (proton pump inhibitors) in order to reduce your stomach’s acid production.
Stomach acids coming out of the nose is a severe type of symptom and would require more drastic measures in order to be alleviated. You might be asked to lose weight and change your eating habits for long-term relief.
Does Lying On Stomach Help Reflux?
Finding a peaceful position to sleep in can be a tough one for acid reflux sufferers. Because lying down prevents gravity from doing its job keeping the food contents back down, patients feel anxious about falling asleep. Sleep deprivation becomes a problem among acid reflux sufferers in fear of choking or asphyxiation while asleep.
Lying down alone can trigger acid reflux effects, but it gets worse with certain positions. Lying flat on your stomach produces the same result as lying on your back, if not worse.
When you’re lying flat on the bed, your stomach and esophagus are on the same level, making it easy for stomach contents to find their way into the esophagus. When you’re standing up or sitting down, you’re allowing gravity to move these digested bits throughout the rest of your stomach.
Lying on your stomach also tends to put pressure on your stomach. This alone could push the stomach contents to travel upwards and cause heartburn.
The next time you want to lie on your stomach, make sure your head is elevated. Support your neck with a pillow and keep it a few inches higher than your stomach. Otherwise, you’re asking for a bad reflux episode.
What Side Do You Lie On For Acid Reflux?
Despite the general discomfort associated with acid reflux, sufferers aren’t entirely hopeless. Research shows that sleeping on the left side is the most beneficial position for sufferers.
Compared to lying down on the right, which has been associated with higher instances of lower esophageal sphincter relaxations and longer esophageal acid exposure, lying on the left side is associated with an increase in sphincter pressure (making it less likely for the LES to malfunction and let in stomach contents) and higher esophageal pH (which neutralizes acid contents from the stomach).
In order to optimize a patient’s sleeping, researchers underwent a study involving different sleeping positions. They found that patients who slept on the left side elevated experienced the less esophageal acid exposure in comparison to those sleeping on the right.
Researchers also found that those sleeping on the left elevated position were able to spend more time sleeping in this position than others, making this not only a beneficial but viable sleeping position for reflux sufferers.
At the end of the day, you should try whatever works best for your body. Some positions work well with patients, while others experience discomfort even after assuming a “good” sleep position.
Why Does Acid Reflux Improve When Lying Down
Despite being a common gastrointestinal disorder, symptoms aren’t always shared among patients. The general consensus is that reflux gets worse after lying down, but it’s also possible to relieve your symptoms by doing so.
If you’re a patient who feels relief after lying down, it’s possible that your reflux may be triggered by the following:
- You engaged in a stressful physical activity and lying down relaxes your body and your stomach
- You were emotionally stressed and lying down has physically relaxed you
- You are in an elevated position, which helps keep the stomach contents from travelling back up the esophagus
As a result, your acid reflux symptoms are alleviated, not aggravated, by lying down. Knowing your triggers is the first step to living with GERD.
Choking On Acid Reflux While Sleeping: What To Do
What Causes It
If you’re suffering from chronic reflux, you might have awoken to coughing, vomiting, or general discomfort in your throat.
When your stomach is regurgitating digested contents, the acid could linger in your throat and irritate the esophageal lining, which could trigger a cough. It’s also possible for acid to travel back up and reach the mouth, which causes choking.
Patients who experience choking often report the following symptoms:
- Waking up in the middle of the night with a dry cough (cough without phlegm)
- Waking up nauseated and with the strong urge to vomit
- Strong acid taste and smell after waking up
- Sharp pain at the back of the throat
- Difficulty breathing within the first few minutes of waking up
Can You Die From Acid Reflux Choking?
Sleep interruption is the worst thing that could happen to a patient suffering from acid reflux. Although inconvenient, there’s no need to worry about aspiration. Aspiration typically occurs as the result of inflammation or infection.
Regurgitation on its own is not going to cause aspiration. Having a full stomach and vomiting afterwards are likelier causes of aspiration. Because the body operates on an automatic flight or fight instinct, patients will wake up during a reflux episode and cough as a response. Aspiration is uncommon in reflux patients because the body naturally wakes up and reacts to the presence of acid in the esophagus.
Aspiration is more common in patients who have an impaired level of consciousness, such as when they’re sedated or drunk.
Relieving Heartburn At Home: Tips For Better Sleep
1. Take Antacids
Take an antacid an hour before going to sleep to neutralize stomach acids. Note that not all antacids are accessible to pregnant women; avoid antacids with magnesium during your pregnancy. Tums, Maalox, and Rolaids are great antacid options for all patients.
If you find that over-the-counter antacids don’t help with your nighttime reflux, ask your doctor for reflux prescriptions. Medicine such as proton pump inhibitors can block acid production altogether and allow your esophagus to heal in the process.
2. Eat Your Last Meal Earlier
Eating meals too late at night is one of the main triggers of nighttime acid reflux. Some patients eat as early as 3 PM in order to prevent nighttime acid reflux.
If you can’t avoid snacking at night, make sure to wait 1 to 2 hours before lying down to allow the food to travel through your digestive system. Taking a 30-minute walk would improve your chances of a good night’s sleep.
3. Sleep with Extra Pillows
Sleeping on an inclined position on your left is the best position for acid reflux sufferers. Throw in a few pillows during bedtime to make yourself more comfortable.
4. Wear Loose Clothing
Wearing tight pajamas can add pressure to your stomach, contributing to your acid reflux symptoms. Wear loose, comfy clothes before going to bed.
5. Drink Ginger Tea
Ginger is a known home remedy to inflammation, and is also a great remedy for heartburn. Boil some ginger to make tea; this can help relieve nausea, allowing you to get a better quality of sleep. Skip the ginger ale though since it’s carbonated and will only make you more acidic.
Get the Best Sleep of Your Life
Tired of not getting enough sleep? Living with GERD doesn’t have to be a nightmare. At Gastro Center NJ, we do everything we can to help make GERD a manageable part of your life.
Whether it’s sleeping on a foam memory pillow or prescribing a specific diet, we’re here to give you solutions that will improve your nighttime reflux, facilitating better sleep.
Get in touch with us today to learn more about nighttime reflux and how the gastroenterologists of Gastro Center NJ can get you the best sleep of your life.