6 Tips to Stop Acid Reflux While Sleeping

Tired of waking up with acid reflux at night? By adjusting your eating habits and sleeping position, you can manage symptoms and improve your sleep quality significantly. Medication may be needed, so talk with your healthcare provider about symptoms and treatment.

Preventing Nighttime Acid Reflux

Acid reflux while sleeping is a common experience for people living with gastroesophageal reflux disease (GERD), a chronic condition in which stomach acid flows back up into the esophagus (the tube that connects your throat to your stomach). It’s estimated that up to 20% of the U.S. population has GERD.

Waking up feeling like you’re choking on stomach acid can be alarming. Fortunately, there are ways to prevent or lessen acid reflux at night.

Foods and Drinks that Aggravate GERD 

Many people with GERD notice symptoms worsen after eating specific foods or drinks. Your healthcare provider or dietitian might suggest avoiding certain items to see if it helps reduce your symptoms.

Some common dietary triggers for GERD include:

• Acidic foods (common culprits are citrus fruits, tomatoes, and tomato products)
• High-fat or greasy foods
• Spicy foods
• Chocolate
• Mint
• Salt and salted foods
• Caffeinated beverages, such as coffee and tea
• Alcoholic beverages
• Carbonated beverages

You may find that there are other foods not on this list that trigger your GERD symptoms. Discuss them with your healthcare provider or registered dietitian.

Late-Night Eating and Acid Reflux

Allowing more time for your food to digest and empty from your stomach can help decrease the likelihood of acid backing up into your esophagus at night.

To alleviate GERD symptoms at night, eat meals at least three hours before lying down or going to bed. This can reduce the risk of choking on reflux during sleep.

In addition, avoiding spicy foods, caffeine, chocolate, and alcohol, especially in the evening, may reduce the chances of acid reflux while sleeping.

Choosing the Right Clothes to Ease GERD 

Tight clothing, especially around your waist and abdomen, increases stomach pressure. This can push stomach contents into the esophagus, causing heartburn and other GERD symptoms.

To help reduce symptoms of GERD, wear clothing that is loose-fitting and comfortable around your waist.

How Your Sleep Position Affects GERD 

Instead of lying flat, use gravity to help relieve GERD symptoms. Elevate your head with a wedge pillow, six to 10 inches high, or keep the head of your bed elevated to reduce nighttime symptoms like choking on reflux.

Sleeping on your left side may also be beneficial. A small study found that those with chronic heartburn had:

• They had less stomach acid in their esophagus, compared to when they slept on their right sides or their backs
• The stomach acid flowed from the esophagus back to the stomach more quickly

Having less exposure to stomach acid in the esophagus can reduce heartburn pain and reduce the risk of tissue damage.

Why Does Smoking Worsen Acid Reflux?

Smoking is considered to be a risk factor for the development of GERD. Additionally, smoking causes more severe symptoms in patients with GERD. If you smoke, quitting may help alleviate your GERD symptoms.

Weight Management and Reducing Reflux 

Excess weight, particularly in the abdomen, is a risk factor for GERD. Researchers suggest that this might trigger symptoms due to:

• An increase in abdominal pressure
• Slower emptying of the stomach
• Decreased lower esophageal sphincter pressure
• Increased temporary lower esophageal sphincter relaxations

Maintaining a healthy weight may help decrease these effects and, in turn, improve GERD symptoms.

Why Acid Reflux Worsens at Night

There are several theories as to what causes acid reflux to be worse at night. 

Gravity: During the day, gravity helps send rising digestive acid in your esophagus back down into your stomach. When you’re horizontal while lying in bed, you don’t have the assistance of gravity to help send refluxed stomach acid back into the stomach, so it stays longer in the esophagus.

Reduced swallowing: While sleeping, you are swallowing less often. This can make it more difficult for your body to push acid reflux back into your stomach. You also produce less saliva during deep sleep, and saliva usually helps neutralize stomach acid. Saliva contains bicarbonate, which is a buffer that can neutralize stomach acid.

Meal timing and size: Eating large meals or eating a meal or snack too close to bedtime can increase stomach acid and pressure, making reflux more likely. 

Managing Acid Reflux Symptoms While Sleeping

If you’ve implemented the above six tips and still have acid reflux symptoms, these strategies may help you manage the symptoms better.

Medication

Medications that are available over the counter or by prescription may help reduce your GERD symptoms. Common GERD medications include:

• Antacids: Neutralize stomach acid and may be useful for intermittent and relatively infrequent symptoms of reflux.
• Histamine 2 (H2) blockers: Reduce stomach acid production by blocking histamine, a chemical that triggers acid release. 
• Proton pump inhibitors (PPIs): Block the three major pathways for acid production and are more effective than H2 blockers. 
• Prokinetic agents: Increase the strength of the lower esophageal sphincter.
• Potassium competitive acid blockers (PCABs): Reduce the amount of acid produced in the stomach and are stronger than H2 blockers
• Promotility agents: Speed up stomach emptying, which helps reduce LES pressure and improves the clearance of acid from the esophagus.

Talk with your healthcare provider about which medication (if any) might be best for you.

Exercise

Regular mild to moderate exercise has been shown to reduce the symptoms of reflux. Regular physical activity can also help you maintain a healthy weight. However, excessive physical activity may be a risk factor for the development of GERD.

Smaller Meals

Eating large volumes of food at one time may increase your chances of reflux and GERD symptoms due to increased stomach pressure. Eating smaller, more frequent meals and snacks may help decrease the likelihood of food backing up into the esophagus and improve symptoms of GERD.

Stress Management

High stress levels can make symptoms of GERD worse. Studies find that people report their symptoms worsen when they’re stressed, with some evidence that stress alters how these symptoms are perceived.

It’s also common for people diagnosed with GERD to have anxiety. A review of 30 studies concluded that about 34% of people with GERD have anxiety. Research also suggests that the connection between GERD and anxiety is bi-directional, meaning anxiety can worsen GERD symptoms, and GERD can also contribute to anxiety. 

Finding a way that helps you relax and destress can go a long way in helping improve your GERD symptoms. Ways to manage stress may include:

• Meditation
• Breathing exercises
• Talking with a friend or therapist
• Reading a good book
• Getting enough quality sleep (aim for at least seven hours each night)