Acid reflux can worsen at night when a person lies down to sleep. Smoking, obesity, and other factors may increase the risk. Dietary and lifestyle changes may help, such as raising the pillow and eating dinner earlier.
Doctors also advise elevating the head of the bed so that gravity can help prevent food from backing up from the stomach into the esophagus, or food pipe, which is the tube that connects the mouth to the stomach.
If a person experiences the condition often, they may need medical treatment.
Research suggests that either the hormone melatonin or medication with a similar action may reduce symptoms.
This article discusses the symptoms, causes, and treatment of acid reflux at night and outlines some prevention and management techniques.
A person with acid reflux, also known as heartburn, might feel a burning sensation in the stomach, chest, and throat.
Other possible symptoms
If the condition occurs regularly, it may be indicative of gastroesophageal reflux disease (GERD).
Acid reflux while trying to sleep
The International Foundation for Gastrointestinal Disorders (IFFGD) notes that 79% of people with GERD experience symptoms after bedtime.
As many as 75% of those with the condition say the symptoms have an effect on their sleep, and 40% claim the loss of sleep affects their ability to function when they get up.
While GERD influences sleep, sleep deprivation also impacts it. A lack of sleep can cause increased sensitivity to acid in the esophagus.
A person with acid reflux after bedtime may have more acute symptoms than a person experiencing it mainly during the day.
This combination of sleep disturbances and more severe symptoms means that experiencing acid reflux while trying to sleep can worsen the quality of life for people with the condition.
Acid reflux occurs when the contents of the stomach rise into the esophagus due to a weakening of the esophageal sphincter.
The sphincter is a muscle that acts as a valve. It relaxes to allow swallowed food to enter the stomach. It then closes to keep food from moving in the opposite direction. If the sphincter is weak, it may not function properly.
Why does the esophageal sphincter weaken?
Various factors may make the lower esophageal sphincter weaker or cause it to relax at times when it should stay closed.
According to the
- smoking
- obesity
- pregnancy
- hiatal hernia
- some medications, such as nonsteroidal anti-inflammatory drugs and certain medications doctors prescribe to treat depression
The IFFGD states that people who experience acid reflux while trying to sleep have a higher risk of complications, such as:
- inflammation of the esophagus
- esophageal cancer
- Barrett’s esophagus, a condition where tissue similar to the intestinal lining replaces tissue in the lining of the esophagus
People with acid reflux can also have:
According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), a person can ease the acid reflux they experience when trying to sleep by:
- elevating the head of the bed 6 to 8 inches
- avoiding lying down 2 to 3 hours after a meal
- eating smaller meals more frequently and not eating heavy meals before bedtime
The side of the body on which a person sleeps may also make a difference. A 2023 review of studies concluded that sleeping on the left side alleviates acid reflux.
Sleeping well
The IFFGD recommends measures that promote restful sleep. Getting a good night’s rest can help prevent symptoms and improve the quality of life for people with GERD.
Suggested measures include:
- going to bed and waking up at the same time every day
- sleeping in an environment that is quiet, dark, and free of electronic devices
- avoiding caffeine for 8 hours before bedtime, as it may take this long for its effects to wear off
A person can make some changes to their diet and lifestyle that may prevent symptoms of GERD, such as acid reflux.
Lifestyle changes
The AAAAI notes that the following lifestyle adjustments can help prevent acid reflux from occurring:
- reducing alcohol intake
- quitting smoking
- reaching or maintaining a moderate weight
Dietary changes
Diet may also play a role in preventing acid reflux. People can try avoiding potential dietary triggers, such as:
Including the following foods in the diet may help prevent or reduce acid reflux:
- fruits
- vegetables
- whole grains
- healthy fats, such as olives, avocado, and oily fish
- lean meat
- eggs
For GERD in general, doctors
Medications
Over-the-counter medications that reduce stomach acid levels may help a person ease symptoms of GERD. They include:
- H2 blockers: These reduce the amount of acid the stomach produces, and people can take them whenever they experience symptoms. An example is famotidine (Pepcid).
- Proton pump inhibitors (PPIs): These reduce stomach acid and are stronger than H2 blockers. An example is omeprazole (Prilosec).
- Potassium competitive acid blockers (PCABs): These work similarly to PPIs but do not have to be taken 30 to 60 minutes before a meal. Vonoprazan (Voquezna) is currently the only PCAB medication.
- Promotility agents: These speed up stomach emptying and reduce acid in the esophagus. An example is bethanechol (Urecholine).
- Off-label antidepressants: Doctors may prescribe antidepressants off-label to treat GERD that does not respond to GERD treatments.
Surgery
Doctors can recommend surgery if behavioral changes and medications are not helping improve symptoms.
Surgical options may include fundoplication. During this procedure, a surgeon joins part of the stomach to the lower esophageal sphincter.
The Society of American Gastrointestinal and Endoscopic Surgeons states that surgeons most commonly perform fundoplication using a laparoscopy. This procedure involves making several small cuts instead of one large one.
Melatonin
Melatonin is a hormone the body produces before bedtime. It enables a person to sleep and can help prevent or ease GERD symptoms, including acid reflux.
The IFFGD states that deep sleep tends to alleviate symptoms of GERD. This discovery led them to theorize that decreasing the time a person stays awake after going to bed may reduce these symptoms.
They then carried out a study to test the effect of the sleep-inducing medication ramelteon, which acts similarly to melatonin.
In the study, the participants who took ramelteon before bed experienced fewer GERD symptoms at night. The benefit was due to the improved sleep the medication produced.
Moreover, a 2019 study reports that melatonin reduces stomach acid secretion and helps the lower esophageal sphincter to stay closed when it should.
Given the findings of the two studies, it appears that melatonin may help by improving sleep quality and reducing the effects in the body that trigger acid reflux.
When acid reflux occurs at night, it is more severe than when a person experiences it mostly during the day.
People with acid reflux are at greater risk of developing complications such as inflammation of the esophagus.
Modifying the diet and making certain lifestyle changes may help manage the condition.
However, if lifestyle adjustments do not prove successful, a doctor may prescribe medication. Melatonin could also be effective in reducing symptoms.