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How to Sleep with GERD

We all need a good night’s sleep, but if you are one of the 20 percent of Americans suffering from GERD[1], you are probably not getting enough of it. Sleep disturbances and GERD, or acid reflux disease, are two conditions that, on the surface, seem unconnected. But they are very connected, and one can often exacerbate the other.

So, what is GERD and why does it impact how you sleep? Does how you sleep have an impact on GERD? Read on to find out the answers to these questions.

 

What is GERD?

GERD is an acronym for gastroesophageal reflux disease and is characterized by stomach acid flowing back up into the esophagus. The esophagus is a muscular tube that runs behind the trachea (windpipe) and its purpose is to carry food from the throat to the stomach by using muscular contractions.

The lower esophageal sphincter (LES) is a group of muscles toward the bottom of the esophagus that, under normal circumstances, closes off to involuntarily prevent stomach acid and other contents from flowing back up from the stomach. But in someone that suffers from GERD, the LES is weak and does not close or open when it is supposed to. This causes stomach acid and content to flow back up from the stomach to the esophagus.[2]

Symptoms of GERD are particularly worse at night. When you are upright, gravity helps to keep stomach acid down in the stomach. But when you are lying flat, you lose gravity’s help and stomach acid easily flows back up.[3]

 

Symptoms of GERD

 Heartburn is a common symptom of GERD and feels like burning in the chest up to the throat. It may also present itself in other ways such as[4][5]:

  • Regurgitation. This happens when stomach acid and food make its way back up the esophagus and into your throat, causing you to taste stomach acid or food.
  • Chest pain.
  • Painful swallowing or difficulty swallowing.
  • Nausea.
  • Hoarseness.
  • Respiratory complications, such as chronic cough or asthma.
  • Wearing of tooth enamel.

 

GERD and Sleep

 Although these symptoms can come about at any time of day, they may be more aggressive at night while you are trying to sleep. There are three main reasons for this.

  1. Stomach acid is secreted in higher amounts at night. Recent research shows that we have a circadian rhythm of stomach acid secretion.[6] Stomach acid is shown to be at its highest around 8 o’clock p.m. until midnight and lowers throughout the night until it reaches its lowest point at 5-11 o’clock a.m. One study showed that acid reflux may be affected by which stage of sleep you are in, with REM sleep possibly showing protection against symptoms of GERD.
  2. We do not swallow while we sleep. When we are awake we swallow, which helps take stomach acid back down to the stomach. Swallowing also helps carry saliva, which contains bicarbonate, to the stomach where it works to neutralize stomach acid.[7] Since we do not swallow while we sleep, saliva is not available as a neutralizer.
  3. Reflux symptoms are worse while lying flat. When you are lying flat, especially on your back, gravity is not helping your stomach acid stay down in your stomach, and it easily flows back up into your esophagus, making symptoms worse.

 

GERD and Sleep Disorders

Several studies have shown that those who experience nighttime heartburn have corresponding sleep disturbances that alter daytime performance.

GERD has a direct impact on sleep and can also put you at greater risk for:

  • Aspirating, which means breathing in stomach contents into your lungs.
  • Sleep deprivation. Having symptoms of GERD can cause you to frequently awaken throughout the night, disrupting your sleep cycle.
  • Exacerbation of sleep disorders, such as obstructive sleep apnea (OSA).

 

GERD and Obstructive Sleep Apnea (OSA)

GERD is prevalent in those that have OSA, at an estimated 58-62 percent.[8] There is limited research to show the reasons behind this correlation. One thought is that periods of apnea may increase pressure through the diaphragm and decrease pressure within the chest, contributing to GERD symptoms.[9] Furthermore, GERD may worsen periods of apnea in those with OSA, by disrupting the body’s ability to breathe effectively. They may then wake up gasping for air and breathing rapidly, which can worsen reflux.

Other researchers believe that obesity is the missing link, not necessarily OSA.[10] Approximately 70 percent of patients with OSA are obese.[11] Excess abdominal fat can put added pressure on the diaphragm, exacerbating GERD symptoms.[12]

 

GERD can interfere with sleep, and poor sleep can impact GERD.

There is evidence to show that GERD can lead to sleep disturbances, but new research is also showing that sleep disturbances can aggravate GERD, although more research is needed to understand why.[13] But what is known is that this can result in a vicious cycle for those that suffer from GERD and sleep disorders.

One study found that subjects had worsening symptoms of GERD while sleep-deprived than they did after a full night’s sleep, concluding that sleep deprivation may increase the sensitivity to pain associated with GERD.

Those that take certain medications for sleep disorders, such as benzodiazepines, may also experience aggravated GERD symptoms. These medications decrease LES pressure, increasing the number of reflux occurrences.[14]

 

Other Risk Factors for GERD

 If you’re suffering from GERD, there are other risk factors to consider.

  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Delayed stomach emptying
  • Genetics[15]

Other lifestyle choices may also put you at increased risk for GERD.

  • Smoking
  • Diet
  • Eating before bed
  • Alcohol
  • Coffee
  • Certain medications

 Treatment Options for GERD

Getting the proper treatment for GERD is important because if left untreated, it can cause other health conditions including adult-onset asthma, sinusitis, and esophageal irritation, scarring, bleeding, narrowing, swelling, ulcers, and in some cases cancer.

Treatment for GERD may vary for everyone, depending on what is causing it. Simple lifestyle changes, such as quitting smoking, changing your sleep position, and a change in diet, may relieve symptoms for some people.

If you experience GERD symptoms primarily at night, you may want to consider changing your sleep position.

 

Best Sleep Position for GERD

Both gravity and anatomy are factors when it comes to sleep position and GERD symptoms.

Avoid back sleeping. Research suggests that back sleeping is the worst position for those suffering from symptoms of GERD. When lying on your back with a weakened LES, stomach acid is free to move from the stomach into the esophagus. GERD symptoms are shown to occur more frequently and last longer in this position.

Avoid sleeping on your right side. If you sleep on your right side, your body needs to fight gravity to return stomach acid to the stomach and although symptoms may appear less often than while sleeping on your back, your LES becomes immersed in stomach content,[16] and stomach acid leaks into your esophagus.

Sleep on your left side to control symptoms of GERD. On your left side, your LES generally stays above the level of stomach contents. In this position, gravity can work in your favor and bring stomach acid back down to your stomach.

Sleeping at an incline while on your left side offers optimal relief from GERD[17]. This position puts your LES in a position well above your stomach acid and gravity can work quickly to take any stomach content back down to your stomach.  There are pillows designed for the specific purpose of helping you sleep at an incline.  Some will find the incline pillow will help with GERD, but that the incline causes shoulder pain.  The MedCline Acid Reflux Bed Wedge is specially designed with a cut-out for your left arm to minimize shoulder irritation.

 

Medications for GERD

If you’ve tried relieving your GERD symptoms already without success, your doctor may recommend medication.  You may be instructed to try an over-the-counter medication, such as an antacid to neutralize stomach acid.  Some medications reduce stomach acid or inhibit its production.  Prescription medications are also available but may come with side effects, such as a deficiency in some vitamins (like vitamin B12), nausea, and fatigue.

 

Treating GERD and OSA

Treating sleep apnea may also treat GERD.  For those with OSA, CPAP (continuous positive airway pressure) machines are the number one treatment option and it’s now being learned that CPAP may also treat GERD. A study published in the American Journal of Clinical Sleep Medicine shows that CPAP therapy can alleviate symptoms of nighttime GERD in people with OSA, without acid-reducing medication.[18]

Equally, it has been shown that treatment of GERD may also ease symptoms of OSA[19].  For patients with OSA that are obese, weight loss may offer relief.

 

Conclusion

If you suffer from poor sleep and also symptoms of GERD, you can bet that one is affecting the other. You may be able to find relief from both ailments with just simple lifestyle changes. But if you need further treatment, you will need to work with your doctor to find out which one is right for you.

 

[1] NIH: Definition & Facts for GER & GERD

[2] https://www.geisinger.org/health-and-wellness/wellness-articles/2017/12/01/22/03/a-new-way-to-say-goodbye-to-gerd-for-good#:~:text=GERD%20is%20a%20severe%20type,bile%20from%20leaving%20the%20stomach.

[3] https://health.clevelandclinic.org/why-does-your-heartburn-always-seem-worse-at-night/

[4]https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes

[5] https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts#complications

[6] https://www.gastrojournal.org/article/S0016-5085(75)80131-4/pdf

[7] https://www.gastrojournal.org/article/S0016-5085(82)80286-2/pdf#:~:text=The%20lower%20bicarbonate%20concentration%20of,acid%2Dneutral%2D%20izing%20component.&text=In%20the%20stomach%2C%20swallowed%20saliva,to%20a%20meal%20(19).

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879818/

[9] https://pubmed.ncbi.nlm.nih.gov/10718464/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702204/

[11] https://obesitymedicine.org/obesity-and-sleep-apnea/#:~:text=About%2070%25%20of%20adult%20OSA,to%20their%20normal%2Dweight%20peers.

[12] https://www.obesityaction.org/community/article-library/obesity-heartburn-what-is-the-link/#:~:text=The%20increased%20risk%20of%20GERD,who%20are%20affected%20by%20obesity.

[13] https://healthblog.uofmhealth.org/digestive-health/why-sleep-disorders-cause-heartburn-and-vice-versa

[14] https://pubmed.ncbi.nlm.nih.gov/237803/

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702204/

[16] https://pubmed.ncbi.nlm.nih.gov/8561144/

[17] https://pubmed.ncbi.nlm.nih.gov/26053170/

[18] https://aasm.org/study-finds-that-cpap-therapy-reduces-acid-reflux-in-people-with-sleep-apnea/#:~:text=Working%20at%20AASM-,Study%20finds%20that%20CPAP%20therapy%20reduces%20acid%20reflux%20in%20people,patients%20with%20obstructive%20sleep%20apnea.

[19] http://www.sleepscience.org.br/details/18/en-US/what-we-know-about-gastroesophageal-reflux-disease-and-obstructive-sleep-apnea-

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