This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.
If you have a stomach ulcer, you may be wondering why the pain is worse at night.
Stomach ulcer pain is worse at night because lying down puts pressure on the ulcer and impairs digestive function – eating sooner than 3-4 hours before bed; eating fast food, fatty meat, citrus fruit, black pepper, chocolate; and taking NSAID can worsen stomach ulcer pain at night.
So what is the best sleeping position if you have a stomach ulcer to reduce pain?
The best position to sleep in with a stomach ulcer is on your back with your head elevated (with pillows or an adjustable bed) to decrease pressure and improve acid drainage – if you are pregnant or have back pain then sleeping on your LEFT side is a suitable alternative.
An adjustable bed is an excellent way to stop stomach ulcer pain at night.
But are there any sleeping positions that you should avoid if you have a stomach ulcer?
The worst position to sleep in with a stomach ulcer is on your front because it puts a large amount of pressure on your stomach ulcer and impairs digestion – you should also avoid sleeping on your RIGHT side for the same reasons.
In the rest of this article, I have used my professional knowledge as a practicing medical doctor and access to scientific journals to explain in more detail why stomach ulcer pain is worse at night and why sleeping in certain positions is better than others.
Essential reading: 6 ways to stop stomach ulcer pain at night.
2 Best Sleeping Positions for Stomach Ulcer Pain Control
Here’s a detailed explanation regarding the best sleeping positions for when you have a stomach ulcer:
1: Sleep on Your Back With Your Head Elevated (Best Position)
The best position to sleep in if you have a stomach ulcer is on your back with your head elevated because it helps with acid drainage, decreases stomach compression, and reduces acid reflux.
You can elevate your head with pillows, but raising the upper portion of an adjustable bed provides better posture and is more comfortable.
Click here to see the best adjustable beds to buy online now.
Better Acid Drainage Means Less Ulcer Irritation
When the upper part of the body is elevated, gravity works in your favor and helps your body to move the acid out of the stomach and into the intestine.
Therefore, less acid will be present in the stomach to irritate the ulcer and disturb sleep.
A recent study published in the journal of Gastroenterology and Hepatology revealed that bed head elevation improved the quality of sleep in 65% of the patients with heartburn, due to decreased acid exposure [5].
Here are 10 causes of morning hiccups and their solutions.
Decreased Compression of the Stomach Reduces Pain
Sleeping on your back or left side reduces the pressure being placed on your stomach.
When you sleep on your stomach or your right side, the weight of the body compresses the stomach and puts pressure on the ulcer – resulting in pain and increasing the backflow of stomach acid.
Click here for 6 ways to sleep better with a stomach ache.
Decreased Acid Reflux Reduces Discomfort
Acid reflux is another problem that increases the pain caused by gastric problems.
Pain receptors are present in abundance in the esophagus.
When food – along with stomach acid – moves back into the esophagus, we experience severe pain.
Back sleeping decreases the chances of acid reflux, as the upper part of the body is higher than the stomach.
This article reveals the 11 best ways to sleep with acid reflux.
1: Sleep On Your Left Side (Better for Back Pain and Pregnancy)
If you have a stomach ulcer and back pain that’s worse when you lie on your back, and/or you are pregnant, then the best sleeping position is on your LEFT side (avoid the right as this can make the pain worse).
The stomach is located to the left of the esophagus, so when sleeping on the right side, stomach contents can easily flow back to the esophagus.
In this instance, clearance of the acid and food from the stomach is delayed, and the risk of ulceration increases.
When you sleep on your left side, gravity works in your favor, and gastric clearance is facilitated.
There is no compression of the digestive system while sleeping on the left side.
A pillow can be placed between the legs for extra comfort.
These are the best soft mattresses for side sleepers.
Left Side Sleeping is Best for Pregnant Women with Gastric Ulcers
Peptic ulcer and reflux disorders are very common during pregnancy, due to the pressure of the growing fetus on the stomach.
Sleeping on the back is not a good option in the third trimester, due to the risks of decreased blood flow and stillbirth.
Sleeping on the stomach is also impossible, so the most recommended position for pregnant women is left-side sleeping.
Find out if it’s safe to sleep in a maternity support belt here.
Left Side Sleeping is Best for People with Back Pain and Stomach Ulcers
Gastric ulcers are commonly encountered in patients with back pain, due to the frequent use of pain medications.
Pain medications damage the protective lining of the stomach and increase the risks of ulcer formation.
The preferred position for people with back pain is sleeping on the left side, with legs slightly bent, and a pillow placed between them.
Sleeping on the back or stomach can exacerbate back pain.
Here are the best adjustable beds to help alleviate your back and stomach ulcer pain at night.
6 Reasons Why Stomach Ulcers Hurt More at Night
The pain of a stomach ulcer usually gets worse at night due to impaired digestive functions and the pressure on the stomach caused by lying down.
When you don’t get enough sleep, stress hormones are released into the body – which further increases gastric acid secretion.
Therefore, it is very important to identify and treat the factors that exacerbate the stomach ulcer, so you can sleep better.
Below, I’ve listed 6 things that can cause your stomach ulcer pain to be worse at night:
1: Eating Too Late at Night
Eating within 3-4 hours before bed is one of the main reasons why stomach ulcer pain is worse at night due to increased secretion of acid from the lining of the stomach and impaired digestive function.
Spicy foods, oily foods, and fast foods increase the chances of gastric ulcer formation – with energy drink consumption also being a potential risk factor.
When you lie down immediately after eating the chances of acid reflux are further increased.
This is because gravity assists gastric clearance, and this effect is lost while you are sleeping.
The acid and food stay for a prolonged period in the stomach and this irritates the ulcer – resulting in pain.
The time between dinner and bedtime is directly proportional to the symptoms of heartburn.
Researchers in Japan conducted studies and proved that those people with a dinner-to-bedtime range of 4 hours or more had fewer symptoms of esophagitis and reflux [9].
I always recommend that my patients eat no sooner than 3 hours before bedtime.
Snacks, desserts, caffeine, or alcohol intake after dinner is associated with the worst outcomes.
The size of the meal is also very important, as a large meal can stay in the stomach for a long time.
So a light meal is recommended before bedtime.
Click here for 15 ways to sleep better after drinking coffee too late.
2: Eating Foods That Increase Gastric Acid Secretion
Nutritional intake is a very important factor that influences the formation of gastric ulcers.
Certain foods like fast foods, fatty meat, caffeine, chocolate, citrus fruit, fried foods, black pepper, energy drinks, and heavily spiced meals are associated with increased severity of gastric ulcers.
These foods increase the secretion of gastric acid and increase soreness in the gastric mucosa.
The best foods for patients with stomach ulcers are those that are non-irritating and don’t stimulate the secretion of acid.
Foods that are rich in fiber – like salads, fruits, vegetables, natural juices, whole grains, and legumes – have a protective role against the formation of gastric ulcers [10].
Foods should be well cooked and well mashed to aid digestion.
I always recommend that my patients eat a balanced diet that provides an adequate number of calories.
Here’s how kiwi can help you sleep better.
3: Sedentary Lifestyle
Physical activity has a direct effect on the development of gastric ulcers and H. Pylori infection.
A sedentary lifestyle results in delayed gastric emptying, obesity, increased secretions of stomach acid, and acid reflux.
Increased physical activity and regular exercise have a well-documented role in the prevention of ulcers.
Increased physical activity is associated with decreased risks of bacterial infections, due to alteration in the immune system.
H. Pylori is the most common cause of gastric ulcers, and a strong immune system is the best defence against the pathogen.
Researchers in the United States revealed in 1999 that regular exercise alters the cells of the innate immune systems – like macrophages, natural killer cells, and neutrophils – in such a way that they become more effective against infectious and neoplastic diseases [11].
The other mechanisms by which physical activity decreases the pain caused by gastric ulcers are by reducing acid secretion, rapid gastric clearance, and reducing stress levels [12].
Try these 8 tips to sleep better with chamomile tea.
4: NSAID Intake at Night
NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed for pain relief in a variety of conditions, such as arthritis, back pain, sciatica, etc.
NSAIDs include Ibuprofen, Diclofenac, Naproxen, and Mefenamic acid.
These drugs decrease the production of prostaglandins that protect the stomach lining from the harmful effects of the acid and therefore cause ulcer formation [13].
The use of these medications should be minimized, and alternative options should be used wherever possible.
If you are forced to take NSAIDs because of some medical condition, then you must take proton pump inhibitors along with them.
Proton pump inhibitors (PPI) like Omeprazole decrease the production of stomach acid and counter the side effects of NSAIDs.
There are many other medicines that also coat the stomach lining and protect it from the acids, these include sucralfate, misoprostol, bismuth, and antacids.
Find out if taking Tylenol can keep you awake here.
5: H.Pylori Infection
H. Pylori is a type of bacteria that infects the lining of the stomach and results in the formation of an ulcer.
It is one of the most common causes of gastric ulcers and is found in 50% of older people.
Ulcers caused by H. Pylori infection are usually resistant to the traditional treatment options, and a specific treatment is needed.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends triple therapy with Clarithromycin, metronidazole, and Omeprazole for 14 days to treat H. Pylori infection.
If this therapy fails, quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole is recommended [14].
Here are 8 ways to stop baby hiccups at night.
6: Smoking
Smoking adversely affects the stomach lining through various mechanisms.
Nicotine present in cigarettes increases the secretion of stomach acid, delays gastric emptying, impairs blood flow and decreases the synthesis of prostaglandins [15].
The only treatment option that works is smoking cessation.
Lifestyle modifications, antacids, PPI, and other medications work only when smoking is discontinued.
Find out how nicotine affects sleep here.
Conclusion: Sleep On Your Back or Left Side
In order to sleep comfortably, a patient with an ulcer should sleep on their back or left side, with the head-end elevated.
Poor eating habits, a sedentary lifestyle, smoking, NSAID intake, and H. Pylori infection are some of the causes of increased pain at night.
Up next: try these 6 ways to sleep more comfortably with a stomach ulcer at night.
Sources and References
[1] “Peptic Ulcer,” Harvard Health Publishing, 2014. https://www.health.harvard.edu/digestive-health/peptic-ulcer-overview (accessed Jan. 02, 2022).
[2] S. Chokroverty, “5 – Physiologic Changes in Sleep,” S. B. T.-S. D. M. Chokroverty, Ed. Butterworth-Heinemann, 1994, pp. 57–76.
[3] S.-H. Ko, M. K. Baeg, S. Y. Ko, and K.-D. Han, “Women Who Sleep More Have Reduced Risk of Peptic Ulcer Disease; Korean National Health and Nutrition Examination Survey (2008-2009),” Sci. Rep., vol. 6, p. 36925, Nov. 2016, doi: 10.1038/srep36925.
[4] “Peptic Ulcer Disease,” Hopkins medicine. https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/esophagus_stomach/peptic_ulcer_disease.pdf (accessed Jan. 04, 2022).
[5] B. A. Khan et al., “Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux,” J. Gastroenterol. Hepatol., vol. 27, no. 6, pp. 1078–1082, Jun. 2012, doi: https://doi.org/10.1111/j.1440-1746.2011.06968.x.
[6] “Sinus Infection (Sinusitis),” CDC. https://www.cdc.gov/antibiotic-use/sinus-infection.html (accessed Jan. 05, 2022).
[7] J. Zenian, “Sleep position and shoulder pain,” Med. Hypotheses, vol. 74, no. 4, pp. 639–643, 2010, doi: https://doi.org/10.1016/j.mehy.2009.11.013.
[8] G. Anson, M. A. C. Kane, and V. Lambros, “Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep,” Aesthetic Surg. J., vol. 36, no. 8, pp. 931–940, Sep. 2016, doi: 10.1093/asj/sjw074.
[9] T. A. Yasuhiro Fujiwara 1, Ai Machida, Yoko Watanabe, Masatsugu Shiba, Kazunari Tominaga, Toshio Watanabe, Nobuhide Oshitani, Kazuhide Higuchi, “Association between dinner-to-bed time and gastro-esophageal reflux disease,” 2005, doi: 10.1111/j.1572-0241.2005.00354.x.
[10] N. D. Vomero and E. Colpo, “Nutritional care in peptic ulcer,” Arq. Bras. Cir. Dig., vol. 27, no. 4, pp. 298–302, 2014, doi: 10.1590/S0102-67202014000400017.
[11] J. A. WOODS, J. M. DAVIS, J. A. SMITH, and D. C. NIEMAN, “Exercise and cellular innate immune function,” Med. Sci. Sport. Exerc., vol. 31, no. 1, 1999, [Online]. Available: https://journals.lww.com/acsm-msse/Fulltext/1999/01000/Exercise_and_cellular_innate_immune_function.11.aspx.
[12] Y. Cheng, C. A. Macera, D. R. Davis, and S. N. Blair, “Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers?,” West. J. Med., vol. 173, no. 2, pp. 101–107, Aug. 2000, doi: 10.1136/ewjm.173.2.101.
[13] C. B. Yegen, “Lifestyle and Peptic Ulcer Disease,” Current Pharmaceutical Design, vol. 24, no. 18. pp. 2034–2040, 2018, doi: http://dx.doi.org/10.2174/1381612824666180510092303.
[14] “Treatment for Peptic Ulcers (Stomach Ulcers),” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment (accessed Jan. 04, 2022).
[15] K. Endoh and F. W. Leung, “Effects of smoking and nicotine on the gastric mucosa: A review of clinical and experimental evidence,” Gastroenterology, vol. 107, no. 3, pp. 864–878, Sep. 1994, doi: 10.1016/0016-5085(94)90138-4.
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Image Attribution and Licensing
Main image: ‘Young woman on the bed with stomachache’ by nenetus (used with permission and commercially licensed through Envato Elements).
Dan is the founder and head content creator at Bedroom Style Reviews.
He has been working as a professional online product reviewer since 2015 and was inspired to start this website when he ended up sleeping on a memory foam mattress that was too soft and gave him backache.
Through in-depth research and analysis, Dan’s goal with this website is to help others avoid such pitfalls by creating the best online resource for helping you find your ideal mattress, bedding, and bedroom furniture.
Dan is a qualified NVQ Level 2 Fitness Instructor with 6 years’ experience helping clients improve their health through diet, exercise, and proper sleep hygiene.
He also holds several college and university-level qualifications in health sciences, psychology, mathematics, art, and digital media creation – which helps him to publish well researched and informative product reviews as well as articles on sleep, health, wellbeing, and home decor.
Dan also has direct personal experience with insomnia, anxiety, misophonia (hypersensitivity to sounds), and pain from both acute and long-standing sporting injuries – he enjoys writing insightful articles around these subjects to help fellow sufferers of such conditions.
Learn more about Dan here.