Woman With Acid Reflux.

11 Ways to Sleep Better With Acid Reflux (Doctor’s Tips)

by
Dr-Babar-Naeem.

This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.

Acid reflux or gastroesophageal reflux disorder (GERD) is a condition in which the stomach contents move back to the esophagus and mouth – potentially causing heartburn, chest pain, choking, recurrent throat infections, and sleeping problems.

About 20% of people in the western world suffer from this disorder (1) and according to research, 75% of people with acid reflux have sleep problems (2).

But why does acid reflux get worse at night?

Acid reflux is worse at night because lying down stops gravity from helping food to pass through the digestive system as smoothly, whilst digestive actions such as swallowing and saliva production are reduced during sleep.

So what can you do to stop acid reflux at night and sleep better?

The most effective way to stop acid reflux at night is to avoid eating sooner than 3 hours before bed; sleep on your left side (avoid sleeping on your front, back, or right side); eat bananas; chew gum 30 minutes before bed; and sleep on an inclined adjustable bed.

In the rest of this article, I have used my professional medical knowledge to provide you with 11 ways to combat acid reflux at night.

Related: see the best adjustable beds to stop acid reflux here.

11 Ways to Stop Acid Reflux at Night

7 Things to Try to Reduce Your Acid Reflux

Here are 11 strategies that you can try tonight to stop acid reflux from ruining your sleep:

1: Sleep On Your Left Side

The most significant step that you can take to combat acid reflux at night is to sleep on your left side and avoid sleeping on your back, right side, or front.

Body position has been shown to affect the food’s movement within the gastrointestinal tract significantly [3].

While you are sitting or standing, the upward movement of the food is reduced, due to the effect of gravity.

However, while you are lying down, the effect of gravity is the same on all parts of the body, and it becomes easier for the food to regurgitate into the esophagus.

Sleeping On Your Left Side is the Best Position for Acid Reflux

The best sleeping position to reduce the discomfort of acid reflux is sleeping on your left side because the position of the stomach is slightly to the left of the abdomen, and so gravity will act to keep the food in the stomach [3].

Sleeping On Your Back Can Make Acid Reflux Worse

Sleeping on your back can make acid reflux worse because, in this position, the contents of the stomach can escape more easily and move into the esophagus where they can cause discomfort.

Sleeping On Your Right Side Can Make Acid Reflux Worse

When we sleep on the right side, the stomach is above the esophagus, which results in easy movement of the food contents back into the esophagus, which exacerbates the acid reflux.

The beneficial effect of gravity is lost in this position, and food stays longer in the esophagus, creating more problems.

Another disadvantage of this position, according to the research, is the increased regurgitation of liquid contents, resulting in coughing and choking.

Sleeping On Your Stomach is the Worst Position for Acid Reflux

Sleeping on your stomach is the worst position for acid reflux because the whole weight of your body puts pressure on the stomach and forces the food contents to regurgitate upward.

Discover 10 causes of morning hiccups and their solutions here.

2: Use an Adjustable Bed to Reduce the Effects of Gravity

An adjustable bed allows you to elevate the upper portion of the bed and doing this has been shown to help reduce acid reflux discomfort at night by preventing the flow of food and digestive juices back into the esophagus [4].

See the best adjustable beds to buy for acid reflux and back pain here.

3: Avoid Eating in the 3 Hours Before Bed

To decrease GERD incidence and improve sleep quality, you should not eat within the three hours before going to bed.

When the interval between meal and sleep is short, the odds of getting acid reflux are increased.

This is because the stomach needs some time to digest and move the food through.

A study conducted in Japan showed that people who ate dinner within 3 hours of going to bed had a 7.5% more chance of developing GERD, when compared to those who waited more than three hours after a meal before going to bed [5].

I always recommend that patients eat their dinner at least 4 hours before going to sleep.

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4: Avoid Citric Fruits

Citrus fruits like oranges, lemons, pomelo, grapefruit, and tomato are associated with an increased risk of acid reflux, and should be avoided.

Studies have shown that citrus fruits slow the food’s movement from the stomach to the intestine, and decrease the lower esophageal sphincter pressure [6].

The acid content of the citrus fruits is also greater than that of other fruits.

The Lower Esophageal Sphincter (LES) is a valve-like structure present at the junction of the esophagus and stomach.

In normal individuals, it only allows the forward movement of the food into the stomach.

If the pressure of the LES is decreased, the food can move backward into the esophagus, resulting in GERD.

If the pressure of the LES is increased excessively, food will not be able to reach the stomach.

Any diet or drug that decreases the LES pressure will increase the symptoms of GERD.

Pressure in the LES can be measured by a test called esophageal manometry, which is used to diagnose acid reflux disorder in certain conditions.

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5: Minimize Consumption of Caffeinated Beverages

Caffeinated beverages like tea, coffee, and hot chocolate increase acid reflux and should be avoided [7].

Firstly, caffeine acts as a gastric irritant, and the body responds by increasing acid production.

Increased acid production causes increased symptoms of GERD.

Secondly, caffeine decreases the lower esophageal sphincter pressure, which increases the regurgitation of the food.

And lastly, forward movement of the food from the stomach into the intestine is decreased.

Food stays in the stomach for a long time, increasing the chances of acid reflux.

I always recommend my patients minimize the use of caffeinated beverages.

Alternatively, you can use chamomile or other decaffeinated teas to get the same benefits.

Explore more ways to sleep after drinking coffee.

6: Avoid Alcohol

Alcohol has a lot of detrimental effects on our health and it can also make acid reflux worse.

Alcohol increases acid secretion from the specialized stomach cells called parietal cells – this inhibits the forward movement of the food and decreases LES pressure.

Alcohol also impairs the stomach’s barrier function against acid damage by decreasing the production of mucus and bicarbonate.

All of these factors facilitate the development of GERD [8].

The effects of alcohol on the symptoms of acid reflux are pronounced in people with a genetic predisposition.

Another very important point that most people do not realize is that GERD is a very dangerous disease in the long term – potentially leading to cancer.

Acid reflux irritates the esophagus, and the body makes some changes there to adapt to this irritation.

Structural changes occur in the food canal and can lead to the condition of Barrett’s esophagus.

If left untreated, the Barrett’s esophagus results in esophageal carcinoma.

Therefore, I always stress the importance of quitting alcohol consumption in order to obtain various health benefits.

Try these 3 ways to sleep better with kiwi fruit.

7: Adopt a Healthy Lifestyle

There are many dietary habits that increase the incidence of acid reflux.

Overeating, skipping breakfast, snacking at night, eating quickly, frequent liquid consumption, and eating hot food are associated with increased GERD incidence [9].

Regular eating habits and vitamin intake are associated with decreased acid reflux risks.

Eat Small Meals Frequently

A heavy meal stays in the stomach for a long time, and puts pressure on the LES.

A small meal allows the stomach to empty rapidly, and decreases the chances of getting reflux.

Therefore, I always recommend taking small meals at regular intervals to minimize the chances of acid reflux.

Eat Light at Night

Another good strategy is to eat a big meal in the morning, and a lighter meal at bedtime.

This will minimize acid reflux at night, and improve sleep quality.

Avoid Physical Activity Soon After Eating

After eating, you should maintain an upright posture for at least 1 hour, and avoid physical activities.

Physical activity immediately after a meal interferes with absorption, and increases the chances of heartburn.

Also, intense exercise too close to bedtime can keep you awake.

Control Obesity

Obesity and being overweight are other factors that exacerbate acid reflux, and disrupt sleep.

Maintaining a healthy weight is essential for controlling reflux symptoms without using any medicine.

Avoid Tight Clothing

Wearing tight clothing puts pressure on the stomach, increasing the chances of food reflux.

Moreover, these can muscle stretch, and interfere with quality of sleep.

So wearing relaxed and comfortable clothing is an excellent choice for avoiding these problems.

Avoid Spicy and Fatty Foods

Spicy and fast foods increase acid production, and stimulate the secretion of already formed acids.

These foods should not be consumed, especially before going to sleep.

Practice Relaxation and Breathing Exercises

30 Minute Guided Meditation for Healing Acid Reflux | Heartburn Relief | Stress and GERD

Stress and anxiety increase the production of stomach acid, and relax the LES.

A simple solution is to practice breathing exercises, which studies have shown reduce stress and GERD symptoms.

A meta-analysis of 7 studies was done in 2020, and it was revealed that breathing exercises relieve the symptoms of GERD.

Try listening to the guided meditation in the video above that’s specifically designed to help you relax and reduce the symptoms of acid reflux.

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8: Quit Smoking

Smoking cessation is essential to controlling acid reflux symptoms and good quality sleep.

Smoking has many well-known adverse effects on our health, such as lung cancer, COPD, heartburn, and peptic ulcers.

Nicotine present in tobacco acts on the muscles of the Lower Esophageal Sphincter (LES), and causes relaxation.

When the LES is relaxed, stomach acid and food contents are regurgitated into the esophagus.

Smoking exacerbates acid reflux by decreasing saliva production, and increasing the production of stomach acid.

It also counteracts the protective effect of mucus.

Smoking also has a direct negative effect on the quality of sleep, independent of acid reflux.

Researchers at the Northwestern University Medical School, Chicago revealed that the incidence of acid reflux disease is much higher among smokers [10].

Another study done in Japan researched the beneficial effects of smoking cessation on acid reflux, and found that smoking cessation improved GERD symptoms in 44% of the patients.

Quality of life was also improved significantly in patients who quit smoking.

Therefore, I always recommend my clients quit smoking for good quality sleep.

Discover how nicotine affects sleep here.

9: Try Home Remedies for Acid Reflux

Below are some home solutions for acid reflux:

Chew Gum for 30 Minutes After a Meal

It may come as a surprise that chewing gum has been shown, in studies, to help acid reflux.

It acts through several mechanisms.

Most acid reflux problems are caused by the regurgitation of the acid into the esophagus.

Chewing gum increases the swallowing movements, and helps with the clearance of this acid.

When acid is removed from the esophagus, the associated problems, including sleep disturbance, are resolved.

A study was conducted in London in 2005, in which the researcher demonstrated that the chewing of gum for 30 minutes after a meal decreased the esophageal pH, and helped with the symptoms of acid reflux [11].

But please remember that chewing gum should be sugar-free, as the presence of sugar can cause more harm than good.

There is another way by which chewing gum helps control GERD symptoms.

Researchers at London Hospital Medical College, UK, revealed that chewing gum increases saliva production.

This increased saliva production helps wash the acid from the esophagus, and controls the symptoms of acid reflux [12].

There is specialized chewing gum called GutsyGum that has been developed to control the symptoms of acid reflux.

This chewing gum contains a chemical called calcium carbonate, which acts as an antacid that antagonizes the acid’s action in the stomach.

Studies have also confirmed that the use of GutsyGum is associated with less heartburn and other symptoms of acid reflux [13].

Bananas Are Alkaline and can Coat the Stomach Lining

Increased intake of alkaline foods like bananas can protect against the incidence of acid reflux and GERD problems by coating the stomach and combating stomach acid.

Fruits and vegetables are also a good source of fiber, vitamins, and minerals required for health.

They have a low glycemic index, and are safe for patients with diabetes and hypertension.

Milk Should Be Used With Caution

It is frequently claimed that the consumption of milk at night helps with the symptoms of acid reflux.

But scientifically speaking, the effects of milk on GERD are variable.

First, calcium carbonate is a well-known calcium supplement, widely used as an antacid.

As milk is a rich source of calcium, it may help with the symptoms of acid reflux.

Second, the problems of patients with GERD are due to a weak LES.

Calcium helps contract muscles, and increases tone.

So by increasing the calcium levels in the body, milk helps increase the tone of the LES.

Milk is also a rich source of various proteins that are helpful for patients with acid reflux.

Some patients report worsening of their acid reflux symptoms after consuming milk.

This may be due to the high fat content of the milk.

Fats relax the LES and keep the food in the stomach for a more extended period of time, which is associated with worsening GERD.

In my opinion, milk neutralizes the acid present in the stomach in the short term, but fat present in the milk stimulates the production of more acid, an effect that is seen later.

As there is no clear scientific evidence regarding the beneficial effects of milk for patients with acid reflux, it should be used cautiously.

If you feel that your symptoms of acid reflux improve after consuming milk, you should continue to do so.

However, if you experience worsening reflux symptoms, you should switch to milk substitutes, like almond milk, or low-fat milk.

Take Ginger 30-60 Minutes Before Eating

Ginger is a very popular kitchen spice, traditionally used for various problems, such as arthritis, muscular aches, constipation, fever, and sore throat.

It is derived from the rhizome of a plant called Zingiber Officinale.

It increases the motility of the esophagus and the stomach (prokinetic effect).

As food is rapidly cleared from the stomach, nausea, vomiting, and other associated problems are resolved.

It also decreases the incidence of stomach ulcers and H. pylori infection.

Experts recommend using 1 to 1.5 grams of dried herb per day, for patients with GERD.

It should be taken 30-60 minutes before a meal, and the dose should not exceed 5 grams per day.

It should be avoided in patients with bleeding disorders [14].

Licorice May Be Harmful

Licorice is a flowering plant of the Fabaceae family, with antioxidant, antimicrobial, and anti-inflammatory properties.

It also offers many benefits for patients with gastric problems, and helps relieve the symptoms of acid reflux.

It increases the production of the mucus that coats the stomach, and protects it from the harmful effects of acid. 

It also helps with the rapid healing of stomach ulcers.

It can cause various side effects, like hypertension, headache, decreased libido, heart failure, and lung problems.

As it is a herbal medicine, it is not regulated by the FDA, and research is limited.

I always recommend my patients avoid products that have limited scientific data regarding their safety and efficacy.

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10: Ask Your Doctor for Suitable Medication

Many types of medication are available for treating acid reflux.

After consultation with a medical practitioner, these should be used if symptoms are not controlled with the dietary and lifestyle changes suggested.

I have given a brief introduction to these medications below.

Prokinetics

These medications increase the motility of the upper gastrointestinal tract, and are very useful for patients with acid reflux.

Prokinetics also strengthen the lower esophageal sphincter (LES), a valve that controls the food’s movements out of the stomach.

When the LES is strong, and food stays for a short time in the stomach, the incidence of acid reflux is decreased. 

Acid is cleared rapidly, and all the associated problems, including sleep disturbance, are resolved.

There are various drugs in this category, including Domperidone, Cisapride, metoclopramide, and Itopride.

Prokinetics are used for various conditions, such as nausea, vomiting, GERD, dysmotility, and constipation.

However, these drugs, although generally safe, can cause headaches, abdominal pain, diarrhea, dizziness, fatigue, and restlessness.

Prokinetics should be taken before a meal for maximum benefits.

Proton Pump Inhibitors (PPI)

PPI is one of the most commonly prescribed medications for acid reflux.

These medicines work by decreasing the production of acid in the stomach.

When the amount of acid is decreased, there are fewer chances for heartburn, stomach ulcers, and associated sleep disturbances.

There are many drugs in this category, including Omeprazole (Risek, Omega), esomeprazole (Nexium), Pantoprazole and Lansoprazole.

For maximum benefit, these should be taken 30 minutes before breakfast.

These are available as a syrup, tablets, capsules, and injections.

One of the most important aspects of these drugs, that I always tell my patients about, is that PPI takes at least two weeks to act.

This is because PPI inhibits acid production in the stomach, but the acid that has already formed is still there to cause damage.

My recommendation is to combine PPI with fast acting drugs like antacids, so that the patient can better control the symptoms.

H2 Blockers

This group of medicines includes Cimetidine, famotidine, ranitidine, and nizatidine.

These are the over the counter (OTC) drugs that reduce the production and release of excess acid.

H2 blockers are commonly prescribed for gastric ulcers, GERD, and acid reflux.

These can cause dry mouth, urinary retention, constipation, headache, and ringing in the ears.

Antacids

This is a class of drugs that neutralize the acid present in the stomach, and are used for quick relief.

In contrast to the PPI and H2 blockers, these do not require time for their action.

They are available without a prescription, and are used to treat stomach ulcers, gastritis, indigestion, and acid reflux.

Many types of antacids are available, including Gaviscon, Pepto-bismol, calcium carbonate, magnesium hydroxide, and aluminum hydroxide.

The NHS recommends taking antacids with food, or soon after eating.

Very few side effects are seen from antacids, but sometimes they can cause flatulence, diarrhea, constipation, and cramps.

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11: Take Extra Care During Pregnancy

Acid reflux is prevalent during pregnancy, and causes indigestion, nausea, vomiting, heartburn, and sleep disturbance.

This is caused by the relaxation of the LES, hormonal changes, and compression of the stomach by the growing baby.

The best way to control the symptoms of acid reflux is by eating healthy foods, keeping an upright posture, sleeping in the left lateral position, and avoiding fatty foods.

If symptoms are not controlled, you should consult a doctor for medications.

Typically, antacids, alginates, omeprazole, or ranitidine are prescribed.

There is a condition called hyperemesis gravidarum, in which symptoms of acid reflux are so severe during pregnancy, that the patient may need hospitalization.

If you are experiencing severe nausea and vomiting that are unresponsive to regular therapies, you should immediately consult a doctor.

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Conclusion: Try Multiple Therapies

Acid reflux is a widespread issue, and can cause very disturbing symptoms.

Simple measures can be taken to prevent acid reflux, like eating healthy, maintaining a healthy weight, sleeping in a lateral position, and smoking cessation.

Simple home remedies, such as chewing gum, banana, or ginger, are also helpful.

If these do not control your symptoms, medications like antacids, PPI, and H2 blockers can be prescribed.

Up next: 6 ways to sleep better with a stomach ulcer.

References

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2: Shaker R, Castell DO, Schoenfeld PS, Spechler SJ. Nighttime Heartburn Is An Under-Appreciated Clinical Problem That Impacts Sleep and Daytime Function: The Results of A Gallup Survey Conducted on Behalf of The American Gastroenterological Association. Off J Am Coll Gastroenterol | ACG [Internet]. 2003;98(7). Available from: https://journals.lww.com/ajg/Fulltext/2003/07000/Nighttime_Heartburn_Is_An_Under_Appreciated.10.aspx

3: Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of Spontaneous Sleep Positions on Nighttime Recumbent Reflux in Patients With Gastroesophageal Reflux Disease. Off J Am Coll Gastroenterol | ACG [Internet]. 1999;94(8). Available from: https://journals.lww.com/ajg/Fulltext/1999/08000/Influence_of_Spontaneous_Sleep_Positions_on.17.aspx

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5: Yasuhiro Fujiwara , Ai Machida, Yoko Watanabe, Masatsugu Shiba, Kazunari Tominaga, Toshio Watanabe, Nobuhide Oshitani, Kazuhide Higuchi TA. Association between dinner-to-bed time and gastroesophageal reflux disease. Am J Gastroenterol .

6: Eslami O, Shahraki M, Bahari A, Shahraki T. Dietary habits and obesity indices in patients with gastroesophageal reflux disease: a comparative cross-sectional study. BMC Gastroenterol [Internet]. 2017 Nov 28;17(1):132. Available from: https://pubmed.ncbi.nlm.nih.gov/29179692

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9: Zhang M, Hou Z-K, Huang Z-B, Chen X-L, Liu F-B. Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review. Ther Clin Risk Manag [Internet]. 2021 Apr 15;17:305–23. Available from: https://pubmed.ncbi.nlm.nih.gov/33883899

10: Kahrilas PJ, Gupta RR. Mechanisms of acid reflux associated with cigarette smoking. Gut [Internet]. 1990 Jan;31(1):4–10. Available from: https://pubmed.ncbi.nlm.nih.gov/2318431

11: Moazzez R, Bartlett D, Anggiansah A. The Effect of Chewing Sugar-free Gum on Gastro-esophageal Reflux. J Dent Res [Internet]. 2005 Nov 1;84(11):1062–5. Available from: https://doi.org/10.1177/154405910508401118

12: v. Schönfeld J, Hector M, Evans DF, Wingate DL. Oesophageal Acid and Salivary Secretion: Is Chewing Gum a Treatment Option for Gastro-Oesophageal Reflux? Digestion [Internet]. 1997;58(2):111–4. Available from: https://www.karger.com/DOI/10.1159/000201432

13: Brown R, Sam CHY, Green T, Wood S. Effect of GutsyGumtm, A Novel Gum, on Subjective Ratings of Gastro Esophageal Reflux Following A Refluxogenic Meal. J Diet Suppl [Internet]. 2015 Apr 3;12(2):138–45. Available from: https://doi.org/10.3109/19390211.2014.950783

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