July 22, 2020 6 min read

Many people don’t realize that the position you sleep in can directly affect reflux symptoms at night. Anatomy and gravity play a significant role in heartburn symptom frequency, length, and severity, so learning how to sleep with acid reflux can offer up substantial relief.

In this post, we’ll discuss the relationship between sleep and reflux symptoms, show you how to sleep with acid reflux, and share some tips for optimal sleeping with GERD. To navigate throughout the article, click on one of the links below, or read through for the complete picture.

Symptoms and Causes of Acid Reflux

Let’s start with a short anatomy lesson.

What you eat travels down your esophagus through your lower esophageal sphincter (LES) and into your stomach where digestion begins. Your LES is essentially a ring of muscles that act as a valve to control the flow of contents between your esophagus and your stomach and vice versa. If your LES functions correctly, what you eat will stay in your stomach with the occasional release of gas, also known as a burp.

Problems arise when your LES doesn’t function properly, allowing your stomach contents to escape back up into your esophagus. These problems can manifest into uncomfortable symptoms, such as:

  • Heartburn
  • Regurgitation
  • Choking
  • Coughing 

These issues can appear throughout the day, but many individuals may find that they intensify at night, leading to physical discomfort, and as a result, poor sleep.

More severe problems, like GERD ( gastroesophageal reflux disease)8, come when reflux goes untreated. Prolonged acid exposure potentially leads to serious health complications, such as erosive esophagitis, peptic strictures, esophageal ulcerations, Barrett’s esophagus, and in rare cases, esophageal cancer1.

woman on bed holding chest from reflux plain

Why is Acid Reflux Worse at Night?

If reflux occurs when you are standing up, gravity and saliva quickly return the acidic content to your stomach. This quick return typically makes your symptoms shorter and minimizes the potential acid damage to the delicate lining of your esophagus that can occur from acid exposure. However, the interference of gravity that reduces reflux symptoms while you’re upright disappears when you lie down to sleep at night; when you lie down, saliva and swallowing slow, make the return of reflux to the stomach more difficult2. Nighttime acid reflux9 can even lead to poor sleep and sleep apnea due to waking up throughout the night due to acid reflux symptoms.

stomach acid infographic

How to Sleep With Acid Reflux & GERD

The good news is, you can learn how to sleep with GERD or acid reflux comfortably by simply adjusting how you position yourself at night. This simple modification can actually go a long way towards reducing your nighttime acid reflux symptoms and protecting you from the harmful effects of refluxed stomach acid.

Let’s take a look at some resting positions that you should avoid, as well as some that are best suited for sleeping with GERD and acid reflux.

infographic back sleeping with gerd

Avoid — Sleeping flat on your back

When lying flat on your back, a poorly functioning LES can allow acidic stomach contents to flow freely into the esophagus. Studies have shown that in this position, symptoms are often more frequent and tend to last longer3. The severity of your symptoms may also increase if you have stomach fat, which pushes down on your stomach and LES and can “force” contents back up into the esophagus and beyond. To reduce your nighttime heartburn and decrease the risks associated with prolonged acid exposure, try to avoid back sleeping at night.

Avoid —  Sleeping flat on your right side

Though episodes may be less frequent on your right when compared to flat on your back, the episodes are much more liquid in nature because your LES is often submerged in the acidic stomach content4. When you sleep flat on your right side, your body then must work against gravity to return acid contents to your stomach, making it a much harder and lengthier process. This position potentially creates a leaky faucet sensation, releasing stomach acid into the delicate lining of your esophagus. 

While liquid reflux can be very distressing, it can also be dangerous — when you lay flat on your right side; acid tends to linger in your esophagus for much longer3. As stomach acid idles in the esophagus, it continues to cause irritation and inflammation10, which can lead to ulcers, chest pain, bleeding, trouble swallowing, and other serious issues.

Embrace —  Sleeping on your left-side

You may have heard that sleeping flat on your left side provides heartburn relief, which is true. In this position, your LES typically stays above “sea level” or above the level of gastric contents making refluxing more difficult. Should reflux escape, gravity is able to return it to your stomach quicker than when on your right side 6-7.

What’s more, reflux on your left side tends to be more gaseous in nature4, which decreases potential damage from acid exposure. Because symptoms tend to be milder and less frequent when lying on your left side compared to on your right side or on your back, lying on your left is considered the optimal flat position for sleeping with GERD and acid reflux.

Embrace — Sleeping at an incline

Opting to sleep on your left side is a step in the right direction, but a simple boost in elevation can further positive results. Studies have shown that sleeping at an incline decreases the frequency of reflux episodes and allows your body to clear reflux at a quicker rate5. As long as your entire torso is elevated, the incline gives gravity a little encouragement in its effort to return reflux to your stomach.

infographic of best sleeping positions for gerd

Best position for reflux relief = left side + incline 

Recent studies show that adding an incline to a left-side sleeping position is the best for natural reflux relief 6-7. This optimal duo makes refluxing virtually impossible because your LES is now positioned well above the level of stomach contents, even if your stomach is really full. And, if you do reflux, gravity is able to quickly return the contents to your stomach. 

By elevating your LES and resting on your left, this position can decrease your nighttime heartburn symptoms and ultimately provide protection from prolonged acid exposure to your esophagus, throat, lungs, and sinuses.

woman waking up pain free

Wrapping Up

So what’s the secret to sleeping reflux-free? Proper sleep positioning! When you lie flat on your back or on your right side, your lower esophageal sphincter (LES) has to work harder against gravity to drive acid back down to your stomach. This exertion and elongated process put your esophagus at a higher risk for exposure to stomach acid. Left untreated, this exposure can manifest into more serious symptoms.

Bottom line: sleeping flat on your left side, or better yet, on your left side and at an incline is ideal for those sleeping with acid reflux symptoms.  

If you want to experience the power of this compound (inclined + left side) position, try the MedCline Reflux Relief System. Our GERD pillow is specifically designed to create and maintain the position clinically proven to be the most effective for natural relief from nighttime heartburn and the other distressing symptoms of acid reflux/GERD.

MedCline Reflux Relief System clinical studies have shown significant improvement for:

  • Gastroesophageal Reflux Disease (GERD) // Acid Reflux
  • Laryngopharyngeal Reflux (LPR) // Silent Reflux
  • Gestational Reflux

References:

  • Lagergren, J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340: 825-831.
  • Fass, Ronnie. PPI bashing’ drives use of alternatives. gastoendnews.com, Sept. 2011.
  • Khoury, Ramez M. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with Gastroesophageal Reflux Disease. The American Journal of Gastroenterology. Vol. 94, No. 8, 1999.
  • Shay SS, Conwell DL, Mehindru V, et al. The effect of posture on gastroesophageal reflux event frequency and composition during fasting. Am J Gastroenterology. 1996; 91: 54-60.
  • Stanciu C, Bennett JR: Effect of posture on gastroesophageal reflux, Digestion 1977, 15: 104-109.
  • Person, E, Freeman, J, Rife, C, Clark, A, Castell, DO. A Novel Sleep Assist Device Prevents Gastroesophageal Reflux: A Randomized Controlled Trial. Journal of Clinical Gastroenterology. 2015 Sep; 49 (8): 655-9.
  • Allampati SK, Lopez R, Ray M, Birgisson S, Gabbard SL. Use of a Sleep Positioning Device Significantly Improves Nocturnal Gastroesophageal Reflux Symptoms. Am J Gastroenterol 2014; 109:S1–S39
  • “What’s the Difference Between Heartburn, Acid Reflux and GERD?,” Cleveland Clinic,https://health.clevelandclinic.org/whats-the-difference-between-heartburn-acid-reflux-and-gerd/, 1 Jul. 2020
  • “'Silent' Nighttime Acid Reflux Symptoms Can Cause Poor Sleep And Sleep Apnea,” Science Daily, https://www.sciencedaily.com/releases/2005/10/051031080008.htm, 1 Jul. 2020
  •  “GERD (Chronic Acid Reflux),” Cleveland Clinic,https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview#:~:text=But%20long%2Dterm%20GERD%20can,pain%2C%20bleeding%20and%20trouble%20swallowing., 1 Jul. 2020