July 22, 2020 7 min read

Many people don’t realize that the position you sleep in can directly affect your acid 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 heartburn, acid reflux, and GERD. To navigate throughout the article, click on one of the links below, or read through for a comprehensive overview.

Symptoms and Causes of Acid Reflux

What causes acid reflux and what does it feel like? 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 a ring of muscles that act as a valve to control the flow of contents between your esophagus and your stomach. 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 appear as uncomfortable physiological symptoms, such as:

  • Heartburn
  • Regurgitation
  • Choking
  • Coughing 

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.

How does acid reflux affect sleep?

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

 woman holding her chest from night time reflux pain

Why is Acid Reflux Worse at Night?

Does acid reflux get worse at night? For some, it can. Here’s how: 

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, you swallow less, and this can also make the return of reflux to the stomach more difficult2. This combination of factors can cause some to struggle with acid reflux at night even more so than during the day.

The discomfort of nighttime acid reflux9 can lead to poor sleep quality as heartburn and other symptoms cause disturbances throughout the night.

 

infographic acid reflux when sleeping on left side

 

How to Sleep With Acid Reflux & Heartburn

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

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

back sleeping for reflux infographic

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, and as a result, exaggerate acid reflux at night. 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.

Instead, sleep at an incline

A simple boost in elevation can produce positive results when it comes to nighttime acid reflux. 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.

Avoid right-side sleeping

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 lie 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.

Instead, sleep 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 stomach acid escape, gravity is able to return it to your stomach quicker than when you’re 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 acid reflux and other gastrointestinal disorders, like GERD.

What is the Best Position for Sleeping with Acid Reflux?

The best sleeping position for acid reflux is on your left side and at an incline. This posture has been proven to offer natural reflux relief and can make refluxing nearly impossible, thanks to the positioning of the lower esophageal sphincter 6-7.  When the LES is positioned above the level of stomach contents, gravity is able to quickly return the contents, like partially-digested foods and acid, back to your stomach. As a result, you’re less likely to experience acid reflux at night.

left side sleeping infographic

 

Physicians suggest that this elevated left-side position can decrease your nighttime heartburn symptoms and ultimately provide protection from prolonged acid exposure to your esophagus, throat, lungs, and sinuses.

Sleep Reflux-Free With Our Reflux Relief System

Still wondering how to sleep with heartburn comfortably? Meet MedCline’s Acid Reflux Relief System, constructed using the clinically-proven and physician recommended posture — elevated on the left-side —  for sleeping comfortably with acid reflux.

Our GERD pillow is specifically designed to manage acid reflux at night by reducing exposure to harmful stomach acid. It can provide instant relief and a long-term solution to nighttime acid reflux.

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

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

woman waking up refreshed

Other ways to manage acid reflux at night

In addition to adjusting your sleeping posture, there are several other steps you can take to mitigate your acid reflux at night and throughout the day.

Here are some additional strategies for managing your acid reflux and heartburn symptoms:

  • Home remedies for heartburn relief: Drinking milk, chewing gum, and using herbal remedies can provide short-term reflux relief when symptoms arise.
  • Acid reflux medications: Antacids, PPIs, and H-2 blockers can offer short- and long-term relief from symptoms. (Check out our post on pill-induced esophagitis to learn about safe pill-swallowing techniques).
  • Avoid trigger foods: Spicy, fatty, and acidic foods can trigger heartburn and should be avoided, especially right before lying down. Try to give yourself at least three hours to fully digest your dinner before bedtime.
  • Maintain a healthy weight: Added pressure on the abdomen can cause acid reflux to flare up.

Key Takeaways

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 can put your esophagus at a higher risk for exposure to stomach acid. Left untreated, this exposure can manifest into more serious symptoms.

The best sleeping position for acid reflux is on your left side with your torso elevated. To learn more about how MedCline’s patented Reflux Relief System can help you manage your acid reflux at night, talk to one of our Sleep Specialists today.

References:

  1. 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.
  2. Fass, Ronnie. PPI bashing’ drives use of alternatives. gastoendnews.com, Sept. 2011.
  3. 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.
  4. 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.
  5. Stanciu C, Bennett JR: Effect of posture on gastroesophageal reflux, Digestion 1977, 15: 104-109.
  6. 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.
  7. 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
  8. “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
  9. “'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
  10.  “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