May 12, 2016 4 min read

Wake Up To The Differences Between Daytime and Nighttime Acid Reflux GERD

While the symptoms of acid reflux are the often the same no matter the time of the day, the resulting pain can be less intense during the night.

When you wake up with heartburn, the burning may be so subdued that you fall back to sleep without addressing the discomfort. However, pain is a misleading indicator as, contrary to what you may feel, acid reflux at night is more severe and should be addressed as aggressively – if not more so – than episodes that occur during the day.

There are enough differences between acid reflux when you’re awake versus asleep to be classified into daytime and nighttime GERD (Gastroesophageal Reflux Disease). Compared with daytime GERD, nighttime reflux occurs less frequently but the episodes last longer. The longer the stomach acid lingers in the esophagus, the greater the risk of inflammation and erosive damage. Not too surprisingly then, long-term health complications are more likely with reflux that occurs while you sleep.

Why the difference? The reasons have to do with physiological changes from day to night. During the day, an upright posture contributes to better digestive efficiency with your stomach emptying more quickly. When there’s nothing in your stomach, then there’s nothing to reflux. Also the normal process of swallowing makes use of saliva that’s formulated to neutralize acid, while also helping to clear refluxed acid from the esophagus.

However, when you’re sleeping, the stomach empties more slowly. Delayed stomach emptying can lead to bloating, which can cause the LES (lower esophageal sphincter) valve to relax and let stomach acid back into the esophagus. Also, the activity of swallowing decreases and, in stages of deep sleep, completely shuts down. When you wake up during the night from reflux, your body may be trying to reactivate the swallowing process and clear the esophagus, as well as protect your airway from acid exposure. Yet it’s possible to sleep through a reflux episode and even painful heartburn, given the altered state of consciousness that accompanies slumber. In which case, acid exposure is longer and potentially more harmful.

A study published in The Journal of Family Practice titled “Diagnostic Challenges: Differentiating Nighttime GERD” reports that esophageal complications of GERD appear to be more severe in patients with nighttime episodes of GERD than in those complaining of daytime reflux. During the night, prolonged acid contact time increases the risk that esophagitis will become erosive.

Not only are there physical implications to nighttime GERD, but there are quality of life issues as well. Sleep disturbances can negatively affect your general health and well-being as well as your work productivity. The lack of sleep can also lead to over-eating, which further compounds reflux.

So what can you do to relieve acid reflux during the night?

1. Don’t eat for at least 3 hours before going to bed

With a bigger window of time between your last meal and going to bed, your stomach has a chance to empty so you won’t have anything to reflux when you go to sleep.

2. Sleep on an incline and on your side

When you sleep on an incline, there’s a drastic reduction in acid exposure and acid clearance time (the time that it takes your body to naturally clear acid from the esophagus). And when you sleep on your side, relief comes more quickly than on your back. Sleeping on your left side means fewer reflux episodes while sleeping on your right side allows your stomach to empty more quickly.

Currently, the only sleep system that keeps you comfortably on an incline and on your side is MedCline™. With its 2-part system, you’ll sleep comfortably in a position that helps alleviate acid reflux. Your esophagus will have some time to heal and you’ll have better rest without reflux disturbances.

Keep in mind that some incline products – like wedge pillows and bed risers – only prop you up at an angle without securing you on your side. If you roll onto your back, you’re not optimally positioned for reflux relief. Or, if you slide down the bed or off the pillow, you won’t have the benefit of gravity to help reduce acid exposure.

Given the differences between nighttime and daytime GERD, it makes sense to attend to reflux episodes after dark as you would in the light of day. Allow yourself more time between eating and going to bed. And use a MedCline reflux relief system – the only system designed for GERD that keeps you on an incline and on your side while you sleep. Even if you’re not experiencing painful symptoms, you’ll have a positive impact on your physical health and quality of life with these simple lifestyle changes.

References: Brunton, Stephen MD; McGuigan, James MD. “Diagnostic Challenges: Differentiating Nighttime GERD.” The Journal of Family Practice. Vol. 54, No. 12. Read More . December, 2005.
Holloway RH; Hongo M; Berger K; & McCallum RW. “Gastric Distention: A Mechanism For Postprandial Gastroesophageal Reflux.” Gastroenterology. 1985 Oct;89(4):779-84. Read More. October, 1985.
Orzel-Gryglewska, Jolanta, “Consequences Of Sleep Deprivation”. International Journal of Occupational Medicine and Environmental Health 2010;23(1):95 – 114DOI 10.2478/v10001-010-0004-9. August 25, 2009. Khan BA, et al. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. J Gastroenterol Hepatol. 2012 Jun;27(6):1078-82. June 27, 2012.