May 12, 2016 7 min read

Waking up with acid reflux and heartburn in the morning can be startling and uncomfortable. And, while you may be familiar with feeling a bit of reflux after eating a large and spicy meal, or even after exercising, it might be jarring to find that you are waking up with acid reflux as well. 


If you experience reflux, heartburn, or GERD (gastroesophageal reflux disease), it’s important to understand the difference betweens symptoms that occur during the day, and those that occur at night — which may be why you are waking up with heartburn. 


In this post, we will cover these topics:


We’ll start with a quick definition of acid reflux and heartburn.  

What Are Acid Reflux and Heartburn?

Your esophagus contains a small muscle that constricts when you’re not eating, keeping stomach acid from splashing out of your stomach back up into your esophagus. However, sometimes this muscle is weakened or doesn’t work properly, allowing acid to move from the stomach into the esophagus. This is the cause of acid reflux and heartburn. 

 

heartburn causes infographic


Acid reflux has a number of symptoms:

  • Heartburn: a feeling of burning pain in the abdomen or chest that usually occurs after eating, while bending over or exercising, or when lying down. 
  • A sour-sweet and irritating feeling of acid splashing up into your esophagus
  • Bitter taste in the mouth
  • Difficulty swallowing, a feeling of something in your throat, and regurgitation 

Note: Heartburn is not directly related to the heart, though pain can occur in the chest because of the location of the stomach and lower portion of the esophagus. However, severe heartburn and heart attack symptoms can sometimes be difficult to tell apart. If you’re experiencing abnormally severe chest pain, it’s important to seek emergency medical attention — especially if you have a personal or family history of heart disease. 


Acid reflux and heartburn in the morning can be both a nuisance and moderately painful. However, if left untreated, they can also cause serious damage to your esophagus — in some cases, this can even lead to esophageal cancer. 


When fighting acid reflux and heartburn, it’s important to know the difference between symptoms that occur during the day and those that occur during the night. 

woman holding her stomach on the bed from reflux pain

The Differences Between Daytime and Nighttime Acid Reflux 

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


If you find you’re waking up with heartburn in the morning or middle of the night, the burning may be so subdued that you fall back to sleep without addressing the discomfort. However, lessened pain can be 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. 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 that 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.


What Can You Do to Relieve Acid Reflux During the Night? 

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

One habit that can make nighttime acid reflux and heartburn worse, and cause acid reflux in the morning, is eating right before bed. Many people prefer to have dinner closer to bedtime, but for those who struggle with acid reflux, this can be a recipe for disaster. 


What can you do? Move dinner a little earlier, and cut down on the late night snacking. You should have your last meal or snack of the day around 3 hours before getting into bed. With a bigger window of time between your last meal and going to sleep, your stomach has a chance to empty so it won’t have anything to reflux when you go to sleep.


Note that some foods, like tomato sauce, citrus, and spicy food can worsen reflux symptoms. It’s also a good idea to avoid excess drinking and smoking — these can also trigger GERD at any hour of the day. 

 

woman speaking with doctor

2. Talk to your doctor about finding the right medication

Certain medications can help keep your reflux symptoms to a minimum and prevent you from waking up with heartburn in the morning. However, as with any medication, there can be side effects, so it’s always a good idea to talk with your doctor before using anything to treat your symptoms, especially if you already use other medications.

In general, there are three kinds of medicine that are used to cut down on heartburn and reflux:

  • Antacids: These often come in the form of chewable tablets that neutralize the acid in your stomach, and are best suited for calming symptoms as needed. 
  • H-2 Blockers: This type of medication slows the production of stomach acid, providing relief over a longer period rather than immediate symptom reduction.
  • Proton pump inhibitors: PPIs are also used to reduce the production of stomach acid.

If you deal with frequent heartburn and acid reflux, you may be suffering from GERD. Before starting any kind of medication, be sure to talk to your doctor to decide what course of action might be best for you. Because medications can come with troubling side effects, it is also worth it to consider less invasive forms of relieving symptoms — often, they can even be more effective. 

3. 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 sleeping on your stomach or back. Sleeping on your left side means fewer reflux episodes, while sleeping on your right side allows your stomach to empty more quickly: this is why many people choose to use a specialized acid reflux pillow.

Currently, the only sleep system that keeps you comfortably on an incline and on your side is a heartburn pillow from MedCline™. With its 3-part construction, you’ll rest in the best sleeping position for reflux that helps alleviate the worst symptoms. Your esophagus will have some time to heal and you’ll have better rest without experiencing reflux disturbances or heartburn in the morning. 

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.

Sleeping with Acid Reflux and Heartburn

how to prevent reflux infographic

Given the differences between nighttime and daytime GERD, it makes sense to do your best to find ways to sleep free of acid reflux. Keep these tips in mind as you find the habit that works best for you:

  • Allow yourself more time between eating and going to bed. Try natural remedies for reflux relief.
  • Avoid smoking and drinking alcohol excessively, especially right before bed.
  • Talk to your doctor about finding a medication that works for you. 
  • Try to avoid sleeping flat on your back or sleeping on your stomach 
  • Consider using a MedCline reflux relief system – the only system designed for GERD that keeps you on an incline and on your side while you sleep. 

Acid reflux can range from a subtle nuisance to intensely painful, but with the right management tips, you can keep your symptoms at bay. Even if you’re not experiencing painful symptoms, you’ll make a positive impact on your physical health and quality of life with these simple lifestyle changes.

References: 

  • "Heartburn - Symptoms And Causes". Mayo Clinic, 2020, https://www.mayoclinic.org/diseases-conditions/heartburn/symptoms-causes/syc-20373223. Accessed 29 Sept 2020.
  • "Heartburn - Diagnosis And Treatment". Mayo Clinic, 2020, https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229. Accessed Sept 2020.
  • 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.