Acid reflux at night: Causes, Symptoms and How to Manage it

There are times when the stomach acid goes right into the esophagus, and causes symptoms like heartburn. Acid reflux, especially while sleeping, is common among people living with the chronic condition known as the gastroesophageal reflux disease or (GERD). Your sleeping position or what you ate for dinner can cause acid reflux at night. You may even have a burning sensation in the chest or have trouble swallowing due to acid reflux. Read to know the causes of acid reflux at night and how to stop it.

What is acid reflux?

Acid reflux happens when the stomach acid goes back into the esophagus, which is the tube connecting the throat to the stomach. Normally, a circular band of muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), prevents the backward flow of stomach contents, says gastroenterologist Dr Kiran D Shinde. However, when this muscle relaxes abnormally or weakens, stomach acid can move up into the esophagus, causing irritation and discomfort.

What are the causes of acid reflux at night?

Experiencing acid reflux at night can be discomforting, and inevitably cause sleep disturbances. As many as 68.3 percent of people with GERD reported sleep difficulties during a study published in the JAMA Network Open journal in 2023. An association was found between the nighttime symptoms and sleep disturbance. Here are the causes:

1. Lying down

When you lie down, particularly if you tend to sleep flat on your back, gravity cannot assist in keeping stomach acid in the stomach. This makes it easier for acid to flow back into the esophagus, leading to acid reflux symptoms such as heartburn and regurgitation.

2. Delayed gastric emptying

The rate at which the stomach empties its contents into the intestines can influence the occurrence of acid reflux. Delayed gastric emptying, which can occur due to factors such as overeating can increase the likelihood of reflux during the night.

3. Increased acid production at night

The body naturally produces more stomach acid at night, which can contribute to the occurrence of nighttime acid reflux, says the expert. This increase in acid production, combined with lying down, can make it easier for acid to reflux into the esophagus while sleeping.

4. Dietary triggers

Consuming certain foods or beverages known to trigger acid reflux can increase the risk of experiencing symptoms at night. Spicy foods, citrus fruits, caffeine, alcohol, and fatty meals are common dietary triggers for acid reflux and may exacerbate symptoms, especially when consumed close to bedtime.

5. Underlying conditions

Certain medical conditions can lead to nocturnal acid reflux. For example, a hiatal hernia, where part of the stomach protrudes into the chest cavity, can weaken the lower esophageal sphincter and increase the risk of reflux. Obesity can also contribute to increased abdominal pressure, which can promote reflux. Also, pregnancy can lead to hormonal changes and increased pressure on the stomach, making acid reflux more common during sleep.

What are the symptoms of acid reflux at night?

Here are the symptoms of acid reflux at night:

• Heartburn is a burning sensation in the chest
• Acid reflux can lead to the regurgitation of stomach contents into the esophagus and sometimes into the mouth. This can result in a sour or bitter taste in the mouth.
• The reflux of stomach acid into the esophagus can cause chest pain or discomfort.
• In some cases, acid reflux can cause irritation and inflammation in the esophagus, making it difficult to swallow food or liquids comfortably.
• Nighttime acid reflux can trigger a persistent cough, which can be a result of stomach acid irritating the throat and airways.
• The irritation caused by acid reflux can lead to a hoarse voice or a sore throat.
• Acid reflux at night can exacerbate asthma symptoms, leading to increased difficulty breathing, wheezing, or coughing, particularly during sleep.
• Nighttime acid reflux can disrupt sleep patterns, leading to frequent awakenings, difficulty falling asleep, or overall poor sleep quality.
• Some people may experience increased saliva production as a result of acid reflux at night.

What you should do when you experience acid reflux at night?

To stop acid reflux at night, follow these tips:

1. Use over-the-counter medications

Antacids, H2 receptor blockers, and proton pump inhibitors are available over-the-counter and can help neutralise stomach acid or reduce its production, says Dr Shinde. But consult with a doctor before using these medications long-term.

2. Adjust your sleeping position

Elevating the head of your bed or using a wedge pillow can help prevent stomach acid from flowing back into your esophagus while you sleep. Sleeping with your upper body slightly elevated can reduce nighttime reflux symptoms.

3. Wear loose clothes

Tight clothing, especially around the waist, can put pressure on the stomach and exacerbate acid reflux symptoms. So, if you wear tight clothes at night, slip into loose ones instead to reduce abdominal pressure.

4. Drink water

Drink water to help dilute stomach acid while also preventing dehydration, which can worsen acid reflux symptoms. However, avoid consuming large amounts of fluid right before bedtime to minimise the risk of nighttime reflux.

5. Manage stress

If you are stressed out, it can exacerbate acid reflux symptoms. Sit up and practice relaxation techniques such as deep breathing for a few minutes. This may help alleviate nighttime reflux and promote better sleep, says the expert.

What to drink when you have acid reflux at night?

While experiencing acid reflux at night, choosing the right beverages can help alleviate symptoms and promote better sleep. Here are some drinks that are generally considered safe for people with acid reflux –

1. Herbal tea

While water is the best option, you can have herbal teas such as chamomile, and licorice root tea. They have soothing properties that may help alleviate acid reflux symptoms. These teas are caffeine-free and can be enjoyed in moderation before bedtime.

2. Non-citrus juices

Citrus juices like orange, grapefruit, and lemon can exacerbate acid reflux symptoms due to their high acidity. Instead, opt for non-citrus juices such as apple, pear, or melon juice, which are less likely to trigger reflux.

3. Almond milk

Almond milk is a non-dairy alternative to cow’s milk that is lower in fat and may be better tolerated by people with acid reflux. It can be consumed plain or used as a base for smoothies and other beverages.

4. Vegetable juice

Freshly squeezed vegetable juices, such as carrot or cabbage juice, can be alkalising and may help neutralise stomach acid, says the expert. Avoid adding acidic vegetables like tomatoes or peppers to your juice blends to minimise reflux risk.

5. Aloe vera juice

Aloe vera juice has anti-inflammatory properties and may help soothe irritation in the esophagus caused by acid reflux. But choose aloe vera juice specifically formulated for internal consumption and to avoid any added sugars or additives.

6. Coconut water

Coconut water is a natural source of hydration that is low in acidity and may help neutralise stomach acid. It is a refreshing alternative to other beverages and can be consumed before bedtime to help prevent nighttime reflux.

How to prevent acid reflux at night?

To prevent acid reflux at night, it is important to avoid certain foods, drinks, and habits that can exacerbate symptoms.

• Spicy foods can irritate the lining of the esophagus and increase stomach acid production, leading to acid reflux symptoms.
• Acidic foods such as citrus fruits, tomatoes, vinegar, and citrus juices, can weaken the lower esophageal sphincter and trigger acid reflux by increasing stomach acidity.
• High-fat foods, such as fried foods, fatty meats, and creamy sauces, take longer to digest and can relax the LES, allowing stomach acid to reflux into the esophagus more easily.
• Caffeinated beverages like coffee, tea, and certain sodas can stimulate stomach acid production and relax the LES, making it easier for stomach contents to reflux into the esophagus.
• Alcohol can irritate the lining of the esophagus and stomach, increase stomach acid production, and relax the LES, all of which contribute to the development of acid reflux symptoms, especially when consumed in excess.
• Carbonated beverages, including sodas and sparkling water, can increase stomach pressure and promote the release of air bubbles in the stomach, leading to bloating, belching, and reflux symptoms.
• Consuming large meals can put pressure on the stomach and increase the likelihood of stomach contents refluxing into the esophagus. Instead, opt for smaller, more frequent meals to prevent overloading the stomach.
• Lying down immediately after eating can delay stomach emptying and allow stomach acid to reflux into the esophagus more easily. Stay upright for at least 2 to 3 hours after meals to minimise reflux risk.

By avoiding these triggers and adopting healthy lifestyle habits, such as maintaining a healthy weight, eating smaller meals, and staying upright after eating, you can reduce the frequency and severity of nighttime acid reflux episodes. If symptoms continue despite these changes, consult with a doctor.