Gastroesophageal reflux disease (GERD) is the medical term for regurgitating stomach acid into the esophagus. The condition can develop from recurring episodes of reflux that feel normal at first but have harmful effects over time.
Some 20% of adult Americans experience gastroesophageal reflux disease. When lying down to sleep or trying to get some shut-eye, most people with GERD notice worsening symptoms, especially heartburn during sleep apnea.
If acid from the stomach travels up into the esophagus, it can cause severe chest discomfort and other symptoms, such as coughing and choking, in the middle of the night.
Although the symptoms of GERD are unpleasant enough on their own, the disease also has long-term consequences, including esophageal damage and an increased risk of cancer.
Some studies believe that the airway pressure fluctuations caused by obstructive sleep apnea can lead to reflux. In contrast, others feel that acid reflux can produce vocal cord spasms, leading to sleep apnea.
But, it remains unclear whether acid reflux triggers sleep apnea or whether sleep apnea triggers acid reflux by making it more difficult to breathe due to pooling in the esophagus.
Read on as we explore a link between the two.
What is GERD?
Gastroesophageal Reflux Disease (GERD) is a long-lasting illness characterized by the regurgitation of stomach acid into the esophagus. There are several potential causes of GERD, some of which include:
- Incorrect diet
- Being overweight
- Certain types of bacteria
- Hiatal hernias
The lower esophageal sphincter (LES) is an aperture between the esophagus and the stomach, facilitating the passage of food into the stomach for digestion.
Those who have reflux have a sphincter that doesn’t close completely or tightly enough. As a result, stomach acid can flow back into the esophagus, giving the characteristic sourness and burning sensation the hallmark of acid reflux.
Other symptoms of GERD include chronic cough or hoarseness, chest pain, nausea, and difficulty swallowing. In addition, there is evidence linking it to respiratory problems such as chronic coughing, wheezing, and difficulty breathing. The nighttime is typically when these symptoms are at their worst.
Those suffering from obstructive sleep apnea syndrome may find relief from their nocturnal heartburn by visiting a sleep center, which may surprise some. But first, let’s discuss why you should be more cautious about your nighttime GERD symptoms than about acid reflux.
Acid Reflux Vs GERD
Heartburn is the most frequent symptom of acid reflux; up to 20% of US adults say they have it at least once a week.
Although both GERD and acid reflux are common, GERD is more serious and is characterized as chronic acid reflux. In addition, a medical condition known as gastroesophageal reflux disease describes the backflow of stomach acid into the esophagus.
Having heartburn from acid reflux after a large meal or after eating too many meals that are difficult to digest is normal. Still, if it happens frequently, you may have gastroesophageal reflux disease (GERD).
Not treating GERD can lead to esophageal lining erosion, which increases the chance of Barrett’s Esophagus and, ultimately, esophageal cancer.
Symptoms of GERD at Night
Most people associate GERD with the uncomfortable burning feeling known as heartburn. However, GERD is not always accompanied by this symptom.
Regurgitation is another common symptom of GERD, which means that acid from the stomach and sometimes food particles flow back up into the mouth or back of the throat.
Acid from the stomach that escapes and travels to the mouth and throat can trigger coughing and an overwhelming sensation of choking. It could lead to a painful throat and a raspy voice. Dysphagia is a condition in which a patient has trouble swallowing or feels like something is clogging their throat.
Radiating chest pain from GERD can affect the neck, back, jaw, and arms and linger anywhere from minutes to hours on top of the discomfort from heartburn. In addition, insomnia is a common complaint among the ones who experience GERD.
Why GERD at Night is Worse Than During the Day?
Since acid remains in the esophagus longer during the night, the damage it causes is more severe than daytime heartburn.
Some cases of GERD are more severe than others, and nighttime GERD is one of the worst. According to research, some of the worst heartburn symptoms are reported by people who suffer from it at night.
Some symptoms include waking up with a sour or acidic taste in your mouth and experiencing more regurgitation at night than during the day. Also common is waking up coughing or choking.
One study published in the American Journal of Gastroenterology found that PPI medication was effective in reducing heartburn and sleep disturbances at night. However, what if heartburn at night isn’t a symptom?
“Silent reflux” or “asymptomatic” overnight GERD affects a significant part of the population. This indicates that individuals suffer from nighttime reflux but are unaware of the problem because they are not experiencing typical symptoms like heartburn. Unfortunately, GERD is often misdiagnosed if it does not often produce obvious symptoms like heartburn.
Sleep disturbance is the most common symptom reported by people with silent reflux. Nighttime awakenings frequently are the only indicators of a health problem.
Studies show that PPI medication for acid reflux is not always effective in preventing overnight arousals. This occurs because the esophageal defenses are also triggered by nonacid reflux, which is not prevented by PPI medication.
Unfortunately, your physician is unlikely to diagnose silent reflux if you complain only of midnight awakenings and sleep disturbances but show no other symptoms of GERD.
Even if you don’t experience heartburn, you should visit a doctor if you wake up with symptoms such as a sour taste in your mouth, coughing, choking, a sore throat, or a hoarse voice.
A more significant sleep issue may be to blame for your nighttime arousal and GERD.
Can GERD Lead to Sleep Apnea?
Sleep apnea is not directly caused by gastroesophageal reflux disease (GERD). However, it can be a complication of obstructive sleep apnea (OSA). There is a high incidence (58-62% of OSA patients have GERD), but few studies explore the connection between the two disorders.
The severity of GERD symptoms increases when obstructive sleep apnea (OSA) is not treated. The reason is sleep apnea can exacerbate existing acid reflux symptoms.
Untreated or misdiagnosed OSA leads to a “vacuum effect,” or negative pressure, in the thorax during apneic episodes. This causes the stomach’s acid or contents to be drawn up the esophagus and into the throat.
One reason is the need for very high negative pressures to be created to draw air through a small opening. Reflux occurs when there is a pressure imbalance between the chest and the abdomen, with the latter experiencing the effects.
Long-term exposure to stomach acid leads to erosion of the esophageal lining, leading to gastroesophageal reflux disease.
There is an association between GERD and OSA, possibly due to shared risk factors such as alcohol use, tobacco use, and obesity.
Even though more study is needed to determine the precise association between GERD and OSA, it is already evident that the two illnesses can occur simultaneously and significantly disrupt a person’s sleep, comfort, and general health.
How Can People With GERD Sleep More Soundly?
People with GERD naturally want to discover ways to lessen their symptoms and sleep better. You can take concrete actions to gain relief from heartburn and GERD and achieve longer, more restorative sleep even though there isn’t a single answer that works for everyone.
1. Work With a Physician
You must visit a doctor if you experience regular sleep disturbances or tiredness during the day, along with persistent or severe GERD symptoms. These are complicated medical conditions. Therefore, a doctor is best equipped to assess the problem, identify a likely cause, request the required tests, and suggest a course of action.
To lessen overnight awakenings, a doctor may treat GERD directly or an underlying problem, such as obstructive sleep apnea.
Both medical and non-medical methods of treatment are available. The treatments are discussed in some detail in the following parts. Still, a doctor is best qualified to weigh the advantages and disadvantages of each patient’s unique situation.
2. Lifestyle Changes
Changing one’s lifestyle to eliminate potential GERD triggers is a common part of treating the ailment. Reducing your intake of hot and acidic meals, keeping your weight under control, and giving up smoking are a few examples.
Some lifestyle adjustments concentrate on advice for how to sleep with GERD because many GERD symptoms worsen at night.
3. Resist Eating at Night
Giving your stomach time to digest and lowering your risk of reflux is possible by having meals at least three hours before bed.
4. Sleep on Your Left Side
According to many studies, the optimal resting position for persons with GERD is on their left side. Sleeping with your left side down minimizes acid exposure to the esophagus and reflux episodes. But other sleeping positions, such as on your back, can increase your risk of reflux.
5. Elevate the Bed’s Head
Reflux can be reduced by doing this. Rather than adding the pillows under your head, elevate the bed’s head by at least six inches. One simple approach to implement this modification is to utilize an adjustable bed frame and pick the greatest mattress to go with it.
Drugs are available to treat GERD and may be required because changing one’s lifestyle doesn’t always help symptoms.
Antacids can provide momentary relief but may not be very beneficial for many people. Proton pump inhibitors (PPIs) and H2 blockers aim to minimize the amount of stomach acid. It’s suggested to consult a physician before using these meds, even if you may get them without a prescription.
Specific types of surgery could be explored to treat GERD in rare situations where neither lifestyle modifications nor drugs have worked.
7. Boost Your Sleep Hygiene
Taking into account one’s sleep hygiene, which includes all the components that influence one’s sleep environment and sleep-related habits, may be helpful for those with GERD who want to sleep better.
An excellent sleep hygiene routine can reduce sleep interruptions and improve the stability of your sleep. Many recommendations for sound sleep are also compatible with GERD lifestyle adjustments like limiting alcohol and caffeine intake. Other essential elements of good sleep hygiene include a regular sleep schedule, a calm bedtime routine, and a peaceful bedroom.
Simple adjustments are often needed to remedy or avoid sleep disorders. But, if the modifications to your lifestyle don’t reduce your nighttime symptoms, you should talk to your doctor. Discuss other options like medication and surgery as alternatives for severe acid reflux.
If you’ve been having trouble sleeping for reasons other than acid reflux, you may have an underlying sleep issue that has gone untreated. Talk to your doctor or a sleep specialist if you suspect that a sleep condition, such as obstructive sleep apnea or insomnia, is affecting the quality of your sleep.
They can diagnose your condition and advise you on the best course of treatment.
The discomfort of acid reflux can make it difficult, if not impossible, to get a restful night’s sleep. Fortunately, you can make simple and comprehensive adjustments to your lifestyle to end reflux. So consider giving them a shot and seeing how you react.