Acid reflux is a common condition and up to 40% of Americans experience symptoms with as many as 10% suffering with daily symptoms. The exact prevalence is unknown because in silent acid reflux there are no obvious symptoms. In addition many people suffer with acute reflux that is not reported and quickly remedied with over-the-counter antacids.
Why reflux occurs when lying flat?
Acid reflux, or more correctly gastroesophageal reflux disease (GERD), arises when the lower esophageal sphincter (LES) malfunctions. This sphincter normally prevents the stomach contents from flowing backwards into the esophagus (food pipe). If it malfunctions, the stomach contents which are acidic then enter the esophagus. It then cause irritation of the esophagus which presents as heartburn, nausea and other GERD symptoms.
The reflux can occur even when sitting or standing but it tends to be worse when the effect of gravity is negated. Bending over at the waist or lying down flat does this and therefore reflux worsens in these positions. The sphincter is already weakened or malfunctioning but the lack of gravity to hold down the stomach contents allows it to seep into the esophagus.
Causes and Triggers
Weakening and malfunctioning of the lower esophageal sphincter is the underlying cause of acid reflux. However, there are various causative and contributing factors to this lower esophageal sphincter (LES) dysfunction. Most of the common causes of acute acid reflux is related to dietary and lifestyle factors. However, with chronic reflux the cause is often a more serious and long term condition that requires medical or surgical management.
This is one of the most common acute causes of reflux and can affect any person. For people who suffer with chronic GERD, overeating worsens the reflux. Eating fast can also be a problem.
Alcohol, Smoking and Caffeine
Alcohol consumption can weaken the lower esophageal sphincter (LES). Nicotine and caffeine also worsens GERD as it increase stomach contractions and stomach acid production.
Certain foods are known to be triggers. Any food or drink with chocolate as well as fatty meals can trigger and worsen gastroesophageal reflux disease (GERD).
Read more about foods and drinks that cause acid reflux.
Pregnancy may contribute to acid reflux in multiple ways. Firstly the pregnancy hormones appear to weaken the lower esophageal sphincter (LES). Secondly the increased pressure within the abdomen due to the growing uterus further contributes to reflux.
In a hiatal hernia, a portion of the stomach slides up into the chest cavity through the small esophageal opening in the diaphragm. This impedes the lower esophageal sphincter and allows for the stomach contents to flow backwards into the esophagus.
There are several drugs that can cause or exacerbate acid reflux. Drugs for heart problems like nitrates and calcium channel blockers, are known to be contribute to reflux. Some asthma medication may also be a problem.
Delayed Gastric Emptying
Any condition that slows down the emptying of the stomach contents can lead to acid reflux. Delayed gastric emptying may be due to a host of causes, like certain drugs, a mass at the outlet of the stomach, nerve dysfunction and so on.
Acid reflux is common in obesity. The increased intra-abdominal pressure due to the large amount of fat accumulation is one of the factors that increases the likelihood of acid reflux in obese people.
These are some of the other causes of reflux:
- Vagus nerve surgery
- Parkinson’s disease
Remedies for Reflux When Lying Down
There are various dietary and lifestyle changes that can help with managing acid reflux. With regards to reflux that worsens with lying down, the following measures may be helpful.
- Eat small meals throughout the day and do not eat up to 3 hours before bedtime. Avoid lying down or napping after a meal, especially after a large meal.
- Elevate the head of the bed. By elevating it by 4 to 6 inches the reflux can be minimized when lying flat. Alternatively a wedge or specially-designed pillow to elevate the torso slightly can be helpful.
- Moderate exercise before bedtime can be helpful in increasing gastric emptying. Avoid strenuous activity particularly workouts involving abdominal exercises which may worsen the reflux.
- Do not smoke or drink coffee late at night. Chocolates should also be avoided. Night time snacking is also not recommended. Instead water should be drank if necessary.
- Sleeping on the side may be helpful. Specifically lying on the left side may be useful in minimizing nighttime acid reflux.
It is important to seek medical advice about acid reflux before attempting to self-manage the condition with dietary and lifestyle changes. Sometimes the symptoms that may appear to be due to acid reflux may instead be a result of cardiac conditions like angina pectoris and even a heart attack.
Treatments for Acid Reflux When Lying Flat
There are several drugs that can be helpful in controlling the symptoms of acid reflux and managing the condition. Antacids are widely used and if necessary it can be taken at bedtime even if there is no reflux. Chronic GERd sufferers may be prescribed acid-suppressing drugs like proton pump inhibitors (PPIs). These drugs should be taken as prescribed and if nighttime heartburn is a problem, it may be prescribed for use at bedtime.
There are other drugs like prokinetic agents which speed up the emptying of the stomach contents. These drugs are not routinely prescribed and only reserved for severe cases. When drugs fail to yield the desired results then surgical procedures like Nissen fundoplication may be required. However, these options should only be considered after medication with dietary and lifestyle changes have been implemented.
It is important to note that the typical symptoms of acid reflux may not always be present. Heartburn is a characteristic symptom but in silent reflux it may be absent. Nausea as well may not be present. Some people experience a difficulty sleeping and the exact cause cannot be identified with silent acid reflux. It is therefore important to have the condition assessed by a medical professional for an accurate diagnosis.