Heartburn is the main symptom of the most common upper gastrointestinal problem – acid reflux, or gastroesophageal reflux disease (GERD) as it medically known. GERD affects between 25% to 40% of Americans and about 10% suffer with symptoms daily. While we all know the typical symptoms like heartburn and nausea, many people do not realize that acid reflux also affects sleep. In fact acid reflux may occur for many of the same reasons that affect sleep. It can be a vicious cycle that leads to long term sleeping problems despite the use of strong prescription sleeping pills.
Acid Reflux and Insomnia
Acid reflux and insomnia are two separate conditions, that are closely related in many people. It is important to understand each condition on its own before looking at the association.
Acid reflux or gastroesophageal reflux disease (GERD), is a condition where the stomach acid rises up into the food pipe (esophagus). While the stomach can handle this corrosive acid, the esophagus can not. As a result the acid irritates the inner lining. It is this irritation that causes the symptom of heartburn – a burning chest pain. Sometimes the pain is not as obvious and just feels like a mild chest discomfort or gnawing type of ache.
Insomnia is a broad term to describe a number of sleeping problems. In any of these problems, the person either is unable to fall asleep or remain asleep for sufficient periods of time to awake refreshed. It may also include excessive sleepiness during the day. The causes of insomnia can be diverse. Every person at some point or the other will have sleeping problems for periods of time. It is usually short lived but some people experience these sleeping problems on an ongoing basis.
Many instances of insomnia are linked to psychogenic factors like psychological stress (work, money, relationship problems) but acid reflux is often overlooked as one of the significant causes of insomnia.
Reasons for Heartburn and Difficulty Sleeping
Acid reflux, which causes heartburn, may arise for different reasons than insomnia. However, psychological stress is one common cause of both acid reflux and insomnia.
In acid reflux, the lower esophageal sphincter (LES) fails to prevent backflow of stomach acid. The LES is a circular band of muscles that keep the lower portion of the esophagus closed except when food has to pass through. By staying closed, the LES can ensure that stomach acid does not flow up into the esophagus and irritate it.
But people who suffer with GERD often have failure of the LES to work efficiently. This failure can be acute or chronic. Overeating, alcohol and caffeine, chocolate, certain foods or strenuous physical activity after eating are some of the reasons for acid reflux, and therefore heartburn. People with chronic GERD have a weakening of this LES that is due to more permanent factors.
How heartburn affects sleep?
Heartburn can affect a person’s quality of life in several ways. Sleep is just one aspect. Sleep is easily disturbed by pain or discomfort and this is how heartburn can lead to insomnia. Unfortunately it is not always obvious. Many people do not even realize that they have acid reflux, or that heartburn is affecting their sleep.
The situation is significantly worse at night when sleeping. Acid secretion increases at night and lying down flat can increase the chance of reflux. These factors make heartburn worse at night and therefore more likely to affect sleep than it may during the day while awake. The role of psychological stress further compounds the situation.
Acid reflux is worsened, but not caused, by psychological stress. Insomnia may be caused and aggravated by psychological stress. A person who is stressed may therefore be prone to both problems. Furthermore the acid reflux may then compound the existing sleeping problem. It is further exacerbated by the fact that insomnia can affect the body in various ways, including disrupting the circadian rhythm and increasing stress levels – both of which can contribute to reflux.
And a vicious cycle occurs where heartburn causes insomnia and insomnia worsens heartburn.
Remedies for Heartburn Insomnia
Insomnia can be remedied by targeting the acid reflux, if heartburn is the cause of sleeping difficulties. It is always worth trying these measures for insomnia even if heartburn is not obvious. It revolves around a few simple lifestyle measures which is easily implemented. Sleeping pills can have serious side effects and have a high risk of addiction.
Do Not Eat 3 Hours Before Bedtime
Ideally you should not have anything to eat about 3 hours before bedtime. This will allow the stomach enough time to empty out the last meal before you lie flat to sleep. It reduces the chance of acid reflux. If you have to eat an hour or two before bedtime for whatever reason, make sure that it is something bland, in a small portion size and preferably liquid. Also try to keep dinner within a moderate size. Never overeat.
Avoid Trigger Foods At Dinner Time
Some foods are worse than others in triggering or worsening acid reflux. Dinner is obviously the most likely mealtime when these foods should be avoided but as far as possible it should be excluded from the diet as long as you suffer with reflux. Always limit alcohol intake, especially around dinner time. Caffeine should also be avoided. Spicy foods and chocolates may aggravate reflux as well.
Sleep With Head Slightly Elevated
Lying flat tends to worsen acid reflux. Therefore a slight elevation of the upper body is advisable if heartburn is a problem during sleep. However, it is not always a matter of simply using an extra pillow or two. This can sometimes strain the neck when sleeping in awkward position. Consider elevating the head of the bed slightly or using special wedges to keep the upper body slightly elevated.
Try An Antacid Immediately Before Sleeping
Antacids are among the most commonly purchased OTC (over-the-counter) medication. It is effective and most are safe to use. If you do use antacids for your heartburn or suspect that reflux is the cause for your sleeping problem, then try taking an antacid just before bedtime. It may offer relief and help you sleep better. Your doctor may then prescribe other acid-suppressing drugs like a proton pump inhibitor (PPI) for longer lasting relief.