Waking up with a stomachache is not uncommon and there may be specific reasons why it occurs at night or when we sleep. While we may all experience the odd stomachache or bout of indigestion at night that can affect our normal sleep pattern, recurring sleep-related stomach symptoms should be investigated. Some of the upper gastrointestinal conditions that present with nighttime and sleep-related symptoms may be relatively symptom-free during the day or while awake.
Causes of Sleep-Related Stomachaches
People who experience sleep-related stomach pains and similar symptoms usually have an underlying gastrointestinal problem. For various reasons these conditions tend to aggravate at night or while sleeping. The more likely conditions which present with sleep-related stomachache includes gastritis, peptic ulcer disease, hiatal hernia and gastroesophageal reflux disease (GERD).
Gastritis is a condition where the stomach wall is inflamed. It is a common stomach condition and frequently occurs in people with H.pylori infection or those who use NSAIDs and certain other drugs. Children may also contract H.pylori infection and suffer with gastritis. The condition presents with a typical gnawing stomach pain and there is often other symptoms associated with indigestion. Pains tend to occur in the upper left quadrant and may worsen after eating or with hunger.
Peptic ulcer disease (PUD) is another relatively common condition particularly in adults. It occurs for many of the same reasons as gastritis but the problem often extends past the stomach into the small intestine. In peptic ulcer disease, open sores (ulcers) form in the wall of the stomach and the first part of the small intestine (duodenum). These stomach ulcers and duodenal ulcers are often very painful and the pain is usually felt in the upper left and upper middle quadrants of the abdomen.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a condition where the acidic stomach contents seep into the esophagus (food pipe). Since the esophagus cannot withstand the acid like the stomach can, it becomes inflamed and may even lead to ulcers forming in the esophageal wall. Heartburn is the typical symptom but there may be discomfort felt lower down in the left upper quadrant where the esophagus connects with the stomach.
A hiatal hernia is a less common upper gastrointestinal condition than those mentioned above. It arises when a portion of the stomach slips through the esophageal opening in the diaphragm to enter the thoracic (chest) cavity. Normally only the esophagus passes through this hole to then connect with the stomach. There are different types of hiatal hernia which may arise for various reasons. Some people may have little to no symptoms while others suffer with severe pain, discomfort and heartburn.
Common Stomach Symptoms When Asleep
Although these conditions may present with a host of signs and symptoms there are some common symptoms seen in all of these conditions. This includes:
- Left upper quadrant abdominal pain and pain under the left ribcage
- Nausea, regurgitation and sometimes vomiting
- Sensation of fullness in the stomach (bloating)
- Hunger pangs despite eating
- Cramps and strong gastrointestinal contractions
- Excessive and/or loud stomach noises
- Excessive belching
Since these symptoms often disturb sleep, there may be other non-digestive symptoms like fatigue, impaired memory, changes in mood, poor concentration and excessive daytime sleepiness. Although a sleep disorder is usually suspected the root cause likes with the gastrointestinal condition and the associated symptoms that affect proper sleep patterns.
Why do stomach symptoms worsen with sleep?
There are many physiological reasons why stomach symptoms worsen with sleep. It is not always the sleep process that is the problem. Instead the aggravation may be time-related (night or early hours of the morning) or due to the sleep position (lying down flat).
During sleep there are various physiological changes in the body. One of these changes which may aggravate the symptoms of underlying digestive conditions is the relaxation of muscles. People who suffer with GERD may find that the relaxation of muscles that make up the lower esophageal sphincter (LES) allows for the stomach acid to flow backward into the esophagus. With hiatal hernia the muscle relaxation may also allow for a portion of the stomach to slip into the thoracic cavity. However, this occurs in conjunction with other time and body position factors.
Lying flat negates the pulling down force of gravity and when it comes to GERD this means that stomach acid can more easily pass into the esophagus. The same reason applies to why the stomach may more easily slip through the diaphragmatic opening in a hiatal hernia. The body’s internal clock also known as the circadian rhythm works on a 24 hour cycle. Stomach acid secretion increases in the early hours of the morning and this may exacerbate the symptoms of peptic ulcers, gastritis and acid reflux.
Hunger can also play a role since a person does not eat for many hours while asleep. Conversely eating just before sleeping can worsen the symptoms of most of the conditions mentioned above.
Treatment and Prevention
The treatment of these conditions or symptomatic treatment depends on the underlying disorder. Several common over-the-counter (OTC) and prescription drugs may be used for most of these conditions. It includes:
- Antacids to reduce neutralize stomach acid.
- Proton pump inhibitors (PPIs) to reduce stomach acid production.
- Metoclopramide to speed gastric emptying.
- Cytoprotective agents to protect the stomach lining so ulcers can heal.
Other drugs may be used for specific conditions. While most of these conditions can be effectively treated, dietary and lifestyle changes can minimize symptoms and prevent it from arising during sleep. These simple preventative measures include:
- Avoid caffeinated and alcoholic beverages for at least 2 hours before bedtime.
- Eat small meals in the evening and do not eat for 3 hours before sleeping.
- Lift the head of the bed or use specially-designed pillows to elevate the upper body slightly.
- Do not take any medication on an empty-stomach unless so prescribed.
- Foods and beverages that tend to aggravate symptoms should be avoided, especially for dinner.
- Tobacco smokers should avoid smoking too close to bedtime or waking up to have a smoke.