Nighttime heartburn can deprive you of sleep--and make you feel worse overall. Unfortunately, sitting up all night in an effort to avoid the heartburn is not a good option. However, you can learn what NOT to do in order to prevent the heartburn before it begins, and allow you to sleep.
Don't lay down too soon after eating. Lying down with a full stomach can cause stomach contents to press harder against the LES, increasing the likelihood that reflux will occur. If you feel like resting soon after eating, try relaxing in a chair or recliner.
Don't eat large meals. Whenever you eat a large meal, there is the risk of your stomach becoming too full, which will put more pressure on the LES. There can also be an excessive production of stomach acid. It is better to eat 5 or 6 smaller meals instead of 3 larger ones. Also, if one of your meals is typically larger than the others, try to have that meal for lunch instead of dinner. This can also help prevent having an over-full stomach at night.
Don't eat a late-night snack. We all like our snacks, and many of us may have gotten into the habit of eating a snack shortly before bedtime. If your stomach is working on digesting food when you go to bed, there is a higher risk of having an episode of heartburn. Try to schedule your snacks for earlier in the day, such as between breakfast and lunch, or between lunch and supper.
Don't eat foods you know are likely to trigger your heartburn. Many people can trace their heartburn back to specific foods that they have eaten. If you suffer from heartburn at night, it may have started with something that you ate during the day. Certain foods can have have a couple different affects on the body that can lead to heartburn. One way is when a food relaxes the LES food comes back upward. Another way is when a food causes the stomach to produce too much acid and this is refluxed into the esophagus. Examples of foods most likely to cause heartburn are:
- Fried (greasy) foods
- High fat meats
- Butter and margarine
- Mayonnaise
- Creamy sauces
- Salad dressings
- Whole-milk dairy products
- Chocolate
- Peppermint
- Caffeinated beverages (e.g. soft drinks, coffee, tea, cocoa)
- Carbonated beverages
- Alcohol
- Spicy foods
- Black pepper
- Citrus fruit and juices (e.g. orange, grapefruit)
- Tomato juice
Don't sleep flat. Lying down flat presses the stomach's contents against the LES. With the head higher than the stomach, gravity helps reduce this pressure, and keeps stomach contents where they belong--in the stomach. You can elevate your head in a couple of ways. You can place bricks, blocks or anything that's sturdy and fits securely under the legs at the head of your bed. You can also use a wedge-shaped pillow to elevate your head.
Don't sleep in tight clothes. Tight fitting clothes are not that comfortable to sleep in even in the best of times. If you suffer from nighttime heartburn, if can be even worse. Clothing that fits tightly around the abdomen can squeeze the stomach, forcing food up against the LES, which in turn can cause the food to reflux into the esophagus. Wearing tight fitting clothing anytime during the day is not a good idea. Clothing that can cause problems include tight-fitting belts and slenderizing undergarments.
Don't drink alcohol. As mentioned above, alcohol should be avoided. The reasons include:
- Alcohol increases the production of stomach acid
- Alcohol relaxes the lower esophageal sphincter, allowing stomach contents to reflux back up into the esophagus
- When the LES relaxes, it causes swallowing contractions to become erratic
- Alcohol makes the esophagus more sensitive to stomach acid
Don't smoke. If you smoke, you should consider stopping. Some of the ways smoking can increase the risk of heartburn are:
- Cigarette smoking slows down the production of saliva
- Smoking stimulates the production of stomach acid
- Smoking can leaken and relax the LES
- Smoking can directly injure the esophagus, making it more susceptible to further damage from acid reflux
Don't forget the water. Remember to drink plenty of water because it helps with digestion. However, do not drink too much water at one time. This can increase the stomach contents and can actually worsen heartburn symptoms. It is better to drink smaller amounts throughout the day rather than large amounts less often.
Don't forget to try an antacid. Antacids will work very quickly on heartburn you may be experiencing before you go to bed. It can also be used for those heartburn episodes that wake you up during the night if the heartburn comes back. Unfortunately, this is very possible. A H2 blocker will work for a longer period of time, usually up to 12 hours, but they take an hour or so to begin working, and you are able to go back to sleep. Another option is to combine the two. The antacid will provide the quick relief you need, and will likely last until the H2 blocker begins to work. Before trying these, you should talk to your doctor about your best options.
If you continue to experience frequent heartburn symptoms at night, see your health care provider. He or she will be able to diagnose whether you are suffering from just occasional heartburn, or something more serious, such as gastroesophageal reflux disease, an peptic ulcer, or a hiatal hernia. You will be able to discuss with your health care provider different treatment options, including medications such as proton pump inhibitors (PPIs).
Sources:
Anil Minocha, M.D., Christine Adamec. How To Stop Heartburn - Simple Ways to Heal Heartburn and Acid Reflux. John Wiley & Sons, Inc, 2001.
Carol Ann Rinzler, Ken DeVault, MD. Heartburn & Reflux for Dummies. Wiley Publishing, Inc, 2004
"Updated Guidelines for the diagnosis and Treatment of Gastroesophageal Reflux Disease." The American College of Gastroenterology
