There's nothing crappier than waking up to a burning pain in your chest. Yep, when heartburn hits in the morning, it's pretty unpleasant.
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But if you notice your chest is on fire frequently first thing (or you have a bitter taste in your mouth, which is another telltale sign of acid reflux), you might be wondering what's going on and whether you should worry.
Here, Niket Sonpal, MD, a New York-based internist and gastroenterologist, shares common reasons why heartburn strikes before the sun's up and what you can do to slash the searing sensation in your chest.
1. You Have Gastroesophageal Reflux Disease (GERD)
Morning heartburn often happens when you have GERD (the medical term for severe, chronic acid reflux).
This condition occurs when stomach acid travels up the esophagus, and the backwash burns your esophageal lining, according to the Mayo Clinic.
In people with GERD, the lower esophageal sphincter (the muscle between the esophagus and stomach) opens inappropriately, Dr. Sonpal says. In other words, when this sphincter is weakened or relaxes abnormally, it allows irritating acidic fluid from your stomach to flow back into your food pipe.
"The number one cause of GERD in America is obesity," Dr. Sonpal says. That's because excess weight can place pressure on the stomach, propelling its contents up into the esophagus.
Other common symptoms of GERD include, per the Mayo Clinic:
- Chest pain
- Difficulty swallowing
- Regurgitation of food or sour liquid
- Sensation of a lump in your throat
- Chronic cough
- New or worsening asthma
- Disrupted sleep
Fix it: If extra weight is exacerbating your GERD, speak to your doctor about healthy ways to lose a few pounds. Also, limiting acidic or spicy foods (which tend to trigger reflux) is a smart strategy to slash GERD symptoms such as heartburn.
2. You’re Stressed
When your stress level is out of control, your heartburn might be hopped up too.
Here's why: Stress releases hormones in the body that loosen up the lower esophageal sphincter muscle, which enables stomach acid to flood back up the food pipe and produce a burning sensation, Dr. Sonpal says.
"Stress also causes us to eat more — and often more quickly — which only compounds the effect.," Dr. Sonpal adds. For example, taking in too much caffeine or alcohol can actually relax and slacken the lower esophageal sphincter, making it simpler for stomach contents to come back up.
Fix it: Try incorporating stress management to hinder heartburn. One simple breathing technique — the 4-7-8 breathing method — can help you relax and unwind when you're feeling stressed. Here's how to do it:
- Start by sitting in a comfortable position.
- Slowly inhale through your nose for a count of 4.
- Hold your breath for another count of 7.
- Exhale for a count of 8.
- Repeat this cycle four times.
3. You Have Hiatal Hernia
Hiatal hernia can aggravate your morning heartburn too.
Hiatal hernia happens when the upper part of your stomach bulges through an opening in your diaphragm (the large muscle that separates your abdomen and chest), according to the Mayo Clinic.
"The diaphragm provides a natural compression to the space between the esophagus and stomach," Dr. Sonpal says. "It is the 'backup' if the lower esophageal sphincter fails," he adds.
This failsafe mechanism usually falters when we age or gain too much weight, Dr. Sonpal says. In both cases, the natural compression of the diaphragm dissipates and loosens. And this leads to a damaging domino effect, causing the lower esophageal sphincter to become looser as well, he explains.
And, as we already know, when this sphincter muscle releases, food and acid may move back into your esophagus, resulting in a heap of heartburn.
In addition to heartburn and acid reflux, other signs of hiatal hernia may include, per the Mayo Clinic:
- Regurgitation of food or liquids into the mouth
- Difficulty swallowing
- Chest or abdominal pain
- Feeling full soon after you eat
- Shortness of breath
- Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding
Fix it: Because obesity is a major risk factor, working to maintain a healthy weight can help reduce your hiatal hernia and heartburn.
The Mayo Clinic also recommends the following lifestyle changes to manage symptoms of hiatal hernia:
- Eat several smaller meals throughout the day rather than a few large meals
- Avoid foods that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion and caffeine
- Avoid lying down after a meal or eating late in the day
- Stop smoking
- Elevate the head of your bed 6 inches
4. You’re Pregnant
Heartburn: Yet another unpleasant pregnancy side effect to add to the long list.
In fact, more than half of pregnant people experience severe heartburn, particularly during the third trimester, according to the Cleveland Clinic.
That's, in part, because your changing hormones cause the digestive system to slow down, Dr. Sonpal says. And when food moves slower through your system, you're more likely to suffer from heartburn (and bloating).
Making matters worse, progesterone (i.e., the pregnancy hormone) can relax the lower esophageal sphincter, allowing stomach acid to snake its way up into the esophagus, per the Cleveland Clinic.
What's more, as the uterus grows, it pushes on the stomach, and this can sometimes force stomach acid up into the esophagus as well, Dr. Sonpal adds.
Fix it: Fortunately, pregnancy-related heartburn is only temporary and should resolve once you've given birth.
In the meantime, here are a few simple strategies to reduce heartburn symptoms while you're expecting, per the Cleveland Clinic:
- Eat several small meals throughout the day instead of three large ones
- Eat slowly
- Drink between your meals, but not with meals
- Avoid fried, spicy or fatty foods
- Avoid citrus fruits and juices
- Limit caffeine
- Don't smoke and avoid alcohol
- Sit up straight when you eat
- Don't eat late at night
- Don't lie down right after eating
- Keep the head of your bed higher than the foot of the bed
5. It's Your Medication
Your morning heartburn could be a byproduct of a medicine you're taking. "Certain medications slow down GI tract movement or open the lower esophageal sphincter, and, as a side effect, cause GERD," Dr. Sonpal says.
The following medications and dietary supplements can increase acid reflux and worsen GERD, per Dr. Sonpal:
- Anticholinergics such as oxybutynin (brand name: Ditropan XL) that are prescribed for overactive bladder and irritable bowel syndrome
- Tricyclic antidepressants such as amitriptyline and doxepin
- Calcium channel blockers, statins, angiotensin-converting enzyme (ACE) inhibitors and nitrates used for high blood pressure and heart disease
- Narcotics (opioids) such as codeine and those containing hydrocodone and acetaminophen, such as Norco and Vicodin
- Sedatives or tranquilizers, including benzodiazepines such as diazepam (brand name: Valium) and temazepam (brand name: Restoril)
- Bronchodilators such as theophylline (brand names: Elixophyllin and Theochron) that are used to treat asthma and other lung problems
While these medications can increase your risk for GERD (and accompanying heartburn), not all people will experience these symptoms, Dr. Sonpal adds.
Fix it: If you suspect your heartburn is a side effect of your medication, speak with your doctor, who may be able to prescribe you a different drug. And never stop taking your medicine before consulting with your physician, as this can be potentially dangerous.
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.