Severe or frequent acid reflux, also known as gastroesophageal reflux disease, or GERD, can be particularly troublesome at night. According to a January 2013 study published in the "American Journal of Gastroenterology," nighttime acid reflux occurs in up to 75 percent of those who suffer from GERD. This can be seriously debilitating, causing loss of sleep and impairing your ability to function the following day. Waking up choking or coughing is a common symptom of nighttime reflux and also one of the most disruptive to your sleep. Fortunately, acid reflux can often be successfully managed by acid-blocking medications and lifestyle changes. However, nighttime choking can be related to other health conditions, so seeking medical attention to evaluate this symptom is important to determine the correct cause and treatment.
Choking From Acid Reflux
Nighttime choking can be related to acid reflux, which occurs when the band of muscle that forms a seal between the esophagus and stomach becomes weakened or fails to close tightly. During sleep, when your body is lying flat with the esophagus and stomach on an even plane, it’s easier for acidic digestive juices to travel upward -- or reflux -- and irritate your esophagus and throat, causing coughing and choking. When caused by acid reflux, coughing and choking at night are commonly related to regurgitation, which occurs when stomach contents spontaneously pass into your mouth. Also, coughing and sometimes choking on acidic stomach fluids can be a reflex cough triggered by the irritation of your esophagus and vocal cords.
Managing Nighttime Acid Reflux
Sleeping with the head of your bed elevated helps prevent acid reflux and reduces the time acid stays in contact with your esophageal tissue. That’s simply because of gravity -- when you sleep with your upper body elevated, acidic stomach contents are less likely to leak into the esophagus compared to lying flat. Foam wedges for sleeping are sold commercially and are the easiest way to sleep on an incline. Another helpful strategy to reduce the chance of nighttime acid reflux is to not lie down within 2 to 3 hours of eating. Finally, consider avoiding large meals or any foods that may trigger your symptoms, including fatty foods, chocolate, citrus fruits and juices, mint and caffeinated or alcoholic beverages.
Other Causes of Nighttime Choking
In addition to GERD, a number of other conditions can cause nighttime coughing and choking. If you have obstructive sleep apnea, you may stop breathing temporarily in your sleep due to blocked airways -- and when breathing resumes you may snort or make a choking sound. Respiratory disorders such as allergies, asthma or post-nasal drip can lead to coughing and choking on fluids such as saliva, mucus or even stomach contents that are regurgitated from excess coughing. Heart failure, a condition in which the heart muscle is damaged and does not pump with enough force, can lead to fluid buildup in the lungs and may cause coughing at night. Other less common conditions can cause nighttime coughing or choking on fluids, so this bothersome symptom needs to be evaluated by a doctor before self-treating for GERD.
Next Steps and Precautions
If you already experience acid reflux symptoms, waking up from coughing and choking may be an indication that you are suffering from severe GERD, which can lead to serious complications if left untreated. GERD is usually managed with the use of acid-blocking drugs called proton pump inhibitors, or PPIs, which are highly effective in reducing symptoms and allowing the esophagus to heal. Helpful lifestyle modifications for improving acid reflux symptoms include weight loss, sleeping with the head of the bed elevated, and avoiding eating within 2 to 3 hours of lying down. Nighttime coughing and choking can also be a sign of another serious condition. If you experience nighttime choking or coughing, chest pain, difficulty swallowing, ongoing hoarseness or persistent heartburn, be sure to visit your doctor for a thorough evaluation.