Acid reflux or heartburn is a painful, burning sensation that occurs when stomach acid travels up from the stomach. Almost everyone experiences acid reflux at some point. Symptoms, including coughing and choking, may increase in severity while trying to sleep, says the National Sleep Foundation.
With severe acid reflux, sometimes acid or stomach contents can be inhaled or aspirated, which can lead to cough, asthma or even pneumonia, cautions Hardeep Singh, MD, a gastroenterologist with St. Joseph Hospital in Orange, California. It's unlikely, though, that choking caused by acid reflux during sleep would cause death, especially in a healthy person, he says.
The Lowdown on Acid Reflux
More than 60 million Americans have heartburn at least once a month, and as many as 15 million experience symptoms every day, according to the American College of Gastroenterology. Pregnant women and the elderly tend to be affected more than other populations.
For some people with acid reflux, known as gastroesophageal reflux disease (GERD), if it's chronic, the gastroesophageal sphincter — which is the valve that functions as a seal between the esophagus and stomach — becomes weak, explains Dr. Singh. This allows fluids containing digestive acids and enzymes to leak back up into the esophagus. And, when the lining of the esophagus comes into prolonged contact with these fluids, it can become irritated, creating the burning sensation of heartburn.
"The stomach always contains acid, even when fasting, and this acid can irritate the esophagus, causing heartburn, chest pain, nausea," Dr. Singh says.
What Brings on Acid Reflux?
Acid reflux is often due to eating too late and not waiting before lying down for bed, says Dr. Singh. The size and contents of your meal can also be factors.
Other lifestyle factors, such as smoking, drinking alcohol or coffee or taking certain medicines can also make your heartburn worse, according to Mayo Clinic. Plus, having certain health conditions can boost someone's risk for GERD. These include being obese, having a hiatal hernia, being pregnant, having delayed stomach emptying or living with a connective tissue disorder such as scleroderma, Mayo explains.
Read more: The 10 Worst Foods for Acid Reflux
Get Relief and Sleep
Because chronic acid reflux can cause poor quality of sleep, the U.S National Library of Medicine suggests specific actions you can take to gain relief and get a solid night's rest.
Plan dinnertime and bedtime: Don't go to bed soon after eating. Stay upright for at least three to four hours after your meal or snack. Eating smaller meals throughout the day instead of a large meal at dinner can help, too.
Elevate sleeping position: Sleep with your head elevated 4 to 6 inches. Extra pillows may not be enough to get the job done. Try using a special wedge support or use risers at the head of your bed to provide the desired elevation.
Dietary restrictions: In addition to eating smaller, more frequent meals, avoid foods that could cause problems. Do not drink alcohol or drinks that include caffeine. High-acid fruits such as pineapples and vegetables, including tomatoes, could also be triggers so minimize or restrict these items.
Lifestyle modifications: If you're overweight, losing weight may provide relief from heartburn. If you smoke, quit. When you choose clothes, select styles that are not too tight and do not put pressure on your stomach.
Medication do's and don'ts: Choose acetaminophen when you need an over-the-counter pain reliever and avoid non-steroidal anti-inflammatory medicines such as aspirin, ibuprofen and naproxen. For quick relief of acid reflux, try antacids to neutralize the stomach acid. Ask your doctor about over-the-counter medications such as H2 antagonists (Pepcid, Tagamet, Zantac or Axid, for example) or proton pump inhibitors (such as Prilosec, Nexium or Prevacid).
If acid reflux is keeping you from getting quality sleep, check in with your doctor to make sure you have no underlying health issues. Waking due to acid reflux could be a sign of a more serious health concern, cautions Dr. Singh. "Untreated reflux can lead to ulcers, scarring and ultimately esophageal cancer," he said. "Esophageal cancer is increasing in incidence rapidly in the United States."
But, if acid reflux is the culprit, your doctor may recommend prescription-strength medications to help you gain relief.
Is This an Emergency?
- Hardeep Singh, MD, gastroenterologist, St. Joseph Hospital, Orange, California
- U.S. National Library of Medicine: “Gastroesophageal Reflux – Discharge"
- American College of Gastroenterology: "Acid Reflux"
- National Sleep Foundation: "GERD and Sleep"
- Mayo Clinic: "Gastroesophageal Reflux Disease (GERD)"