Why Do I Get Heartburn At Night?

Overview

Have you ever experienced a burning sensation in your chest when you are trying to sleep? This discomfort is known as heartburn and it can often flare up at night. It is unpleasant and can make sleep uncomfortable. . Heartburn at night is a common occurence but frequent heartburn at nighttime can indicate gastroesophageal reflux disease (GORD). GORD is a chronic conditionthat has a significant impact on sleep and overall well-being. However, by implementing lifestyle and dietary modifications, you can reduce GORD symptoms and minimize heartburn at night.t.¹

This article aims to provide comprehensive information to help you prevent and treat heartburn at night.

What causes heartburn at night?

Heartburn is defined as a burning sensation in the middle of the chest. It occurs when  food and acid leak up from the stomach into the oesophagus, the muscular tube connecting your mouth to your stomach. The lower oesophageal sphincter, a muscle band, acts as a valve to allow food to enter the stomach during swallowing and preventing its backflow. However, if the lower esophageal sphincter fails to close completely, it can result in the reflux of food and acid from the stomach, leading to the sensation of heartburn.^1,2

Heartburn tends to be worse at night due to a combination of factors. The absence of gravity whilst laying flat, makes it much easier for stomach acid to reflux back up into the oesophagus through the malfunctioning lower esophageal sphincter. Additionally, during sleep, there is a decrease in swallowing and saliva production during sleep which prevents clearance of theoesophagus and the neutralisation of stomach acid.²

Reflux of stomach contents can also lead toother symptoms such as a sore throat, a sour taste in themouth and coughing. The disruption of sleep caused by acid refluxcan have a significant impact on various aspects of  your daily life such as, work productivity, mood and overall quality of life.²

Heartburn at night is associated with several risk factors:  eating  too late or too large a meal at nightt, obesityt, smoking, drinking alcohol and high stress levels.

Dietary triggers

Eating certain foods, especially at night, can trigger heartburn through relaxing the lower oesophageal sphincter or increasing acid production. These can include:

• Tomatoes 
• Spicy food
• Citrus fruits
• Chocolate
• Alcohol
• Carbonated beverages
• Tea, coffee and other caffeinated drinks
• Fatty and greasy food

Gastroesophageal reflux disease (GORD)

Frequent heartburn, especially at night, can be a symptom of gastroesophageal reflux disease, according to a study.³

Research has shown that gastroesophageal reflux disease negatively affects sleep by awakening patients from sleep and making it difficult to sleep in the first place.⁴ GORD symptoms include:

• Heartburn – usually after eating which can be worse at night or when lying down
• Regurgitation of food or sour liquid
• Chest pain
• Trouble swallowing or feeling like you have a lump in your throat
• An ongoing cough
• Laryngitis – inflammation of the vocal cords
• Worsening or new asthma.⁵

Eating large meals or late at night

Eating a large meal before you sleep can negatively affect your stomach. It can take your stomach 4 to 5 hours to fully empty a meal so eating before bedtime can increase the risk of heartburn. In addition, a large meal which is high in fat can take even longer to digest.⁶

Obesity

People who are obese or overweight tend to suffer from heartburn more than those who are not. This is because excess weight puts pressure on the abdomen and can increase the chance of reflux. Losing weight can help relieve these symptoms.⁶

Smoking

Chemicals inhaled  when smoking can irritate the oesophagus and relax the lower esophageal sphincter, increasing the likelihood of stomach acid reflux.

Pregnancy

It is common for pregnant women to experience heartburn at night, even if they have never experienced it before pregnancy. Research shows that 17-45% of pregnant women experience heartburn. This is mostly due to hormonal changes, the pressure of the baby against your stomach as it grows, weight gain and stress levels. Symptoms usually occur soon after eating and are usually more common later in the pregnancy (from 27 weeks onwards).⁷,⁸

Management and treatment for heartburn at night

There are a few different ways to help manage heartburn at night.

Elevated head and chest

Raising the head of your bed by at least 10 to 20 cm, so your head and chest are above the level of your waist, can help prevent stomach acid travelling up through the oesophagus. It is important to raise the bed itself and not to stack up pillows as this can lead to neck or back pain and actually increase pressure on the stomach.^1,2

Sleep on your left side

Sleeping on the left side of the stomach is better for those who suffer from heartburn. The shape of the stomach and positioning of the lower oeseophageal sphincter means on your left side, the acidic contents can pass through the lower oesophageal sphincter into the stomach instead of back up through the oesophagus.. A body pillow can be used to help you stay on your left side as well as keep your head elevated.²

Medication

Acid reducers are a type of medication that decrease the production of stomach acid. Patients with gastroesophageal reflux disease are often prescribed proton pump inhibitors (PPIs) or histamine antagonists (H2 antagonists). Proton pump inhibitors include omeprazole and lansoprazole.¹

Another type of medications are antacids which work by neutralising the acid in your stomach which relieves indigestion and heartburn. In addition, a preparation containing alginate can also be used as medication. Alginate reduces heartburn by forming a raft on top of the acid that sits in the stomach.^1,6

These medications should be taken with food or soon after eating as this is when you are likely to get heartburn. Although these medicines can help improve your symptoms, they do not cure heartburn and so are not long-term solutions.¹

Can I prevent heartburn at night

There are many different ways to prevent heartburn from occurring at night. It is recommended to:

• Avoid trigger foods
• Avoid smoking and alcohol
• Eat smaller, less fatty food – a meal of less than 500 calories and 20g of fat is ideal for someone with chronic heartburn
• Wait at least 3 hours after eating to go sleep
• Lose weight if obese or overweight
• Sleep on your left side with your head and chest elevated
• Check the side effects of medications -  some medications can cause heartburn
• Wear loose clothing – tight clothes can put pressure on your stomach which can lead to heartburn symptoms
• Stay sitting upright when eating
• Avoid exercising after a meal¹

When to see a doctor

Contact your GP or call NHS 111 if:

• You have had heartburn almost every day for more than 3 weeks
• Lifestyle changes and medications are not working
• You also have other symptoms such as frequently vomiting, losing weight or food getting stuck in your throat

A GP can help you by providing you with stronger treatments that can reduce your heartburn. They can also identify any serious causes of your symptoms.¹

Summary

Heartburn is a prevalent condition  affecting millions of people worldwide. Heartburn at night can be  caused by a variety of risk factors such as eating a large, fatty meal at night, smoking, drinking alcohol and dietary triggers. Frequent heartburn at night-time can be a symptom of gastroesophageal reflux disease (GORD). Management and preventation of night-time heartburn typically involve a combination of dietary changes and lifestyle modifications as well as medication.. These changes may include avoiding heartburn triggers, sleeping on your left side with your head and chest elevated.as well as medicationssuch as acid reducers, antacids and alginate.