Acid Reflux and Sleep

In the old days, we called it heartburn. Now we call it acid reflux, or by its acronym GERD—gastroesophageal reflux disease.

Whatever you want to call it, if you’ve ever had it and tried to sleep, you know what an uncomfortable exercise in frustration that can be.

GERD affects millions of people worldwide and most of them encounter it at bedtime or as they sleep.

It’s no surprise that people who suffer from acid reflux have sleep problems: results from the 2001 Sleep in America poll show that Americans with heartburn at bedtime are more likely to suffer from insomnia, sleep apnea, excessive daytime sleepiness, and restless legs then their companions without heartburn.

 

What is gastroesophageal reflux disease (GERD)?

We all carry acid in our stomachs to do the work of digestion. GERD results when acid from the stomach backflows into the esophagus, giving us the sensation of “heartburn.”

The higher the acid rises, the more severe the symptoms. If it rises to the throat or larynx, it can cause coughing and choking.

During sleep, if the acid makes it this far back up the throat, there is also the dangerous risk for breathing in, or aspirating, the acid into the respiratory system. 

Digestion, remember, is ruled by its own circadian rhythms. Digestion at night is meant to take longer as we sleep. Our swallowing behavior and saliva production change during the postprandial period into sleep as well.

With less swallowing (due to sleep) and slower production of saliva to clear acid, the time when acids can remain in contact with the tissues of the upper airway and esophagus is prolonged, leading to coughing, gasping, even tissue damage.

Symptoms of GERD

Heartburn isn’t the only sign you have GERD. In fact, some people with GERD never have heartburn. But they might have more than one of the following symptoms:


What causes GERD?

Researchers don’t know why some people get GERD while others don’t. However, there are certain risk factors that seem to lead to GERD, such as:

Age. Anyone can experience the symptoms of acid reflux, but it is usually more prevalent in people between the ages of 45 and 64.

Diet. Certain foods can trigger GERD (see below).

Pregnancy. The positioning (and crowding) of the baby can interfere with smooth digestion and lead to GERD.

Late, heavy meals. Your body, at bedtime, is primed by circadian system regulations to head into sleep, but a late, heavy meal will require an extra and unexpected digestive effort. Once you recline, the help that gravity offers with digestion is lost, leading to problems with both a slow digestion and positional changes that increase the odds of acid reflux.

Obesity. Added weight around the girth can apply pressure to the organs, forcing acidic fluids back into the throat.

Alcohol. Its muscle relaxant quality can make the valve between the stomach and the esophagus less effective in keeping digestive acids contained inside the stomach.

Smoking. Nicotine relaxes the muscles in the lower esophagus, much in the same way as alcohol.  

There are also some foods that commonly trigger a case of acid reflex at bedtime, such as:


What is the relationship between GERD and sleep?

Apparently experiencing one can lead you to experiencing the other.

One 2010 study confirmed an association between obstructive sleep apnea (OSA) and GERD. Almost 25 percent of people with sleep apnea also experienced GERD.

During episodes of OSA, the drop in blood oxygen caused by having apneas can lead to smooth muscle relaxation in the valve at the top of the stomach. This, in turn, becomes floppy, allowing for the contents of the stomach to re-enter the esophagus, leading to GERD.

OSA has also been found to lead to changes in pressure inside the chest which can predispose someone with sleep apnea to the additional problems of acid reflux.

These findings came from a multicenter longitudinal cohort study of sleep-disordered breathing. The presence of increased body weight, daytime sleepiness, insomnia, high blood pressure, and asthma were also found to be strong predictors for nighttime heartburn. 

Using certain sleep medications was also identified as a risk factor for GERD among subjects with OSA. Some researchers also surmise that obesity may be a shared common element for those experiencing both conditions.

While the exact relationship between OSA and GERD is not fully understood, evidence shows that treating OSA tends to improve the symptoms of GERD.

GERD can also lead to sleep fragmentation, in which the sleep architecture of the person with acid reflux is broken up by arousals caused by the discomfort of GERD. Often, these arousals include leaving the bed to fetch medication or propping pillows to elevate the head. They may also lead to periods of insomnia. Lack of sleep has been shown to make people with GERD hypersensitive its symptoms, as well.

If GERD leads to these problems, night after night, sleep fragmentation can lead to sleep deprivation, with a daytime symptom of sleepiness and reduced cognitive function as potential results.

 If left unchecked, sleep fragmentation becomes sleep debt, which opens the gates to multiple other chronic health problems, including obesity, depression, heart disease, stroke, and type II diabetes.

Finding relief from GERD

Lifestyle changes can help. Here are some aspects of good sleep hygiene that can help you overcome your problems with GERD:

For pregnant women, GERD often comes to an end following the delivery of the baby.

Some over-the-counter medications can also help, at least temporarily, but if you have a persistent problem with the symptoms of acid reflux, and it’s beginning to impact your sleep health on a regular basis, seeing a doctor for diagnosis and treatment is recommended. Don’t be surprised if you are also screened for sleep apnea at that time.


 

Sources:

Digestive Health Matters/International Foundation for Functional Gastrointestinal Disorders
Journal of Neurogastroenterology and Motility
National Sleep Foundation
New England Journal of Medicine
Sleep Review
Sleep Scholar

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