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GERD: The Link Between Sleep and Heartburn

Nearly 80 percent of heartburn sufferers say they have heartburn during the night.

There is growing evidence that nighttime heartburn disrupts sleep. Many sufferers complain that they feel tired even after a full night's sleep, because they are unaware of their brief awakenings.

Although many people have occasional heartburn, sometimes heartburn can be persistent and frequent (occurring at least two times a week). In these cases, it is called gastroesophageal reflux disease (GERD). "Reflux" means to "flow back," and refers to the stomach acids that flow back into the esophagus in this disease. GERD that occurs at night is called nocturnal GERD.

A person with GERD feels a burning in the center of the chest (heartburn), but also may have belching, bloating, coughing, regurgitation, a bitter taste in the mouth and throat, and early feelings of fullness during meals.

GERD often occurs in people with the sleep disorder obstructive sleep apnea, and when it does, GERD can be severe. A person who has sleep apnea temporarily stops breathing many times during the night. Researchers don't know if GERD causes sleep apnea, if sleep apnea causes GERD, or if there are other reasons two conditions might occur in the same person.

If it persists, nocturnal GERD can damage the delicate lining of the esophagus. Although reflux episodes occur less frequently at night than during the day, the esophagus lining is exposed to the stomach's corrosive contents much longer at night. Reasons for this prolonged exposure include reduced production of saliva during sleep, less frequent swallowing and the lack of help from gravity in keeping stomach contents. Because of this, nocturnal GERD may be more damaging to the esophagus than daytime GERD.

Complications of nocturnal GERD include erosive esophagitis and the precancerous condition Barrett's esophagus, as well as esophageal cancer. All of these are more common in people who have nocturnal GERD.

If you have nocturnal GERD, you can take steps that may help ease the symptoms:

• Eat meals at least two to three hours before lying down
• Raise the head of your bed by six to eight inches
• Avoid foods and beverages that give you problems (alcohol, carbonated drinks, etc.)
• Lose weight if you are overweight

If lifestyle changes don't ease your nocturnal GERD, talk to your doctor. Drug therapy is available. Your doctor will be able to tell you if drug therapy is appropriate for you.