Make saving on Rx even easier

Get the Free SingleCare app

(23,450)
Open app
Close Menu
Hello
Explore

What causes acid reflux at night? Related conditions and treatments

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated May. 8, 2024  •  Published Jan. 23, 2024
Fact Checked
What causes acid reflux at night? Related conditions and treatments
In this article:

Overview: What does acid reflux at night look/feel like?

Acid reflux is the backflow of stomach acid and stomach contents into the esophagus, the muscular tube connecting the throat to the stomach. Normally, the stomach and esophagus are separated by a tight ring-shaped muscle, the lower esophageal sphincter or LES. If this muscle doesn’t completely close, stomach contents and stomach acid back up into the lower part of the esophagus, a condition called gastroesophageal reflux or acid reflux. When stomach acid hits the lining of the esophagus, the cells of the esophagus are not meant to withstand acid, and it hurts the esophageal lining. Most people describe the pain as a burning sensation right behind the breastbone, which is why it’s called heartburn. Other symptoms include regurgitation, chest pain, trouble swallowing, nausea, belching, and sour taste. Acid reflux is more common at night or after a big meal. As a result, poor sleep quality, sleep disorders, and daytime tiredness and drowsiness are considered related symptoms of acid reflux.

RELATED: The effects of sleep deprivation on your body

Key takeaways:

  • Acid reflux at night is a common symptom caused by gastroesophageal reflux disease (GERD). Contributing causes include sleep position, late eating, nighttime wakefulness, and sleep disorders.

  • Typically, acid reflux at night does not require immediate medical attention.

  • Acid reflux at night generally does require treatment. It typically resolves with treatment in a few days, but it may take longer in some people.

  • Treatment of acid reflux at night may include lifestyle changes, dietary changes, sleep hygiene changes, over-the-counter medications, prescription medications, and surgery in the most severe cases.

  • Acid reflux at night can be managed with lifestyle changes, dietary changes, and good sleep hygiene.

  • Use coupons for acid reflux at night treatments, like Tagamet HB (cimetidine), Prilosec (omeprazole), and Prevacid (lansoprazole), to save up to 80%.

What causes acid reflux at night?

Acid reflux at night is caused by gastroesophageal reflux disease (GERD). Four out of five people with GERD experience nighttime acid reflux. In 3 out of 4 people with acid reflux at night, the acid reflux affects the quality of their sleep.

The most significant contributing cause is sleep position. During the day, acid reflux usually happens after a meal. In the daytime, stomach contents do not reach the lower esophageal sphincter because of gravity. After a meal, the stomach gets filled, and stomach contents can leak through the LES. When people lie down at night, the walls of the stomach become the floor. Stomach contents now reach the lower esophageal sphincter, where they can leak into the esophagus through a loose lower esophageal sphincter.

Another contributing cause is the body’s response to acid reflux. During the day, salivation and swallowing increase when acid makes contact with the esophagus. Both activities help to wash stomach contents back into the stomach. This doesn’t happen during sleep unless someone wakes up, so the esophagus is exposed to more stomach acid during sleep.

Researchers have found that another significant contributing cause is wakefulness The more time people spend awake in bed, the more likely they will experience acid reflux. Lying in bed awake while watching TV or reading is strongly associated with nighttime acid reflux. 

Because wakefulness in bed is one cause of acid reflux, people who regularly wake up during the night are more likely to report acid reflux symptoms. These include people with sleep apnea or nocturia (urinating often during the night).

There is also a clear connection between nighttime acid reflux and . Researchers believe the cause-and-effect relationship goes both ways: acid reflux can cause sleep disorders, and sleep disorders can cause acid reflux symptoms.

Eating within three hours of bedtime is another significant cause of nighttime heartburn or acid reflux. An increased volume of stomach contents makes acid reflux more likely when people lie down at night. 

Should I be worried about acid reflux at night?

If nighttime acid reflux is interfering with sleep, daytime performance, and quality of life, see a doctor or other healthcare professional. If GERD is a regular occurrence and symptomatic, get treatment. Untreated GERD can result in complications like sore throat, chronic cough, stomach ulcers, esophagitis, Barrett’s esophagus, and esophageal cancer. 

Emergency room treatment for GERD symptoms is rarely necessary unless you suspect that you’re having bloody vomit, a heart attack, or a similar cardiovascular event. Besides chest pain, other common symptoms of a heart attack that are not typical symptoms of GERD are shortness of breath, lightheadedness, dizziness, and shoulder pain.

How is the cause of acid reflux at night diagnosed?

For people who have not yet been diagnosed with GERD, healthcare professionals will start with a review of symptoms, a medical history, and a physical examination. If there are risk factors for heart disease, the clinician may do a cardiac evaluation to rule out a cardiac cause.

At some point in the process, a primary care provider may refer the case to a specialist in digestive health called a gastroenterologist. That specialist may want to examine the lining of the esophagus. Called an endoscopic examination, the patient will be asleep with conscious sedation, and then the doctor will insert a tube with a camera and light attached down the mouth to look for telltale signs of stomach acid irritation or damage. Biopsies may be taken during the endoscopy. Biopsies do not cause pain when they are taken, nor afterward

The most definitive test for acid reflux is a 24-hour monitoring of acid levels in the esophagus, called a 24-hour pH-impedance test. Most patients find this mildly uncomfortable but not painful. Other tests may involve measuring the strength of the muscles in the esophagus. Finally, a quick and inexpensive way of diagnosing acid reflux is to give a person a proton pump inhibitor, one of the most effective medicines for controlling acid reflux. If symptoms of GERD improve, that’s usually enough to make a diagnosis and continue treatment. 

Since acid reflux at night is strongly associated with sleep disorders, people may need to be evaluated for sleep problems such as insomnia or sleep apnea. Clinicians will start by asking about sleep habits, arousal during the night, and quality of sleep. A primary care physician may refer the case to a sleep medicine specialist for definitive diagnosis and treatment.

RELATED: Who should get a sleep apnea test?

How to stop acid reflux at night

Acid reflux at night treatment options are nearly identical to GERD treatments. However, additional treatments may be needed to address sleep disorders or bad sleeping habits. Treatments include:

  • Lifestyle changes, including weight loss, dietary changes, and dietary restrictions

  • Sleeping hygiene and sleeping habit changes

  • Treatment for disorders that affect sleep quality, such as sleep apnea

  • Use of over-the-counter or prescription medications that induce sleep, such as melatonin or ramelteon—however, some medications that are used to induce sleep, like benzodiazepines and Ambien (zolpidem), have been shown to worsen acid reflux at night, so medical treatment needs to be carefully calibrated

  • Over-the-counter antacids

  • Over-the-counter or prescription stomach acid reducers, including proton pump inhibitors (PPIs) and H2 blockers

  • Prokinetic agents that speed up stomach emptying, such as Reglan (metoclopramide)

  • People who don’t respond to GERD medications may benefit from a variety of surgical interventions

RELATED: What’s the best heartburn medicine for you?

Living with acid reflux at night

Living with acid reflux at night means preventing acid reflux at night. This will require some changes: lifestyle changes, dietary changes, and sleep changes.

In terms of lifestyle, try to do the following:

  • See a healthcare professional and get a diagnosis and treatment plan

  • Take all medications as prescribed

  • Keep a journal of your symptoms and possible triggers

  • Lose weight and maintain a normal BMI

  • Stop smoking

  • Reduce stress

  • Practice relaxation techniques

  • Exercise for 30 minutes most days of the week

One of the most effective ways to prevent acid reflux is to change your diet. Here are some generally accepted good dietary practices for people with acid reflux:

  • Stop eating three hours before bedtime

  • Avoid large meals—substitute several smaller meals

  • Eat more high-fiber foods like grains, cereals, and vegetables

  • Try to eat foods that have a high water content, like watermelons

  • Add alkaline foods to your diet, such as bananas and cauliflower

  • Avoid acidic foods like citrus fruits or tomatoes, especially before bedtime

  • Avoid fatty foods like fried foods, cheese, or fatty meats

  • Avoid spicy foods, carbonated beverages, coffee, and tea

  • Avoid foods that might relax the muscles in your esophagus, such as alcohol, peppermint, or chocolate

  • Avoid triggering foods

  • Avoid alcohol

Finally, research has shown that wakefulness at night significantly contributes to problems with acid reflux, especially going to bed and staying awake instead of sleeping. Some changes you should consider making include:

  • See a doctor about any chronic problems that inhibit falling or staying asleep

  • Consider taking melatonin supplements if falling asleep is a problem

  • Elevate the head to 30 degrees when sleeping by adding a foam wedge

  • Change your sleep position—try sleeping on your left side 

  • When you go to bed at night, go to sleep—turn off the light and remove all distractions such as TVs, cell phones, or anything else

  • Do relaxing activities before going to bed, such as meditation, bathing, yoga, stretching, or similar activities

  • Go to bed at the same time nightly to train your body to sleep

  • Wake up at the same time each morning

  • Avoid drinking as alcohol causes drowsiness but decreases the quality of sleep

  • Above all, get up out of bed if you don’t fall asleep within 20 minutes—becoming vertical will decrease the likelihood of experiencing acid reflux

RELATED: The best diet for acid reflux: 3 foods to eat—and 8 to avoid

Most importantly, change your lifestyle 

Acid reflux is a real physical problem but attacks are strongly influenced by lifestyle habits. For example, acid reflux at night is influenced by your sleep habits. That doesn’t mean that you’re to blame. It only means that you have some power over the condition. You can exercise that power in a variety of ways: diet, relaxation, exercise, and sleep hygiene. The good news is that all these changes make people healthier and happier, even those who have never had acid reflux.

RELATED: 21 ways to sleep better tonight

What’s next? Additional resources for people with acid reflux at night

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

...