Why Is Acid Reflux Worse At Night
One reason that acid reflux is worse at night has to do with gravity. When youre active and awake, youre normally in an upright position. Gravity helps you digest without any acid coming back up into your esophagus. In the evening as you relax, or when youre laying down in bed, its easier for acid to make its way back up into your esophagus.
During the day you swallow often. This helps keep stomach acid down. However, during the night youre no longer swallowing, and stomach acid is more likely to backflow into the esophagus. The saliva you swallow can also neutralize stomach acid, but during the night you arent producing or swallowing saliva.
What Does Heart Rate Look Like With Sleep Apnea
With each apnea, the heart rate decreases. During apnea, a relative bradycardia is observed. After the end of the apnea, when the breath is replenished, a relative tachycardia is observed. Blood pressure decreases during the apnea and increases toward the end of the apnea as sympathetic tone increases.
What Are The Symptoms Of Gerd
Heartburn, which involves a painful burning sensation in the chest, is the most common symptom of GERD, but not all cases of GERD involve heartburn.
Another common symptom of GERD is regurgitation, which means a small amount of stomach acid and sometimes bits of food come up into the mouth or back of the throat.
When leaks of stomach acid rise to the mouth and throat, it can cause coughing and a feeling of choking. It may cause a sore throat, including a hoarse voice. Some patients experience difficulty swallowing, known as dysphagia, or the feeling of something blocking their throat.
On top of the discomfort from heartburn, GERD can cause radiating chest pain that can affect the neck, back, jaw, or arms and last for minutes to hours. This symptom is frequently associated with nighttime awakenings for people with GERD.
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What Do I Do If I Think I Have Gerd
With GERD when reflux and heartburn happen more than once in a while the tissue lining your esophagus is getting battered regularly with stomach acid. Eventually the tissue becomes damaged. If you have this chronic acid reflux and heartburn you can see its affecting your daily eating and sleeping habits.
When GERD makes your daily life uncomfortable in this way, call your healthcare provider. Although GERD isnt life-threatening in itself, its chronic inflammation of the esophagus can lead to something more serious. You may need stronger prescription medications or even surgery to ease your symptoms.
Additional Tips To Control Acid Reflux At Night
You can also make some lifestyle changes that may help you manage the occurrence of acid reflux at night and promote a well-rested night.
Some of these lifestyle recommendations include:
A doctor may also prescribe medications or recommend surgery to treat GERD when appropriate. Talk with your doctor about your symptoms so they can prescribe treatment or lifestyle recommendations to manage your condition and improve your sleep health.
If you have GERD, youre not sentenced to a lifetime of sleepless nights from acid reflux at night. By making simple tweaks to your sleeping positionchoosing the Incline + Left-Side sleepingyou can take control of your symptoms and get the recovery sleep everyone deserves.
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Pathophysiological Evidence For A Causal Link Between Gerd And Sleep Disturbance
There is considerable evidence to indicate that GERD can be affected by abnormal sleep physiology. Conversely, it is also possible that disturbed sleep enhances perception of intra-esophageal reflux events. However, few studies have been conducted and these have shown inconsistent results .
Possible pathophysiology of sleep disturbance and gastroesophageal reflux disease .
Gerd And Sleep Apnea: Which Causes The Other
Sleep apnea and gastroesophageal reflux disease are two conditions that appear unrelated. However, research shows a correlation between the two.
What Are Sleep Apnea and GERD?
Sleep apnea is a disorder that causes people to stop breathing during sleep. Obstructive sleep apnea , the most common type of apnea, occurs when the airway is blocked by soft tissue at the back of the throat. Many people who experience sleep apnea are unaware that their sleep cycle is interrupted throughout the night because they do not awaken completely. They usually complain of daytime sleepiness, headaches, forgetfulness and dry mouth.
About 60 percent of people with sleep apnea have chronic acid reflux, also known as gastroesophageal reflux disease . Acid reflux occurs when the lower esophageal sphincter remains open and gastric acid backflows into the esophagus. Common symptoms of GERD include heartburn, chest pain, a sour taste in the mouth and bad breath. However, it is possible to have GERD and not experience symptoms at all.
GERD Treatment Helps Remedy Sleep Apnea
Although researchers do not fully understand the relationship between sleep apnea and GERD, studies show that sleep disturbances may induce GERD and that untreated acid reflux impairs sleep. One study followed 48 adults who experienced GERD over three times per week. The men and women who had the most severe GERD symptoms also reported the worst sleep problems.
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How To Prevent Complications From Acid Reflux
You may be able to reduce acid reflux and prevent complications by adopting the following habits:
- Avoid certain foods. Greasy, fatty, acidic, and spicy foods are more likely to lead to reflux. Other foods, such as peppermint, tomato sauce, garlic, onions, citrus, and dark chocolate are also known to trigger reflux.
- Change your eating habits. Try to eat meals at least 2 to 3 hours before you go to bed or lie down. This will give your stomach time to digest the food youve eaten. Also, eating smaller portions and chewing slowly may help prevent excess reflux.
- Lose excess weight. Carrying excess weight around your middle can push your stomach upward, making it easier for acid to rise into your esophagus.
- Limit alcohol and caffeine. Both alcohol and caffeine can increase acid reflux.
- Quit smoking. Smoking makes it more difficult for the sphincter that separates your esophagus from your stomach to close properly after food enters your stomach.
- Sleep on an incline. If acid reflux and heartburn strike at night, place some blocks under the head of your bed so that your upper body is slightly higher than your stomach. You can also look into special wedge pillows that are made for people with GERD.
- Wear looser clothing. Tight-fitting pants can put additional pressure on your abdomen, forcing the contents of your stomach upward.
While Trying To Sleep
The International Foundation for Gastrointestinal Disorders note that 79% of individuals with GERD experience symptoms after bedtime.
As many as 75% of those with the condition say the symptoms have an effect on their sleep, and 40% claim the loss of sleep affects their ability to function when they get up.
While GERD influences sleep, sleep deprivation also has an impact on GERD. A lack of sleep can cause increased sensitivity to acid in the esophagus.
A person with acid reflux after bedtime may have more acute symptoms than a person experiencing it mainly during the day.
This combination of sleep disturbances and more severe symptoms means that experiencing acid reflux while trying to sleep can worsen the quality of life for people with the condition.
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When Does Acid Reflux Become Gerd
Those with an ongoing condition are typically diagnosed with Gastroesophageal Reflux Disease .
GERD is considered a chronic form of acid reflux. It may require a more proactive treatment strategy than those who experience heartburn less frequently.
GERD can have a dramatic impact on sleep, leading to risks of:
- aspirating stomach acid while asleep
- aggravating or contributing to obstructive sleep apnea , and
- experiencing sleep fragmentation caused by the discomfort of heartburn symptoms
These chronic symptoms may signal something more serious than occasional distress caused by overeating.
Gerd And Cpap Therapy
CPAP therapy treats those with OSA as well as the other two sleep apnea types. CPAP machines use light air pressure to keep airways open. This process helps ensure that those passages dont collapse during sleep.
Alongside the early studies trying to establish a GERD-sleep apnea correlation, there arose a sort of echo wave of research investigations probing the question of whether using a CPAP machine might also ease GERD symptoms.
A 2016 study showed that 62 of 79 patients with sleep apnea had acid reflux symptoms at the start of the research. Interestingly, the mean heartburn score decreased by 62 percent among those with sleep apnea who were strict users of their CPAP therapy.
In the same year, another unrelated study countered a prevailing notion that CPAP therapy actually causes acid reflux. Since then, most sources seem to agree that CPAP and GERD treatments work well in sync.
CPAP therapy has shown promising results working in combination with various acid reflux treatments.
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What Is Obstructive Sleep Apnea
Obstructive sleep apnea is a condition where you stop breathing during the night. You may wake up feeling like youre choking or cant breathe. Obstructive sleep apnea is caused when the muscles of the throat relax during sleep. When these muscles are too relaxed, they will actually close the throat and block your airway. Your brain will realize youre not breathing and wake you up to tighten the muscles and restart the flow of air. You may wake up many times during the night, but not remember having woken up.
Inflammatory Bowel Disease And Sleep
Several tools have been used to evaluate sleep disturbances in humans. Buysse and colleagues developed a sleep evaluation tool, the Pittsburgh Sleep Quality Index , which is a 19-item self-rated questionnaire that assesses sleep quality and disturbances over a 1-month period. This index has a sensitivity of 90% and specificity of 86% for distinguishing good sleepers from poor sleepers. Recently, increased attention has been given to the relationship between sleep disturbances and disease activity in IBD. Ali and colleagues conducted a prospective observational cohort study confirming the quality of sleep and disease activity in IBD using the PSQI scale. All patients with active disease had an abnormal PSQI score. Of the 30 patients with histologic evidence of inflammation on endoscopic evaluation, all were found to have abnormal PSQI scores independent of clinical disease activity . The study concluded that an abnormal PSQI score has a positive predictive value of 83% for histologic inflammation, which suggests a strong association between poor sleep quality and clinically active IBD. Similar findings were seen in a cohort study conducted by Graff and colleagues, which showed that patients with active IBD experienced worse sleep than those with inactive IBD . However, this study utilized laboratory markers such as CRP as markers of disease activity without endoscopic evaluation.
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Elevate Your Upper Body For Nighttime Gerd Relief
Laying flat on your back can exacerbate your reflux symptoms, making it easier for acid to wash into your esophagus and throat. This could give you a sore throat in the morning, an unpleasant acidic taste in your mouth, or even wake you during the night with a choking or gagging sensation.
If youre most comfortable sleeping on your back, elevating your upper body places yourself at a comfortable incline that helps relieve nighttime GERD symptoms. This is because your esophagus is now higher than your stomach this makes it more difficult for stomach acid to reach your esophagus, because gravity will be working against it.
Youll want to use a special wedge-shaped pillow for this, however. Normal pillows will only elevate your head, and not your upper body. Be sure to use a wedge pillow that is thick at the top for ideal results.
What Is Acid Reflux
Acid reflux, more commonly referred to as heartburn, occurs when stomach contents repeatedly flow backward into the esophagus. This can happen at any time of day.
A muscle known as the lower esophageal sphincter attaches at the lower end of the esophagus where it drains into the stomach.
The chief role of the LES is to provide a one-way valve between the throat and the stomach it opens up as you swallow food to allow it to enter the stomach for digestion.
In healthy individuals, this valve remains shut except for the purposes of driving digestion during mealtime.
However, when the LES doesnt close properly or tightly enough, a reflux of digestive juices and stomach contents can rise back into the esophagus. This leads to the usual acidic sensation and taste that characterizes heartburn.
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Diagnosis And Treatment For Gerd
GERD can be diagnosed via a few different tests, as well as a thorough medical history taken by your doctor. To confirm a diagnosis of GERD, you may have:
- Endoscopy: Also known as an upper endoscopy, this procedure is performed by inserting a thin, flexible tube through your mouth and down into your esophagus. The tube has a light and a camera on the end. With this, the doctor is able to look at the lining of your esophagus and even at the inside of your stomach. In addition to studying it, your doctor may be able to get tissue samples to test for inflammation or cancer cells.
- Esophageal manometry: This is a test that measures the rhythm of the contractions in your esophagus. It is also able to measure the force of each contraction. This information gives some insight into how effectively your esophagus is working.
- Upper GI X-ray: This x-ray is taken after you drink a chalky liquid that coats the esophagus, giving the doctor a different view of your GI tract . Sometimes, you may be asked to swallow a pill made of barium, which can help diagnose an esophageal stricture .
Common treatments for GERD include medications and lifestyle changes. Lifestyle changes that may improve GERD symptoms include:
- Quitting smoking or avoiding being around secondhand smoke
- Beginning a diet and exercise plan that is geared towards weight loss or maintaining a healthy weight
- Not lying down immediately after meals
Medications that may improve or manage GERD symptoms include:
What To Know About Acid Reflux And Gerd
Mild or occasional acid reflux isnt usually cause for concern. While it may cause temporary discomfort, it doesnt present any major health risks.
People who experience acid reflux more than twice a week may have GERD, a condition thats associated with more symptoms and complications.
Common symptoms of GERD include:
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Does Gerd Cause Sleep Apnea
Put simply, no GERD does not cause sleep apnea, but it can occur secondary to obstructive sleep apnea . Although there are few studies examining the relationship between the two conditions theres a high prevalence, with 58-62% of OSA patients with GERD.
With untreated obstructive sleep apnea , GERD symptoms are more severe than for someone who doesnt have OSA. This is because sleep apnea can make acid reflux symptoms worse.
If you have untreated or undiagnosed OSA a vacuum effect, or negative pressure, is created in the thorax during apneic events. This draws the stomach acid or contents up the esophagus to the back of the throat. This is in part because you have to create large negative pressures to bring air in through a narrow aperture. When there is negative pressure in the chest, it creates positive pressure in the belly resulting in reflux.
Over time, exposure of the esophagus to stomach acid causes erosion of the esophageal lining, and the end result is gastroesophageal reflux.
The Immune System And Gastrointestinal Diseases
Cytokines are key mediators of the immune system and work to induce and control inflammation. Research shows that the sleep-wake cycle is affected by the release of cytokines, specifically interleukin -1, IL-6, and tumor necrosis factor , which increase fatigue and promote sleep. Conversely, sleep loss has been shown to activate IL-1 and TNF.
There is a strong body of evidence that supports changes in cytokine release, specifically an increase in proinflammatory cytokines, in most gastrointestinal disorders. Changes in serum cytokine levels with these underlying diseases will affect sleep, as cytokines are major modulators of the sleep-wake cycle.- Vgontzas and colleagues studied 25 young healthy subjects and restricted their sleep from 8 hours per night to 6 hours per night for 1 week. The 24-hour secretion of IL-6 increased in men and women and TNF increased in men. This study supports the key role that cytokines play in the modulation of the sleep-wake cycle.
Serum levels of multiple cytokines, including TNF, IL-6, and IL-8, as well as levels of vascular endothelial growth factor have been shown to be elevated in patients with colorectal cancer. Cytokines are not only produced by tumor cells, but also produced by surrounding cells such as macrophages and mast cells, which are recruited by the tumor. Additionally, IL-6 is a growth factor for colon cancer and promotes tumor cell growth and survival.
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Irritable Bowel Syndrome Functional Dyspepsia And Sleep
IBS is defined as abdominal discomfort associated with changes in bowel habits. Emerging research on the pathophysiology of IBS has included bowel dysmotility, small bowel bacterial overgrowth, autonomic dysfunction, visceral hyperalgesia, and microscopic inflammation. Functional dyspepsia refers to discomfort in the upper abdomen that may be described as postprandial heaviness, early satiety, bloating, nausea, and/or epigastric pain. Emerging insight into the pathophysiology of functional dyspepsia suggests that dysmotility, visceral hypersensitivity, and the immune system all play a role in the pathogenesis of the condition. IBS is a common disorder that affects a significant percentage of the general population. It is likely that patients with IBS and functional dyspepsia have increased nocturnal autonomic arousal, which may result in poor sleep. It has also been postulated that patients with IBS spend more time in REM sleep, which is characterized by arousals and stimulatory effects on colonic motility, which may lead to sleep disturbance.