This question haunts every GERD sufferer, especially those who are battling insomnia caused by acid reflux. One of life’s great certainties, many of us take SLEEP for granted. While those who are blessed with the ability to fall off to sleep any time anywhere don’t give it a second thought, sleep can seem like an elusive mistress for many others….especially those who suffer from night-time acid reflux.
Insomnia and Acid Reflux: A Double Whammy
Insomnia is a broad term used to describe a variety of sleeping problems. In essence, a person has insomnia if he/she is either unable to fall asleep or remain asleep for sufficient periods of time to awake refreshed. Acid Reflux adversely affects sleep quality by awakening the patient from sleep during the night. While insomnia and acid reflux are two different medical problems, they often co-exist together to throw in a double whammy.
Studies have found a significant association between disturbed sleep and GERD, and this may be bidirectional. Sleep disturbances induce gastrointestinal (GI) distress, while at the same time GI symptoms only worsen sleep patterns. According to research done by Mayo Clinic College of Medicine “Nighttime reflux can lead to sleep disturbance and sleep disturbance may further aggravate GERD by prolonged acid contact time and heightened sensory perception. This may facilitate the occurrence of complicated GERD and decreased quality of life. The interplay between sleep problems and GERD is complex.”
Many patients with GERD experience sleep fragmentation. What’s worse, sleep deprivation can adversely affect GERD severity by enhancing the perception of acid in the esophagus causing esophageal hypersensitivity, and potentially by increasing esophageal acid exposure time. In a nutshell – Heartburn makes it difficult to sleep, inadvertently causing insomnia. You can remedy this by addressing the heartburn, not the insomnia.
Sometimes when patients complain about their relentless insomnia, physicians don’t always consider GERD as a contributing factor. As a result, many treatments focus on prescribing sleeping pills to help regulate sleep cycle, which only worsens GERD. In a study conducted at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, researchers found that GERD patients taking popular sleep aid zolpidem (also popularly known as Ambien) suffered from increased duration of each esophageal acid reflux event. Since nocturnal acid exposure was prolonged, scientists believe that hypnotic use by patients with GERD could lead to increased risk for complicated disease.
So if you often reach for sleeping pills to help you sleep because you’re worried that staying awake will worsen GERD, it’s time to take lifestyle changes and diet modifications more seriously.
What Are The Symptoms Of Night Time Reflux Causing Insomnia?
- Difficulty falling asleep at night for fear you’ll have severe heartburn.
- Waking up few hours after going to bed by the pain of heartburn. For some, this may cause nausea and for others, a burning sensation in the chest.
- Regurgitation, in which a small amount of stomach acid and food comes back up the esophagus and into your mouth.
- Waking up with in the middle of the night with a nasty taste in your mouth. The result – fitful, uneven sleep.
- Blocked nose and sore throat keeping you up at night. Often mistaken for allergies, undiagnosed night-time reflux can cause chronic sinusitis, laryngitis, headaches and even dental erosions.
- A backsplash of stomach acid can sometimes get into the lungs, causing asthma-like symptoms.
- Not feeling well-rested after a night’s sleep because you were up several times, thanks to heartburn.
- Sleep apnea is also linked to GERD and causes sleep disturbances.
If your insomnia is caused by acid reflux, you may suffer from daytime tiredness or sleepiness. You could also have difficulty paying attention, focusing on tasks or remembering things. All this can add extra stress to your life, resulting in irritability, depression or anxiety.
What Can You Do To Minimize Night Time Reflux And Sleep Better?
As we have discussed above, the best way to minimize acid reflux causing insomnia is to address the reflux, and the insomnia will resolve on its own. By learning ways to avoid night time heartburn, you can improve your sleep too.
- Eat a light meal and avoid all your heartburn triggers at dinner time. Alcohol, chocolate, spices and caffeine are common culprits for nighttime reflux.
- Have your dinner 2 to 4 hours before bedtime, so your stomach isn’t struggling to digest food by the time you go to bed.
- Sleeping on your left side can ease symptoms, as it reduces the backflow of stomach acid.
- Elevate your head and shoulders with extra pillows, or raise your headboard a few inches so that gravity keeps stomach acid and contents from traveling back up into the esophagus.
- Wear ultra-comfy night clothes. Avoid wearing anything snug or pajamas with a tight waistband.
- Try a herbal bed-time tea to help calm your mind and allow you to drift off to sleep.
- While it’s good to drink a lot of water when you have GERD, avoid drinking water just before bed time. It’ll only wake you up in the middle of the night because you have to use the bathroom, and it may not be easy to drift back to sleep.
- Don’t nap in the daytime. Naps may make you feel relatively refreshed in the evening, but will interfere with your ability to fall asleep and also make acid reflux more severe in some cases.
- Try a wedge pillow which slightly elevates the head, shoulders, and torso to prevent stomach contents to come back up into the esophagus. These ensure complete comfort and good sleeping posture. Choose one that is 6 to 10 inches thick on one end.
- Avoid exercising after dinner. Not only can an intense workout on a full stomach trigger heartburn, it also stimulates your heart, brain and muscles, which makes it harder to fall off to sleep. We recommend a gentle stroll post dinner which will aid digestion, but not a full-blown gym workout.
With a few lifestyle adjustments, you can save yourself a lot of the discomfort that comes from the dual problems of acid reflux and insomnia. For more details, read our article on tips to avoid night-time heartburn.
Stress – The Biggest Culprit For Night Time Reflux And Insomnia
Stress is at the heart of both night time acid reflux and insomnia. Stress and GERD are deeply linked, as are stress and sleep disturbances.
When stressed, you become extra-sensitive to smaller amounts of acid in the esophagus – the bane of life as a GERD sufferer. In fact, a study found that reflux patients under stress reported more painful symptoms related to acid reflux, but none of the patients showed an increase in gastric acid. So it’s not that you’re producing more gastric acids when you’re stressed….you’re only more sensitive to acid exposure in periods of stress. To top that, stress coupled with exhaustion will also make it harder for you to fall asleep. Stress causes hyperarousal, which disrupts the balance between sleep and wakefulness.
Leave all worries of your job where they belong – in the office. A stress-free bed time routine will help keep acid reflux at bay and ensure that you go to bed in a calm, peaceful state of mind. This is why it is also important to avoid any confrontations and arguments with your partner or other family members at night; somethings are best done in the morning. If you are unable to shake off stress even after a relaxing bath and bedtime tea, we recommend deep breathing exercise to help you relax. We’ll go a step further and also recommend that you don’t watch movies and TV shows with violence, gore and horror before bedtime to keep your stress levels down.
Consider These Supplements For Night Time Reflux Causing Insomnia
Since sleeping pills will only worsen your GERD symptoms in the long run, what can you take to help sleep peacefully? Some dietary supplements can provide relief from acid reflux and improve sleep quality at the same time. These don’t come with undesirable side-effects and help symptoms of heartburn naturally.
Magnesium deficiency has been associated with acid reflux. Magnesium aids in the functioning of LES (lower esophageal sphincter) that works as a lid between the esophagus and the stomach to keep stomach contents from coming back up the esophagus. Magnesium is also vital for the function of GABA receptors, which are calming neurotransmitters that the brain requires to switch off and go to sleep. In simpler words – magnesium supplements improve sleep quality and can also help with acid reflux. Try 200 to 400 mg of magnesium citrate or glycinate twice a day, but be aware that excessive magnesium supplementation may result in diarrhea, nausea, and stomach cramping for some people.
Melatonin has long been used as a sleep aid, but is also effective in inhibiting gastric acid secretion and seems to control the lower esophageal sphincter. Melatonin is naturally produced by pineal gland to regulate the wake/sleep cycle and other daily biorhythms. Low levels of melatonin can lead to insomnia as well as worsen GERD. Start with 500 mcg to 5 mg at night.