Heartburn at night, or waking up with heartburn in the morning, is a common symptom that many people encounter. In fact, people with heartburn often report that their symptoms are most noticeable during the night while sleeping.
While most cases of nighttime heartburn are not a medical emergency, the experience can be extremely frustrating due to the discomfort and disrupted sleep patterns. Luckily, in most instances, you can manage heartburn at night through some minor lifestyle adjustments with over-the-counter medications.
What is Heartburn?
Heartburn is a burning sensation in your upper chest and throat caused by stomach acid leaking into the lower region of your oesophagus. These sensations can vary in severity and length, lasting between a few minutes and a couple of hours.
If you’re experiencing heartburn, you’re not alone. Around 1 in 5 Australians experience heartburn symptoms at some point in their life. Despite causing discomfort and pain, occasional heartburn isn’t particularly a flag for an underlying health condition or disease. However, if you’re experiencing persistent heartburn more than two times a week, your symptoms may indicate a more severe gastrointestinal condition.
Why Do I Get Heartburn at Night?
Sleeping during the night is one of the most common times to experience heartburn. This is because when lying down for prolonged periods while sleeping, the flat position allows food and stomach acid to flow into the oesophagus. As stomach acid backs into your oesophagus throughout the night, your heartburn symptoms gradually increase until you eventually wake with a painful burning sensation.
You may be at particular risk of experiencing heartburn during the night if you:
- Eat large meals before going to bed.
- Eat spicy, acidic, or fatty foods (especially those containing large amounts of onion, garlic, peppermint, citrus fruits or tomatoes).
- Drink excessive amounts of alcohol, caffeinated drinks, carbonated beverages and coffee.
- Eat large meals before going to bed.
- Smoke tobacco frequently.
- Take prescription medications such as tricyclic antidepressants, calcium channel blockers, antibiotics and anticholinergics.
- Take other medications such as ibuprofen, aspirin or iron supplements.
Heartburn at Night Symptoms
If you are waking up with the following symptoms, you may be suffering from nighttime heartburn:
- A sour, bitter or acidic taste in your mouth.
- Sore throat.
- Chest pain or difficulty swallowing.
While infrequent symptoms of nighttime heartburn are not of serious concern, chronic heartburn at night may indicate more severe causes and gastrointestinal conditions. These include:
- Gastro-oesophageal Reflux Disease (GORD)
- Hiatal hernia
- Stress
- Pregnancy
The following section will provide corresponding symptoms of these conditions and provide specific heartburn treatment advice.
Gastro-Oesophageal Reflux Disease (GORD)
If you’re experiencing frequent heartburn at night, you may suffer from gastro-oesophageal reflux disease (GORD), also referred to as gastroesophageal reflux disease (GERD). This gastrointestinal condition occurs when the barrier between your oesophagus and stomach (called the lower oesophageal sphincter) is weakened. Consequently, this barrier remains open and allows stomach contents to enter the oesophagus, causing heartburn and acid reflux.
Aside from disruptive nighttime heartburn, you may have GORD if you present the following symptoms:
- Nausea.
- Bad gut breath.
- Lower back pain.
- Regurgitating sour-tasting foods or liquids.
- Feeling a lump or ball in your throat.
- Chronic coughing and throat pain.
- Chest pain and discomfort.
- Laryngitis.
- Dysphagia (difficulty swallowing).
People with GORD commonly report that their symptoms are worse during the night, as lying down stops gravity from keeping the contents away from the oesophagus. Furthermore, our capacity to produce saliva (a known stomach acid neutraliser) is reduced while sleeping. This may raise the acidity level of the stomach contents sitting in your oesophagus, increasing discomfort and pain intensity.
Remedies for Nighttime GORD
If you wake up frequently during the night due to GORD, you can use a range of remedies to help relieve symptoms. This can include:
- Make small lifestyle changes: Avoid certain foods and drinks that further damage the lower oesophageal sphincter, such as coffee, alcohol, tobacco and chocolate.
- Avoid eating directly before bed: Ensure your last meal is at least 3 hours before sleeping to allow your digestive system to process the food properly.
- Sleep with your head elevated on your left side: This is the best position to help reduce the risk of stomach acid entering your oesophagus.
- Try over-the-counter medications: These can include proton pump inhibitors, H2 blockers or antacids to reduce stomach acid production. However, always speak to a doctor when addressing the side effects of otc medications.
You should also consider consulting a gastroenterologist for further medical examination, especially if you find your nighttime heartburn and other symptoms persist. If left untreated, GORD can lead to serious complications including oesophagitis, oesophageal cancer, ulcers and strictures.
At the Centre of Gastrointestinal Health, we can help manage your GORD and prevent nighttime heartburn that may be disrupting your sleep. For more information on how we provide advice, diagnosis or treatment options, see our GORD management service page.
Hiatal Hernia
A hiatal hernia is another possible explanation for persistent heartburn throughout the night. This type of upper body hernia arises when your stomach protrudes through the diaphragm, a muscle that separates the abdomen from the chest cavity. While smaller hernias commonly go unnoticed, larger forms can force stomach contents to flow upwards into the oesophagus, causing chronic reflux.
Medically reviewed studies have found that nearly 60% of patients with hiatal hernias experience nocturnal heartburn, also reporting corresponding symptoms such as acid reflux.
Hiatal hernia symptoms are similar to GORD, such as:
- Nausea.
- Black stools.
- Difficulty breathing or shortness of breath.
- Bloating.
- Dysphagia.
- Early satiety.
- Chest pain and discomfort.
- Regurgitation of sour-tasting foods or liquids.
These symptoms tend to aggravate if you are unable to digest your food adequately before going to bed.
Remedies for Hernia Night Relief
The best way to manage or prevent nocturnal heartburn symptoms caused by a hiatal hernia is to allow for the complete digestion of food before going to bed. This will ensure that there is no excess production of stomach acid that could leak into your oesophagus and trigger nighttime symptoms.
To achieve this, we recommend:
- Avoid eating right before bed: Like GORD, you shouldn’t eat 3 to 4 hours before bed.
- Know your triggers: Understanding your triggers for acid reflux is important when managing heartburn symptoms at night. For instance, if you notice that your symptoms are worse after eating spicy foods, you should take note and avoid similar meals.
- Sit upright when eating: A proper position will help ensure that food correctly enters your stomach so it can be digested. It’s also a good idea to remain seated upright an hour after eating to ensure proper digestion.
- Ensure you chew your food: The more your food is chewed, the less stomach acid is needed for digestion. Therefore, this reduces the risk of excess stomach acid leaking into your oesophagus while sleeping.
- Eat smaller portions: Try eating several smaller meals throughout the day, rather than the traditional 3 per day.
If you suspect that you have a hiatal hernia, it is also important to avoid lifting heavy objects and avoid tight or restrictive clothing, as this can worsen the condition. Trying to lose weight through safe and controlled exercise is another viable option to help minimise the severity of your symptoms.
To ensure a proper diagnosis, you will need to consult a gastroenterologist for an endoscopy, confirming the size and location of your hiatal hernia. Hernias are unlikely to fix themselves, so you will need to undergo a hernia repair to correct the condition and effectively relieve heartburn symptoms.
Stress
Persistently waking up with heartburn during the night is another common symptom of stress. Your brain and gut are closely connected, meaning that increased stress levels can influence your digestive system’s efficiency.
According to Harvard Health Publishing, increased stress levels can slow your digestive process to focus on addressing the “perceived threat”. Consequently, this can increase stomach acid production to help digest foods, therefore raising the risk of heartburn.
Furthermore, when often dealing with stress, we tend to look to substances such as caffeine, alcohol or tobacco as a coping mechanism. In effect, excessive use of these substances is linked to weakening your lower oesophageal sphincter and increasing the risk of heartburn.
Some common physical symptoms of stress include:
- Fatigue.
- Difficulty breathing.
- Chest pain or discomfort.
- Disrupted sleep.
- Lack of appetite.
Remedies for Stress-Induced Heartburn
While everyone experiences stress, it is important to understand calming techniques to manage both mental and physical symptoms. Some options may include:
- Daily exercise.
- Breathing exercises.
- Meditation.
- Therapy.
In the meantime, if you’re feeling abnormal amounts of stress it is important to avoid acidic or fatty foods that may trigger heartburn during the night. Furthermore, avoiding alcohol, caffeine and tobacco can also help prevent the risk of nighttime heartburn.
Pregnancy
Pregnancy is another possible cause for experiencing heartburn throughout the night. Pregnant women in the later stages of their first to early second trimester are likely to experience heartburn, particularly during the night or after waking in the morning.
The gradual weight gain during pregnancy causes stress on your stomach, weakening the lower oesophageal sphincter and pushing stomach acid upwards towards your oesophagus. Furthermore, the shift in hormone production during pregnancy is linked to impacting your digestive system, with women experiencing a reduced capacity to dispose of stomach acid after digestion.
Some other common symptoms experienced with heartburn during pregnancy include:
- Nausea and vomiting.
- Regurgitation of sour-tasting stomach contents.
- Sensitive to certain smells and tastes.
- Increased fatigue and inability to sleep.
Similar to GORD, pregnant women note that their symptoms are aggravated at night while sleeping. This is due to your sleeping position, which effectively allows acid to pool into your oesophagus throughout the night.
Pregnancy Nighttime Heartburn Relief
As previously mentioned, making a few small lifestyle adjustments can help you minimise the risk of waking during the night with discomfort caused by heartburn. These include:
- Avoid eating three hours before going to bed.
- Eat several smaller meals throughout the day.
- Eat slowly in an upright position.
- Ensure proper digestion by remaining seated upright for an hour after eating.
- Avoid foods that trigger your heartburn.
Other effective remedies for preventing nighttime heartburn include sleeping on your left-hand side with your head elevated. Patients find that this sleeping position helps avoid stomach acid leaking upwards into their oesophagus, avoiding heartburn at night.
You can also consider a range of nonprescription medications, such as stomach acid neutralisers or antacids. However, we recommend consulting your obstetrician before taking certain medications to ensure your and your child’s safety.
Complications from Chronic Heartburn at Night
Chronic heartburn, whether during the day or at night, can cause severe damage to your oesophagus. This is because your stomach acid can gradually burn the lining of your oesophagus, leading to a build-up of scar tissue that narrows the pipe. Therefore, after a prolonged period of heartburn, you may feel a lump in your throat and struggle to swallow. As a result, you can develop an oesophageal stricture and require a dilation procedure.
Increased damage to the oesophagus can also change the cells in your oesophagus, which can lead to Barrett’s oesophagus, oesophageal ulcers, and in extreme cases, cancer. For this reason, it is essential to consult a medical professional to provide medical advice, diagnosis and treatment options to minimise the damage inflicted on your oesophagus.
At the Centre of Gastrointestinal Health, we provide expert services to help you manage your heartburn, no matter the cause. You must seek medical attention if you’re suffering from persistent heartburn that wakes you during the night or early morning. Our clinic can provide quality care to your gastrointestinal health and ensure the best outcomes possible. For more information, call us today at 1300 580 239 or book an appointment for an initial consultation.
FAQs
Does Throwing Up Make Acid Reflux Better?
No. Forcing yourself to throw up can increase the risk of damage to your oesophageal lining to a high level of acidity. Instead, consider drinking a glass of water and sitting upright to help reduce nausea. If symptoms persist, we recommend seeking medical attention.
What Happens if You Have Heartburn Every Night?
Having heartburn every night can cause significant damage to your oesophagus, increasing the risk of oesophagitis, Barrett oesophagus and oesophageal cancer or ulcers. You should seriously consider seeing a doctor if you have persistent heartburn at night every night.