Sweet Dreams: Avoiding Nighttime Heartburn

By Michael Castleman

According to a recent report by the U.S. Centers for Disease Control and Prevention, some 60 million American adults suffer from poor-quality sleep -- trouble falling asleep and staying asleep and waking in the morning feeling unrefreshed. Reasons include: nicotine and caffeine (both stimulants), alcohol and an irregular sleep schedule (both sleep disrupting), poor sleep conditions (uncomfortable bed, too much noise and/or light) -- and heartburn.

You may be surprised that heartburn ranks as a significant cause of sleep problems, and yet, “heartburn is a major cause of disrupted sleep,” says Dr. James Parish of the Sleep Disorders Center at the Mayo Clinic in Scottsdale, Ariz. Recent studies support him. Researchers in Oklahoma City tested 81 people who complained of sleep problems and found that one-third of them suffered from heartburn and didn’t even know it. In another study, Brazilian scientists surveyed 91 adults who had difficulty sleeping and found that those with sleep problems were almost twice as likely to suffer chronic heartburn (or gastro-esophageal reflux disease, a.k.a. GERD) compared with people who had no sleep problems.

To understand how heartburn can sabotage sleep, you must first understand that heartburn has nothing to do with the heart. It occurs when stomach acid backfires (or refluxes) up the esophagus, the tube that carries food down to the stomach. When stomach acid refluxes, it irritates the esophagus, causing a burning sensation in the chest.

When you’re standing or sitting, gravity helps keep stomach acid where it belongs. But when you lie down, gravity is no longer on your side and reflux is more likely to occur. Lying down after eating (for example, going to bed shortly after dinner) only compounds the problem because food stimulates acid production in the stomach. Unfortunately, few people who complain of poor sleep appreciate the role heartburn plays in insomnia. The good news is that if you do discover that heartburn is behind your sleepless nights, there are many ways to avoid heartburn-disrupted sleep:

Don’t eat a big meal shortly before bed
“Eating late is a major contributor to sleep-disrupting heartburn,” says Dr. Mick Meiselman, a gastroenterologist at Northwestern Healthcare in Evanston, Ill. And researchers in Japan recently found that avoiding eating for three hours before retiring significantly reduced sleep-disrupting heartburn. (Light bedtime snacks are usually okay as long as you don’t have GERD.)

Raise your head while sleeping
Use an extra pillow or foam wedge, or place bricks under the head of your bed.

Avoid heartburn trigger foods
These vary from person to person, but common trigger foods include: fatty foods, chocolate, coffee, tea (black, green, oolong or white) and alcohol.

Lose the pot belly
Abdominal fat presses against the stomach, pushing acid up into the esophagus.

Quit smoking
Smoking increases the production of stomach acid and causes the lower esophageal sphincter (LES) at the base of the esophagus to relax. Since the job of the LES is to keep stomach acid from backing up, you can guess what happens when it slacks off on the job. Add increased stomach acid, and smoking is a double-whammy for heartburn.

Soothe your stomach
An hour before retiring, drink a stomach-soothing beverage, like chamomile tea.

Ask your doctor about medication
If lifestyle changes don’t provide sufficient relief, talk to your doctor about medication options. Antacids are the oldest stomach-acid suppressors. They provide immediate, short-term relief and can be taken after eating or 30 minutes before retiring. Like antacids, H2 blockers (technically, histamine-2 receptor antagonists) provide immediate relief, but last longer -- six to 12 hours instead of one to two. For frequent heartburn that interferes with sleep, a proton pump inhibitor (PPI) may be your best bet. While these need to be taken daily and don’t provide relief right away, once they do, you’ll feel better 24/7. Indeed, researchers at the Eastern Virginia Medical School recently surveyed 18 people with severe, chronic heartburn. Only two said they enjoyed restful, undisrupted sleep. After taking a PPI for four weeks, half reported significantly improved sleep.

So if heartburn is keeping you up at night, don’t despair. By making some simple lifestyle adjustments or talking to your physician about medication, sweet dreams can be yours again.

Michael Castleman has been called "one of the nation's leading health writers" (Library Journal). He is the author of 11 consumer health books and more than 1,500 health articles for magazines and the Web.

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