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Brandon Peters, M.D.

30 Days to Better Sleep: Avoid Heartburn at Night

By January 15, 2013

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There are few things as miserable as waking with the discomfort of heartburn. As you make progress in sleeping better, one of the key milestones is avoiding heartburn at night.

Heartburn goes by many names: reflux, gastro-esophageal reflux disease, GERD, water brash, acid indigestion, or pyrosis. It all amounts to the same thing, however. The esophagus is a muscular tube that extends from the mouth to the stomach. At the connection between the esophagus and the stomach is a muscular ring called the lower esophageal sphincter (LES). This cincture is meant to close and keep the contents of the stomach from regurgitating back into the esophagus or mouth. When the lower esophageal sphincter becomes weak, or the acidity of the stomach excessive, heartburn occurs.

People who suffer heartburn can list the inciting culprits: coffee, tomato products, citrus, chocolate, fatty foods, peppermint, and alcohol. A glass of orange juice, a spicy dinner, a few pints of beer; these are the stuff of a night of indigestion. Many of these foods actually cause the lower esophageal sphincter to relax and become leaky. How can this be avoided? The most obvious solution is to not eat or drink these particular foods. It may also be especially important to avoid late meals. These may not be the only necessary remedies, however.

Believe it or not, there are actually sleep disorders that can contribute to heartburn and reflux. The most common contributor is obstructive sleep apnea. It may seem bizarre that a breathing problem can contribute to a condition that affects the stomach and esophagus, but these pipes are closely related.

The esophagus lies directly behind the windpipe or trachea. Sleep apnea is characterized by a collapse of the airway during sleep. This occurs in the muscular portion that is able to collapse, most often at the back of the throat. The effort to breathe will persist through this obstruction, with the brain prompting the diaphragm and respiratory muscles to continue working. When the lungs expand against a closed airway, a negative pressure is created. This negative pressure within the thorax can suck the contents of the stomach into the esophagus, resulting in reflux.

Therefore, it is imperative to treat sleep apnea. If you experience heartburn at night, this is a necessary consideration. In the context of loud snoring, pauses in breathing during sleep, and excessive daytime sleepiness, it is virtually diagnostic of sleep apnea. Interestingly, untreated heartburn may lead to a side effect with the mainstay therapy for sleep apnea called continuous positive airway pressure (CPAP) treatment. Some people have aerophagia, or air swallowing, that leads to belching, flatulence, or bloating. Aerophagia seems to occur due to weakness in the lower esophageal sphincter, allowing air to get into the stomach during treatment. This may improve with the use of medications to treat GERD (such as proton pump inhibitors), over-the-counter gas relief such as simethicone or Gas-X, or by raising the head of the bed by 30 degrees.

If you find heartburn disrupting your sleep at night, you may start by making some simple dietary changes and avoid large meals too close to bedtime. In the setting of other symptoms suggestive of sleep apnea, you should speak with your doctor. It is possible to sleep well at night, and this certainly should include avoiding unnecessary heartburn.

Check out the entire series, "How to Sleep Better in 30 Days."

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